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.

Sonography in male infertility: a look beyond the obvious.

Infertility affects 15-20% of the reproductive age range population; the male factor accounts for up to 40-60% of these. With female factor infertility catching most of the limelight in research, diagnosis and treatment, the other half of the problem has not been duly addressed. Imaging has an important role to play in the evaluation of male infertility, especially to identify correctible (obstructive) causes. We review the scrotal, trans-rectal sonographic and Doppler findings in infertile men to aid in the accurate diagnosis and proper management of such patients.

Correlation of Pirani score and Foot bimalleolar angle in the treatment of idiopathic congenital talipes equino varus by Ponseti method in infants.

AIM: Correlation of Pirani score and Foot bimalleolar (FBM) angle in the treatment of idiopathic congenital talipes equino varus (CTEV) by Ponseti method in infants. MATERIAL AND METHODS: 35 feet with idiopathic CTEV deformity <1 year were prospectively treated by Ponseti method. Deformity evaluated each successive week of treatment by Pirani score and FBM angle. Feet were divided according to Pirani score in groups : one(0-2.0), two(2.5-4) and three(4.5-6). Correlation between mean Pirani score and mean FBM angle was evaluated every week and at follow up, firstly by using Pearson's and Spearman's correlation and then, after dividing data in groups by using ANOVA. RESULTS: Correlation between Pirani score and FBM angle was statistically significant(p value <0.05). CONCLUSION: Pirani score decreases and FBM angle increases with correction. Pirani score and FBM angle correlated in severity of deformity and correction achieved, thus FBM angle provides objective evidence of clubfoot deformity/improvement/deterioration.

Impact of cataract surgery in reducing visual impairment: a review.

PURPOSE: The aim was to assess the impact of cataract surgeries in reducing visual disabilities and factors influencing it at three institutes of India. MATERIALS AND METHODS: A retrospective chart review was performed in 2013. Data of 4 years were collected on gender, age, residence, presenting a vision in each eye, eye that underwent surgery, type of surgery and the amount the patient paid out of pocket for surgery. Visual impairment was categorized as; absolute blindness (no perception of light); blind (<3/60); severe visual impairment (SVI) (<6/60-3/60); moderate visual impairment (6/18-6/60) and; normal vision (≥6/12). Statistically analysis was performed to evaluate the association between visual disabilities and demographics or other possible barriers. The trend of visual impairment over time was also evaluated. We compared the data of 2011 to data available about cataract cases from institutions between 2002 and 2009. RESULTS: There were 108,238 cataract cases (50.6% were female) that underwent cataract surgery at the three institutions. In 2011, 71,615 (66.2%) cases underwent surgery. There were 45,336 (41.9%) with presenting vision < 3/60 and 75,393 (69.7%) had SVI in the fellow eye. Blindness at presentation for cataract surgery was associated to, male patients, Institution 3 (Dristi Netralaya, Dahod) surgeries after 2009, cataract surgeries without Intra ocular lens implant implantation, and patients paying <25 US $ for surgery. Predictors of SVI at time of cataract surgery were, male, Institution 3 (OM), phaco surgeries, those opting to pay 250 US $ for cataract surgeries. CONCLUSION: Patients with cataract seek eye care in late stages of visual disability. The goal of improving vision related quality of life for cataract patients during the early stages of visual impairment that is common in industrialized countries seems to be non-attainable in the rural India.

Interaction of eta mesons with nuclei.

Back in the mid-1980s, a new branch of investigation related to the interaction of eta mesons with nuclei came into existence. It started with the theoretical prediction of possible exotic states of eta mesons and nuclei bound by the strong interaction and later developed into an extensive experimental program to search for such unstable states as well as understand the underlying interaction via eta-meson producing reactions. The vast literature of experimental as well as theoretical works that studied various aspects of eta-producing reactions such as the π(+)n → ηp, pd → (3)Heη, p (6)Li → (7)Be η and γ (3)He → η X, to name a few, had but one objective in mind: to understand the eta-nucleon (ηN) and hence the η-nucleus interaction which could explain the production data and confirm the existence of some η-mesic nuclei. In spite of these efforts, there remain uncertainties in the knowledge of the ηN and hence the η-nucleus interaction. Therefore, this review is an attempt to bind together the findings in these works and draw some global and specific conclusions which can be useful for future explorations.The ηN scattering length (which represents the strength of the η-nucleon interaction) using different theoretical models and analyzing the data on η production in pion, photon and proton induced reactions was found to be spread out in a wide range, namely, 0.18 ≤ Re aηN ≤ 1.03 fm and 0.16 ≤ Rm aηN ≤ 0.49 fm. Theoretical searches of heavy η-mesic nuclei based on η-nucleus optical potentials and lighter ones based on Faddeev type few-body approaches predict the existence of several quasibound and resonant states. Although some hints of η-mesic states such as (3)(η)He and (25)(η)Mg do exist from previous experiments, the promise of clearer signals for the existence of η-mesic nuclei lies in the experiments to be performed at the J-PARC, MAMI and COSY facilities in the near future. This review is aimed at giving an overall status of these efforts.

Patient satisfaction regarding eye care services at tertiary hospital of central India.

PURPOSE: To evaluate patients' satisfaction regarding eye care services and suggest policy changes accordingly. STUDY DESIGN: Descriptive study. MATERIALS AND METHODS: This study was conducted between September 2005 and June 2006. Patients attending the eye clinic of Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India, and admitted as in-patients in this hospital were our study population. Randomly selected patients were interviewed by trained staff. Close-ended questionnaire was used to conduct these structured interviews. Their responses were grouped into one of five categories and evaluated to determine satisfaction for different components of eye care services. RESULTS: Three hundred and twenty persons were interviewed. The satisfaction was of excellent grade among 77 (48.1%) patients attending clinic and 156 (97.5%) patients who were admitted in the hospital. The participants expressed dissatisfaction for the long waiting period in clinics, poor cleanliness, and insufficient toilet facilities. Those admitted in the hospital felt that food facilities were less than the expected quality. Child-friendly facilities received high satisfaction scores. CONCLUSION: Although eye care services both in clinics and in the wards were satisfactory according to the end-users, there are scopes for improvement. Patient satisfaction surveys should be encouraged in hospitals for better accountability and also for strengthening the quality of eye care services.

Acute intestinal obstruction: an unusual complication of mucocele of appendix.

A rare case of intestinal obstruction due to compression of ileocecal junction by mucocele of appendix is presented. Imaging with ultrasound or computed tomography (CT) is useful in establishing preoperative diagnosis. Avoidance of rupture of during appendicectomy is critical in preventing potential complication of pseudomyxoma peritonei.

A comparison of the effects of diltiazem and glyceryl trinitrate ointment in the treatment of chronic anal fissure: a randomized clinical trial.

PURPOSE: Anal fissure is a common problem affecting all age groups with an equal incidence in both sexes. Traditional surgical treatments, like manual anal dilatation or a sphincterotomy, effectively heal most fissures within a few weeks but such procedures may result in anal incontinence. In recent years, various medical therapies have been used for the treatment of chronic anal fissure without fear of incontinence. METHODS: Ninety patients with a symptomatic anal fissure were randomly divided into three groups. Group I was treated with 2% diltiazem ointment, Group II was treated with 0.2% glyceryl trinitrate (GTN) ointment, and Group III was kept as the control group. The improvement in the signs and symptoms, the time taken for healing, and side effects were recorded in each group. The patients were followed up monthly and then every 3 months for any recurrence of fissure. Comparative evaluations of the three groups regarding an improvement in symptoms, progress in healing, appearance of side effects, and recurrence were made using the Tukey HSD test. RESULTS: Diltiazem ointment was found to be superior regarding pain relief, fewer side effects, and late recurrence as compared with GTN ointment. CONCLUSION: Diltiazem ointment (2%) and GTN ointment (0.2%) are both effective treatment modalities for chronic anal fissure, with diltiazem giving better patient outcome.

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

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.

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.