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Purpose: To observe the photoreceptor anomalies in cases of ametropic amblyopia. Methods: A prospective study with 25 isoametropic amblyopic children in the age group of 5–14 years and 25 age?matched controls was done. Examination included refraction, best?corrected visual acuity (BCVA), and color vision. Adaptive optics (AO) and multifocal electroretinogram (mf?ERG) were done to assess the anatomy and function of photoreceptors. The subgroup analysis of the improved and non?improved groups was done. Results: The mean cone density in cases and control in the superior, temporal, and nasal quadrants was respectively as follows (21640 ± 5713, 24040 ± 3386, P = 0.01) (19755 ± 6282, 21832 ± 2911, P = 0.03) (19897 ± 5418, 22171 ± 3660, P = 0.01) (20768 ± 4799, 22819 ± 3241, P = 0.01). The amplitude of N1 wave and P1 wave in cases was significantly low compared to the controls. Cases with subnormal color vision had reduced BCVA (0.55 ± 0.018) in comparison to the children with normal response (0.350 ± 0.014). Cone density was also significantly reduced in children with subnormal color vision. Sixteen out of 25 cases showed BCVA improvement with spectacles. Baseline cone density was found to be significantly higher in the improved group. There was no correlation between BCVA and AO parameters. Conclusion: Patients with ametropic amblyopia show subnormal photoreceptor properties than controls. Low cone density may be associated with defective color vision and poor prognosis in these cases
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Purpose: To assess the macular vessel density (VD) on optical coherence tomography angiography (OCT?A) using proprietary software (automated) and image processing software (manual) in diabetic patients. Methods: In a retrospective study, OCT?A images (Triton, TOPCON Inc.) of type 2 diabetics presenting to a tertiary eye care center in North India between January 2018 and December 2019 with or without nonproliferative diabetic retinopathy (NPDR) and with no macular edema were analyzed. Macular images of size 3 × 3 mm were binarized with global thresholding algorithms (ImageJ software). Outcome measures were superficial capillary plexus VD (SCP?VD, automated and manual), deep capillary plexus VD (DCP?VD, manual), and correlation between automated and manual SCP?VD. Results: OCT?A images of 89 eyes (55 patients) were analyzed: no diabetic retinopathy (NoDR): 29 eyes, mild NPDR: 29 eyes, and moderate NPDR: 31 eyes. Automated SCP?VD did not differ between NoDR and mild NPDR (P = 0.69), but differed between NoDR and moderate NPDR (P = 0.014) and between mild and moderate NPDR (P = 0.033). Manual SCP?VD (Huang and Otsu methods) did not differ between the groups. Manual DCP?VD differed between NoDR and mild NPDR and between NoDR and moderate NPDR, but not between mild and moderate NPDR with both Huang (P = 0.024, 0.003, and 0.51, respectively) and Otsu (P = 0.021, 0.006, and 0.43, respectively) methods. Automated SCP?VD correlated moderately with manual SCP?VD using Huang method (r = 0.51, P < 0.001) with a mean difference of ?0.01% (agreement limits from ?6.60% to +6.57%). Conclusion: DCP?VD differs consistently between NoDR and NPDR with image processing, while SCP?VD shows variable results. Different thresholding algorithms provide different results, and there is a need to establish consensus on the most suited algorithm
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Background: Adequate post-operative analgesia is the prime duty of anesthesiologist and several adjuvants have been usedalong with local anesthetics to prolong the duration of brachial plexus block. The present study aimed to compare the effect ofnalbuphine and magnesium sulfate as an adjuvant to ropivacaine and ropivacaine alone in nerve stimulator guided supraclavicularbrachial plexus block in patients scheduled for orthopedic upper limb surgeries.Materials and Methods: A total of 90 patients of in the age group of 20–65 years of either sex of the American Society ofAnesthesiologists Grade I and II were divided into three groups of 30 each. Group R received 30 ml of 0.75% ropivacaine alone,Group RM received 30 ml of 0.75% ropivacaine plus 150 mg of magnesium sulfate, and Group RN received 30 ml of 0.75%ropivacaine plus 20 mg of nalbuphine. All the groups were compared with respect to onset and duration of sensory and motorblockade, post-operative analgesia, need for rescue analgesia, hemodynamics, and side effects.Results: Onset of sensory and motor block was earliest in Group RN and was highly significant (P < 0.001) when compared toGroup R and Group RM. Mean duration of post-operative analgesia was 8.70 ± 1.18 h in Group R, 11.73 ± 1.23 h in Group RM,and 14.40 ± 1.25 in Group RN. Duration of sensory and motor block and post-operative analgesia were significantly prolonged(P < 0.001) both in Group RM and Group RN when compared to Group R.Conclusion: Both nalbuphine and magnesium sulfate are effective adjuvant as compared to ropivacaine alone as they prolong theduration of block as well as post-operative analgesia when used for supraclavicular brachial plexus block. However, nalbuphinehas proven to be a better adjuvant as compared to magnesium sulfate as it also results in earlier onset of sensory and motorblock and better patient and surgeon satisfaction scores.
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Introduction: Laryngeal mask airway (LMA) cuff pressure has been implicated as a prime reason for post-operative sore throat.LMA cuff pressure increases when the air is used for the cuff inflation during oxygen: Nitrous oxide (O2: N2O) anesthesia, whichresults in post-operative pharyngolaryngeal adverse events. We conducted this study to compare the effect of LMA supremecuff inflation with air, air: Oxygen, and oxygen: Nitrous oxide mixture in adults.Aim: The aim of the study was to compare the changes in cuff pressure intraoperatively with different gas composition (air,air: Oxygen mixture, and oxygen: Nitrous oxide mixture) used to inflate the LMA supreme by a manometer and post-operativepharyngolaryngeal morbidity.Design: It was a potential randomized double-blind study which was conducted on 120 patients admitted for elective surgeryunder general anesthesia.Materials and Methods: A total of 120 patients were randomly allocated into three groups of 40 each according to thecomposition of gases used to inflate the supreme LMA cuff to achieve 40 cm H2O cuff pressure, air was used as cuff inflationmedium in Group A, air: Oxygen mixture in Group AO, and oxygen: Nitrous oxide mixture in Group ON.Statistical Analysis: The cuff pressure, ventilatory parameters, and post-operative pharyngolaryngeal complications werenoted. The analysis was done by Student’s t-test and Chi-square test. P < 0.05 was considered statistically significant.Results: In Group A and Group OA cuff pressure significantly increased from initial cuff pressure of 40 cm H2O until the end ofthe surgery to 74.35 ± 7.41 cm H2O and 56.35 ± 3.63 cm H2O, respectively. An initial decrease in cuff pressure was observedat 15 min to a mean of 32.85 ± 1.42 cm H2O in Group ON which again gradually increased to near initial pressures to a meanof 40.10 ± 2.31 cm H2O toward the end of surgery. Cuff volume increased in Group A and Group AO; however, it decreased inGroup ON (23.18 ± 4.45 ml, 18.73 ± 2.61 ml, and 11.50 ± 1.93 ml, respectively) from initial values. Ventilatory and hemodynamicparameters were comparable in all the three groups. A significant difference in pharyngolaryngeal morbidity was observedbetween Group A and Group ON.Conclusion: Cuff inflation with 50% O 2: N2O mixture provided more stable cuff pressure in comparison to air and O2: Air mixtureduring O2: N2O anesthesia. Ventilatory parameters and hemodynamic parameters did not change with variation in SLMA cuffpressure. Post-operative pharyngolaryngeal morbidity had a strong correlation with cuff pressure and was more in Group Aand least in Group ON.
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Non Fermenter Gram negative bacilli (NFGNB) has emerged as important hospital pathogens they are more significant as they are found to be multi drug resistant. Resistance to carbapenems is common among NFGNB. AIMS & OBJECTIVES: To isolate & identify NFGNB from various clinical samples and to detect resistance to carbapenem in isolates resistant to Imipenem. MATERIAL & METHOD: NFGNB isolated from various samples were speciated using standard tests. Isolates resistant to Imipenem were subjected to detection of MBLs(Metallo-β-lactmase) and Amp-C. RESULTS: Out of 1566 samples received, NFGNB were 200. Among them 112 were Pseudomonas aeruginosa from which 31 were found to be resistant to Imipenem, of which 3 were MBLproducer by Modified Hodge test while 4 were MBLproducer by EDTAdisc synergy test. Out of 200 NFGNB 71 were Acinetobacter baumanii, of which 23 were found to be resistant to Imipenem, of which 6 were MBLproducer by Modified Hodge test, while 4 were seen to be MBL producer by EDTAdisc synergy test. Nineteen isolates of Acinetobacter baumanii were found to be resistant to cefoxitin of which 6 were found to be Amp-C producer by Amp-c disc test. None of the Pseudomonas aeruginosa were Amp-C producer. Other NFGNB isolated were either sensitive to Imipenem or if resistant were not MBLor Amp-C producer.