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Purpose: This study was conducted to evaluate the accuracy of intraoperative aberrometry (IA) in intraocular lens (IOL) power calculation and compare it with conventional IOL formulas. Methods: This was a prospective case series. Eyes with visually significant cataract and axial hyperopia (AL <22.0 mm) underwent IA?assisted phacoemulsification with posterior chamber IOL (Alcon AcrySof IQ). Postoperative spherical equivalent (SE) was compared with predicted SE to calculate the outcomes with different formulas (SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal ? and Hill?RBF). Accuracy of intraoperative aberrometer was compared with other formulas in terms of mean absolute prediction error (MAE), percentage of patients within 0.5 D and 1 D of their target, and percentage of patients going into hyperopic shift. Results: Sixty?five eyes (57 patients) were included. In terms of MAE, both Hoffer Q (MAE = 0.30) and IA (MAE = 0.32) were significantly better than Haigis, SRK/T, and Barrett Universal ? (P < 0.05). Outcomes within ±0.5 D of the target were maximum with Hoffer Q (80%), superior to IA (Hoffer Q > IA > Holladay 2 > Hill?RBF > Haigis > SRK/T > Barrett Universal ?). Hoffer Q resulted in minimum hyperopic shift (30.76%) followed by Hill?RBF (38.46%), Holladay 2 (38.46%), Haigis (43.07%), and then IA (46.15%), SRK/T (50.76%) and Barrett Universal ? (53.84%). Conclusion: IA was more effective (statistically significant) in predicting IOL power than Haigis, SRK/T, and Barrett Universal ? although it was equivalent to Hoffer Q. Hoffer Q was superior to all formulas in terms of percentage of patients within 0.5 D of their target refractions and percentage of patients going into hyperopic shift
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Purpose: To evaluate the gonioscopic changes in patients receiving Descemet’s stripping endothelial keratoplasty (DSEK) without pre?existing ocular hypertension (OHT) and to report its correlation with post?surgery OHT, graft survival, and visual outcomes. Methods: Adult patients who underwent DSEK surgery from April 2014 to March 2018 with at least 2 years of follow?up were analyzed in this retrospective study. Demographic details, indication of DSEK, necessary anterior and posterior segment findings, and the post?DSEK OHT details were documented. Results: A total of 58 patients (23 males and 35 females) with a mean age of 61.44 ± 8.8 years were included in the study. The most common etiology for DSEK surgery was pseudophakic bullous keratopathy in 47 eyes (81.03%). A total of 22.41% (13/58) eyes showed elevated intra?ocular pressure (IOP) following DSEK surgery. The most common cause of IOP elevation was steroid?induced OHT in seven eyes (12.06%). Gonioscopy examination revealed areas of peripheral anterior synechiae (PAS) in 17 (29.3%) eyes. OHT was found in 4/17 (23.5%) eyes having PAS. Three of these cases required trabeculectomy + goniosynechiolysis (GSL), and the fourth case required GSL alone to control IOP. These four cases also required repeat DSEK for failed grafts. The mean pre?operative best corrected visual acuity was 1.62 logMAR (range 1.17–1.77), which gradually improved to 0.79 logMAR (range 0.3–1.77) after 2 years (p < 0.00001). Conclusion: PAS was found to be an important factor associated with post?DSEK ocular hypertension in our study. OHT in PAS cases required definitive surgical treatments to control IOP. It adversely affected the graft survival and in turn affected visual outcomes also.
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Globally, the prevalence of chronic coronary syndrome (CCS) increases with age. In India, there is a rapidly growing burden of coronary artery disease (CAD), which has become the leading cause of morbidity and mortality. Despite recommended medical therapy, patients with CCS are still at risk of ischemic events. Currently, dual antiplatelet therapy (DAPT) is recommended in the form of aspirin and a P2Y12 inhibitor or low dose rivaroxaban in patients with stable CAD and/or peripheral artery disease (PAD). A low dose of rivaroxaban in combination with aspirin is a promising approach; however, for patients who might benefit the most, it still remains a challenge. Clinical trial data on this new drug was certainly very encouraging, with evidence from the COMPASS trial and prespecified subgroups of COMPASS trials suggesting that the addition of rivaroxaban to aspirin was associated with a significantly lower risk of ischemic events, mortality, and tolerable bleeding profile in patients with CCS and high-risk factors. This combination is cost-effective and generally well tolerated in patients with CAD and/or PAD, as well as patients with CCS and multimorbidity or high-risk populations.
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Purpose: To study the clinical presentation, mycological profile, and risk factors of fungal keratitis (FK) cases presenting at two tertiary?care centers, one each at North (Chandigarh) and Northeast (Assam) India, and to compare the spectrum of fungi recovered from the clinical and environmental samples at both locations. Methods: All patients with suspected FK were enrolled from both the centers between January 2018 and December 2019. Corneal samples were collected and processed as per standard laboratory protocols. Demographic details and clinical and mycological profiles were noted in all patients. Environmental sampling from the soil, air, and the vegetative matter was performed from both locations and neighboring districts. Results: Of the 475 suspected cases, 337 (71%) were diagnosed as FK (median age: 50 years; 77.2% males). The presence of diabetes, hypertension, blurred vision, and corneal discoloration was significantly higher in patients with FK compared to those without FK. Aspergillus sp. (52.1%) and Fusarium sp. (47.61%) were the predominant etiological agents isolated from cases in North and Northeast India, respectively. FK due to melanized fungi was associated with diabetes, trauma with animal tail, and corneal discoloration. A similar spectrum of fungi was seen in environmental and clinical samples in both the regions. Conclusion: The difference in etiological agents of FK and environmental fungal isolates in North and Northeast India highlights the need to identify the ecological niche of potential fungal pathogens. Prospective, multicenter studies, systematic environmental sampling, and the evaluation of the differences in causative agents and clinical presentation of FK from different parts of the country can substantially improve our understanding of its region?specific clinico?epidemiological profile.
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Aims and Objective: The present study aimed to evaluate 2 bone graft materials, that is, biphasic hydroxyapatite and ??tricalcium phosphate, in the treatment of periodontal vertical bony defects. In term of attachment level, probing depth and radiographic bone level changes. Also, a new digital method of radiographic assessment was used for measurement of vertical bone defect. Material and Methods: Ten subjects with periodontitis and having two or more vertical bony defects were enrolled in the study. Patients were classified randomly into 2 groups. Group I consisted of the experimental site where defect was filled with biphasic hydroxyapatite and ??tricalcium phosphate graft and Group II consisted of control site where only the open flap debridement (OFD) was carried out. Clinical parameters were evaluated at baseline, 3 and 6 months; Radiographs were taken at baseline and 6 months after surgery. Results: Overall, by the end of 6 months, biphasic hydroxyapatite and ??tricalcium phosphate and OFD treatment groups exhibited a significant reduction in probing depth almost by 75% and gain in clinical attachment level at follow?up. In the biphasic hydroxyapatite and ??tricalcium phosphate group, radiographic bone level gain appeared to be greater than in the OFD group. Conclusion: In the present study, biphasic hydroxyapatite and ??tricalcium phosphate have shown promising results and have showed reduction in probing depth, a resolution of osseous defects and gain in clinical attachment level when compared to open flap debridement.
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Purpose: To determine the pattern of corneal thickness and epithelial thickness distribution in healthy North Indian eyes by using spectral domain optical coherence tomography (SD?OCT). Methods: The observational study measured total corneal and epithelial thickness in the central 2 mm zone and eight sectors each in paracentral 2�mm (ring 1) and midperipheral 5�mm (ring 2) zones on SD?OCT. Results: The study included 67 eyes of 67 subjects with a male:female ratio of 32:35 and mean age of 25.04 � 4.54 years. The mean central corneal and epithelial thicknesses were 505.97 � 30.12 ?m and 60.48 � 8.37 ?m, respectively. The epithelium of inferior and infero?nasal sectors in ring 1 and inferior sector in ring 2 was significantly thicker than the radially opposite sectors of the respective rings (P = 0.001; P = 0.01 and P = 0.02, respectively). Sector?wise analysis did not reveal any significant correlation between the total corneal thickness and epithelial thickness (all P > 0.05) except in the outer superior sector where there was a weak positive correlation (r = 0.28, P = 0.02). Central epithelial thickness in males (60.59 � 9.28 ?m) and females (60.37 � 7.58 ?m) was comparable (P = 0.91). Pachymetry was thinnest in the inferior, inferonasal, and inferotemporal sectors in 44.79% of eyes (n = 30), while thinnest epithelium was seen in the superior, superonasal, and superotemporal quadrants in 50.75% of eyes (n = 34). Conclusion: The epithelial thickness distribution in this sample of topographically normal healthy North Indian eyes was nonuniform and independent of the underlying corneal thickness. Epithelium was thinner in the superior cornea, whereas total corneal thickness was minimum in the inferior part
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Neonatal endocarditis is a rare but usually fatal disease. Fungal endocarditis is an uncommon complication of invasive fungal infections and is associated with a high burden of morbidity and mortality. It frequently occurs in premature infants. The majority of these infections are caused by Candida (60-70%) and Aspergillus species (20-25%). The diagnosis is difficult because the criteria that have suggested and used in adults are not readily applicable for neonates. The incidence of fungal endocarditis in a neonate is on the rise, reported in the last decade secondary to use of central venous lines, frequent use of broad-spectrum antibiotics and neonatal surgical interventions.
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Myomectomy during the cesarean section is a debatable procedure because of raised risk of associated uncontrollable hemorrhage and postoperative morbidity. 38 years, elderly primigravida, who conceived after primary infertility with large leiomyoma in the lower uterine segment, underwent myomectomy during the cesarean section. Her intra-operative hemorrhage was within normal limits and post-partum period was uneventful. Conclusion of this study is Safety and feasibility of myomectomy along with cesarean largely depends upon the case selection, experience of the obstetrician and backup ICU and transfusion facilities.
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Background: “Communication with patients” is an important skill needed for every physician in their clinical practice. These soft skills are required in dealing with patients at every step which include history taking from the patients, explaining them the diagnosis, the prognosis of the disease with associated complications. Dealing with empathy, taking informed consent, explaining the operative procedure and the complications associated with surgery, the art of breaking bad news are the mandatory skills for a good clinician. Labouring women like other patients also require special attention and empathy. So, the residents working in labor room need commitment to develop these soft skills in order to improve the labor room experience of expectant mothers. Objective of this study was to analyse role of a formal training in labor room communication skills among post graduate students of the department of obstetrics and gynecology.Methods: Faculty and students’ sensitization was done after approval from institutional ‘ethics committee’ for conducting this study. Pre-workshop assessment of residents for communication skills attitude and effective communication was done through ‘communication skill attitude scale’ (CSAS) and ‘GAP-KALAMAZOO scale’. Workshop for communication skills on the framework of Calgary Cambridge patient interview model and online teaching of students through what’s app videos, role-play demonstrations was followed by reassessment of the residents through above used scales.Results: Results depicted both improvements in attitude and effective communication skills among residents. 100% of the students were convinced and opined that good communication skills necessary for perfect clinical practice.Conclusions: The skill to communicate with patients is a fine art and needs to be mastered to be a good clinician. A formal training in effective communication skills is absolutely necessary to bring professionalism in medical practice.
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Annular pancreas is a rare congenital anomaly which usually presents with gastrointestinal symptoms early in life. In adults mostly it remains asymptomatic or may present with abdominal or features of duodenal obstruction the increased diagnosis of which is attributed to the improved imaging modalities. We hereby report our experience of adult annular pancreas in whom clinical presentation initially mimicked gastric or duodenal outlet obstruction. Adult annular pancreas was diagnosed with the aid of computed tomography of the abdomen and treated successfully with Roux-en-Y isoperistaltic gastrojejunostomy.
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Disseminated blood-borne metastases from carcinoma of the gall bladder are uncommon and usually occur late. The most common site of extra-abdominal metastasis is lung followed by brain. Skeletal metastases in carcinoma gall bladder are very rare. To date there have only been a few case reports of bone metastasis in carcinoma gall bladder at the time of presentation. Authors here present a rare case of carcinoma gall bladder that progressed to isolated sacrum metastasis.
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Adhesive Intestinal obstruction is the most common cause of intestinal obstruction in post-operative period. Diagnosis is based on history, clinical examination, plain X-ray abdomen. Authors here report an interesting case of intestinal obstruction after surgery for chronic calcific pancreatitis with pancreatic duct stone with intractable pain. In post-operative period patient developed features of intestinal obstruction, patient was planned for re- exploration and it was found that band was formed by left fallopian tube with transition point at terminal ileum and treated successfully with left Salpingectomy. Very few cases of fallopian tube as cause of intestinal obstruction have been reported in literature and it should be considered as one of the cause of intestinal obstruction in females presenting with acute abdomen.
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Introduction: Multimodal analgesia is currentlyrecommended for postoperative pain control in laparoscopicsurgeries. Our study aimed at comparing the postoperativeanalgesic efficacy of three different concentrations ofRopivacaine when instilled periportally just before closure inlaparoscopic cholecystectomy.Material and methods: 200 patients posted for laparoscopiccholecystectomy were randomly allocated into four groups of50 patients each. Three groups received preclosure periportalinstillation of 20 ml Ropivacaine 0.125%, 0.25% and 0.5%respectively whereas the fourth group received 20 ml normalsaline. Pain was recorded on visual analog scale at frequentintervals for 24 hours postoperatively and categorised as eithermild, moderate or severe. Tramadol 1mg/Kg was administeredas rescue analgesic in patients with moderate to severe pain.Results: A statistically significant difference was found amongthe four groups with the number of patients experiencingmild and moderate pain with P values of 0.009 and 0.02respectively. The number of patients experiencing mild andmoderate pain was significantly less with Ropivacaine 0.5%when compared with Ropivacaine 0.125% (P=0.01 and 0.03),Ropivacaine 0.25% (P=0.002 and 0.03) and normal saline(P=0.02 and 0.0007). The number of patients requiring rescueanalgesia at various time intervals was also significantly lesswith Ropivacaine 0.5% when compared to the other groups(P<0.05).Conclusion: Ropivacaine 0.5% when administeredas preclosure periportal instillation in laparoscopiccholecystectomy, provided better postoperative analgesiaand significantly less requirement of rescue analgesia, ascompared to equivalent volumes of Ropivacaine in lowerconcentrations of 0.25% and 0.125% which were no betterthan normal saline.
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Background: Caesarean section is most frequently performed surgery worldwide. Patients experience moderate to severe pain in the first 48 hours post-operatively. Aim of this study was to evaluate the efficacy of dexmedetomidine and dexamethasone as an adjunct to bupivacaine in ultrasound guided TAP block for postoperative analgesia in patients of caesarean section.Methods: A total 120 ASA I and II patients undergoing elective and emergency caesarean section under subarachnoid block were randomly divided into three groups B, BDM, BDX to receive bupivacaine alone or dexmedetomidine or dexamethasone as an adjunct to bupivacaine in ultrasound guided TAP block. Postoperatively, the patients were evaluated for pain level at rest and on movement with a 10 cm visual analog scale (VAS) pain score (0 = no pain and 10 = worst pain), time to demand of first analgesic request, number of analgesic requirements, nausea or vomiting, sedation and patient satisfaction at 0 hours and at 2, 4, 6, 12, 18, and 24 hours.Results: VAS score was significantly higher in group B in comparison to BDM and BDX, and higher in BDX in comparison to group BDM. Mean duration of analgesia was significantly higher in group BDM in comparison to group B and BDX. Total number of rescue analgesic demands were significantly lower in group BDM in comparison to group B and BDX. Sedation score and satisfaction score was higher in group BDM as compared to group B and BDX.Conclusions: Addition of dexmedetomidine and dexamethasone as an adjunct to bupivacaine reduces postoperative pain, prolongs analgesia, decreases demand for additional analgesics and provides better maternal satisfaction as compared to plain bupivacaine group in TAP block in patients undergoing caesarean section under subarachnoid block. Among dexmedetomidine and dexamethasone, dexmedetomidine had prolonged analgesia as compared to dexamethasone group.
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Background: Ultrasound guided TAP block is safe, simple and effective method of providing postoperative analgesia in surgeries involving abdominal wall incision by blocking anterior branches of thoracolumbar nerves originating from T6-L1. Our aim to study the efficacy of dexmedetomidine and clonidine as an adjunct to levobupivacaine in ultrasound guided TAP block for postoperative analgesia in patients undergoing TAH.Methods: Prospective, double blind randomized control study. Ninety ASA I and II patients scheduled for TAH were randomly assigned in a double blinded study and divided into three groups. Group L received 18ml of 0.25% levobupivacaine+2ml of NS to make total volume of 20ml on each side. Group LC and Group LD received 18ml of 0.25% levobupivacaine + 1 mcg/kg of clonidine or dexmedetomidine diluted in NS to make total volume of 20ml on each side. USG guided TAP block was given when subarachnoid block level regressed to T10 level. Postoperatively patients were assessed for pain scores, HR, SBP, DBP, nausea vomiting, sedation and satisfaction scores at 0, 2, 4, 6 and 12 and 24 hours. Statistical analysis was performed using SPSS software 17. p value<0.05 was considered significant.Results: Pain scores were significantly lower in LD and LC groups as compared to L group and demand for first rescue analgesic was delayed in LD group (491.50±73.29min) and group LC (268.00±35.47min) as compared to group L (129.17±10.67min). The total number of demand doses in 24 hours were significantly less in group LD (1.00±0.00) followed by group LC (2.03±0.18) and group L (2.77±0.57) respectively. Incidence of hypotension, bradycardia and sedation was more in LD group as compared to LC and L groups.Conclusions: TAP block with dexmetomidine as an adjunct to levobupivacaine provides prolonged postoperative analgesia as compared to clonidine as an adjunct and plain levobupivacaine.
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Background: Cervical cancer is the second highest cause of cancer-related mortality in women, and the only sign of this cancer in the early stages is the loss of abnormal cells. Clinical signs of the disease appear only after cancer has reached advanced stages. Conversely, this cancer in precancerous conditions is completely curable and screening with conventional Papanicolaou (CP) has reduced the mortality by 70% but it is also associated with a significant number of false-negative cases (20-50%). In 1996, liquid-based cytology (LBC) method was developed to overcome the disadvantages of the previous method expecting to have good features such as high sensitivity, faster sample preparation, and decreased the rate of inadequate smears.Methods: This descriptive-analytic study was conducted at the Department of Pathology and Department of Obstetrics and Gynaecology, government medical college, Datia for the period of 11 months from April 2018 to February 2019. The study includes total 80 subjects. Total No. of Pap smear examined (both LBC and CPS) are 160.Results: There were statistically significant differences of satisfactory/unsatisfactory rate, smear cellularity, background clarity and detection of endocervical cells, in between liquid based cytology and conventional Pap smear finding (p<0.05). Diagnostic efficacy i.e. sensitivity and specificity of LBC is greater than CPS for evaluation of cervical cytology.Conclusions: Results shows, that LBC may improve the sample's quality, reduce the number of unsatisfactory smear and increases the diagnostic efficacy.
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Background This study was conducted to assess the effect of percutaneous coronary revascularization (PCR) on plasma NT-proBNP concentration in patients with chronic stable angina (CSA). Methods This prospective open label interventional study included 22 patients with moderate to severe CSA, normal left ventricular (LV) systolic functions and critical (>90%) proximal stenosis in one of the three major epicardial coronary arteries. After stabilization of medications for 8 weeks, resting supine plasma NT-proBNP levels were measured and patients underwent PCR of the involved vessels. Eight weeks later, with medications unaltered; plasma NT-proBNP levels were repeated and compared with the baseline levels. LV systolic and diastolic functions were assessed before and after PCR. Results The mean age of the patients was 61.27 ± 8.87 years. Out of 22 patients, 20 were male and 2 were female. PCR was performed on left anterior descending coronary artery (LAD) in 12 patients and in a non-LAD vessel in 10 patients. After 8 weeks of successful PCR, there was a significant overall reduction in mean plasma NT-proBNP levels (from 244.36 ± 218.99 to 168.68 ± 161.61 pg/mL, p = 0.016). The patients who underwent PCR of LAD demonstrated significantly reduced NT-pro-BNP levels after PCR (p = 0.009). In the non-LAD group, NT-proBNP levels also decreased, albeit insignificantly (p = 0.432). Reduction in NT-proBNP was independent of change in LV systolic functions. Conclusion Successful PCR, by relieving myocardial ischemia, significantly reduced plasma NT-proBNP levels in majority of the patients with chronic stable angina secondary to critical epicardial coronary artery stenosis.
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Pulmonary epithelioid hemangioendothelioma (PEH) is a rare vascular neoplasm, predominantly encountered in women, more often in the age group of 40 years and below. It is a tumor of borderline malignant potential with a clinical course intermediate between hemangioma and angiosarcoma. The tumor has variable prognosis, and treatment options include surgical excision in operable cases and chemotherapy in disseminated ones. The present report describes complete clinical, radiological, and histopathological features of PEH with osteoclast‑like giant cells and metaplastic ossification in a 20‑year‑old boy who presented with dyspnea and episodes of hemoptysis with review of literature.