Chop and tumble nucleotomy – A technique for safe nuclear emulsification in posterior polar cataract

A modified phaco chop technique for nuclear emulsification in posterior polar cataracts with nuclear sclerosis that avoids hydrodissection or nuclear rotation has been described. After performing a vertical chop maneuver to divide the nucleus, two pie-shaped nuclear fragments are removed from either side of the initial chop. The remaining nuclear fragments are then sequentially tumbled toward the center using the second instrument and emulsified while maintaining an intact epinuclear shell, which safeguards the fragile posterior capsule. The technique was successfully performed in 62 eyes of 54 patients with posterior polar cataract and grade II–IV nuclear sclerosis. The Chop and Tumble nucleotomy is a safe and effective technique for phacoemulsification in posterior polar cataracts with nuclear sclerosis, where hydrodissection and nuclear rotation are typically avoided

Cataract surgery outcomes in pediatric patients with systemic comorbidities

Purpose: The aim of the study was to evaluate the outcomes of cataract surgery in patients of the pediatric age group with systemic comorbidities. Methods: Medical records of 54 eyes (30 patients) of the pediatric age group with systemic comorbidities who had undergone cataract surgery in a tertiary?care center were reviewed. The following parameters were recorded: systemic comorbidity; toxoplasmosis, rubella, cytomegalovirus, herpes simplex, HIV (TORCH) profile, best spectacle?corrected visual acuity (BSCVA), strabismus, nystagmus, and cataract morphology. Results: Thirty patients with a mean age of 55 months (9 months–14 years) were included. On average, every child was seen by three physicians, and the mean duration between the first visit to a physician and presentation to our center was 2.23 ± 0.67 years. The various causes for delay in referral include multiple referrals due to a lack of general anesthesia services in 78% of cases, a long waiting list at the referral hospital in 35% of cases, and a lack of awareness at the primary?care physician level in 50% of cases. The mean BSCVA at presentation was 1.4 logMAR (0.3 to 3 logMAR). The most common cataract morphology was that of zonular cataract (31.48%; 17/54). Strabismus and abnormal eye movements were observed in 27.7% (15/54) and 33.3% (18/54) of eyes, respectively. Various systemic associations were periventricular leukomalacia (12/30), Down’s syndrome (6/30), seizure disorder (6/30), cardiac valvular anomalies (6/30), Marfan’s syndrome (4/30), hypothyroidism (4/30), rubella (3/20), cytomegalovirus (3/20), cerebral palsy (2/30), nephrotic syndrome (2/30), Type 1 diabetes mellitus (1/30), microcephaly (1/30), cryptogenic West syndrome (1/30), congenital rubella syndrome (1/30), and Tourette syndrome (1/30). The mean postoperative corrected distance visual acuity (CDVA) at 2?year follow?up improved to 1.0 logMAR (0 to 3 logMAR). No postoperative complications were reported at the final follow?up. Around 70% of the parents reported improvement in their child’s psychomotor skills. Conclusion: Intellectually impaired pediatric patients with cataract should be operated upon whenever there is a presence of infrastructure, and unnecessary delay in surgery should be avoided by referring the patient to higher centers. Even though objective improvement in visual acuity was suboptimal, there was definitely an improvement in the psychomotor skills of the patients.

Digital Competence Among Research Scholars In Relation To Their Academic Achievement And Selected Demographic Variables

In the present study digital competence and academic achievement of 100 research scholars of various streams of Punjabi University, Patiala were studied. Teachers' Digital Competence Scale by Ramkrishna (2017) was used to collect the data pertaining to the digital competence of research scholars and one demographic data sheet developed by the investigators was used to collect information about gender, stream of study, experience of research work and academic achievement. Gathered data were analyzed by using the statistical techniques. The results show that the level of digital competence of research scholars has various levels and no research scholar possess high level of digital competence. Academic achievement of research scholars has also various levels. There is no significant difference in digital competence of research scholars with regard to gender and research experience. There is significant difference in digital competence of research scholars with regard to stream of study. Research scholars from the stream of education and languages are less competent in digitalization as compared to the research scholars from the stream of engineering, management & science. Moreover, the high academic achievers are more digitally competent as compared to low academic achievers. Further, there is significant and positive relationship between digital competence and academic achievement. So we conclude that the high digital competence enhance the academic achievement.

Spectrum of bacterial keratitis in North India: A retrospective analysis of six years at a tertiary care eye center

Purpose: To analyze the pattern of bacterial pathogens causing infective keratitis and their resistance to the recommended antibiotics over six years. Methods: It was a retrospective study of 9,357 cases of bacterial keratitis from January 2015 to December 2020, at a tertiary care ophthalmic center. A total of 9,547 corneal specimens were obtained from the study subjects. Demographic details of the patients, pathogenic bacteria isolated, and their antimicrobial susceptibility were noted and analyzed. Results: Bacterial pathogens were identified in 23.52% of the specimens. The most common isolates were coagulase?negative Staphylococci (60.75%), followed by Pseudomonas aeruginosa (14.23%), Staphylococcus aureus (13.92%), gram negative bacilli of the family Enterobacterales (8.64%), Streptococcus spp. (1.72%), Acinetobacter spp. (0.13%), and other non?fermenting gram?negative bacilli (0.57%). In Staphylococci, 55–80% of isolates were resistant to erythromycin, and 40–70% to fluoroquinolones, while no resistance was observed against vancomycin. 40–60% of isolates of P. aeruginosa were resistant to cephalosporins, 40–55% to fluoroquinolones, and 30–60% to aminoglycosides. Also, 40–80% of isolates of Enterobacterales were resistant to cephalosporins, and 50–60% to fluoroquinolones. Most gram?negative isolates were susceptible to carbapenems and polymyxin B. Conclusion: To the best of our knowledge, our study is the largest compilation of microbiological profile of bacterial keratitis from North India. It highlights the current trend of the bacterial pathogens that cause infectious keratitis. Staphylococci and Pseudomonas were found to be the most common pathogens. Increased resistance was seen against some of the commonly prescribed empirical antibiotics. Such evidence is useful for restructuring the empirical prescription practices from time to time.

Intraoperative optical coherence tomography-guided management of postlaser-assisted in situ keratomileusis epithelial ingrowth

We describe a modified technique of intraoperative optical coherence tomography (iOCT)?guided removal of post?laser?assisted in situ keratomileusis (LASIK) epithelial ingrowth with interface ethyl alcohol and mitomycin C application to prevent a recurrence. Epithelial ingrowth was visualized as hyperreflective deposits in the interface on iOCT, and the location and extent were noted at the beginning of the procedure. A simple dimple?down maneuver was performed to help identify the circumference of the LASIK flap. iOCT helped to delineate the flap edge and ensure dissection in the correct plane with complete removal of epithelial cell nests. Real?time visualization of the interface helped in on?table decision making regarding the extent of lifting the flap to encompass the entire region of hyperreflective epithelial ingrowth, as well as the need for additional interventions to ensure complete flap apposition at the end of surgery. All patients gained an uncorrected visual acuity of 20/20–20/25 with no recurrence

Nesting Preferences of Birds in Relation to Exotic Trees in Ludhiana, Punjab

Birds have very close association with trees. Trees offer a platform to birds for nesting, roosting, foraging, breeding and feeding purposes. The introduction of exotic (non-native) flora can effect or modify inherent species richness, communal alignment and species abundance, as well as species relationships and communal structure. Birds are exclusively sensitive to alterations both in terms of environmental and ecological. Introduction of exotic trees and human disturbance have also affected the bird diversity. The main objective of the present study was to find out the nesting preference of avian species in relation to exotic trees at two selected locations i.e. Punjab Agricultural University, Ludhiana (Location I) and Gurpal Nagar, Ludhiana (Location II) from June 2018 to July 2019. Five different exotic trees species selected were Safeda (Eucalyptus tereticornis), Poplar (Populus deltoides), Bottle brush (Callistemon viminalis), Monkey Puzzle (Araucaria araucana), Silver Oak (Grivillea robusta). A total 31 nests (6 on Bottle brush tree, 2 on Silver oak tree, 7 on Poplar tree, 16 on Eucalyptus tree) were recorded. Out of these, 5 nests were of Baya weaver Ploceus philippinus, 4 nests were of Rose-ringed Parakeet Psittacula krameri, 20 nests were of House Crow Corvus splendens and 2 nests were of Common Myna Acridotheres tristis. Four bird species were observed nesting at location I while only one was observed at location II. Less bird diversity recorded was at location II (8) as compared to location I (23) because of the anthropogenic activities which disturbed the natural habitat at that location

Spot protein/creatinine ratio as a marker for fetomaternal outcome in hypertensive disorder of pregnancy

Background: Gestational hypertension is defined as systolic BP level of > 140 mmHg or a diastolic BP of > 90 mmHg that occur after 20 weeks of gestation. Pre-eclampsia is the hypertensive disorder of pregnancy, associated with adverse fetomaternal complications. It is assosciated with proteinuria. 24 hours urine collection is cumbersome, time consuming and potentially misleading if collected inaccurately. The spot P/C ratio has been considered equivalent to 24-hour urinary protein for predicting proteinuria. Aim of study was to compare spot P/C ratio to 24 hours urinary protein in patients of pre-eclampsia and to determine the fetomaternal outcome in the patients admitted in Dayanand Medical College and Hospital, Ludhiana.Methods: A prospective simple random study. It included 100 hypertensive pregnant women being evaluated for pre-elampsia, regardless of the alerting signs or symptoms. The main measures were the urinalysis of patients which included urinary spot P/C and 24 hours urinary protein excretion and the fetomaternal outcome in these patients. The data was statistically analyzed.Results: A good positive correlation existed between the P/C ratio and 24 hours protein excretion, with a correlation coefficient (r) of 0.912. The sensitivity and specificity of 24 hours urinary protein versus spot P/C ratio ranged between 86.29%-99.51% and 8.35%-99.95% respectively. The positive and negative likelihood ratio of 24 hours urinary protein versus spot P/C ratio was 48 (ranged between 6.89-334) and 0.04 (ranged between 0.01-0.16) respectively. The positive and negative predictive value of 24 hours urinary protein versus spot P/C ratio was 97.96% and 96.08% respectively. Our data showed that urine spot P/C ratio above 3.9/mg strongly predicts significant proteinuria of more than 4 gram/day.Conclusions: Spot urinary P/C ratio with suspected preeclampsia can be used as a rapid alternative test to 24 hours urinary protein.

Gall Bladder Perforation Secondary to Enteric Fever: An Interesting Case of Acute Abdomen

Gallbladder perforation usually occur in acute obstructive (calculus) cholecystitis, and its incidence is high in patients with diabetes mellitus, recent severe trauma, critical illness, severe burn. 2-11% patients of acute cholecystitis progress to gallbladder perforation. Acute cholecystitis is a rare complication of enteric fever and perforation of gallbladder in such cases is an uncommon occurrence in pediatric population. Clinical features of spontaneous gall bladder perforation are non-specific especially in children. Ultrasound as well as computerized tomography (CT) abdomen and pelvis lack specificity for detecting gallbladder perforations in enteric fever. Diagnosis is usually confirmed intraoperatively when the gallbladder is visualized and perforation is seen. Hence the treating surgeon must consider this rare condition in differential diagnosis while treating any child with acute abdomen.

Pleomorphic Adenoma of the Accessory Axillary Breast: A Rare Case Report

Pleomorphic adenoma (PA) is the most common tumor type in the salivary gland. PA is uncommon in the breast tissue. Only 73 cases of PA of the breast have been reported in the world literature. But no case in the accessory axillary breast has been reported so far. It is most commonly seen in postmenopausal women and is characterized by an admixture of epithelial and myoepithelial cells embedded in abundant myxomatous stroma. Its clinical and histologic appearance can be challenging and may lead to a misdiagnosis of invasive carcinoma. We report a case of pleomorphic adenoma (benign mixed tumor) of the accessory axillary breast, which is an extremely rare location for this tumor.

A Study of LVEF in Patients of Subclinical Thyroid Dysfunction with Heart Failure

Heart failure is clinically defined as a syndrome caused by cardiac dysfunction generally resulting from myocardial muscle dysfunction or loss. Heart failure is a leading cause of hospitalization in people older than 65. Extensive evidence indicates that the cardiovascular system responds to the minimal but persistent changes in circulating thyroid hormone levels, which are typical of individuals with subclinical thyroid dysfunction. Subclinical hypothyroidism is associated with impaired LV diastolic function and subtle systolic dysfunction and an enhanced risk for atherosclerosis and myocardial infarction. Methods: A total of 200 patients between age group of 45 to 75 yrs, presenting in medical emergency and medical outdoor of Guru Nanak Dev Hospital, Government Medical College Amritsar with heart failure were studied.Comparison of Thyroid Profile and LVEF was done at Baseline, 3 months and 6 months. Results: The change in TSH, FT3, FT4, LVEF was significant at 3 months and 6 months as compared to baseline. Changes in FT4, LVEF, were significant at 3 months and 6 months, thus signifying progression of disease and worsening of cardiac functions. Conclusion: In treatment group in subclinical hyporthyroidism patients, after comparing the thyroid profile and 2D Echocardiography after 6 months; TSH, LVEF both have shown improvement (p <0.05).

Traumatic Spigelian Hernia in Adults: A Rare Clinical Scenario

Handlebar hernias are very rare and arise following a sudden force from a handle-like object impacting a focal area of the abdomen, which results in a disruption of the underlying abdominal muscle and fascia without necessarily disrupting the overlying skin. Other than a reducible swelling on the abdominal wall, the physical examination of such patients is usually unremarkable and the diagnosis could easily be missed. Delay in the diagnosis can lead to incarceration or strangulation of bowel loops and subsequent morbidity. A large proportion of reported cases are in children. Here, we are reporting a case of traumatic Spigelian hernia following blunt trauma in an adult male. The significance of our case is that it provides some evidence that blunt trauma to abdomen may play an etiological role in development of some Spigelian hernias in adult as well.

Sclerosing Adenosis in Axillary Supernumerary Breast: A Case Report

Swellings in the axilla especially in women are always viewed with suspicion owing to a large number of these being associated with breast carcinoma presenting as nodal metastasis. In a country like India, tuberculous lymphadenopathy is also amongst the first differentials. We present a case of a woman with left sided axillary swelling which on Fine Needle Aspiration Cytology (FNAC) turned out to be sclerosing adenosis of the accessory axillary breast. Accessory breasts may present as asymptomatic masses or cause symptoms such as pain or restriction of arm movements. Both benign and malignant tumors can arise in accessory breasts. So far cases of fibroadenoma and carcinoma breast have been reported but sclerosing adenosis has never been reported. Accessory breasts as mass in the axilla may prove to be a diagnostic challenge for surgeon. FNAC being an easy and accurate technique can be very helpful in differentiating such lesions.

Non Surgical Management Of Intra Oral Sinus In Mandibular Canine With Two Canals And Mandibular First Premolar With Two Roots: A Case Report

The root canal morphology of teeth is more often highly complex and variable. Therefore, any attempt to perform successful endodontic treatment must be preceded with thorough and detailed knowledge of the root canal morphology and its possible variations.1 The majority of mandibular canines are single rooted with one root canal. The possibility of having two canals in mandibular canines is reported to be infrequent.2,3 Mandibular first premolars have also been typically described in literature as single–rooted with incidence of extra roots to be rarely present.4 This paper describes a case report on non surgical management of intra oral sinus with presence of two root canals in mandibular canine (Vertucci Type II) and two rooted mandibular first premolar (Vertucci Type IV) in same patient, which is a rare entity.

Papel do exercício combinado sobre a dor de dismenorréia primária em mulheres jovens: uma quase-experiência / Role of combined exercise on primary dysmenorrhea pain among girls: a quasi-experiment

INTRODUÇÃO: Dismenorréia primária é uma dor que atinge o abdômen inferior antes e durante a menstruação. A dismenorréia primária é dor que mais afeta mulheres durante a adolescência. Felizmente, para muitas, o problema alivia à medida que amadurecem, particularmente após uma gravidez. Embora possa ser doloroso e por vezes debilitante por breves períodos de tempo, não é prejudicial. OBJETIVO: Investigar os efeitos de exercícios selecionados sobre a dor de dismenorréia primária em mulheres jovens. MÉTODO: Mulheres jovens com idade de 21,1 ± 2,0 anos foram incluídas neste estudo. A intervenção com exercícios incluiu fortalecimento do grupo muscular central (Core), flexibilidade, exercícios do barril e de resistência. A duração da intervenção foi de nove semanas com frequência de duas sessões por semana e duração de 30 minutos. O projeto foi aprovado pelo comitê de ética no hospital de Kasturba Universidade de Manipal, Índia (número de registro: IEC315 / 2015) RESULTADOS: Os exercícios reduzem a intensidade da dor entre mulheres jovens com dismenorréia. A escala analógica visual (VAS) foi utilizada para medir a intensidade da dor. Houve uma diferença significativa na pontuação para as condições pré-teste (6.94 ± 1.33) e pós-teste (5.02 ± 1.15), p < 0,001. CONCLUSÃO: Este estudo mostra que o exercício misto de flexibilidade, estabilidade do centro de força e exercício do barril pode reduzir a dor primária da dismenorréia entre as meninas. [AU]

INTRODUCTION: Primary dysmenorrhea is the pain of lower abdominal before and during the menstruation. Primary dysmenorrhea is more likely to affect girls during adolescence. Fortunately for many women, the problem eases as they mature, particularly after a pregnancy. Although it may be painful and sometimes debilitating for brief periods of time, it is not harmful. OBJECTIVE: The purpose of this study was to investigate effects of selected exercise on primary dysmenorrhea pain among girl. METHOD: Young women aged (21.1±2.0) were included in this study. The intervention with exercises included core strengthening, flexibility, kegel and endurance exercises. The duration of the intervention was eigth weeks, two times per week with duration of 30 minutes per session. Visual Analogue Scale (VAS) was used to measure the intensity of pain. RESULTS: The results show that exercise effects to reduce pain intensity among young women with dysmenorrhea. There was a significant difference in the score for pre-test (M: 6.94, SD: 1.33) and post-test (M: 5.02, SD: 1.15) conditions; t (9.1) = 2.34, p= 0.000. CONCLUSION: This study shows that the mixed exercise of flexibility, core stability and kegle exercise can reduce the primary dysmenorrhea pain among girls. [AU]

Clinicopathological Study of Uterine Lesions in Hysterectomy Specimens

Background: Women worldwide suffer from various gynaecological disorders that require hysterectomy as a treatment option. Objectives: Our aim was to conduct a histopathological study of various uterine lesions in hysterectomy specimens and to correlate the findings with clinical indications. Methods: A prospective study was done on 200 hysterectomy specimens. The specimens were fixed in formalin and the tissue was adequately processed. The sections were stained with routine Haematoxylin and Eosin stain. Results: In this study the most common clinical indication for hysterectomy was leiomyoma (57.0%) followed by utero-vaginal prolapse (28.5%). Clinical indication of leiomyoma was confirmed by histopathology in 96.5% cases, whereas that of cervical dysplasia, cervical polyp, squamous cell carcinoma cervix, chronic pelvic inflammatory disease, adenomyosis and endometrial carcinoma was confirmed in 100% cases. Conclusion: The ultimate diagnosis and prognosis depends on the histopathological examination; therefore every operated specimen must be subjected to histopathology.

A Comparative Study of Efficacy of Local Corticosteroid Injection Versus Ultrasound Therapy in the Treatment of Planter Fasciitis

Background: Plantar Fasciitis is a frequent disorder involving the plantar fascia. Usually, syndromes that involvemanifestation of the typical heel pain are called plantar fasciitis. Common treatments can be divided into noninvasive and and invasive treatments, such as corticosteroid injection (CSI), botulinum toxin injection, platelet-rich plasma (PRP) injection and surgery. Methods: Total 80 patients were taken up for the study that completed the follow-up. Patients by random sampling were divided in two groups. Patients were divided in Conservative ultrasound therapy and Local Steroid Injections group of 40 patients each. Results: Treatment outcome was found almost similar in both treatment group, the betterment was found better with ultrasound with more duration of treatment but this is not statistically significant. Conclusion: Findings of our study suggest that As both treatment modalities are at par on comparison of their treatment outcome it is better to go for conservative approach.

Prevalence of Upper Limb Neuropathy in Rehabilitated Spinal Cord Injured Patients in North India

Background: Upper extremities are principally adapted for grasping or seizing activities. In individuals with spinal cord injury, they are additionally used for transfers, wheelchair propulsion, and daily living activities, putting additional strain on the joints. For this reason, it is essential to distinguish the effects of these increased demands in terms of prevalence of peripheral neuropathies in rehabilitated spinal cord injured population from developing countries. Methods: Spinal cord Injury patient with a neurological level below T2, who were independent in activities of daily living was monitored during the yearly follow up. Electrodiagnostic study of median, ulnar, radial nerve was graded in a scale of 0-2 with 0 being normal, 1 being neuropathy of one hand and 2 being an association of both the hands and the final conclusion was based on this study. Results: There were 45 wheelchair users, 5 walker users, 30 elbow crutch users, 10 subjects using sticks and one subject with a unilateral transtibial amputation using an axillary crutches. Thirty eight patients were using tricycle for independent mobility. Among 55 patients using wheel chair CTS was observed in 70% patients. In the same group 24% had ulnar neuropathy and 16% had radial neuropathy.Conclusion: Findings of our study suggest that upper limb compressive neuropathy was highly prevalent among the spinal cord injury patients. Further, current study recorded carpal tunnel syndrome was the most common neuropathy incorporated with paraplegia patients especially using wheel chair and crutches. We strongly advocate for the importance of the modification of in the vocational instruments like light weight or electrical wheelchair etc along with improvement in accessories like grip style, gloves etc to avoid the constant pressure and repetitive trauma to upper limb of paraplegia patients with spinal cord injury

Starry sky appearance in Neurocysticercosis

Endemic in India, Neurocysticercosis (NCC) is perhaps one of the oldest known and perhaps the most common parasitic infections of the human nervous system. It is a major cause of epilepsy and neurological disease in many developing countries. In 2015, the WHO Food borne Disease Burden Epidemiology Reference Group identified T. solium as a leading cause of deaths from food-borne diseases, resulting in a considerable total of 2.8 million disability-adjusted life-years (DALYs). T. solium cysticercosis was added by WHO to the list of major neglected tropical diseases in 2010. The diagnosis is imaging based which shows characteristic “starry sky” appearance in heavy infestation cases.

Interferon alfa‑2b in the management of recurrent conjunctival papillomatosis.

A 2‑year‑old boy presented with a recurrent strawberry‑like reddish mass arising from the left caruncular region for 8 months. An incisional biopsy was performed elsewhere 2 months earlier, followed by an increase in size of mass, significant epiphora, and intermittent bleeding. On examination, exuberant exophytic gelatinous mass with multifocal origin was observed arising from inferior forniceal conjunctiva and caruncle. Clinical differential of multifocal conjunctival papilloma was kept, and topical interferon alfa‑2b (INFα‑2b) was started. No clinical reduction in mass or symptomatology was observed over 6 weeks. Excision biopsy with cryotherapy and subconjunctival injection of INFα‑2b was performed over all foci. Conjunctival papilloma was confirmed on histopathology, and topical INFα‑2b was continued in postoperative period for 3 months. At 14 months of follow‑up, no recurrence, epiphora, or bleeding was noticed. We advocate a possible role of local INF therapy in managing and preventing recurrences of conjunctival papillomatosis.