Intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in patients with axial hyperopia

Purpose: This study was conducted to evaluate the accuracy of intraoperative aberrometry (IA) in intraocular lens (IOL) power calculation and compare it with conventional IOL formulas. Methods: This was a prospective case series. Eyes with visually significant cataract and axial hyperopia (AL <22.0 mm) underwent IA?assisted phacoemulsification with posterior chamber IOL (Alcon AcrySof IQ). Postoperative spherical equivalent (SE) was compared with predicted SE to calculate the outcomes with different formulas (SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal ? and Hill?RBF). Accuracy of intraoperative aberrometer was compared with other formulas in terms of mean absolute prediction error (MAE), percentage of patients within 0.5 D and 1 D of their target, and percentage of patients going into hyperopic shift. Results: Sixty?five eyes (57 patients) were included. In terms of MAE, both Hoffer Q (MAE = 0.30) and IA (MAE = 0.32) were significantly better than Haigis, SRK/T, and Barrett Universal ? (P < 0.05). Outcomes within ±0.5 D of the target were maximum with Hoffer Q (80%), superior to IA (Hoffer Q > IA > Holladay 2 > Hill?RBF > Haigis > SRK/T > Barrett Universal ?). Hoffer Q resulted in minimum hyperopic shift (30.76%) followed by Hill?RBF (38.46%), Holladay 2 (38.46%), Haigis (43.07%), and then IA (46.15%), SRK/T (50.76%) and Barrett Universal ? (53.84%). Conclusion: IA was more effective (statistically significant) in predicting IOL power than Haigis, SRK/T, and Barrett Universal ? although it was equivalent to Hoffer Q. Hoffer Q was superior to all formulas in terms of percentage of patients within 0.5 D of their target refractions and percentage of patients going into hyperopic shift

A study on the effect of mobile phone use on sleep

Background & objectives: Several studies have been conducted globally to assess the impact of usage of mobile phones on quality and duration of sleep as also on day time sleepiness. The objective of the present study was to assess the effect of mobile phone usage on the quality and composition of sleep in a sample from Indian population. Methods: The study was conducted at two tertiary care hospitals in north India from July 2014 to September 2019. A total of 566 participants were recruited in this study from both the centres. Sleep quality was assessed with the help of the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Subsequently, actigraphy was done in 96 participants and polysomnography in 95 participants. Results: Of the 566 participants, 128 (22.61%) had PSQI ?5, reflecting poor sleep quality. A higher use of mobile phone was significantly associated with a poor sleep quality as a component of PSQI questionnaire (P=0.01) and higher overall PSQI score (P=0.01). The latency from sleep onset to N2 and N3 sleep stages was significantly shorter in participants having a higher mobile phone usage as compared to those with a lower usage [Median (range): 13.5 min (1.5-109) vs. 6.5 min (0-89); P=0.02] and [Median (range): 49 min (8.5-220.5) vs. 28.75 min (0-141); P=0.03], respectively. Interpretation & conclusions: This study focused on the maladaptive changes brought on by mobile phone usage on sleep. More studies with larger sample sizes need to be done that may serve to confirm the hypothesis generating findings of our study

Reflection about the hemodialysis water microbiological quality in Brazil

Abstract Dialysis has been widely used in the treatment of patients with chronic kidney diseases and is considered a global public health issue. This treatment, which has changed the prognosis and quality of life in patients with chronic renal failure, can lead to complications that are often fatal. For this reason, there is a need for validation of alternative tests that favor the monitoring of treated water for dialysis in real-time to promote and prevent injuries to patients submitted to this procedure.

Pattern of Alcohol Consumption in Patients of Alcoholic Liver Disease in India

Background: Alcohol-related chronic liver disease (ALD) and its complications are major causes of morbidity and mortality. Predisposing factors for ALD include the amount, type, duration of alcohol consumption, patient’s genetic predisposition, race, sex, and other comorbid conditions. Aims: To study the dose, duration, and type of alcohol consumption in ALD and the effect of these parameters on severity and outcome Methods: This was a prospective study conducted at the Department of Gastroenterology, SMS hospital, Jaipur, between December 2017 to December 2018. All patients with alcoholic liver disease admitted in the department were consecutively enrolled. Data relating to dose, duration, type, alcohol intake pattern, biochemical, ultrasonographic, and clinical parameters were analysed. Results: One hundred ten patients (age 43.5±9.9, all-male) were studied. Mean alcohol consumption was 130.47±35.37gm/day. Sixty-three (57.3%) patients consumed <120gm, 25(22.7%) between 120-239gm, while 22(20%) patients consumed =240gm of alcohol per day. The mean duration of alcohol consumption was 15.89±6.57 years. Fifty-nine (53.63%) patients consumed country-made spirit, 25 (22.72%) branded spirit, 23 (20.91%) mixed or variable type, while three (2.73%) patients consumed only wine. The occurrence of hepatic encephalopathy (HE) was significantly associated with dose (p <0.001) and type (p <0.001) of alcohol consumption. MELD Na score significantly correlated (r=0.48, p <0.001) with dose of alcohol. Conclusion: Our study found a dose-dependent relationship of alcohol intake with hepatic encephalopathy and MELD-Na score. The incidence of ALD did not change with the type of alcohol consumed. Low lymphocyte counts were significantly associated with dose and duration of alcohol intake.

Prospective Study of Benign Breast Disease in a Rural Tertiary Care Hospital

Objective of the present study was to evaluate different patterns of benign breast diseases and theirmode of presentation and also to correlate between clinical and pathological findings in cases ofpalpable lesion of breast. A total of 130 patients who attended the Surgery Department in MMIMSRMedical College, Mullana, Ambala with various forms of BBDs, during the period from January 2014to April 2016, were studied. Early diagnoses by doing a triple assessment such as a clinical examination,fine-needle aspiration cytology or a core needle biopsy, and imaging methods such as ultrasonographyor mammography. The clinical diagnoses were compared with the cytological or histological findingswherever possible, and their accuracies were evaluated. Out of the 130 patients who were studied,majority of patients who presented with breast lumps, were in the reproductive age group. Fibroadenoma(41.5%) and fibrocystic (14.6) diseases were the most common BBD's. Most patients presented aspainless lump which is need to be differentiated from carcinoma. BBD's most commonly affectedupper and outer quadrant. Most of the patient (61%) presented within 6 months of development ofbreast lesion showing increasing awareness in females of rural India. BBDs are common in femalepatients. The triple assessment provided a quick diagnosis, and it alleviated unnecessary anxiety fromthe patients about breast cancer. The clinical diagnosis of a breast lump, as confirmed by cytologyand histology, was accurate in most of the cases.

The role of laparoscopy in patients with abdominal trauma

Background: Use of laparoscopy in penetrating trauma has been well established; however, its application in blunt trauma is gaining popularity as a useful diagnostic tool to avoid unnecessary laparotomies where there is diagnostic dilemma. Even though recent case reports seem to suggest that these patients can be managed using laparoscopy, the practice is not yet wildly adopted.Methods: All adult patients who presented with abdominal trauma laparoscopic surgery was considered in patients who were deemed fit for the same in the Department of General Surgery, MMIMSR, Mullana, Ambala during a period of 18 months starting from January 1st 2015 to June 30th 2016. Data was analysed using descriptive statistics.Results: A total of 53 patients with either blunt or penetrating abdominal trauma that required surgery were included in the study. Exploratory laparotomy was performed in 45 patients (84.91%) and laparoscopy was performed in 8 patients (15.09%). Overall mesenteric injury (45.28%) was the most common intra-abdominal injury noted. The most common organ involved in blunt trauma was the spleen (68.97%). The mean operating time of laparoscopy was lesser by 57 minutes as compared to exploratory laparotomy. The use of laparoscopy avoided negative and non-therapeutic laparotomy in 2 patients (25%). Therapeutic laparoscopy was performed in 3 patients with repair of bowel and mesenteric injuries. There was no documented procedure‑related morbidity and mortality.Conclusions: The positive outcomes from the study suggest that laparoscopy can be safe and feasible in both diagnostic and therapeutic interventions in carefully selected blunt abdominal trauma patients.

Adult-onset bilateral optic neuritis: a rare presentation

A rare case of adult-onset bilateral optic neuritis without associated autoimmune or infectious disorders has been reported in this study. A 19-year-old male described sudden bilateral diminution of vision (sequential) with headache with no other remarkable history. Ophthalmological findings revealed asymmetrically reduced visual acuity on the initial visit. Fundus examination showed nerve fibre layer oedema (more in right eye). Radiological examination was suggestive of bilateral, asymmetrical optic neuritis. Visual evoked potential tests suggested asymmetrical and sequential P100 delay. No auto-immune/infectious aetiology was found. The condition was diagnosed as an atypical presentation of optic neuritis with sequential bilateral involvement. Patient was treated with intravenous methyl prednisolone followed by tapering oral doses owing to the bilaterality of the involvement. A careful follow-up is being performed. The condition involving bilateral inflammation of the optic nerves can have hazardous outcome and hence prompt, careful and comprehensive diagnostic and treatment approach is necessitated.

Aortic regurgitation after chemoport catheter insertion: Diagnostic dilemma

Catheter insertion in central vein can potentially cause accidental arterial injury. However it is very unusual to see such catheter in aorta causing aortic regurgitation. Pressure monitoring and Ultrasound guidance can reliably prevent accidental arterial puncture.

Assessment of prophylactic effect of Senna auriculata (L.) Roxb. leaves on alcohol-induced pancreatitis in rat model.

Aqueous leaf extract of Senna auriculata (L.) Roxb. syn. Cassia auriculata (SLEx) is known to possess potential antidiabetic and antioxidant properties. Based on the known correlation between exocrine pancreatic function and endocrine secretary capacity, here, we studied the prophylactic effect of the SLEx on alcohol induced pancreatitis in rats. To induce chronic pancreatitis, the rats were fed with unsaturated fat i.e. corn oil (2.5 mL/kg) along with high dose of ethanol (10.2 g/kg) for 4 wk, and was increased 0.6 g/kg after every 2 days for 1 wk and then 0.6 g/kg after every 4 days for a period of 4 wk. SLEx was orally administered to rats at dose of 400 mg/kg/day for 4 wk. At the end of 4th wk, pancreatic enzymes i.e., α-amylase, lipase, serum and pancreatic MDA levels were estimated. Pancreatic histopathological studies were also performed. The SLEx significantly reduced the serum levels of α-amylase and lipase along with significant suppression in serum and pancreatic tissue lipid peroxidation. Histomorphological studies did not show any fatty vacoules in acinar cells of SLEx-treated rats. However, vacoulation was seen in acini of pathogenic control rats. With the results, we conclude that Senna auriculata aqueous leaf extract has potential to reduce the ethanol-induced pathogenecity, and it possesses prophylactic effect on alcohol-induced pancreatitis. However, a long term trial is needed to ascertain its therapeutic potential for pancreatitis.

Pre and per operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters.

Background: Cholecystectomy is the procedure of choice for symptomatic gall stones. Laparoscopic Cholecystectomy (LC) may be rendered difficult by various problems encountered during surgery. Several factors have been implicated with a difficult case, but no reliable criteria are available yet to identify patients preoperatively with a difficult LC. Preoperative prediction of a difficult LC can help the patient as well as the surgeon prepare better for the intraoperative risk and the risk of conversion to open cholecystectomy. The present study was undertaken to evaluate role of various factors responsible for conversion from laparoscopic to open cholecystectomy and also to study the intraoperative problems faced by the surgeon responsible for conversion in order to make the procedure safer for the patient as well as the surgeon. Methods: In 50 consecutive patients who underwent LC during 2013 to 2014 patient’s characteristics, clinical history, laboratory data, ultrasonography results and intraoperative details were prospectively analyzed to determine predictors of difficult LC. Results: Of 50 patients 3 (06%) required conversion to open cholecystectomy. Significant predictors of conversion were obscured anatomy of Calot’s due to adhesions, sessile gall bladder, male gender and gall bladder wall thickness >3 mm. Conclusions: With preoperative clinical and ultrasonographic parameters, proper patient selection can be made to help predict difficult LC and a likelihood of conversion to open cholecystectomy.

Study evaluating chronic abdominal pain and functional abdominal pain syndrome.

Background: Chronic abdominal pain (CAP) is a prevalent condition with a wide etiology and is often associated with significant health care utilization. A functional diagnosis, particularly, Functional abdominal pain syndrome (FAPS) is more challenging and has been a less extensively studied condition in adults as compared to other common functional gastrointestinal disorders. Hence, this study attempts to formulate a definite line of investigations, study various causes of chronic abdominal pain and to evaluate FAPS, in a population from Central India. Methods: 100 patients in the age-group of 10-60 years with chronic abdominal pain were selected. A careful history, clinical examination and investigations were performed and final diagnosis was made on the basis of the available data. Results: Eighty-nine out of hundred patients were found to be having some organic disorder causing CAP while eleven had functional gastrointestinal disorders. FAPS was diagnosed in three patients on the basis of Rome III diagnostic criteria while one had unspecified functional abdominal pain. Conclusions: CAP is a multifactorial condition yet, a thorough history coupled with a complete physical examination and investigative profile help to a great extent in diagnosing the cause. FAPS should be diagnosed on the basis of a careful clinical history and characteristic pain behaviour during physical examination. A cost-effective and conservative approach should be adopted for investigations. Unlike the organic causes, FAPS should be treated with a biopsychosocial approach with a variable combination of pharmacological, cognitive-behavioural and psychological interventions.

Study of voluntary alteration of visual evoked potentials: Evaluating role in functional visual loss.

Background: Pattern reversal visual evoked potentials (PRVEP) are one of the recommended tests for detection of functional visual loss. However, voluntary alterations producing abnormal records have been reported in the normal subjects limiting the role of the test. Hence, this study aimed to record voluntarily altered PRVEP responses and to study the role of various modifications in the technique for detection of the condition. Methods: 20 normal subjects in the age-group of 18-25 years were studied. PRVEP records were obtained in the normal perceiving states and then with voluntary alterations in different stimulus conditions and the changes in the mean P100 latency and N75-P100 amplitude were compared and analysed using paired t-test. Results: 15 out of 20 subjects could voluntarily alter their PRVEP records with 26 out of 30 eyes demonstrating statistically significant abnormal records in terms of latency delay or amplitude reduction or both. Modifications in the technique with increased check size, field size and binocular stimulation reduced the number of abnormal records. But, mean P100 latency and N75-P100 amplitude recorded from the above stimulus conditions in voluntarily altered states were still statistically significantly altered from those in the normal perceiving conditions (p<0.05). Conclusion: Normal subjects can voluntarily produce abnormal PRVEP responses. Various modifications in the technique like increase in the check-size, field size and binocular stimulation should be employed if voluntary alteration is suspected, but interpretation should be made carefully in the context of clinical findings of the subject.

Protective effect of alcoholic extract of stem of Entada pursaetha in dextran sulphate sodium-induced colitis in mice.

Oxidative stress has been shown to play a critical role in the pathogenesis of ulcerative colitis (UC). Entada pursaetha has been demonstrated to have antioxidant and anti-inflammatory effects. In this study, we investigated the effects of stem of alcoholic extract of E. pursaetha (PSE) in dextran sodium sulfate (DSS)-induced colitis in mice. The protective effect of PSE was determined at three different doses of 30, 100 and 300 mg/kg body weight by oral gavage for 7 days. Morphological (colon length and colon weight/length ratio), clinical (disease activity index) and macroscopic (damage score) features were determined using standard criteria. Lipid peroxides (determined as malonaldehyde; MDA), enzymatic (superoxide dismutase; SOD and catalase; CAT) and non- enzymatic antioxidants (reduced glutathione; GSH), nitrate and nitrite (NOx) levels and myeloperoxidase (MPO) activity in colon tissues were determined. The DSS damaged the colonic tissue, increased MPO activity, lipid peroxidation and NOx levels, reduced the antioxidant enzymes and glutathione and lowered the body weight. PSE significantly reduced the inflammation of colon and reversed the increase in MPO activity induced by DSS. It also significantly increased the SOD and catalase activities and did not elicit any effect on depleted levels of GSH in the colonic tissue. In addition, PSE also significantly decreased colonic NOx and MDA levels compared to DSS-treated mice; reduced both infiltration of inflammatory cells and the mucosal damage in colon on histopathological examination. The results suggested the protective potential of PSE in DSS-induced colitis and this might be attributed to its anti-inflammatory and antioxidant activities.

Effect of alcoholic extract of Entada pursaetha DC on monosodium iodoacetate-induced osteoarthritis pain in rats.

Background & objectives: Osteoarthritis (OA) is a degenerative disease characterized by joint pain and progressive loss of articular cartilage. Entada pursaetha has been traditionally used in the treatment of inflammatory disease, liver ailment, etc. In this study we investigated suppressive effect of ethanolic extract of E. pursaetha (EPE) on monosodium iodoacetate (MIA)-induced osteoarthritis pain and disease progression by histopathological changes in joints in a rat model. Methods: OA was induced in right knee of rat by intra-articular injection of 3 mg of MIA and characterized by pathological progression of disease and pain of affected joint. Spontaneous movements, mechanical, thermal and cold sensitivity were monitored at days 0 (before drug and MIA injection), 7, 14 and 21 of MIA administration. EPE (30, 100 and 300 mg/kg), vehicle or etoricoxib (10 mg/ kg; reference drug) were administered daily for 21 days by oral route. Results: EPE at various doses significantly reduced mechanical, heat, cold hyperalgesia and increased the horizontal and vertical movements in intra-articular MIA injected rats. EPE prevented the damage to cartilage structure and reduced the cellular abnormalities. Articular cartilage of rats treated with EPE at 300 mg/kg group was almost normal with well-developed smooth surface and chondrocytes were distributed individually or arranged in column. Interpretation & conclusions: the present findings showed that the EPE was not only able to mitigate pain and hyperalgesia but also inhibited MIA-induced cartilage degeneration in vivo. EPE may have the potential to become therapeutic modality in the treatment of osteoarthritis. However, further studies need to be done to confirm these findings in other models and clinical trials.

A family with Charcot-Marie-Tooth disease (type 1): evaluating diagnostic role of nerve conduction studies.

We aimed to report a case history of a family with Charcot-Marie-Tooth disease and to assess the role of nerve conduction studies in the diagnosis. A 10-year-old girl presented with difficulty in walking with a history of delayed motor milestones and slowly progressive weakness in distal muscles of both the lower limbs, with similar group of complaints in her father and a younger brother. Clinical examination of the patients was done and nerve conduction studies were performed. Clinical features and nerve conduction studies suggested the diagnosis as Charcot-Marie-Tooth disease with characteristic electro-diagnostic findings of Charcot-Marie-Tooth disease type-1. Charcot-Marie-Tooth disease is a rare disorder found in India. Although genetic tests form the basis of accurate diagnosis, yet nerve conduction studies, to a great extent, prove to be remarkable in approaching the diagnosis and distinguishing the common subtypes of this rare condition.

Protective effect of alcoholic extract of Entada pursaetha DC. against CCl4-induced hepatotoxicity in rats.

The alcoholic extract of stem of E. pursaetha (PSE, 30, 100, 300 mg/kg body weight, po for 7 days) showed hepatoprotective activity against CCl4 (2 mL/kg body weight, ip)-induced hepatotoxicity. The extract exhibited a significant dose-dependent hepatoprotective effect comparable to standard drug silymarin, by preventing increase in serum levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total protein, and total bilirubin, lactate dehydrogenase; by lowering hepatic levels of malonaldehyde, nitrate-nitrite, myeloperoxidase activity; enhancing activities of antioxidant enzymes, superoxide dismutase, catalase and increasing reduced glutathione levels in liver, which suggests the antioxidant property of PSE. Histopathological studies also supported the above biochemical parameters. The results suggested that alcoholic extract of E. pursaetha possesses significant hepatoprotective activity in CCl4-induced acute hepatotoxicity in rats and this is likely to be mediated through its antioxidant activities.