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Purpose To study the outcomes and complications of Nd: YAG laser capsulotomy in patients with uveitis. Methods This study retrospectively evaluated outcomes of Nd: YAG laser capsulotomy in 260 eyes of 260 patients with uveitis. The main indications for performing capsulotomy were a visually significant posterior capsule opacification (PCO) and inability to visualize the posterior segment. The presence of 5 or

Background: Fat embolism syndrome (FES) is a rare and underdiagnosed complication associated with sickle cell disease. Case report: We report the case of a 12-year-old girl with sickle cell disease who initially presented with features of acute vaso-occlusive crisis. However, she later developed neurological and respiratory complications along with a decrease in hemoglobin and platelet counts. She was evaluated and diagnosed with FES. The patient was successfully managed with red cell exchange and therapeutic plasma exchange, leading to complete recovery. Conclusion: Prompt diagnosis and early management can significantly improve the outcome of this rare, though highly morbid complication.

Daratumumab is a monoclonal antibody; anti-CD38 is used for the treatment of multiple myeloma and other hematological disorders. Daratumumab, binds to CD 38 on red blood cells (RBCs), interfering with pretransfusion testing. This interference can lead to cross match incompatibility and panreactive indirect Antiglobulin tests (IAT).Panreactive IAT can mask presence of underlying clinically significant alloantibodies, especially in patient with history of multiple blood transfusions. This can lead to delays in transfusion, increased risk of transfusion reaction and potential risk for transfusion recipients. Daratumumab induced potential serological interference needs to be resolved by using appropriate methodologies like dithiotheritol (DDT) and enzymatic treatment of reagents or donors cells to overcome these incompatibilities. Effective communication between clinical practitioners and blood centre before starting daratumumab therapy can prevent unnecessary workload and delay in transfusion. Here, we describe the case of interference in prretransfuison testing caused by Daratumumab in the red cell compatibility testing of a patient with severe aplastic anemia and strongly positive DSA levels.

Purpose: The aim of this study was to compare the diagnostic performance of COVID-19 Reporting and Data System (CO-RADS) and computed tomography (CT) severity score (CT-SS) in patients with clinically suspected coronavirus disease. Methods: A cross-sectional study was done. Patients presenting to the emergency department with symptoms suspicious for COVID-19 were participated. Patients referred with a positive reverse transcription polymerase chain reaction (RT-PCR) had chest CT evaluation done by CO-RADS and CT-SS, respectively, by an independent investigator. A binomial logistic regression analysis was performed to calculate the sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the two scoring systems in diagnosing COVID infection, considering RT-PCR as the reference standard. Results: A total of 400 cases were evaluated. Two hundred sixty-eight patients with a clinical suspicion of COVID-19 had a positive RT-PCR. The mean duration of symptoms was 5.5 ± 3.4 (range, 1–21 days). The mean CO-RADS and CT-SS scores were 3.7 ± 1.4 (range, 1–5) and 9.1 ± 7.5 (range, 0–28), respectively. Air leaks, including pneumothorax, pneumomediastinum, and surgical emphysema, were observed in six cases. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of CO-RADS was 93.8, 80, 90.7, 92.1, and 90%, respectively. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of CT-SS were 95, 76, 86, 89, and 85%, respectively. The area under the curve (AUC) for CO-RADS was 0.943 [95% confidence interval (CI), 0.909–0.976, P < 0.001] and AUC for CT-SS was 0.877 (95% CI, 0.821–0.933, P < 0.001), respectively. The cut-off values of CT-SS and CO-RADS were 7.1 and 4.2, respectively. Conclusion: Both scoring systems had good sensitivity, specificity, and diagnostic accuracy in comparison to RT-PCR test to diagnose COVID-19 infection.

In hematopoietic stem cell transplantation (HSCT) recipients, BK virus-related hemorrhagic cystitis is a well-known complication. It increases the risk of death and morbidity of HSCT recipients with simultaneous increase in healthcare cost burden, as a result of prolonged hospital admissions. There are many conservative therapeutic strategies available for the treatment that are effective in treatment of milder forms of hemorrhagic cystitis. Vesical artery embolization is one of the nonsurgical bailout procedure in patient's refractory to medical therapy with added advantage of avoidance of high-risk definitive surgical procedure of cystectomy or urinary diversion in these critical immunosuppressed patients.

Purpose: To evaluate effectiveness of omega-3 fatty acid supplements in relieving dry eye symptoms and signs in symptomatic visual display terminal users (VDT). Methods: A randomized controlled study was done; eyes of 470 VDT users were randomized to receive four capsules twice daily for 6 months (O3FAgroup), each containing 180 mg of eicosapentaenoic acid and 120 mg docosahexaenoic acid. The O3FA group was compared with another group (n = 480) who received four capsules of a placebo (olive oil) twice daily. Patients were evaluated at baseline, 1, 3, and 6 months, respectively. The primary outcome was improvement in omega-3 index (a measure of EPA and DHA ratio in RBC membrane). Secondary outcomes were improvement dry eye symptoms, Nelson grade on conjunctival impression cytology, Schirmer test values, tear film breakup time (TBUT), and tear film osmolarity. Means of groups (pre-treatment, 1, 3, and 6-months) were compared with repeated measure analysis of variance. Results: At baseline, 81% patients had low omega-3 index. In the O3FA group, a significant increase in omega-3 index, improvement in symptoms, reduction in tear film osmolarity, and increase in Schirmer, TBUT, and goblet cell density was observed. These changes were not significant in the placebo group. Improvement in test parameters was significantly (P < 0.001) better in patients with low omega3 index (

Hereditary hemorrhagic telangiectasia (HHT) (Osler–Weber–Rendu syndrome) is a rare vascular disorder that usually presents with epistaxis, mucocutaneous telangiectasia, and gastrointestinal bleeding. Patients with pulmonary arteriovenous malformations (AVMs) are at serious risk of cerebral stroke due to paradoxical embolism, indicating the need for early diagnosis and intervention. We report a 24-year-old man who presented with hypoxemia and a history of recurrent spontaneous epistaxis, and radiologic workup demonstrating pulmonary and hepatic AVMs. He was diagnosed with HHT and treated by endovascular embolization.

Data now plays a central role in civic life and community practices. This has created a pressing need for new forms of translation and sense-making that can engage diverse publics. Research-based Theatre (RbT) has proven to be an effective approach to delivering qualitative data to community stakeholders. We extend this tradition by proposing “community-engaged data theatre”. This approach translates quantitative data into theatrical language to engage communities in deliberative conversations on relevant issues. Community-engaged data theatre requires bridging multiple disciplines and involves creating new definitions and shared vocabularies in discourses that formerly have had little overlap in meaning. In this article, we share key insights from our initial experiments in which we adapted quantitative and qualitative data to devise a pilot piece in collaboration with a local community partner. In this essay, we communicate our collaborative process in polyvocal, artistic form. We edit and adapt materials from our conversations and creative practices into scenes illustrating how we taught and learned from each other about data science, participatory modeling, material deliberation and Composition to pilot our lab’s first community-engaged data theatre prototype.

Data literacy is a growing area of focus across multiple disciplines in higher education. The dominant forms of introduction focus on computational toolchains and statistical ways of knowing. As data driven decision-making becomes more central to democratic processes, a larger group of learners must be engaged in order to ensure they have a seat at the table in civic settings. This requires a rethinking to support many paths into data literacy for a variety of learning styles. In this paper we introduce “data theatre,” a set of activities designed for data novices that may have limited experience or comfort with spreadsheets, math, and other quantitative operations. Through iterative co-design over three workshops, we tested and produced two activity guides for educators, building on long-standing practices in participatory theatre that center social justice and liberation. Our initial findings provide very early evidence that this approach can help these learners overcome hesitations to working with information, begin building a critical perspective when viewing data, and create emotionally impactful data stories told through theatrical performance. This prototype work suggests to us that the concept of “Data theatre” warrants further study to build a more robust understanding of its affordances and limitations.

Context: In general anesthesia, intubation/extubation and use of succinylcholine elevate intraocular pressure (IOP). Elevation of IOP during anesthesia may be detrimental to patients with preexisting ocular conditions such as glaucoma and uveitis. Regional anesthesia (spinal) lowers mean arterial and may lead to hemodynamic changes. Aims: We aimed to study changes in IOP and mean arterial pressure (MAP) in patients undergoing abdominal and lower-limb surgery following general and regional anesthesia. Setting and Design: A prospective comparative nonrandomized study was done. One hundred and twenty patients were randomly allocated to receive either general (Group A, n = 60) or regional anesthesia (Group B, n = 60), respectively. An independent investigator recorded MAP and IOP (Perkins handheld tonometer). Statistics: A one-way repeated measures analysis of variance (ANOVA) was done to determine whether there are any significant differences between the means of three or more levels of a within-subject factor (IOP and MAP) over time. Results: In Group A, there was a significant rise in IOP (ANOVA, P = 0.007) after general anesthesia over time. In Group B, the change in IOP (ANOVA, P = 0.219) was not statistically significant over time. However, there was a significant reduction in MAP over time. Between the groups, the mean change in IOP was significantly higher in patients in Group A and mean MAP significantly lower in Group B, respectively. Conclusion: Patients with glaucoma, uveitis, and cardiovascular diseases should have IOP monitoring prior to deciding the type of anesthesia and after anesthesia for lower-limb and abdominal surgeries. Sudden loss of vision after anesthesia needs immediate attention.

Purpose: To evaluate the long-term outcomes of manual small-incision cataract surgery (MSICS) in eyes with uveitis. Methods: Patients who underwent MSICS for uveitic cataract from 2009 to 2019 were retrospectively evaluated. Visually significant cataract and presence of less than five cells per high-power field in the anterior chamber for a minimum of 3 months were the prerequisites for surgery. Patients with follow-up less than 9 months were excluded. Results: After exclusion, 283 eyes of 264 patients were evaluated. The mean age of patients was 44.3 ± 11.3 years. The mean follow-up duration was 22 ± 11.5 months. The mean surgical time was 11.2 ± 3.2 min. One hundred and seventy-two eyes (60.8%) had anterior uveitis, 78 (27.5%) had posterior uveitis, and 33 (11.7%) had panuveitis. At the final follow-up, 253 eyes (88.4%) had corrected distance visual acuity (CDVA) better than 0.6 log of minimum angle of resolution (LogMAR) unit. The final endothelial cell counts were significantly (analysis of variance [ANOVA], P = 0.001) lower in eyes with human leukocyte antigen (HLA)-B27–associated uveitis and in eyes with idiopathic anterior uveitis. Patients on systemic corticosteroids had significantly better (P = 0.031) final visual acuity than those without preoperative corticosteroids. Recurrent uveitis (43.8%), Posterior capsule opacification (PCO) (19.4%), glaucoma (8.5%), cystoid macular edema (CME; 13.5%), and Epiretinal membrane (ERM) (5.6%) were the frequent complications. A significantly worse (ANOVA, P = 0.001) visual prognosis was seen in patients with Vogt–Koyanagi–Harada disease (VKH), sarcoidosis, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), and serpiginous choroiditis. Conclusion: MSICS is safe in most cataracts due to uveitis and results in improvement in CDVA at 9 months. Posterior capsule opacification, macular edema, persistent uveitis, etiology of uveitis, and use of preoperative steroids significantly influenced the visual outcome.

Background: Patients with alcohol dependence often suffer from comorbid psychiatric illnesses like depression which may influence treatment and outcomes. Sociodemographic factors may potentially influence depressive symptoms in patients with alcohol dependence. Aims: To study the prevalence of depressive symptoms in patients with alcohol dependence and to identify sociodemographic factors affecting this association. Methods: Patients with alcohol dependence above 18 years of age were included. The diagnosis was made by ICD-10 diagnostic criteria. The severity of alcohol dependence was rated with the severity of the alcohol dependence questionnaire (SADQ) and depression with the Hamilton depression rating scale (HAM-D). Sociodemographic data were recorded in each patient. Statistical analysis was done using independent t-tests, Chi-square tests, one-way analysis of variance (ANOVA) and Pearson’s correlation analysis. Results: The mean SADQ Score was 21.5±8.6 (range, 9-48). The severity of alcohol dependence was mild in 15(25%), moderate in 40(66.7%) and severe in 5(8.3%), respectively. The mean Hamilton depression rating scale score was 7.8±3.9(range, 3-17). The prevalence of depression in our study was 38.3%. Out of these, 17(28.3%) had mild and 6 (10%) had moderate depression. There was a positive and significant correlation between SADQ scores and depression scores (Pearson’s correlation coefficient, r=0.494, P=0.001). Patients who were unemployed (ANOVA, P=0.046, separated (ANOVA, P=0.002), and joint family (ANOVA, P=0.039) had significantly higher depression scores.Conclusion: In conclusion, sociodemographic factors like unemployment, marital separation and living in joint families may significantly influence the association between alcohol dependence and depression.

Introduction: Socio-demographic factors may play a pivotal role in anxious and depressed alcohol dependent patients. Identifying the patterns and impact of these factors may be important in the successful management of Alcohol Use Disorders (AUDs). Aim: To assess the patterns and impact of socio-demographic factors in anxious and depressed alcohol dependent patients. Materials and Methods: This cross-sectional study was conducted at Rama Medical College Hospital and Research Centre Hapur, Uttar Pradesh, India, from August 2018 to January 2020. Patients with history of substance dependence, gross brain damage, severe medical complications, or evidence of drinking during the hospital stay were excluded. Severity of Alcohol Dependence Questionnaire (SADQ) was used to rate the extent of alcohol dependence and Hamilton Depression Rating Scale (HAM-D or HDRS) to rate depression. Socio-demographic data was recorded in each patient which included age, gender, background, education level, employment status, occupation, marital status, and family type. The severity of anxiety symptoms was measured on Hamilton Anxiety Rating Scale (HAM-A). Independent t-tests, Chi-square tests, one-way Analysis of Variance (ANOVA) and Pearson’s correlation analysis were used for statistical analysis. A p-value

ABSTRACT Objective: To describe a unique situation of a sewing needle lodged in the parapharyngeal space and elucidate the problems encountered in its successful removal. Methods: Design: Case Report Setting: Tertiary Private Hospital Patient: One Result: A 24-year-old male tailor accidentally swallowed a sewing needle that pierced the oropharyngeal wall and was wedged in the parapharyngeal space. After a thorough physical examination, 70 degree rod endoscopy, radiography and doppler ultrasonography and intraoperative C-arm X-ray for intraoperative localization and as a guide for extraction all yielded less than optimal guidance. Although an intra-oral approach was initially taken, the transcervical approach provided the best access. Conclusion: Removal of a sharp foreign body in the parapharyngeal space should be considered a surgical emergency owing to its close proximity to vital structures and the potential for serious complications. Identifying the exact location may require a variety of imaging modalities, and foreign body extraction may entail multiple surgical approaches.

Purpose: To compare the safety and efficacy of tacrolimus 0.03% ointment with dexamethasone 0.05% ointment for subepithelial infiltrates (SEIs) following adenoviral keratoconjunctivitis (AK). Methods: A randomized, double blind trial was done. Eligibility criteria was corrected distance visual acuity of 6/9 Snellen or worse for at least 4 weeks with corneal SEIs following AK. The grading of SEIs was done on a scale of 0 to 3; 0, no infiltrates, 1 mild infiltration, 2 moderate infiltration and 3, severe infiltration. Consecutive patients with SEIs following AK were randomized to receive either topical tacrolimus 0.03% or dexamethasone 0.05% ointment twice daily for 6 months. Treatment was successful if there was reduction of SEIs and improvement in vision. Results: A total of 45 patients each were assigned to the Tacro and Dexa groups, respectively. Baseline characteristics of patients did not differ significantly (P > 0.001). There was a significant change in symptoms, vision and SEIs in both the groups. However, the magnitude was greater in tacro group. Treatment was successful in 37 (92.5%) patients in Tacro and 34 (85%) patients in dexa group. In dexa group, after a period of 1.24 ± 0.24 months, 7 (15.6%) patients developed a significant rise in intraocular pressure (IOP). Three (7.5%) eyes in tacro and 6 (15%) eyes in dexa group had recurrence of SEIs after cessation of therapy. Conclusion: Tacrolimus 0.03% is an effective alternative to dexamethasone 0.05% with low recurrence rate, no significant rise in IOP but may cause burning and foreign body sensation in some patients.

Background: Indwelling Double-J ureteral stenting is commonly used in urological practice and has various complications. This study aimed to assess the frequency of bacterial stent colonization and stent-associated bacteriuria after indwelling it for different time durations and to evaluate the significance of urinary cultures for identification of colonizing microorganisms. Materials and Methods: A prospective cross-sectional study was conducted. Midstream urine from 72 patients undergoing J stent insertion was investigated microbiologically before stent insertion and on the day of stent removal. The stents were removed by aseptic manipulation, and 1–3 cm of the tip located in the bladder was collected for microbiological study. The urine and stent samples were cultured, and the bacterial pathogens were identified using standard microbiological methods followed by Phoenix automated system. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method. Results: Bacterial colonies were found in 47.2% (34 of 72) of the stents. Of the multiple pathogens identified, Escherichia coli (20%) was the most common, followed by Streptococcus sp. (17.5%) and Pseudomonas sp. (12.5%). The bacteria did not colonize within the first 2 weeks of stent placement. Results showed that 55% of the isolates were resistant to erythromycin, 52.5% to ampicillin, 42.5% to piperacillin, and least resistant being 17.5% for tetracycline and imipenem. However, 81.3% and 66.7% of the stents were colonized when placed for 90–120 days and 60–90 days, respectively. Conclusion: High prevalence of bacterial isolates and risk of bacteriuria and colonization was found in the DJ stent tips, with E. coli being dominant colonizer. Most of the bacteria were resistant to different classes of antibiotics. Bacteriuria and stent colonization gradually increases with the duration of stent retention in the body.

Background: Harvest of hematopoietic progenitor cells via leukapheresis is being used increasingly for transplants in India. Adequate yield of cells per kilogram body weight of recipient is required for successful engraftment. Collection efficiency (CE) is an objective quality parameter used to assess the quality of leukapheresis program. In this study, we calculated the CE of the ComTec cell separator (Fresenius Kabi, Germany) using two different formulae (CE1 and CE2) and analyzed various patient and procedural factors, which may affect it. Materials and Methods: One hundred and one consecutive procedures in 77 autologous donors carried out over 3 years period were retrospectively reviewed. Various characteristics like gender, age, weight, disease status, hematocrit, preprocedure total leukocyte count, preprocedure CD34 positive (CD34+) cells count, preprocedure absolute CD34+ cell count and processed apheresis volume effect on CE were compared. CE for each procedure was calculated using two different formulae, and results were compared using statistical correlation and regression analysis. Results: The mean CE1 and CE2 was 41.2 and 49.1, respectively. CE2 appeared to be more accurate indicator of overall CE as it considered the impact of continued mobilization of stem cells during apheresis procedure, itself. Of all the factors affecting CE, preprocedure absolute CD34+ was the only independent factor affecting CE. Conclusion: The only factor affecting CE was preprocedure absolute CD34+ cells. Though the mean CE2 was higher than CE1, it was not statistically significant.

AIM: To compare the safety and efficacy of phacoemulsification and small incision cataract surgery (SICS) in patients with uveitic cataract.METHODS:In aprospective, randomized multi-centric study, consecutive patients with uveitic cataract were randomized to receive phacoemulsification or manual SICS by either of two surgeons well versed with both the techniques. A minimum inflammation free period of 3mo (defined as less than 5 cells per high power field in anterior chamber) was a pre-requisite for eligibility for surgery. Superior scleral tunnel incisions were used for both techniques. Improvement in visual acuity post-operatively was the primary outcome measure and the rate of post-operative complications and surgical time were secondary outcome measures, respectively. Means of groups were compared using t-tests. One way analysis of variance (ANOVA) was used when there were more than two groups. Chi-square tests were used for proportions. Kaplan Meyer survival analysis was done and means for survival time was estimated at 95% confidence interval (CI). A P value of RESULTS:One hundred and twenty-six of 139 patients (90.6%) completed the 6-month follow-up. Seven patients were lost in follow up and another six excluded due to either follow-up less than six months (n=1) or inability implant an intraocular lens (IOL) because of insufficient capsular support following posterior capsule rupture (n=5). There was significant improvement in vision after both the procedures (paired t-test; PP=0.384). The mean surgically induced astigmatism (SIA) was 0.86±0.34 dioptres (D) in the phacoemulsification group and 1.16±0.28 D in SICS group. The difference between the groups was significant (t-test, P=0.002). At 6mo, corrected distance visual acuity (CDVA) was 20/60 or better in 60 (90.9%) patients in Phaco group and 53 (88.3%) in the manual SICS group (P=0.478). The mean surgical time was significantly shorter in the manual SICS group (10.8±2.9 versus 13.2±2.6min) (PP=0.459), persistent uveitis (Chi-square, P=0.289) and posterior capsule opacification (Chi-square, P=0.474) were comparable between both the groups.CONCLUSION:ManualSICS and phacoemulsification do not differ significantly in complication rates and final CDVA outcomes. However, manual SICS is significantly faster. It may be the preferred technique in settings where surgical volume is high and access to phacoemulsification is limited, such as in eye camps. It may also be the appropriate technique for uveitic cataract under such circumstances.

AIM:To compare surgical peeling and aspiration and neodymium yttrium garnet laser capsulotomy for pearl form of posterior capsule opacification (PCO).METHODS:A prospective, randomized, double blind, study was done at Rotary Eye Hospital, Maranda, Palampur, India, Santosh Medical College Hospital, Ghaziabad, India and Laser Eye Clinic, Noida India. Consecutive patients with pearl form of PCO following surgery, phacoemulsification, manual small incision cataract surgery and conventional extracapsular cataract extraction (ECCE) for age related cataract, were randomized to have peeling and aspiration or neodymium yttrium garnet laser capsulotomy. Corrected distance visual acuity (CDVA), intra-operative and post-operative complications were compared.RESULTS:A total of 634 patients participated in the study, and 314 (49.5%) patients were randomized to surgical peeling and aspiration group and 320 (50.5%) to the Nd:YAG laser group. The mean pre-procedural logMAR CDVA in peeling and neodymium:yttrium-aluminium-garnet (Nd:YAG) laser group was 0.80±0.25 and 0.86±0.22, respectively. The mean final CDVA in peeling group (0.22±0.23) was comparable to Nd:YAG group (0.24±0.28; t test, P=0.240). There was a significant improvement in vision after both the procedures (P<0.001). A slightly higher percentage of patients in Nd:YAG laser group (283/88.3%) than in peeling group (262/83.4%) had a CDVA of 0.5 (20/63) or better at 9mo (P<0.001). On the contrary, patients having CDVA worse than 1.00 (20/200) was also significantly higher in Nd:YAG laser group as compared to peeling group (25/7.7% vs 15/4.7%, respectively). On application of ANCOVA, there was less than 0.001% risk that PCO thickness and total laser energy had no effect on rate of complications in Nd:YAG laser group and less than 0.001 % risk that PCO thickness had no effect on complications in peeling group respectively. Sum of square analysis suggests that in the Nd:YAG laser group, thick PCO had a stronger impact on complications (Fischer test probability, PrPrPrP=0.527) and cystoid macular edema (P=0.068), did not differ significantly between both the groups. However, intraocular pressure spikes (P=0.046) and retinal detachment (PP<0.001). Recurrence of pearls was the most common cause of reduction of vision in the peeling group (24/7.6%, P<0.001).CONCLUSION:There is no alternative to Nd:YAG laser capsulotomy for fibrous subtype of PCO. For pearl form of PCO, both techniques are comparable with regard to visual outcomes. Nd:YAG laser capsulotomy has a higher incidence of IOP spikes and retinal detachment whereas recurrence of pearls may occur after successful peeling and aspiration. When posterior capsulotomy is needed in patients with retinal degenerations, retinopathies and pre-existing retinal breaks, the clinician should be cautious about increased risks of possible complications of Nd:YAG laser capsulotomy.

This case report presents a rare root canal system in a mandibular second molar tooth, a single root with a single canal. C-shaped canals with varying configuration are commonly observed in single-rooted mandibular second molars. The access cavity displayed only one round/oval canal orifice which is very rare. The knowledge of dental anatomy is an essential tool for the success of endodontic treatment. The early recognition of these configurations facilitates cleaning, shaping, and obturation of the root canal system. Therefore, a clinician thus requires to have adequate knowledge about root morphology and its variation. Thorough knowledge of the root canal anatomy is necessary to perform a successful endodontic treatment.

Objective: This study aims to demonstrate a novel laparoscopic technique of tapering megaureter without disrupting the blood supply and disconnecting the ureter. Materials and Methods: Eight cases of primary obstructive megaureter in the age group of 14–22 years underwent laparoscopic extravesical ureteric reimplantation between August 2011 and July 2015 using our novel technique. Five patients had obstruction on left side and three on right side. Follow-up ultrasonography at 1 month and 3 months, voiding cystourethrogram (VCUG) at 3 months and intravenous urogram (IVU) at 6 months was obtained to assess the development of reflux and to look for adequate drainage of the obstructive ureter. Results: Average age of the patients at the time of surgery was 18.5 years. Mean operating time was 95 min. Mean blood loss of 20 ml. VCUG done after 3 months showed no reflux in all cases. IVU done after six months showed no obstruction and complete drainage of dye. Conclusion: Our technique of tapering obstructed megaureter over a preplaced ureteral dilator is time saving and also helps in preserving blood supply to lower ureter. As a result, ureteric anastomotic stricture rate is very low. It is easily reproducible in the open as well as by robotic.

Aims: Prolonged contact lens wear is often accompanied by dryness of the eyes. The aim of this study was to compare conjunctival impression cytology (CIC) and tear film tests such as tear film break up time (TBUT) and Schirmer test for dry eye evaluation in contact lens wearers and measure their correlation with dry eye symptoms. Setting: A case control study was done at three referral eye centers. Materials and Methods: The eyes of 230 contact lens users were compared to 250 eyes of age- and sex-matched controls. Participants were recruited based on their response to a questionnaire of dry eye symptoms, (Dry Eye Scoring System, DESS © ) and measurements of TBUT, Schirmer test, and CIC was done. A correlation analysis between symptom severity and tear film tests was performed. Pearson′s coefficient, R 2 > 0.5 was considered significant. Results: As compared to controls (r2 = 0.010), Nelson grade correlated significantly with dry eye symptoms (r2 = 0.765), among cases. However, there was moderate correlation between dry eye symptoms, Schirmer test, and TBUT (r2 = 0.557 and 0.530, respectively) among cases and a weak correlation among controls (r2 = 0.130 and 0.054, respectively). The sensitivity of TBUT was 86.4%, specificity was 82.4%, positive likelihood ratio (LR) was 4.50 [95% confidence interval (CI) 3.46-5.85)], and negative LR was 0.09. The sensitivity of the Schirmer test was 48.2%, specificity 88%, LR 2.12 (95% CI 1.48-2.96), and negative LR 0.83. Conclusion: CIC correlates better than Schirmer and TBUT with dry eye symptoms. It may be the most appropriate test for dry-eye evaluation in contact lens wearers.

Purpose: To study factors affecting laser energy levels required for neodymium: yttrium aluminium garnet (Nd: YAG) laser capsulotomy and to evaluate whether any correlation exists between applied laser energy levels and complications. Methods: The present study examined 474 consecutive patients for a number of factors including age, type of posterior capsule opacification (PCO), material and fixation of intraocular lens (IOL) and complication rates, versus energy levels used for Nd: YAG laser capsulotomy. Results: Mean patient age was 55.6 ± 8.7 years and mean follow up period was 22.9 ± 4.5 months. IOL biomaterial (KW ANOVA; P = 0.173) and patient′s age (P = 0.246) did not significantly influence total laser energy requirement for capsulotomy. However, total laser energy levels were significantly higher (KW ANOVA; P < 0.001) with fibro-membranous and fibrous subtypes of PCO. Complications such as IOL pitting, intraocular pressure (IOP) elevation, uveitis, retinal detachment (RD) and cystoid macular edema (CME) were significantly more common when higher energy levels was used. The mean total energy in patients with RD was 77.7 ± 17.7 mJ as compared to 43.4 ± 26.9 mJ in the rest of the cohort. RD was more common in patients with higher axial length [n = 7 (63%)] (P < 0.001). Conclusion: Type of PCO significantly influenced laser energy levels required for capsulotomy, whereas IOL biomaterial and fixation did not. Complications such as IOL pitting, uveitis, IOP elevation, RD and CME was significantly more common when total laser energy was higher. It is recommended that the lowest possible single pulse laser energy be used for capsulotomy to minimize complications.

Aim: The aim of this in vitro study was to compare the antimicrobial efficacy of calcium hydroxide-based sealer (Apexit Plus), zinc oxide eugenol-based sealer (Endoflas FS) and resin-based sealer (EndoRez) root canal sealers against Enterococcus faecalis microbial type culture collection (MTCC) 439 and Candida albicans MTCC 239 using agar diffusion test. Materials and Methods: In the present study, 20 Mueller Hinton agar (MH agar) plates were employed. Three wells were made by removal of agar at equidistant points and filled with root canal sealers according to manufacturer′s instructions. The strains of the bacteria and fungi used in this study were E. faecalis MTCC 439 and C. albicans MTCC 227. Both micro organisms were grown at 37°C for 24 h in MH Broth and seeded into MH agar to produce a turbidity of 0.5 on the McFarland scale, which corresponds to a concentration of 10 8 CFU/mL. This MH broth was used as a second layer. The seeded agar was then added over the plates immediately after the insertion of sealer cements. After incubation, the diameters of zones of inhibition around the plates were measured. Results: The results were statistically analyzed using two way ANOVA test. Against both the micro organisms used in this study, Endoflas FS showed the largest zones of inhibition followed by Apexit Plus and EndoRez. Conclusion: Within the limitations of this study, it can be concluded that: Root canal sealers showed different inhibitory effects depending on their types and microbial strains tested. Against Enterococcus faecalis and Candida albicans, zinc oxide based sealers showed the highest microbial zones of inhibition followed by the calcium hydroxide based sealer and resin based sealer respectively

Introduction: Dietary consumption of omega-3 fatty acids has been found to be beneficial in patients with dry eye syndrome. Aim: To evaluate the efficacy of dietary omega-3 fatty acids (O3FAs) for dry eye in patients with psoriasis with and without meibomian gland dysfunction. Materials and Methods: An interventional, non-randomized, controlled, multi-center study was done. Psoriatic patients were recruited when they had either dry eye symptoms and/ or Schirmer

Aims and Objectives: To compare the diagnostic value and accuracy of dry eye scoring system (DESS), conjunctival impression cytology (CIC), tear film breakup time (TBUT), and Schirmer's test in computer users. Methods: A case-control study was done at two referral eye centers. Eyes of 344 computer users were compared to 371 eyes of age and sex matched controls. Dry eye questionnaire (DESS) was administered to both groups and they further underwent measurement of TBUT, Schirmer's, and CIC. Correlation analysis was performed between DESS, CIC, TBUT, and Schirmer's test scores. A Pearson's coefficient of the linear expression (R 2) of 0.5 or more was statistically significant. Results: The mean age in cases (26.05 ± 4.06 years) was comparable to controls (25.67 ± 3.65 years) (P = 0.465). The mean symptom score in computer users was significantly higher as compared to controls ( P < 0.001). Mean TBUT, Schirmer's test values, and goblet cell density were significantly reduced in computer users (P < 0.001). TBUT, Schirmer's, and CIC were abnormal in 48.5%, 29.1%, and 38.4% symptomatic computer users respectively as compared to 8%, 6.7%, and 7.3% symptomatic controls respectively. On correlation analysis, there was a significant (inverse) association of dry eye symptoms (DESS) with TBUT and CIC scores (R 2 > 0.5), in contrast to Schirmer's scores (R 2 < 0.5). Duration of computer usage had a significant effect on dry eye symptoms severity, TBUT, and CIC scores as compared to Schirmer's test. Conclusion: DESS should be used in combination with TBUT and CIC for dry eye evaluation in computer users.

AIM: To evaluate the role of dietary supplementation of omega-3 fatty acids in dry eye syndrome.METHODS: A prospective, interventional, placebo controlled, double blind randomized trial was done at two referral eye centers. Two hundred and sixty-four eyes of patients with dry eye were randomized to receive one capsule (500mg) two times a day containing 325mg EPA and 175mg DHA for 3 months (omega-3 group). The omega-3 group was compared to a group of patients (n=254) who received a placebo (placebo group). There were 4 patient visits (at baseline, 1 month, 2 months and 3 months). On each visit, recording of corrected distance visual acuity (CDVA), slit lamp examination and questionnaire based symptom evaluation and scoring was done. A symptomatic score of 0-6 was mild, 6.1-12 moderate and 12.1-18 severe dry eye. Response to intervention was monitored by routine tear function tests like Schirmer I test, tear film break-up time (TBUT), Rose Bengal staining and most notably, conjunctival impression cytology.RESULTS: Sixty-five percent of patients in the omega-3 group and 33% of patients in placebo group had significant improvement in symptoms at 3 months (P=0.005). There was a significant change in both Schirmer’s test value and TBUT values in the omega-3 group (PPCONCLUSION: Omega-3 fatty acids have a definite role for dry eye syndrome. The benefit seems to be more marked in conditions such as blepharitis and meibomian gland disease. The role of omega fatty acids in tear production and secretion needs further evaluation.

A case of multiple esophageal foreign bodies, which were retrieved successfully by rigid esophagoscopy in a 1-year old child is being reported. There are few cases of multiple esophageal foreign bodies in children reported in the literature; this case was unique in presentation as there was no history of foreign body ingestion. This case also highlights the serious neglect present in our society towards children of lower socio-economic strata despite this child being the 1st child in the family.

Schwannoma in head and neck region are quiet common and generally arise from last four cranial nerves. Spinal accessory nerve involvement is very rare. We are hereby presenting an extremely rare case of paediatric XI nerve schwannoma hitherto unreported in English medical literature till date.

OBJECTIVE: The aim of this study was to assess the antibody response to combined passive-active immunization versus active immunization against hepatitis B in 71 patients with acute leukemia with negative hepatitis B virus serology at presentation. METHODS: The first group (n=28) received a double dose of hepatitis B vaccine at 0, 1, 2 and 6 months and immunoglobin (HBIG) at 0 and 1 month concurrently with vaccine but at a different intramuscular site. The second group (n=43) received double dose of hepatitis B vaccine at 0, 1, 2, and 6 months. HBsAg and anti-HBs titers were determined one month after the 1st, 2nd, 3rd and 4th doses of vaccine. RESULTS: In the vaccine-only group, 2.56%, 8.33%, 14.28% and 34.29% of patients developed anti-HBs titer ≥10 IU/L after the 1st, 2nd, 3rd and 4th doses of vaccine, respectively. In the HBIG group, 91.30%, 91.30%, 69.56% and 73.91% of patients developed anti-HBs titer ≥10 IU/L after the 1st, 2nd, 3rd and 4th doses of vaccine, respectively. Those in the vaccine-HBIG group maintained their anti-HBs titer ≥10 IU/L from the 1st to the 4th doses. In the vaccine-only group, 34.29% of patients gained protective antibody titer after receiving the 4th dose of vaccine. Subgroup analysis of age (pediatric vs adult) and disease (acute lymphoblastic leukemia vs acute myeloid leukemia) groups showed no effect of either on the development of protective antibody titer. The incidence of HBsAg positivity one month after the 4th dose of vaccine was 8.62%. No patient became positive for anti-HCV or HIV antibody before or after chemo therapy. CONCLUSION: Combined HBIG and vaccine may protect acute leukemia patients during the intensive chemotherapy period.

Background: Numerous restorative materials are being used in dentistry to achieve adequate strength and restore aesthetics. However, a perfect ideal restorative material has still eluded dentist. Dental amalgam is versatile material with self-sealing property, but is unaesthetic. Other restorative materials like, composites require conservative preparation, but exhibits polymerisation shrinkage resulting in microleakage. To overcome these drawbacks a high strength restorative material reinforced with ceramic and zirconia fillers known as zirconomer has been introduced. The aim of this study was to evaluate the microleakage of these three different restorative materials. Materials and Methods: Thirty non-carious human permanent first and second molars were utilized in this study. Class I cavities were prepared on the occlusal surface; cavities were then restored with amalgam, composite and zirconomer as per manufacture’s instruction. All samples were stored for 24 hours in distilled water followed by thermocycling. The entire tooth surface was painted with two coats of varnish to within 1mm of the restoration margins. The teeth were immersed in dye. Teeth were sectioned and observed under stereomicroscope. Result: In this study the zirconomer exhibited the highest micro leakage as compared to composite and amalgam but composite having higher micro leakage as compared to amalgam and lower micro leakage as compared to zirconomer. Conclusion: Even though composite and amalgam are being marketed aggressively and new material like zirconomer are on origin, amalgam still proves to be one of the best materials.

Richter syndrome (RS) represents the clinico-pathologic transformation of indolent lymphomas to an aggressive lymphoma, most commonly diffuse large B-cell lymphoma. Majority of the patients have a previous diagnosis of Chronic Lymphocytic Leukemia and the median time to transformation is 2-4 years. De novo RS is extremely uncommon. RS frequently arises in the lymph nodes or bone marrow and rarely presents with extra nodal involvement, common sites being the gastrointestinal tract, eye, central nervous system, lung and kidney. Involvement of testis by RS is extremely rare and we came across only one such reported case in the literature. We are reporting this case as our patient presented with de novo RS at an extremely uncommon extra nodal site, testis.

To evaluate the efficacy of peeling and aspiration of Elschnig pearls. Retrospective study in a medical college hospital. Records of 217 eyes which underwent surgical peeling and aspiration for membranous PCO between 2006 and 2009, was reviewed. Peeling and aspiration was fashioned with a blunt tipped 20G cannula after stabilizing anterior chamber with anterior chamber maintainer. Post-operative vision and complications were analyzed. Mc Nemar and Chi square tests. The mean age was 56.84 years. 85.71% patients achieved best corrected visual acuity (BCVA) of 20/20 at 3 m. Recurrence of pearls, uveitis and cystoid macular edema were the most common causes of reduced vision. Peeling and aspiration of pearls seem to be a viable alternative to Neodymium yttrium garner aluminium (Nd: YAG) laser capsulotomy for membranous PCO.