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

Prevalence, clinical profile, and stroke risk of atrial fibrillation in rural Andhra Pradesh, India (the AP-AF study)

The burden of atrial fibrillation (AF) is increasing worldwide. It is often asymptomatic, with stroke being the first manifestation in some. AF burden in the community and the practice of stroke prophylaxis has not been studied in India. The problem might be higher in rural regions due to poor health awareness and challenges to healthcare access. This study aimed to estimate the prevalence of AF, clinical profile and stroke risk in rural India. Methods: This is a community-based cross-sectional study done in rural Andhra Pradesh (AP). Adults from 40 villages formed the study population. We did a door-to door survey to collect information on demographics, and medical history. Electrocardiogram was recorded using a smart phone based Alivecor device. Participants diagnosed with AF underwent echocardiogram. Study cardiologists assessed the cardiovascular risk profile and collected detailed medical history. Results: Fourteen of the 4281 individuals screened had AF (0.3%). The mean age of the sampled population was 44 ± 16.5 years with 56% women. The mean age of participants with AF was 71 ±7.8 years; males were 71%. Except for one, all were non-valvular AF. Majority had a CHA2D2S2Vasc score of 2. Three had history of stroke. Two were on anticoagulant therapy but without INR monitoring. Conclusion: The prevalence of AF is lower in this study compared to studies from the developed countries. Non-rheumatic cardiovascular risk factors were primary causes for AF. Non-adherence to stroke prophylaxis is a major threat that needs to be addressed

Comparative evaluation of chelating efficacy of nano-chitosan, pomegranate extract, and ethylenediaminetetraacetic acid on primary radicular dentin An in vitro study

Background: Irrigation is a crucial aspect of root canal treatment, and it is imperative to employ chelating agents to eliminate the smear layer during biomechanical preparation. They in turn react with mineral content of dentin, leading to decreased strength and increased susceptibility to fracture. Aims: This study aimed to assess and compare mineral loss and microhardness from primary root canal dentin following the usage of different irrigating solutions and determine the least detrimental irrigant among the tested solutions. Materials and Methods: Sixty-six primary anterior teeth were divided into three groups with 22 in each– Group I: 17% ethylenediaminetetraacetic acid (EDTA) Group II: 0.2% Nano chitosan Group III: Pomegranate extract. The decoronated teeth were split longitudinally. Half of it was directly subjected to Vickers test, and the other half was immersed in a magnetic stirrer bath containing test solution to record the mineral loss from solution. Postmicrohardness values were recorded on the specimen and compared with initial values. Statistical Analysis Used: Statistical analysis was done using SPSS software (Version 20, SPSS, IBM, Armonk, NY, U. S. A). Results: Descriptive statistics were calculated, and the groups were compared using analysis of variance test and post hoc Tukey test. Pomegranate extract showed least effect on mineral content and microhardness compared to 17% EDTA and 0.2% nano chitosan. P ≤ 0.05 was considered statistically significant. Conclusion: Pomegranate aril extract showed better results with selected parameters.

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

Pregnancy with pancytopenia: an observational study

Background: Pancytopenia is the reduction in all three major cellular elements of blood; hence it is the simultaneous presence of anaemia, leukopenia and thrombocytopenia. Pancytopenia is associated with many maternal and foetal complications during pregnancy like maternal sepsis, postpartum haemorrhage, pre-eclampsia and preterm labour, IUGR and intrauterine foetal demise.Methods: The study was conducted at BLDE (Deemed to be) University, Shri B. M. Patil Medical College Hospital and Research Centre. It’s an observational study done from November 2019-April 2020. The participants enrolled in the study were subjected for further clinical and laboratory evaluation and followed for feto-maternal outcome.Results: The incidence of pancytopenia with pregnancy in this study was 3% and all the patients were vegetarian by diet along with vitamin B12 and folic acid deficiency. They were associated with different maternal and foetal complications.Conclusions: Proper dietary counselling and well-balanced dietary plans even with plant originate food can prevent the micronutrients deficiency and avoid the deleterious consequences like pancytopenia.

A study of hypertensive disorders of pregnancy and the fetal outcome in a tertiary care hospital: a prospective study

Background: Pregnancy induced hypertension is one of the major causes of feto maternal morbidity and mortality in pregnancy. The exact cause of PIH is unknown certain factors are known to increase the risk of PIH such as risk factor includes that young women with first pregnancy.Methods: The objective of this study was to assess the socio-demographic and clinico-pathological profile of the patients with hypertensive disorders of pregnancy and its associated fetal outcomes. A prospective study was conducted in department of obstetrics and gynecology Shri B. M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura Karnataka from 15th July to 15th December 2018. All women admitted to labour ward with diagnosis of hypertensive disorders of pregnancy were included in the study after ruling out the exclusion criteria and thorough history, examination and laboratory evaluation were done and followed till delivery.Results: A total of 123 pregnant women with hypertensive disorder of pregnancy were enrolled in the study. Most of the participants were in the age group of 20 to 30 years. The PIH was seen mostly in primigravida, lower socioeconomic status and with lower educational levels. Emergency LSCS is the most common mode of delivery.Conclusions: The hypertensive disorder in pregnancy affects the majorly younger age group. It is most commonly seen in low socio-economic and uneducated population. Hence, there should be provided with proper antenatal care, early detection of hypertensive disorders for better feto-maternal outcome.

Chronic rheumatic heart disease and congenital heart disease complicating pregnancy: a study of the cardiac events, the maternal and perinatal outcome during 2011-2013 at tertiary care centre

Background: Objective of this study was to assess the prevalence of chronic rheumatic heart disease and congenital heart disease complicating pregnancy, study the maternal and perinatal outcome, and indications for termination of pregnancy.Methods: Preconception counseling, antenatal care by pregnancy heart team as per protocol. One 2nd gravida (G2A1) with 26 weeks gestation, underwent mitral valve replacement during 26th week gestation i/v/o infective endocarditis associated with severe mitral regurgitation.Results: Authors had CRHD: CHD = 29:21, out of 50 cases, the ratio was 1.3:1 in this study. Atrial septal defect (ASD) was the predominant lesion in this study -29% ASD alone and 9% associated with pulmonary artery hypertension. Eisenmenger's syndrome, was associated with ASD in three and VSD in two. Corrected lesions were 24%. In the rheumatic heart disease, mitral stenosis was the predominant lesion and PBMV was done in four (13.7%) cases. In CRHD cases, surgically corrected by prosthetic heart valve were -11 (37.9%). In CRHD total corrected cases, by prosthetic heart valve and percutaneous balloon mitral valvotomy (PBMV) account for 51.7%. One patient had PBMV procedure during 5th month of present pregnancy i/v/o severe mitral stenosis with mitral valve area -0.8 cm2 and another patient had PBMV during her first pregnancy. In this study 42% were in NYHA class I. 14% were in NYHA class IV. CHF was seen in 10%. Termination of pregnancy was necessary in 6 with CHD and 5 with CRHD. There were 39 deliveries with one set of twins. All the babies were alive. Maternal mortality was confirmed in one case with Eisenmenger’s syndrome + HELLP syndrome. Live birth rate was higher in cases with NYHA class I/II than in those with NYHA class III/IV (82.8% versus 66.60%).Conclusions: Management by a pregnancy heart team as per guidelines would reduce mortality.

Identification, synthesis, and characterization of β-isomer as process related impurity in production of methocarbamol from guaifenesin

Methocarbamol is a central nervous system depressant with skeletal muscle relaxant properties indicated to treatspasms. During the synthesis of methocarbamol from guaifenesin, both potential known and an unknown impurity(0.05%–0.1%), high performance liquid chromatography) were observed. The later was separated using preparativeliquid chromatography. Upon the findings of the 1H nuclear magnetic resonance, Mass, and IR spectral analysis, theunknown impurity was designated as a β-isomer of methocarbamol [1-hydroxy-3-(2-methoxy phenoxy) propan-2-ylcarbamate]. The impurity isolation, its structure elucidation, and the potential formation mechanism are discussed.

Predictors of mortality in children hospitalized with severe acute malnutrition

Background: Severe acute malnutrition (SAM) is a leading cause of morbidity and mortality in children worldwide. Identification of factors contributing to mortality is crucial to decrease the mortality due to SAM. This study aims at identification of factors affecting mortality in hospitalized SAM children.Methods: This study was done in general pediatric wards of a Government tertiary care center from July 2015 to June 2016. Total 200 children admitted to the hospital with Severe Acute Malnutrition (SAM) as per World Health Organization (WHO) criteria were enrolled. Demographic and clinical data were recorded in structured proforma. These children were followed up till death or discharge and their progress and outcome were noted. The risk factors considered were younger age (infancy), female sex and presence of systemic illness, sepsis, retroviral positivity, severe anaemia, pneumonia and diarrhea and these were compared between those who died and survivors.' Univariate analysis and logistic regression analysis were performed to determine the significant risk factors.Results: The mortality rate was 10.5%. Presence of systemic illness, sepsis and retroviral positivity were significant risk factors at the end of univariate analysis and multivariate logistic regression, while the others were insignificant.Conclusions: Systemic diseases, sepsis and retroviral disease are poor prognostic features and are risk factors of mortality in hospitalized SAM children.

Vitamin D deficiency and its correlation with pregnancy outcome

Background: There is a growing concern about the high prevalence of vitamin D deficiency and its relationship with variety of diseases worldwide. The objective of this study was to determine the prevalence of vitamin D deficiency and its association with pregnancy outcome.Methods: This was a cross sectional study conducted among 150 antenatal women from October 2014 to April 2015. Data containing socio-demographic details, vitamin D level, serum calcium, pregnancy complications and growth situation of newborns were collected and analyzed.Results: A total 150 pregnant women participated in the study, 75.3% were vitamin D deficient, 22.1% vitamin D insufficient and 2.6% normal. There was no significant adverse maternal outcome. NICU admission was required in 28.3 and 15.2% in the vitamin D deficient and insufficient groups respectively.Conclusions: Women from different socioeconomic status, irrespective of parity and educational levels had vitamin D deficiency and insufficiency. This study fails to show a relation of vitamin D deficiency with other high-risk factors of pregnancy and does not show any adverse fetal outcome.

A study on contraceptive use among women attending immunization clinic at McGann teaching hospital, Shimoga

Background: India is the first country to implement National family planning programme in 1952. Use of contraceptives can prevent at least 25% of all maternal deaths by allowing women to prevent unintended pregnancies and unsafe abortions, and protect themselves from sexually transmitting diseases. Even though there is wide availability of various types of contraceptives, the rate of population growth and unplanned pregnancies is still high. The acceptance and knowledge of contraceptive methods varies within the societies and factors responsible operate at the individual, family and community level.Methods: A hospital based, cross-sectional study was conducted during August 2018 at McGann Hospital, Shimoga. The study sample included 200 women in the age group of 20 to 40 years attending immunization clinic with their children. Informed consent was taken from the subjects after explaining the purpose of the study to them. A pre-tested, semi-structured questionnaire was used to collect data by face-to-face interview of the study participants.Results: Out of 200 women 51% were aged between 20 to 24 years of age. Majority (72%) were Hindus. 67.5% were currently using contraception. Among acceptors of family planning 42.3% had undergone tubectomy. OCP was the most commonly used temporary method of contraception. Age of the woman, religion, education, husband’s education and number of children were found to be significantly associated with contraceptive usage.Conclusions: Factors influencing fertility and contraceptive practices should be properly assessed and addressed. Newly married couples should be motivated for accepting spacing methods.

Comparative evaluation of the bond strength of self-adhering and bulk-fill flowable composites to MTA Plus, Dycal, Biodentine, and TheraCal: an in vitro study

OBJECTIVES: This study aimed to compare the shear bond strength (SBS) of a self-adhering flowable composite (Dyad Flow) and a bulk-fill flowable composite (Smart Dentin Replacement [SDR]) to several pulp-capping materials, including MTA Plus, Dycal, Biodentine, and TheraCal.MATERIALS AND METHODS: Eighty acrylic blocks with 2-mm-deep central holes that were 4 mm in diameter were prepared and divided into 2 groups (n = 40 each) according to the composite used (Dyad Flow or SDR). They were further divided into 4 sub-groups (n = 10 each) according to the pulp-capping agent used. SBS was tested using a universal testing machine at a crosshead speed of 1 mm/min. Data were analyzed using 2-way analysis of variance. A p value of < 0.05 was considered to indicate statistical significance.RESULTS: A statistically significant difference (p = 0.040) was found between Dyad Flow and SDR in terms of bond strength to MTA Plus, Dycal, Biodentine, and TheraCal.CONCLUSIONS: Among the 8 sub-groups, the combination of TheraCal and SDR exhibited the highest SBS.

Comparative evaluation of the bond strength of self-adhering and bulk-fill flowable composites to MTA Plus, Dycal, Biodentine, and TheraCal: an in vitro study

OBJECTIVES@#This study aimed to compare the shear bond strength (SBS) of a self-adhering flowable composite (Dyad Flow) and a bulk-fill flowable composite (Smart Dentin Replacement [SDR]) to several pulp-capping materials, including MTA Plus, Dycal, Biodentine, and TheraCal.@*MATERIALS AND METHODS@#Eighty acrylic blocks with 2-mm-deep central holes that were 4 mm in diameter were prepared and divided into 2 groups (n = 40 each) according to the composite used (Dyad Flow or SDR). They were further divided into 4 sub-groups (n = 10 each) according to the pulp-capping agent used. SBS was tested using a universal testing machine at a crosshead speed of 1 mm/min. Data were analyzed using 2-way analysis of variance. A p value of < 0.05 was considered to indicate statistical significance.@*RESULTS@#A statistically significant difference (p = 0.040) was found between Dyad Flow and SDR in terms of bond strength to MTA Plus, Dycal, Biodentine, and TheraCal.@*CONCLUSIONS@#Among the 8 sub-groups, the combination of TheraCal and SDR exhibited the highest SBS.

Insulin resistance and the severity of coronary artery disease based on obesity status in stable-angina patients: A cross-sectional analysis

The evaluation of coronary artery disease (CAD) concerning the metabolic status and body mass index (BMI) is poorlystudied. This study was designed to observe the relationship between insulin resistance (IR) and the severity of CADon the basis of the metabolic and phenotypic status in stable-angina patients. A cross-sectional study was conductedon 532 patients with stable angina and coronary angiogram was done to diagnose the CAD for all. Determination ofmetabolic obesity was done using the National Cholesterol Education Program-Adult Treatment Panel III criteria.Phenotypic obesity was defined as BMI ≥ 25 kg/m2. Homeostasis model assessment IR in correlation with the severityof CAD was measured using SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for theTreatment of Narrowed Arteries) Score. The average age of the patients was 57.58 ± 10.40 years, and 69.4% weremales. Out of 532 subjects, 51.3% were hypertensive, 14.5% were smokers, 29.1% consumed alcohol, 49.3% weremetabolically obese, and 50% were phenotypically obese. Increase in IR increased the risk of severity of CAD inmetabolically obese subjects (OR = 2.51, p = 0.048). In the phenotypically obese group, the relationship between IRand the severity of CAD was not statistically significant (OR = −2.19, p = 0.08). The study concludes that the increasedIR increases the risk of severity of CAD in metabolically obese subjects.

Permanent HIS bundle Pacing Feasibility in Routine Clinical Practice: Experience from an Indian Center

There is a paucity of experience regarding His bundle pacing (HBP) at laboratories initially attempting the procedure, especially in the Indian scenario. Patient who underwent HBP were selected for pacing therapy or in lieu of cardiac resynchronization therapy (CRT) at a single center. Among 22 patients attempted, 19 patients underwent successful implant, achieving selective HBP in 14 patients. There was a significant improvement in left ventricular ejection fraction (LVEF) (49.3 ± 9.3 vs. 36.7 ± 9.2) in the LV dysfunction subgroup (n = 6). Over a follow-up of 15 ± 6.5 months, thresholds were stable in all except one patient, and there was no requirement of lead revision. In summary, we found that HBP is a feasible option for achieving physiological pacing.

Study of blood pressure in relation with age, sex and BMI in school going children of age group 5-15 years in Amalapuram, Andhra Pradesh, India

Background: The measurement of blood pressure is an important component of routine Pediatric physical examination. Children with higher levels of blood pressure tend to maintain higher blood pressure levels in adulthood in comparison to their peer group. The aims and objectives of this study were to define the normal pattern of blood pressure and prevalence of hypertension in urban school children between the age group of 5-15 years and to evaluate relationship of blood pressure with variables such as age, sex, height, weight and BMI in Amalapuram, Andhra Pradesh.Methods: This was a prospective cross-sectional observational study conducted from July 2016 to December 2018 in Department of Pediatrics, KIMS Amalapuram.Results: The overall prevalence of hypertension in the present study was 3.2%. Of these 16 children 11 were males amounting to 4.41% of total number of males and 5 were females amounting to 1.99% of total number of females. The prevalence of hypertension was more in the males. It was observed that there is not much increase in mean blood pressure up to 130 cms (both in males and females) and increased significantly and gradually in children above 130 cms of height. Blood pressure increases gradually and in a proportionate manner with increase in weight and BMI.Conclusions: Blood pressure is an important vital sign which reflects the integrity of the cardiovascular system, renal, endocrinal system and other systems in the body. Blood pressure of an individual varies with age, sex, height, weight and BMI. It also has a strong correlation with family history of hypertension. Thus, concluded that hypertension has its roots in childhood and early adolescence.

Elder abuse among residents of Shivamogga: a cross sectional study

Background: As per the WHO estimates the global population of people aged 60 years and above will increase from 900 million in 2015 to about 2 billion in 2050. Abuse of elderly has become a problem even in India. Due to social taboo, the elder abuse at community setting is usually not reported. Even though elder abuse is an important public health problem, very little is known about the extent of abuse especially in developing countries. Methods: A community based cross-sectional study was conducted in Shivamogga. A total of 200 elderly persons were interviewed using a pretested semi structured questionnaire. The person showing suggestive score was further asked about type of abuse and perpetrator of mistreatment. Results: Our study showed total prevalence of elder abuse in the community to be 24%. The extent of abuse was more among females especially the housewives. The most common type of abuse was verbal abuse followed by psychological abuse. Son was the common perpetrator of mistreatment. Conclusions: Elder abuse is much prevalent in the community. There is a need for further studies to generalise the findings.

Effect of extraction or nonextraction orthodontic treatment modality on favorability of eruption of impacted third molars

Objective: The objective of the study is to determine if extraction of permanent teeth, for orthodontic purpose, causes a change in third molar angulation and also to determine if extraction of permanent teeth causes an increase in eruption space available for third molars. Methods: This systematic review includes retrospective cohort studies which evaluated the change in third molar angulation or eruption space available for third molars among orthodontic patients treated by a fixed appliance with either extraction or nonextraction protocol. Search engines used were MEDLINE, IndMED, Web of Science, Cochrane, EMBASE, and Google Scholar from the year 1975 to 2015. Separate data collection forms were used to extract data from the studies. The Cochrane Risk of Bias Assessment Tool was used to assess the studies included in the systematic review. Results: Fifteen studies included in the systematic review proved that third molar angulation and eruption space improved in patients treated with extraction treatment modality. However, two studies concluded that change in third molar angulation and eruption space occurred irrespective of the type of treatment involved. Conclusion: The angulation and eruption space of third molar improved following extraction of premolar or molar. Nonextraction treatment modality did not cause any adverse effects.

Discrepency in grade between preoperative biopsy and final specimen in stage I carcinoma endometrium: an institutional review

Background: Most endometrioid endometrial cancer are well differentiated (Grade I). Grade of the tumor is an important predictor of nodal metastasis and the discordance in histological grade of endometrial cancers between diagnostic biopsy and definitive surgery specimen was analyzed in our Institute.Methods: Around 221 patients diagnosed with carcinoma endometrium between 2006 and 2014 were taken into study. Histologic differentiation of the tumour between diagnostic biopsy and definitive surgery were analysed. All demographic data, tumor factors, follow up and recurrence were recorded.Results: Of the 221 patients taken into consideration for analysis, median age of presentation was 57 years with range between 38-77 years. The overall median body mass index was 27.70kg/m2. 66 % of patients had comorbid illness, with 33% having both diabetes and hypertension. Open staging was performed in 150 patients and laparoscopic staging in 71 patients. Mean duration of surgery was 3.06 hrs in laparoscopic staging and 2.74hrs in open staging. The median tumour size was 4cm.The median number of nodes dissected were 13. Discordance in the grade of tumour between diagnostic biopsy and surgical biopsy were 58.8% of grade 1 tumour, 16.2% of grade 2 tumours and 18.9% of grade 3 tumours.Conclusions: Discrepancies in correlation of the grade of tumour in diagnostic biopsy and tissue obtained at surgery supports the need for surgical staging in all patients.