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The mechanical theory is one of the oldest concepts regarding the development of glaucomatous neural degeneration. However, after a prolonged period of relative monopoly among the various theories explaining the pathogenesis of glaucoma, this concept gradually faded away from discourse. Several developments in the recent past have rekindled interest in the mechanical theory of glaucoma. Now we know a lot more about the biomechanics of the eye, prelaminar changes, mechanisms of retinal ganglion cell death, biomechanical features of the optic nerve head and sclera, extracellular matrix composition and its role, astrocytic changes, axoplasmic flow, and postlaminar factors such as translaminar pressure difference. These factors and others can be categorized into prelaminar, laminar, and postlaminar elements. The objective of this review was to present a concise analysis of these recent developments. The literature search for this narrative review was performed through databases, such as PubMed, Google Scholar, and Clinical Key. [ABSTRACT FROM AUTHOR]

Background: Left Atril Appendage(LAA) is one of the most contractile structure of the heart. Elevated Left atrial pressure (LAP) can change the flow profile in and out of LAA. There is little data on the effect of LAP on LAA flow velocities for patients in sinus rhythm, and it's not properly known that by evaluation of LAA flow spectra and its velocities, the LAP can be predicted. We tried to find the relationship between LAA flow velocities and LAP, with the premise that LAA flow velocities can be used as a surrogate for measuring LAP, by obtaining a regression equation in this prospective observational study.Methods: In forty patients with normal systolic and diastolic heart function undergoing elective off pump coronary artery bypass (OPCAB) under general anaesthesia, TEE based LAA flow velocities were measured and simultaneous direct measurements of LAP was done by the surgeon. We also studied the relation between the ratio of early mitral inflow velocity (E) and mitral lateral annular early diastolic velocity (E'), that is, (E/E') in all patients.Results: We found significant correlation between E/E' and LAP (r = 0.424, p = 0.024) however there was no significant correlation between LAA flow velocities and LAP.Conclusion: LAA flow profile can not be used under anaesthesia to evaluate LAP however E/E' shows a strong correlation with directly measured LAP. [ABSTRACT FROM AUTHOR]

Background: Serum anti-Mullerian hormone (AMH) is a significant determinant of ovarian reserve. It is still not clear about the rate at which AMH declines with t age and varies across populations. Aim: The present study examined the AMH levels specific to the North and South Indian populations and attempted to establish an age-dependent reference parametrically. Settings and Design: This was a prospective study in a tertiary centre. Materials and Methods: Serum samples were collected apparently from 650 infertile women (327 from North and 323 from South Indians). AMH was measured using an electrochemiluminescent technique. Statistical Analysis Used: Comparison of the AMH data between North and South regions was done by independent t-test. For each age, seven empirical percentiles (3th, 10th, 25th, 50th, 75th, 90th and 95th) were applied. AMH nomograms for the 3th, 10th, 25th, 50th, 75th, 85th, 90th and 95th percentiles were produced using the lambda-mu-sigma method. Results: AMH levels remarkably decreased with increasing age in the North Indian population, but in the South Indian population, they did not decline beyond 1.5 ng/mL. Further, in the North Indian population, AMH levels were significantly higher in the age group of 22-30 years (4.4 ng/mL) than in the South Indian population (2.04 ng/mL). Conclusion: The present study suggests a major geographical difference in mean AMH levels according to their age and ethnic background, regardless of their subjacent pathologies. [ABSTRACT FROM AUTHOR]

The same procedure is repeated on the other side, and once the securing device is knotted on these air knots, long threads are wound around the catheter from both sides so as to reach the multi-lumen catheter hub with fixation holes [Figure 2]. To the Editor, Central vein catheters (CVCs) through major neck vein are always needed in major surgeries for various reasons, and securing them properly after placement for a short term is equally important. [Extracted from the article]

The aim of this clinical report is to document a rare and unusual case of calcifying odontogenic cyst (COC) in the maxillary anterior region in a 13-year-old girl. A COC is an extremely uncommon developmental, odontogenic entity and accounts for 0.3%-0.8% of odontogenic cysts. The lesion presents as an array of varied radiographic and clinicopathological characteristics and biological attributes and exists in three histomorphologic patterns - benign cystic, solid (neoplastic) and aggressive (malignant) forms. Thus, several nomenclatures and classifications have been put forth to explain the nature of the clinical entity. However, ambiguities regarding the exact nature of the lesion still prevail. Due to nonspecific clinicoradiographic features, histopathological interpretation remains the key for diagnosis. We report an uncommon occurrence of COC in a 13-year-old female who reported to our Outpatient Department with an asymptomatic right midfacial swelling. The clinical and radiographic findings were suggestive of adenomatoid odontogenic tumor and dentigerous cyst. The decision to enucleate the lesion was considered, and histopathological features were compatible with the diagnosis of COC. Re-ossification with no recurrence was noticed after a 1-year follow-up. COC is an unusual developmental odontogenic cyst that clinically and radiologically simulates other more common jaw entities. Thorough knowledge of the bizarre presentation and biological attributes of such lesions are imperative for an early diagnosis and definitive treatment. Long-term follow-up is advocated to prevent recurrences. [ABSTRACT FROM AUTHOR]

Parapapillary atrophy is a condition which is seen in around 70% of normal individuals. Classically divided into zone alpha and beta, recently, it has been further categorized into zone gamma and delta. Some of these zones of parapapillary atrophy are more prevalent and larger in size in glaucoma patients. Studies have also found the rate of progression of glaucomatous change to be faster in patients with this anomaly. This condition is of clinical significance in glaucoma suspects, as it could be another pointer indicating potential risk of converting to glaucoma. On the contrary, there are other studies which question the relevance of these clinical features in glaucoma patients. In the light of these conflicting reports, it becomes an interesting exercise to explore this controversial area further. This review attempts to determine the role of parapapillary atrophy and its relevance with glaucoma. With this purpose, an online search for this term was conducted on search engines such as PubMed, Google Scholar, and others. [ABSTRACT FROM AUTHOR]

Objectives: The objective was to compare the efficiency and assess postoperative complications of 2.00 mm unicortical locking plates and three-dimensional (3D) plates in surgical correction of uncomplicated mandibular fracture. Materials and Methods: A prospective cohort study of twenty patients of uncomplicated mandibular fractures, who were operated either by noncompression unicortical 2-mm locking mini-plate or by noncompression unicortical 2-mm 3D mini-plate, were enrolled and followed up for the study outcomes such as operative time, postoperative infection, and postoperative occlusion. Results: Majority of the patients (90%) were male who had road traffic accident. In 80% of cases, mandibular fracture site was parasymphysis. The mean operating time for 3D plates (43.20 min) was significantly lower than that for locking plates (54.82 min), P < 0.001. All cases operated by 3D plates compared to 60% by locking mini-plates did not need intermaxillary fixation, P = 0.025. The 80% of cases operated by 3D plates did not require postoperative occlusion correction compared to 30% in another group, P = 0.01. For other parameters such as postoperative sensory disturbance, postoperative infection, incidence tooth damage, vertical displacement of mandible, feeling of plate after platting, and chewing efficiency after 1 week, there were no statistical significant differences between the two groups. Conclusions: The outcome of 2.0mm 3D mini-plate is better in terms of operating time required, post-operative need of intermaxillary fixation and occlusal correction. While the outcome is similar to the use of non-compression unicortical 2.00mm locking miniplate in parameters like infection rate and incidence of tooth damage etc. [ABSTRACT FROM AUTHOR]

Context: Road traffic injuries is estimated to be the ninth leading cause of death across all age groups globally. People in need of trauma care, after a road crash, are most likely to survive if they receive definitive care within the first hour (Golden hour) after the crash. Essential prehospital care includes prompt communication, treatment, and transport of injured people to formal healthcare facilities. Aims: To assess the availability and utilization pattern of existing facilities for post-crash emergency care in Aligarh. Settings and Design: The present study was undertaken on two National highways- NH-91 and NH-93 and the connecting bypass roads of Aligarh district of Uttar Pradesh. Subjects and Methods: All the individuals who met road traffic accident (RTA) between the earmarked areas from 1st October, 2018 to 30th September, 2019 and reported for treatment (either on their own or brought by relatives, passersby, ambulance or police) to the selected hospitals were included in the study. Statistical Analysis Used: Data presented in the form of frequency tables and percentages. Results: Out of 665 patients interviewed during the study period, 556 (83.61%) patients were males and 109 (16.39%) were females with M: F ratio been 5.10:1. Among the first responders, 448 (67.36%) were lay persons and 42 (6.31%) were police personnel. 261 (39.25%) of patients received help within 10–30 min of RTA. Use of toll-free no. was limited to 265 (39.84%) patients. Ambulance was the mode of transport in 155 (23.30%) of RTA cases. 589 (88.58%) of patients reported to Government hospitals. Conclusions: Post-crash emergency care is in nascent stage in Aligarh district of Uttar Pradesh. Toll free numbers and ambulances are available but proper utilization and quality of care is lacking. Lay person is the most important personnel in improving the post-crash care. [ABSTRACT FROM AUTHOR]

Background: Various medications are used in the treatment of chronic systemic diseases that affect the periodontium. Antidepressants in mentally depressed patients are prescribed for a long term, but their effect on the periodontium has not been studied adequately. A case–control study was conducted to know the effect of two commonly prescribed antidepressants – venlafaxine (serotonin–norepinephrine reuptake inhibitor [SNRI]) and fluoxetine (selective serotonin reuptake inhibitor [SSRI]). These drugs have been shown to possess anti-inflammatory properties but do not protect the periodontium from insults caused by these medications, which are significantly associated with the presence of destruction of the periodontium. The aim of this study was to clinically evaluate the effect of antidepressants on various periodontal parameters. Materials and Methods: The study sample consisted of 182 depressed patients divided into three study groups: Group I – the control group diagnosed as depressed on the first visit, Group II – depressed patients taking fluoxetine 20 mg/day, and Group III – patients taking venlafaxine 75 mg/day. Patients in Groups II and III were on isolated antidepressant medication at least for a period of 3 or more months. Mental depression in patients was assessed with the Patient Health Questionnaire-based Hamilton Depression Rating Scale with scoring of ≤16. All the depressed patients were assessed for periodontal health on the basis of the clinical periodontal parameters. Results: The commonly prescribed antidepressants such as fluoxetine and venlafaxine do not protect the periodontium from destruction in spite of possessing anti-inflammatory properties; therefore, these drugs may be considered as a risk factor for periodontal health. The comparative periodontal indices on nonusers of antidepressants or control group (Group I), users of SSRI (fluoxetine) (Group II), and users of antidepressants-SNRI (venlafaxine) (Group III) showed increased periodontal parameters, especially debris index (DI), calculus index (CI), gingival index (GI), periodontal pocket depth (PD), and loss in clinical attachment level. There was no significant difference for CI and GI, probing PD, and clinical attachment levels except DI which was significantly different (P ≤ 0.001). Conclusion: The depressed patients receiving fluoxetine or venlafaxine should be regularly evaluated for periodontal health status as these drugs are risk factors for normal periodontal tissues. Further, these medications did not protect the periodontium from periodontal inflammation, although possessing anti-inflammatory properties. [ABSTRACT FROM AUTHOR]

Serratus Anterior fascial plane (SAP) block is a high-volume interfascial plane block that has been used in adult patients in cardiac surgery with good postoperative pain relief. We report a case of a 9 year old female child who underwent ostium secundum atrial septum defect closure and was given bilateral SAP block. The patient was extubated within 4 hours of surgery and was pain free in the postoperative period without the use of any opioids. [ABSTRACT FROM AUTHOR]

Presently the management of glaucoma is limited to lowering of intra-ocular pressure (IOP). Since this modality does not appear to be successful in all cases there is increasing focus on non-IOP lowering medications. Coenzyme Q is a naturally occurring compound similar to vitamins. There are a few reports suggesting the neuroprotective efficacy of this agent in glaucoma models. The present systematic review was undertaken to study the pharmacology, physiology, metabolism and role of Coenzyme Q in glaucoma. An English-language search for relevant items was undertaken using PubMed, Google Scholar, Scopus and other databases. The present review found a positive outcome of Coenzyme Q as a neuroprotectant being reported in all studies. However, the review also found that the majority of studies on Coenzyme Q have been reported by a single group of researchers. In order to have a more wide-ranging impact regarding the efficacy of Coenzyme Q in glaucoma, it would be useful to undertake further multi- center trials. [ABSTRACT FROM AUTHOR]

Ebola virus disease (EVD), a fatal viral hemorrhagic illness, is due to infection with the Ebola virus of the Filoviridae family. The disease has evolved as a global public health menace due to a large immigrant population. Initially, the patients present with nonspecific influenza-like symptoms and eventually terminate into shock and multiorgan failure. There exists no specific treatment protocol for EVD and only supportive and symptomatic therapy is the line of treatment. This review article provides a detailed overview of the Ebola virus; it's clinical and oral manifestations, diagnostic aids, differential diagnosis, preventive aspects, and management protocol. [ABSTRACT FROM AUTHOR]

Pleomorphic adenoma (PA), also called mixed tumor, is the most common benign tumor of the salivary glands that mostly occurs in the parotid or submandibular glands but may also occur in the minor salivary glands that are distributed throughout the oral cavity. The common sites of PA of the minor salivary glands are the palates followed by lips and cheeks. Surgical removal with adequate margins is the principal treatment. We present a case of PA (arising from the minor salivary gland of the upper lip) – a rare site in a 65-year-old female who presented with a swelling upper lip of 2-year duration. Fine-needle aspiration cytology of the swelling revealed PA which was confirmed by histopathological examination after complete excision of the swelling. [ABSTRACT FROM AUTHOR]

Abstract A number of ocular diseases can be attributed to contaminated water and we have coined a term “Water-related ocular diseases (WRODs)” to denote this wide-spectrum of conditions. WRODs are directly related to human contact with water and can occur through toxic, allergic, inflammatory or infective mechanisms. The non-infective causes can include chemicals used to clean swimming pools, oil spills and water-sport related injuries. Similarly, a number of infective organisms causing ocular diseases are transmitted through water. Since, these conditions can occasionally prove devastating, a review was done with the following aims: (i) To study the epidemiology of WRODs (ii) To assess the clinical presentation and current management of WRODs (iii) To highlight the future challenges and possible solutions to these problems. The online search was conducted utilizing search engines such as PubMed, Google Scholar, ClinicalKey and the Virtual Library of the Ministry of Health, Malaysia for relevant terms such as water-borne, swimming pool and eye infections. [ABSTRACT FROM AUTHOR]

Glaucoma suspects are controversial clinical dilemmas. These individuals harbor certain risk factors or demonstrate some clinical features suggestive of an increased probability to develop glaucomatous optic atrophy in the future. These characteristics range from high intraocular pressure; optic disc, visual field, or retinal nerve fiber layer abnormalities; or abnormal angles to a positive family history of glaucoma and other risk factors. Individuals having these characteristics should be assessed diligently before a diagnosis of glaucoma is made. Glaucoma is a chronic, lifelong condition, having a negative impact on the quality of life, with an increased risk of medication-related side-effects, adverse economic impacts, and the need for lifestyle changes in the patient. Overdiagnosis and unnecessary treatment of such individuals is bereft of any advantage. This review aims to provide a practical blueprint for the proper diagnosis and management of such glaucoma suspects. [ABSTRACT FROM AUTHOR]

Infection due to hepatitis C virus (HCV) is a major cause of fibrosis and hepatocellular carcinoma in Pakistan. In the current review, pattern of HCV genotypes and subtypes in Khyber Pakhtunkhwa province was ascertained in light of the available literature. After thorough analysis, genotype 3 (58.27%) was determined to be the leading HCV genotype, followed by genotypes 2 (12.39%), 1 (9.54%) and 4 (0.86%). The proportions of genotypes 5 and 6 were recorded as 0.09% and 0.22% respectively. Subtype wise, 3a accounted for 48.67%, followed by subtype 2a (10.91%), 3b (9.43%), 1a (5.84%), 1b (3.66%), 2b (1.45%) and genotype 4 with its undefined subtypes contributed a portion of 0.86%. The cumulative share of subtypes 1c, 2c, 3c, 5a and 6a was less than 1%. In 11.51% cases, the subtype was untypeable while in 7.17% cases mixed subtypes were recorded. Gender wise, proportions of most HCV subtypes were marginally higher among males as compared to females. On the basis of studied groups, 3a was pervasive among all groups except in intravenous drug users where 2a was the major HCV subtype. Similarly, based on various geographical locations (provincial divisions), subtype 3a revealed a ubiquitous distribution. Conclusively, HCV 3a persists to be the principal subtype across the province of Khyber Pakhtunkhwa. The considerable number of untypeable subtypes in most studies urges for an improved genotyping system on the basis of local sequence data and practice of sequencing for determination of underlying subtype in untypeable cases. Further, studies on identification of subtypes transmission pattern are imperative for assessment of transmission origin and reinforcement of efficient control strategies. In addition, the current review emphasizes the need of attention toward HCV risk groups and ignored southern side of Khyber Pakhtunkhwa province for better holistic understanding of HCV genotype distribution pattern in the province. [ABSTRACT FROM AUTHOR]

Lens-induced factors are important and common mechanisms causing acute elevation of intraocular pressure. While in most cases, the diagnosis and management are straight-forward, in others it is difficult and can lead to improper procedures, complications and poor visual outcomes. This review was done with the aim of studying the various types of lens-induced glaucomas, classifying them in an easy way to understand manner, their clinical features, current management and future possibilities. [ABSTRACT FROM AUTHOR]

Glaucoma is a multi-factorial neurodegenerative disorder. The common denominator in all types of glaucomas is retinal ganglion cell death through apoptosis. However, this cellular demise in glaucoma is detected late by structural or functional analyses. There can be a 10-year delay prior to the appearance of visual field defects and pre-perimetric glaucoma is an issue still being addressed. However, a new cutting-edge technology called detection of apoptosing retinal cells (DARC) is being developed. This technique is capable of non-invasive, real-time visualization of apoptotic changes at the cellular level. It can detect glaucomatous cell damage at a very early stage, at the moment apoptosis starts, and thus management can be initiated even prior to development of visual field changes. In future, this technique will also be able to provide conclusive evidence of the effectiveness of treatment protocol and the need for any modifications which may be required. This article aims to provide a concise review of DARC technology. [ABSTRACT FROM AUTHOR]

An understanding of the pathogenesis of glaucoma is one of the foundations in glaucoma management. A number of theories have been presented to explain glaucomatous neural degeneration. The vascular theory attempts to explain the causation of glaucoma on the basis of vasogenic factors and altered hemodynamics in the body; however, this theory remains controversial. There are proponents for and against the role played by vascular factors in the development of glaucomatous optic nerve degeneration. This review aims to analyze the various studies performed to provide evidence for and against the vascular theory of glaucoma. It also affirms the need to undertake further studies regarding the pathogenesis of glaucoma and integrate them into our management strategies. The literature search for this systemic analysis was performed using search engines, such as PubMed, The Virtual Library of the Ministry of Health Malaysia, Google Scholar, and ClinicalKey. [ABSTRACT FROM AUTHOR]

A 17-year-old young girl was seen by us with complaints of progressive, painless decreasing vision in one eye for the last 4 years. No other supporting history could be elucidated. On examination, a large choroidal mass was found. Since the features were suggestive of malignant melanoma of the choroid, an enucleation of the eye was performed. Subsequently, histopathological examination of the enucleated eye revealed findings consistent with melanocytoma of the choroid. This case is unique in that the patient was of relatively young age and the tumor was huge compared to previous such reports. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to evaluate hard and soft tissue change after bimaxillary surgery in class III patients by focusing on sella, nasion, A point (SNA) and sella, nasion, B point (SNB) angle and aesthetic outcome. Materials and Methods: The sample consisted of 96 skeletal Class III patients (42 women, 54 men) with a mean age of 25 years with standard deviation (SD) of 8.4. The youngest patient was 16-years-old and the oldest 51-years-old at the time of surgery. In total, seven skeletal parameters, eight soft tissue parameters, and two dental parameters were evaluated on the cephalograms. Result: At the beginning of the treatment 49 Patients had SNA between 80° and 84°, 34 had SNA of less than 80° and 13 had SNA of more than 84°. Post surgically, 25 patients had SNA of 78°–84°, 19 had SNA less than 78° and 52 patients had SNA of more than 84°. Out of 96 patients 22 had SNB of 78°–82° before surgery, 16 had less than 78° and 58 had SNA of more than 84°. Postoperatively, we measured SNB of 78°–80° in 42, less than 78° in 18 and of more than 82° in 36 patients. The inclination of the maxilla relative to the cranial base changed from 7.2° (SD = 4)–8° (SD = 5.1) and the mandible changed from 35.7° (SD = 6.6) to 36° (SD = 6.3) postoperatively which was not significant. The distance from upper lip to E-line increased by 2.6 mm (SD = 3.9) after surgery (P < 0.001), while, the lower lip distance to E-line decreased slightly by 0.9 mm (SD = 3.2) (P < 0.01). Nasolabial angle was decreased by 9.5° (SD = 9.4) after surgery (P < 0.001). The nose prominence also decreased from 18.2 mm (SD = 3.5) –16.5 mm (SD = 3.3). Conclusion: Although in many cases we did not have a SNA angle or SNB angle in normal range but a good aesthetic outcome have been observed. Consequently our study showed that soft tissue change and aesthetic aspects should be considered in surgical planning and achieving SNA angle or SNB angle of norm range should not be the only goal. As we could show the advancement of maxilla will result in a better lip and nose profile and this should be considered in treatment planning. [ABSTRACT FROM AUTHOR]

Background: Bronchiolitis is a self-limiting disease of children caused by viral infections of the small airways with a wide spectrum of illness severity. Search of the literature reveals a need for refinement of criteria for testing for concomitant severe bacterial infections as well as appropriate therapeutic interventions for patients <90-day-old diagnosed with clinical bronchiolitis. We believe that a better understanding of the disease spectrum will help optimize health-care delivery to these patients. Aims: The aim of this study was to determine the clinical profile at presentation, disease course and outcome of bronchiolitis in <3-month-old infants who presented to our Pediatric Emergency Department (PED) during one disease season. Settings: Retrospective chart review during one bronchiolitis season, from November 1, 2011 to April 20, 2012. Subjects: All <90-day-old infants presenting with clinical bronchiolitis presenting to Urban PED of a tertiary care university hospital during one bronchiolitis season. Materials and Methods: A retrospective chart review based on computer records of all emergency department visits of infants less than 90 days with a clinical diagnosis of bronchiolitis, covering the period between November 1, 2011 and April 30, 2012. Results: Out of the total of 1895 infants <90 days of age, 141 had a clinical diagnosis of bronchiolitis and 35 needed admission to hospital. Blood for culture was obtained from 47 infants, urine for culture was obtained from 46 infants and cerebrospinal fluid for culture was obtained from eight infants. One case of bacteremia was documented, but this was found to be a contaminant. No cases of meningitis occurred among these infants. However, one infant had a positive urine culture consistent with infection (Escherichia coli). Conclusion: Based on the results, it can be conclude that the risk of bacteremia or meningitis among infants <90 days of age with fever and bronchiolitis is low. The risk of urinary tract infection in this age group is also low, but it is higher than the risk for meningitis or bacteremia. Our data for admission and treatment guidelines are similar to those published from other countries. [ABSTRACT FROM AUTHOR]

Primary adrenal Non-Hodgkin's lymphoma is rare. The symptoms of the disease and response to treatment are variable depending on the type of lymphoma, tumor size, and presence of adrenal insufficiency. We report two cases of primary adrenal lymphoma who had varied presentations. One presenting with abdominal pain and weight loss was documented to have unilateral disease without any adrenal insuficiency and showed a good response to combination chemotherapy, while the second one had bilateral adrenal involvement with adrenal insufficiency and died after second chemotherapy. Functional adrenal involvement in lymphoma depends on the extent of involvement; patients with bilateral involvement almost always have adrenal insufficiency. [ABSTRACT FROM AUTHOR]

Microfilaria is a major public health problem in tropical and subtropical countries and is an endemic problem in India. Wuchereria bancrofti is the most common filarial infection. In some cases, microfilariae and adult filarial worm have been incidentally detected in fine-needle aspirates of various lesions; detection of microfilaria from subcutaneous site or from abscess site is even rarer. We here report an unusual case of Bancroftian microfilariasis in a 68-year-old female coming from endemic area presenting with right submandibular abscess. Our aim is to highlight the chances of finding microfilaria and adult worm in cytology of an unsuspected case at an unusual site. [ABSTRACT FROM AUTHOR]

Background: Studies have documented the impact of intra-abdominal hypertension (IAH) on virtually every organ. However, it still remains strangely underdiagnosed. The aims of the study were to assess, in patients undergoing emergency laparotomy, whether intra-abdominal pressure (IAP) is an independent predictor of morbidity and mortality, to evaluate the effects of IAH, and to identify hidden cases of abdominal compartment syndrome (ACS). Materials and Methods: The study comprised 197 patients undergoing emergency laparotomy. IAP was measured preoperatively and then postoperatively at 0, 6, and 24 hours. Duration of hospital stay, occurrence of burst abdomen, and mortality were noted as outcomes. Results: At admission, incidence of IAH was 80%. No significant association was found between IAP and occurrence of burst abdomen (P > 0.1). IAP was found to be a significant predictor of mortality in patients undergoing laparotomy (P < 0.001). Elevated IAP was found to affect all the organ systems adversely. The incidence of post-op ACS was 3.05% in the general population and 13.16% in trauma patients. The mortality rate for this subgroup was 100%. Conclusions: IAP is a significant predictor of mortality in patients undergoing laparotomy. IAH has detrimental effects on various organ systems. A more frequent monitoring with prompt decompression may be helpful in decreasing the mortality rate. Further studies are required to establish a screening protocol in patients undergoing laparotomy to detect and manage cases of IAH and ACS. [ABSTRACT FROM AUTHOR]

Background: Small bowel obstruction is the commonest surgical emergency encountered in childhood. We observed that intestinal obstruction caused by ascariasis is one of the leading causes of death in our children and consumes a major portion of our hospital resources. Other causes include intussusception, adhesions, volvulus, hernias, and worm obstruction. The aim of this study was to analyze the presentation, diagnosis, management of mechanical bowel and complication of obstruction in children. Patients and Methods: The study was conducted from Jan 2005 to Dec 2007 in the Department of Pediatric Surgery at Sheri- Kashmir Institute of Medical Sciences, Srinagar, Kashmir. All patients who presented in the emergency department with the diagnosis of intestinal obstruction were recruited. Patients with a dynamic obstruction were excluded from the study. Diagnosis was based on history and radiological findings. Data regarding the type of management, operative findings, operative procedure and post-operative complications were collected. Results: There were 207 patients admitted for intestinal obstruction. Males and females were equally affected. Most of the children (55%) were aged 3-5 years. The causes of obstruction included ascariasis 131 (63.2%), adhesion 23 (11.1%), intussusception 21 (10.1%), obstructed hernia 17 (8.2%), and volvulus 11 (5.3%). One hundred twenty-six patients needed an operative intervention and 81 were treated conservatively. The operative procedures performed included enterotomy in 37 (29.3%), milking of worms in 18 (14.2%), resection anastomosis in 31 (24.6%) and adhesiolysis in 13 (10.3%). Appendicular perforation was seen in 4 (1.9%) and worm in gall bladder in 1 (0.5%) patients. Surgical complications were wound infection in 18 (14.2%), burst abdomen in 5 (3.9%) and fecal fistula in 3 (2.3%) patients. Conclusion: Intestinal obstruction is associated with considerable morbidity and mortality in children. Obstruction by ascariasis constituted the majority of intestinal obstruction in this study. Efforts should be made to eradicate ascariasis in endemic areas through proper sanitation, hygiene and use of antihelminthics. [ABSTRACT FROM AUTHOR]

Necrotizing scleritis is an uncommon but potential disastrous infection to the eye. It is commonly caused by vaso-occlusive autoimmune diseases such as rheumatoid arthritis or surgically-induced, and rarely due to infections. In this article, we presented a rare case of necrotizing scleritis caused by herpes infection in an immunocompromised patient. A 49 years old, retroviral positive gentleman presented to our clinic with a painful, red right eye associated with watering, photophobia and blurring of vision. His right eye rapidly deteriorated leading to an impending perforation of the sclera despite intensive antimicrobial therapy. The patient was started on acyclovir ointment and subsequently improved remarkably salvaging the eye from the need of an evisceration. Although the visual prognosis was poor, structural integrity of the eye was achieved. [ABSTRACT FROM AUTHOR]

Periorbital necrotizing fasciitis is a rare but potentially fatal infection. It is most commonly caused by Gram-positive group A β-haemolytic Streptococci and rarely by fungal infections. In this report, we present a rare case of periorbital necrotizing fasciitis caused by Aspergillus species in an immunocompromised patient. He presented to us with a history of a slowly progressive eyelid necrosis leading to a loss of vision in one eye. The patient was started on an antibiotic and subsequently, surgical debridement and enucleation were performed. A few days post-operatively, yellow white mould colonies were noted to grow on the wound surface. Microbiology cultures identified them as Aspergillus species and intravenous amphotericin B 10 mg was added daily. However, despite the extensive medical and surgical treatments, he failed to respond and succumbed from septicaemia and multi-organ failure. [ABSTRACT FROM AUTHOR]

A 34-year-old patient with a swelling over the upper eyelid for nearly 1 year was seen in our clinic. The history, examination and investigations were suggestive of a benign lacrimal gland tumor. The tumor and lacrimal gland were resected. Subsequent histopathological examination revealed the tumor was a primary ductal adenocarcinoma of the lacrimal gland. This is a very rare tumor with less than half a dozen cases reported so far. This case report is being presented to highlight an unusual presentation of this rare malignancy. [ABSTRACT FROM AUTHOR]

An 11-year-old boy was involved in an injury with a fish-hook to his eye. The hook had impaled itself to the cornea and deeper structures. There was associated corneal edema and hyphema, making visualization difficult. In this case, we performed the unusual "cut-it-out" technique to remove the hook from the eye. [ABSTRACT FROM AUTHOR]

Kearns-Sayre syndrome (KSS) belongs to the group of neuromuscular disorders known as mitochondrial encephalomyopathies. It has characteristic syndromal features, which include: chronic progressive external ophthalmoplegia, bilateral atypical pigmentary retinopathy, and cardiac conduction abnormalities. So far, only a single case has been reported where a patient with KSS had a normal retina. Herein, we report this extremely rare variant of KSS, which not only presented later than the normal age of presentation, but also had minimal pigmentary retinopathy. [ABSTRACT FROM AUTHOR]