RESUMO
The outcome of a retinopathy of prematurity (ROP) program initiated in five districts of Odisha over 3 years with partnerships between the government and non-government organizations was prospectively analyzed. The mentoring partners trained the district ophthalmologists and neonatal care providers; the program was handed over when the trainees were considered competent enough to diagnose and treat babies with ROP. During the project period (July 2016–June 2019), 3058 babies were examined; ROP was detected in 33.81% (n = 1034) and 5.06% (n = 159) babies required treatment. At the end of the project, ROP screening was possible in all five districts, and treatment was possible in three districts. ROP care nodal centers were built in one government medical college. To strengthen the initial gain, we recommend creating an Odisha Retinopathy of Prematurity (OD-ROP) steering committee with private–public partnerships to support the program and monitor its progress in other districts of Odisha.
RESUMO
Context: Subclinical hypothyroidism (SCH) is defined by an elevated Thyroid stimulating hormone (TSH) level in presence of normal serum free T4 concentration. Thus serum TSH measurement is the necessary test for diagnosis of mild thyroid failure. Aims: Evaluation of the pulmonary function by spirometry in patients of SCH, correlate the pulmonary function with fT3, fT4, TSH level and assess any change in pulmonary function in patients of SCH following treatment. Settings and Design: Prospective case control study from December 2014 to November 2016 in tertiary medical college of eastern India Methods and Material: 70 patients and 35 age sex matched controls were included in the study. The main outcome measures of the study were based on a comparison of spirometric findings of subclinical hypothyroidism with the control group and change in spirometric parameters after 3 months follow up with levothyroxin replacement. Statistical analysis used:The statistical comparisons were done by SPSS software version 20. Pvalue was considered significant if <0.05. Results: The study population 90% were females and 10% males. The mean TSH of the patients with subclinical hypothyroidism was 11.49±8.44 and that of the control group was 3.22±0.79, it was statistically significant. Forced expiratory volume in 1 second of subclinical hypothyroidism patients was significantly lower than control group. The mean FEV1/FVC% was higher in subclinical hypothyroidism as compared with control. After 3 months of thyroid hormone replacement the TSH level was normalised. With improvement of TSH all the respiratory parameters improved significantly. Conclusions: Though mild restrictive pattern of respiratory function abnormality occurs in subclinical hypothyroidism, it cannot be ignored. Hence they should be evaluated and clinical approaches should be taken accordingly at the earliest.
RESUMO
Purpose: To analyze the causes for late presentation in a series of patients with advanced retinopathy of prematurity (ROP) in a tertiary eye care institute in Eastern India. Methods: We analyzed our medical records and ROP database retrospectively from 2007 to 2015 and prospectively thereafter till 2017 to identify the factors for late presentation in babies with advanced ROP (stages 4 and 5). Results: A total of 71 eligible subjects were analyzed. The mean chronological age was 15.1 months (2 months to 14 years). The three important barriers were: (1) the system and neonatal care policy failure (n = 45; 63.3%), (2) parental negligence and ignorance (n = 19; 26.7%), and (3) ophthalmologist's misdiagnosis or unavailability (n = 7; 10%). Majority of the babies (63.3%) were admitted in the neonatal care unit when they were due for ROP screening with an average duration of stay of 35.5 days. Conclusion: The main barriers to early screening for ROP were related to availability of trained human resources, ignorance of “parents and health care personnel,” and distance from the point of care. This calls for training of ophthalmologists, advocacy with neonatologists and parents, and create systems for better coordination and compliance of the care providers.