Management of acute corneal hydrops with compression sutures and air tamponade

Background: Acute corneal hydrops is a vision threatening complication of corneal ectasia like keratoconus, keratoconus, keratoglobus, Pellucid marginal degeneration, Terrien’s marginal degeneration and post refractive surgery keratectasia. The associated risk factors for development of corneal hydrops (CH) are early onset of keratoconus, microtrauma associated with contact lens use, eye rubbing, allergic conjunctivitis, atopy, and Down’s syndrome. With the conservative approach of management of CH, it takes longer time (in months) for corneal oedema to get resolved and there is development of vascularization and scarring. This video presents the simple technique of using compression sutures along with pneumodescemetopexy by intracameral air injection for management of CH. It led to rapid resolution of corneal oedema. It is a simple technique, with no need of special gases like C3F8 or SF6 and can be easily performed at a very basic set up. Purpose: To highlight the efficacy of simple technique of applying compression sutures and air tamponade in management of CH and to demonstrate the efficacy of anterior segment OCT in diagnosis and to assess the prognosis of a case of CH. Synopsis: A 9-year-old boy presented with CH, with anterior segment OCT showing torn descemet’s membrane and fluid pockets in corneal stroma. Four full-thickness compression sutures were applied and intracameral sterile air was used for pneumodescetopexy. The serial post operative clinical and OCT picture showed rapid resolution of corneal oedema. Highlights: This video highlights the use of OCT imaging in the diagnosis of CH and full-thickness compression sutures as the safe and effective technique in the management of acute CH.

Allergic Conjunctivitis: A Practice Pattern Survey From North India

PURPOSE: The purpose of this survey was to establish the prevalence of AC and to know the practice pattern of managing ocular allergy in north India. METHODS: A descriptive cross sectional study done in the states of north India, involving registered practicing ophthalmologists (RP). The survey was conducted in the month of May 2019. 14 fourteen survey questionnaire prepared on significant clinical situations related to ocular allergy was sent via goggle form to 300 Ophthalmologists of north India. The response was recorded and analyzed. RESULTS: The survey was participated by 232 RP (77.33%) out of 300 whom the questionnaire was sent. The results analysis involved epidemiological, treatment and complication pattern. CONCLUSION:AC patients form a significant proportion of our clinical patients specially in summer season. The chronic nature of this disease specially VKC needs a judicious use of different pharmacological agents considering their adverse effects. Newer molecules like Alcaftadine, Bepotastine and various Immunomodulators need further study by randomized clinical trials for their relative efficacy as survey are not sufficient to give us a clear indication towards rationalized use.

A Comparable Study on Efficacy of Granisetron and Promethazine in Controlling Hyperemesis Gravidarum

Purpose: Hyperemesis gravidarum is one of the leading causes of hospitalization during pregnancy. This randomized study wasaimed to compare and evaluate the efficacy of granisetron and promethazine in controlling nausea and vomiting in pregnancy.Materials and Methods: This study was done in the Department of Obstetrics and Gynaecology, Nalanda Medical College andHospital, Patna, Bihar, over a period of 6 months from February 2019 to July 2019. The included patients were administeredgranisetron and promethazine randomly and evaluated for nausea and vomiting by senior gynecologist blinded to designated drugs.Results: This study showed that granisetron was more effective than promethazine in controlling nausea and vomiting inpregnant patients. Greater patient satisfaction and less adverse drug reaction were observed in women receiving granisetron.Conclusion: Hyperemesis gravidarum is a health-related problem with social, economic, and psychological dimensions.All efforts, especially simple outpatient strategies, can reduce the severity of this condition and will help pregnant women tocontinue her pregnancy with satisfaction.

Comparative Study on Serum Calcium Level in Preeclampsia Patients and Normal Pregnancy at Medical College & Hospital

Preeclampsia is a multi-system disorder with varied etiology. Serum calcium derangements have been reported in this group. Methods: The present comparative study included 50 cases with preeclampsia and 50 controls. History was taken from each patient and thorough clinical examination was done. Serum calcium levels were estimated and compared. Result: Serum calcium levels were lower in women with preeclampsia and the difference was statistically significant (p=0.000). Conclusion: Hypocalcaemia may have a role in pre-eclampsia.

Hypertensive disorders of pregnancy: a clinical study in a rural tertiary care centre of western Uttar Pradesh, India

Background: The aim of study was to find out the frequency and clinical outcome in hypertensive disorder of pregnancy (HDP) in a rural tertiary care centre. Hypertensive disorder of pregnancy is a commonest medical disorder which constitutes about 12-22% of all pregnancies and it is a major cause of maternal morbidity as well as mortality world wide.Methods: It is a retrospective hospital-based study to find out the clinical outcome in different hypertensive disorder of pregnancy in a rural tertiary care centre of western Uttar Pradesh.Results: Present study showed the prevalence of HDP was 4.01% among the study population. Most of the patients were primipara ,unbooked and less than 25 years of age. The most common HDP was mild preeclampsia  and HELLP was its commonest  complication.Conclusions: Hypertensive disorder of pregnancy (HDP) is still a major cause of maternal mortality and morbidity. Authors intend to aware the pregnant women regarding high risk factors of pregnancy and motivate them for regular antenatal care so that  complications of  hypertensive disorders can be  managed timely.

Prevalence and biochemical profile of subclinical hypothyroidism among female patients attending OPD of a teaching hospital in Bihar: A hospital based observational study

Background: Hypothyroidism is one of the leading endocrine problems worldwide. Prevalence of high rates of subclinical hypothyroidism has been found in hilly areas. It leads increased risk of cardiovascular diseases, dyslipidemia and proneness to fractures. Materials and methods: The present cross-sectional study was conducted upon female patients above the age of 18 years attending OPD and thorough clinical and biochemical evaluation of thyroid disease was done. Results: 67.1% of the females were euthyroid. 27.2% suffered from hypothyroidism of which 9.1% was overt and 18.1% was subclinical in nature. Prevalence of subclinical hypothyroidism was higher when the age advanced. Conclusion: The prevalence of subclinical hypothyroidism is high in this area.

Evaluation of Changing Axial Length in Eyes after Paediatric Cataract Surgery

Background: Evaluation of changing axial length in eyes after paediatric cataract surgery. Aim – To assess the change in axial length of eye after paediatric cataract surgery which will help us to determine the amount of under-correction required in IOL power with increase in age. Methods: 32 patients were divided in three age groups; 0-2 years, 2-5 years and 5-10 years. Post cataract surgery, in all the patients axial length measurement, intraocular pressure recording and cycloplegic refraction was done at 6month, 1 year and after 2year of surgery. An unpaired T-test was performed to check the significance of study. Results: The change in axial length in first group(0-2 years) was higher at the end of 2 years (1.82mm) than second (1.74mm) and the third group (0.85mm). The mean axial growth of aphakic eye was higher (1.65mm) than the pseudophakic eyes of the same age group. Maximum growth rate (40-56% of the total growth) was observed in the first 6months of surgery in all the three groups. Myopic eyes in group 2 had higher mean axial growth (2.28) than the non-myopic eyes (1.28) of the same study group. Myopic eyes in the other group also had higher growth rate. Conclusion: Paediatric eye is a growing system with an eminent myopic shift which necessitates the required adjustment in IOL power to achieve emmetropia at adult age. As the rate of growth in axial length is maximum between 0-2 years of age, the required reduction in IOL power is more in this group to achieve the final status of emmetropia.

Letter from Ganiyari.

The forest is called Achanakmar. For non-Hindi-speaking friends, this would roughly translate into ‘being struck, suddenly’. Can you think of a name more theatrical, formidable? I am not sure how many in or around the forest have been ‘struck’ by animals from this wildlife sanctuary. Close by, in the gentler surrounds of Ganiyari, Chhattisgarh; the tribal Baigas, Gonds, Abhuj Maria and many others are being struck with far more regularity and finality by something else. We would like to believe that what is striking them is disease; in some ways it is. Yet, what is truly striking them, I believe, is poverty. And apathy. This is a remote, rural, neglected region of India, which is difficult to reach and impossible to remember once one arrives in New Delhi and gets consumed by the more important and urgent calls of life. The local population is chronically malnourished. Life is hard and regular employment difficult to come by. Many families carry the toll of alcoholism. The favoured spirits are derived locally from the Mahua tree. Men and women are equally afflicted. Families often tend to be large with five or more children not being unusual. If under such circumstances, disease strikes, the blow can be fatal. Diseases are rampant. Tuberculosis and diabetes may be the star attractions but anaemia, infections, infestations, deficiency syndromes, sickle cell disease, bites, stings and every other disease one can think of, jostle for attention. If one looks around for the available public healthcare for the indigenous population, one is not surprised. There is almost nothing. These people do not matter and we are too busy and important to be bothered about them. So people continue to fall sick, suffer and die. God forbid, they show a little spunk and try getting treatment in one of the private clinics or hospitals at the nearby Bilaspur or the slightly further Raipur. There is a high likelihood of them then falling into an endless spiral of debt from which they might never recover. Enter Jan Swasthya Sahyog or JSS (Fig. 1). Each word in this name is meaningful. A few bold, committed and extremely unusual doctors initiated the project more than a decade ago. Spend a few days at JSS and what impresses you is how rooted the idea is in the local community and how organically the community connects with it. Each one is an equal stakeholder. Taking one person’s name here would mean disrespecting the hundreds of others. The founder doctors had the audacity to not only conceive such a project but have also dedicated their lives bringing their vision to fruition. The community in its response surpasses my

Murine models of Aspergillosis: Role of collectins in host defense.

Aspergillus fumigatus, a ubiquitous fungus, causes a wide spectrum of clinical conditions ranging from allergic to invasive aspergillosis depending upon the hosts’ immune status. Several animal models have been generated to mimic the human clinical conditions in allergic and invasive aspergillosis. The onset, duration and severity of the disease developed in models varied depending on the animal strain/fungal isolate, quantity and mode of administration of fungal antigens/spores, duration of the treatment, and type of immunosuppressive agent used. These models provide insight into host and pathogen factors and prove to be useful for evaluation of diagnostic markers and effective therapies. A series of studies established the protective role of collectins in murine models of Allergic Bronchopulmonary Aspergillosis and Invasive Pulmonary Aspergillosis. Collectins, namely surfactant protein A (SP-A), surfactant protein D (SP-D) and mannan binding lectin (MBL), are pattern recognition molecules regulating both innate and adaptive immune response against pathogens. In the present review, we discussed various murine models of allergic and invasive aspergillosis and the role of collectins in host defense against aspergillosis.

Evaluation of diagnostic efficacy of hepatobiliary scintigraphy as a diagnostic procedure in pediatric practice with special reference to cholestatic jaundice.

Background: The objective was to assess the diagnostic efficacy of hepatobiliary scintigraphy (Tc99 mebrofenin) in case of cholestatic jaundice in pediatric practice. Method: Study conducted on 45 cases from 0-6 yrs. of age. Out of 45 pt 20 pt excluded from study Hepatobiliary Scintigraphy (Tc99m Mebrofinin) was performed in 25 cases. Injection of Tc99m mebrofinin (1-2 mCi) IV was given to each subject. Dynamic hepatic scan was done upto initial 1 hour study and additional delayed images were taken at 4 & 24 hrs only in case of non-visualization of tracer in the intestine after initial 1 hr. study. Results: In this study hepatobiliary scintigraphy was 100% sensitive, 93.73% specific, 80% positive predictive values, 100% negative predictive value, 6.23% false positive result and virtually no false negative result for biliary atresia. Conclusion: It is concluded that Tc99m mebrofenin hepatobiliary scintigraphy has proven to be reliable noninvasive imaging modality in evaluating cholestatic jaundice in pediatric practice as it carries a high sensitive & specific value, good positive & no negative predictive value, few false positive & virtually no false negative results.

Prevalence of symptomatic and asymptomatic coronary artery disease in patients with stroke.

Background. Studies have shown that myocardial infarction is a leading cause of death in patients recovering from stroke or transient ischaemic attacks. We aimed to study the prevalence of symptomatic and asymptomatic coronary artery disease (CAD) in patients with stroke. Methods. Eighty-six patients with stroke were evaluated for risk factors and presence of CAD. Patients without a previous diagnosis of CAD underwent stress–rest gated technetium-99m (Tc99m) tetrofosmin myocardial perfusion SPECT (MPS) scan to estimate the presence or absence of a reversible perfusion deficit. Results. Thirty-three patients (clinically asymptomatic for CAD) did not consent for the MPS scan. Among the remaining 53 patients, 13 patients had been previously diagnosed to have CAD, 8 patients were suspected to have underlying CAD and 32 patients were asymptomatic. Among the patients with suspected CAD, 2 had abnormal MPS scans and one had triple-vessel disease on coronary angiography. Of the asymptomatic patients, 6 had CAD. The overall proportion of CAD among patients with stroke was 41.5% (22/53) and that of asymptomatic CAD 18.8% (6/32). Conclusion. A considerable number of patients with stroke may have associated CAD. An optimal management strategy in stroke patients who have silent CAD may improve clinical outcomes.

Spectrophotometric analysis of bovine serum albumin in presence of some bischalcones.

We have synthesized a series of bischalcones by the Claisen-Schmidt condensation and their effect was observed on bovine serum albumin. We have found that the synthesized bischalcones interacted with bovine serum albumin irrespective of the nature and position of the substituent with a little difference.

In-vitro studies of some chalcones on acid phosphatase.

Chemicals/compounds interact with biologically significant molecules such as enzymes, proteins, receptors, nucleic acids etc. due to the presence of various reactive groups. These interactions may result in physiological changes and are also responsible for a compound to be pharmacologically/ therapeutically active. Chalcones are known to possess significant therapeutic activities such as antiinflammatory, analgesic, antimicrobial, antioxidant, anticancer, antimalarial, antiviral, antitubercular, etc. In the present work we have evaluated the effect of chalcones on the activity of acid phosphatase of two different sources.

Stimuli-sensitive hydrogels: A novel ophthalmic drug delivery system.

Background: Stimuli-sensitive hydrogels are three-dimensional, hydrophilic, polymeric networks capable of imbibing large amounts of water or biological fluids on stimulation, such as pH, temperature and ionic change. Aim: To develop hydrogels that are sensitive to stimuli, i.e. pH, in the cul-de-sac of the eye for providing a prolonged effect and increased bioavailability with reduction in frequency of administration. Materials and Methods: Hydrogels were formulated by using timolol maleate as the model drug, polyacrylic acid as the gelling agents, hydroxyl ethyl cellulose as the viscolizer and sodium chloride as the isotonic agent. Stirring of ingredients in pH 4 phosphate buffer at high speed was carried out. The dynamic dialysis technique was used for drug release studies. In vivo study for reduction in intraocular pressure was carried out by using albino rabbits. Statistical Analysis: Drug release studies data were used for statistical analysis in first-order plots, Higuchi plots and Peppas exponential plots. Student t-test was performed for in vivo study. Results: Viscosity of the hydrogel increases from 3.84 cps to 9.54 cps due to change in pH 4 to pH 7.4. The slope value of the Peppas equation was found to be 0.3081, 0.3743 and 0.2964. Up to 80% of drug was released in an 8 h drug release study. Sterile hydrogels with no ocular irritation were obtained. Conclusions: Hydrogels show increase in viscosity due to change in pH. Hydrogels were therapeutically effacious, stable, non-irritant and showed Fickian diffusion. In vivo results clearly show a prolonged reduction in intraocular pressure, which was helpful for reduction in the frequency of administration.

Spectrum of malignancies in Allahabad, North India: a hospital-based study.

OBJECTIVE: To study the spectrum of malignancies in the Allahabad region of North India. This was a hospital-based analysis of malignancies from January 1991 to October 2006. MATERIALS AND METHODS: The basic information in the cancer registry included data on personal identification, demographic characteristics, diagnosis, primary site and morphology of tumours. The basis of diagnosis was histological examination of the biopsy material. RESULTS: Total of 58,031 biopsies were examined, out of which 3,133 (5.4%) were diagnosed as malignancies. Of these, 1,893 (60.4%) patients were males and 1,240 (39.6%) were females, yielding a male: female sex ratio of 1.5:1. The majority of cases (2,772, 88.5%) were above the age of 30, with predominance at 41-50 years of age group (804, 25.6%). Most commonly reported tumours were those of oral cavity (370; 11.8%), oesophagus (267; 8.5%), stomach (239, 7.6%), oropharynx (207, 6.6%), cervix (192, 6.1%), breast (190, 6.0%), larynx (101, 3.2%), skin (81, 3.2%), prostate (77, 2.4%) and the urinary bladder (66, 2.1%). CONCLUSIONS: It is concluded from this retrospective study of tumours reported at this hospital over 16 years, that oral and oropharyngeal malignancies were the commonest malignancies in men, while in females, carcinoma of cervix and breast were the most frequent.

Prevalence of oral pre-malignant and malignant lesions at a tertiary level hospital in Allahabad, India.

OBJECTIVE: In a previous article, we reported the prevalence rates of oral mucosal lesions in this hospital from 1990-2001. This study was planned to study the spectrum of potentially malignant and malignant oral lesions in Allahabad, North India in the subsequent years till 2007 and to assess change in pattern of prevalence, if any. MATERIALS AND METHODS: This is a single institutional retrospective study in and around Allahabad from 1990 to 2007. Data was collected year wise with reference to age, sex, site involved and histopathological findings. RESULTS: 1,151 oral biopsies were reviewed. Of these, 365 biopsies were benign, 344 were potentially malignant and 442 were malignant. The buccal mucosa was the most frequently involved site in benign and premalignant lesions, however in malignant lesions, the tongue was most common site. Oral submucous fibrosis constituted the highest number of patients in premalignant group, while in malignant group, squamous cell carcinoma was most prevalent. CONCLUSION: This study showed that potentially malignant and malignant oral lesions were widespread in the patients visiting the hospital in this region.

HIV seroprevalence in patients with tuberculosis in Allahabad, North India.

250 patients with evidence of pulmonary tuberculosis and 50 nontubercular patients as a control group were subjected to Tuberculin test, Chest X-Ray, sputum microscopy, screening for HIV by ELISA and confirmation by Western blot if ELISA test was found positive. In the study group, 11 tested positive for HIV-1 and 239 tested seronegative, however, in the control group all patients were HIV seronegative. HIV infection was most prevalent in young males in the 21-40 year age group, with a history of tuberculosis, either residing, or working in an urban area away from their family. All our cases were of the HIV-1 serotype.

Female infertility: role of vaginal hormonal cytology, endometrial biopsy and endocrinological evaluation.

Female infertility can be categorised into those who fail to ovulate (anovulatory infertility) because of some defect at hypothalamic-pituitary-ovarian axis and those who are ovulatory (ovulatory infertility), but are infertile because of some lesion present in genital tract. The role of vaginal hormonal cytology, endometrial biopsy and endocrinological evaluation in the detection of ovulation and various ovulatory dysfunction was studied in 42 infertile female patients. On the basis of cytological findings, of the 42 patients, 14 were found to be ovulatory, 26 anovulatory (which include 5 cases of atrophic changes) and 2 inconsistent due to inflammatory changes. Endometrial biopsy showed evidence of ovulation in 15, anovulation in 27 cases. Hormonal evaluation indicated some sort of endocrinological disorders in 15 patients, which may underlie anovulatory infertility in these patients, while results were within normal range in the rest 27 patients. Results of vaginal cytology and endometrial biopsy showed correlation in respect to ovulation in 93.33% of the cases.

Extramedullary blast crisis in chronic myeloid leukemia--a case report.

Presence of focal poliferation of myeloblasts at an extramedullary site even when peripheral blood/bone marrow blast count is less than 20% in a case of chronic myeloid leukaemia leads to a diagnosis of blast crisis. A case of focal extramedullary blast crisis with chronic myeloid leukaemia is reported here.