Awareness and knowledge among paramedical staff about glaucoma surgeries and post-surgery counseling – A questionnaire based study at a tertiary eye care center in Central Rural India

Purpose: To determine the level of awareness and knowledge about glaucoma surgery and post?surgery counseling amongst paramedical staff at a tertiary eye?care hospital. Methods: This observational cross?sectional study included a random sample of 94 hospital personnel: 37 general nurse midwives, 47 ophthalmic assistants, and 10 patient caretakers (PCTs). Participants were administered a questionnaire about glaucoma surgery and post?surgery counseling of patients. Results: The study included 41 (43.6%) females and 53 (56.4%) males. The mean age of the participants was 24.85 ± 4.54 years. All participants were aware of trabeculectomy surgery in glaucoma (100%). A total of 95.7% knew that surgery helps in controlling IOP, of whom 57 (60.6%) participants got information during their course of learning. Overall 53 (56.4%) believed that surgery is done when medication failure occurs, and 58 (61.7%) knew that surgery helps in preserving vision. A total of 63 (67.0%) participants knew to counsel patients to visit an ophthalmologist when called for and take the treatment as advised, whereas 74 (78.7%) correctly said to visit an ophthalmologist immediately if pain/diminution of vision/discharge occurs. Overall, PCTs were found to be having significantly better knowledge (P = 0.01) compared to others and they also reported ophthalmologists as the chief source of information. Conclusion: This study revealed that paramedical staff had an excellent awareness of trabeculectomy surgery. However, the knowledge and counseling parts of the questionnaire revealed less than satisfactory responses. So, there is a need to continuously educate paramedical staff members so that they can help in propagating information about the role of glaucoma surgery and the importance of proper follow?up

Gonioscopic angle evaluation and its correlation with graft survival and post-operative ocular hypertension in patients of Descemet’s stripping endothelial keratoplasty

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.

Pediatric cataract and surgery outcomes in Central India: a hospital based study.

BACKGROUND: A review of pediatric cataract cases operated between January 2003 and March 2005 in the tribal belt of central India was carried out. AIM: We present the profile of cataract cases in children <or=18 years and postoperative visual status in the eyes operated upon. SETTINGS AND DESIGN: This was a retrospective medical record retrieval type of cohort study in a hospital setting. MATERIALS AND METHODS: Pediatric ophthalmologists examined children and operated eyes with cataract. The personal profile, preoperative, intraoperative and postoperative details were noted. The surgical procedures included cataract extraction, intraocular lens implantation, posterior capsulorrhaxis and anterior vitrectomy in most of the cases. We evaluated the visual status of eyes with cataract before and 6 weeks after surgery. STATISTICAL ANALYSIS: We used univariate type of parametric type of statistical analysis. RESULTS: A total of 575 eyes of 502 children had cataract. Cataract in 65 children was bilateral and in 437 cases it was unilateral. Congenital cataracts were in 88 (17.5%) eyes. Traumatic cataracts were noted in 170 (33.9%) eyes. The proportion of cataract was higher in males than in females. Variation in 'number of cataracts' among different age groups was noted. Vision following surgery was more than 6/18 in 84 (16.4%) eyes. The vision could not be assessed in 256 (44%) eyes. CONCLUSION: Improvement of child health care is needed for early detection of cataract in children. Role of rubella and trauma in childhood cataract should be investigated and addressed. Visual assessment and postoperative care should be further improved.

Prevalence of celiac disease among siblings of celiac disease patients.

AIMS: To determine the prevalence of celiac disease (CD) in siblings of patients with this disease in Punjab, where wheat is the staple diet. METHODS : Families of 80 patients with CD diagnosed as per modified ESPGAN criteria were offered family screening. Their siblings aged 2-15 years were tested for serum IgA anti-tissue transglutaminase antibody (anti-tTG) antibody. Those with positive or borderline test and some of those with negative test underwent endoscopic duodenal biopsy. Siblings with characteristics histological findings and showing improvement on follow-up were labeled as having celiac disease. RESULTS: Of the 63 siblings of 48 index cases studied, 15 tested positive for anti-tTG; of these 13 had celiac disease. Three tested borderline for anti-tTG; none of them had CD. Of the 45 anti-tTG-negative subjects, two agreed to undergo biopsy; one of these had features of CD. Overall, 14 of 63 (22%) siblings had CD, including 8 who had no symptoms suggestive of CD. CONCLUSIONS: CD is common among siblings of patients with CD in Punjab and may be asymptomatic.

Bleeding gastric lipoma: case report and review of the literature.

We present a rare case of a bleeding gastric lipoma diagnosed by computed tomography. Surgical treatment was followed by an uneventful recovery. Histopathological confirmed the diagnosis.

Primary liposarcoma of the omentum: a case report and review of the literature.

A case of round cell liposarcoma of omentum in a 45-year-old man is reported. The patient presented with abdominal pain, swelling and fever of 4-month duration. Abdominal ultrasonography and computed tomogram confirmed the presence of an abdominal mass, but the omental origin of the tumour was revealed only on laparotomy. In addition to the main tumour mass, multiple nodules were present in the omentum. The tumour was excised with omentum. Histopathology of the tumour revealed a round cell liposarcoma. The patient expired 9 months after operation. Eight other cases of liposarcoma of omentum reported in English literature are reviewed.

Intracranial hemorrhage in late hemorrhagic disease of the newborn.

This study was conducted to evaluate the clinical profile and outcome in late hemorrhagic disease of the newborn (HDN) with particular reference to intracranial hemorrhage. Infants (n = 42) presenting with late HDN from January 1998 to December 2001 were studied. Majority (76%) were in the age group of 1-3 months. All were term babies on exclusive breast-feeding and none received vitamin K at birth. 71% patients presented with intracranial hemorrhage, commonest site being intracerebral and multiple ICH. Visible external bleeding was noted in 1/3rd of patients only. Three patients expired. Late HDN is still an important cause of mortality and morbidity in developing countries where vitamin K prophylaxis is not routinely practiced. Isolated intracranial hemorrhage is a common mode of presentation.

Solitary tuberculous abscess of liver.

Tuberculous liver abscess (TLA) is an extremely rare condition even in the country where tuberculosis is an alarming public health problem. Here a case of TLA is reported from Nepal with diagnostic and management principles and review of literature.

Agenesis of gallbladder in symptomatic patients.

Three women and one man among 771 patients, who underwent laparotomy with diagnosis of symptomatic gallbladder disease over a period of 5 years, were found to have agenesis of the gallbladder. Preoperative ultrasonography suggested cholelithiasis in all the four patients; three patients with jaundice had choledocholithiasis in addition. The absence of gallbladder was established by meticulous operative exploration and carefully repeated ultrasonography in postoperative period. The patients having choledocholithiasis underwent choledocholithotomy, while the fourth patient had no definitive procedure. One patient expired on 17th postoperative day following biliary leak, septicemia and liver failure. Another two patients were well and symptom free, while the fourth patient remained symptomatic. Awareness of the possibility of agenesis of gallbladder may allow the surgeon to attempt confirmation of diagnosis by non-operative methods and avoid surgical exploration in specific instances.

Prevalence of atherosclerosis risk factors in adolescent school children.

The emerging epidemic of atherosclerotic cardiovascular diseases in developing countries may have its roots in childhood. We studied atherosclerosis risk factors--tobacco use, obesity, hypertension, total cholesterol level and dietary intake of atherogenic nutrients in adolescent school children aged 13-17 years in Western India. Two hundred thirty-seven children (89 boys, 148 girls) were examined and prevalence of risk factors determined. Family history of coronary heart disease was found in 16 (6.8%), smoking or tobacco use in one (0.4%) and obesity (BMI > 90th percentile) in 24 (10.1%), borderline hypertension (> or = 136/86) in 65 (27.4%) and definite hypertension (> or = 142/92) in 17 (7.2%). Borderline hypercholesterolaemia (170-199 mg/dL) was in 78 (32.9%) and definite hypercholesterolaemia (> or = 200 mg/dL) in 16 (6.8%). Mean calorie intake was 1450 +/- 348 per day. Fats provided 38.4 +/- 8 percent of the calories, saturated fats contributed to 20.3 +/- 6.4 percent of calories, monounsaturated fats to 12.9 +/- 2.4 percent and polyunsaturated fats to 5.0 +/- 3.7 percent. Dietary cholesterol intake was 164 +/- 95 mg/day, sodium chloride intake 12.8 +/- 5.7 gm/day and fibre intake 6.5 +/- 4.6 gm/day. This study shows a high prevalence of metabolic and dietetic coronary risk factors among adolescents of the middle- and upper-middle class in India.

Influence of alcohol intake on high density lipoprotein cholesterol levels in middle-aged men.

To study the influence of alcohol (ethanol) intake on high density lipoprotein cholesterol (HDLC) levels, we studied 210 healthy middle-aged men (age 45 +/- 8 years). Other factors influencing HDLC (physical exercise, diet, smoking and body mass index) were also studied. Individuals were classified according to daily ethanol consumption. There were 39 teetotallers, 29 took drink, 30 took 1-1.9, 25 took 2-2.9, 26 took 3-3.9, 28 took 4-4.9 and 33 took 5 or more drinks per day (1 drink = 14 gm ethanol). The overall mean serum total cholesterol was 191.4 +/- 53 mg/dl and HDLC was 46.4 +/- 9 mg/dl. Total cholesterol in teetotallers was not different from those consuming different amounts of alcohol. HDLC in teetotallers (44.5 +/- 8 mg/dl) was significantly lower than in those taking 1-1.9 drinks (46.7 +/- 11 mg/dl, p < 0.05) and 2-2.9 drinks/day (51.4 +/- 9 mg/dl, p < 0.01) but was not different from those consuming > or = 3.0 drinks. There was a weak positive linear correlation between ethanol and HDLC (r = 0.016). HDLC levels were significantly lower in smokers (43.5 +/- 9 vs 47.2 +/- 11 mg/dl in non-smokers), in non-vegetarians (43.5 +/- 10 vs 46.2 +/- 9 mg/dl in vegetarians) and in those with sedentary habits (42.4 +/- 7 vs 46.1 +/- 10 mg/dl in physically active). Low level ethanol consumption (< 3 drinks or 42 gm per day) is associated with increased HDLC levels.

Awareness of cholesterol as coronary risk factor among general practitioners at Jaipur.

Widespread information about preventive measures has decreased incidence of coronary artery disease (CAD) in developing countries. However this trend is not seen in India. Cholesterol and other lipoproteins play important role in CAD. In order to assess whether this information has reached General Practitioners (GP's) and their action regarding the recommendations of the US National Cholesterol Education Programme (NCEP), G.P.'s were assessed with the help of a questionnaire. The response rate to the questionnaire was 78.4% of the total G.P.'s of the city. The findings of the study were compared to the NCEP guidelines. Results indicate that, "Ideal", "High" and cholesterol levels dietary needing precautionary measures intervention (ie. 198.2 +/- 13 mg/dl, 256.1 +/- 32 mg/dl and 247.9 +/- 26 mg/dl respectively) were similar to the NCEP guidelines. Levels where therapy is recommended (ie 293.9 +/- 34 mg/dl) is significantly more than NCEP guidelines. Though 77.1% of doctors were aware of protective effect of HDL cholesterol (ie 51.1 +/- 6 mg/dl), routine measurement of lipid profile was undertaken by only 57.1% doctors with mean age of recommendation being 34.1 +/- 11.6. Routine dietary advice and cholesterol estimation was done in 71.4% patients with CAD and 67.3% of patients with hypertension and diabetes. Analysis of action taken falls short of the NCEP recommendations and indicates a need for intensive training of the G.P.s.