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Background The purpose of study was to compare the changes in blood pressure in patients undergoing phacoemulsification cataract surgery under topical and peribulbar anaesthesia during preoperative, intraoperative and postoperative period. Methods In this prospective cohort study, 240 patients undergoing phacoemulsification were divided into topical (Group 1) and peribulbar (Group 2) equally. Proparacaine 0.5% drops were used for topical anaesthesia, and Inj lignocaine with Inj bupivacaine were used to give peribulbar anaesthesia. Preoperative blood pressure was taken 30 min before surgery with automated sphygmomanometer. Intraoperative blood pressure was taken during phacoemulsification, and postoperative blood pressure was taken 1 h after surgery. Outcomes assessed were systolic, diastolic and mean blood pressure. Results Systolic blood pressure in Group 1 was significantly increased in the intraoperative phase, whereas it was significantly decreased in Group 2 in the intraoperative phase. Diastolic and mean blood pressure in Group 1 showed no significant change, whereas in Group 2, both showed significant reduction in intraoperative and postoperative phases. Conclusion The increase in intraoperative systolic blood pressure in topical group could be due to discomfort from microscope light, iris manipulation, irrigation and aspiration during surgery. The decrease in intraoperative systolic and diastolic blood pressure in peribulbar group could be due to systemic absorption of local anaesthetic. The mean preoperative systolic blood pressure was also higher in the topical group, which could be due to anxiety or stress under topical anaesthesia. The changes in blood pressure need to be observed so that timely intervention can be made to achieve favourable postoperative outcome.

Neuromyelitis optica spectrum disorders (NMOSDs) are rare autoimmune-mediated chronic inflammatory disorders involving the central nervous system. The concept of NMOSDs has widened up recently. Its diagnostic criteria have broadened the knowledge of this particular disease including the atypical cases where antiaquaporin-4 antibody is negative and anti-myelin oligodendrocyte glycoprotein (MOG) antibody is positive. Myelin oligodendrocyte glycoprotein is a protein expressed on the outer surface of myelin sheath and oligodendrocytes of the central nervous system. The detection of anti-MOG-Ab is emerging evidence, and thus, research on the role of this antibody in such seronegative cases is still underway. Early diagnosis and adequate therapy is essential in such cases. Here, we report an eight-year-old girl who was diagnosed with NMOSDs and found to have anti-MOG antibodies in place of AQP-4 antibodies.

Shulman's disease (eosinophilic fasciitis) is a very rare autoimmune disorder with an unknown etiopathogenesis. During the initial period of disease, it usually causes limb and trunk edema followed by collagenous thickening of the subcutaneous fascia. Eosinophilia is a predominant laboratory finding during the initial phase of the disease and less prominent in the later phases. Patients may also present with arthritis, myositis, peripheral neuropathy, and rarely pleuropericarditis. Here, we are reporting a case of eosinophilic fasciitis presenting with vague constitutional symptoms, fever, and peripheral blood eosinophilia followed by rapidly evolving skin tightening with joint contractures and muscle stiffness, which misled the treating team toward Scleroderma and its overlap syndromes. The diagnosis was finally clinched by a full-thickness skin biopsy along with underlying fascia and muscle tissue from an effected area, with a gratifying treatment response to standard immune suppression.

Purtscher-like retinopathy is a rare phenomenon reported in disorders including acute pancreatitis, collagen vascular diseases, fat embolism, chronic renal failure, amniotic fluid embolism, battered baby syndrome and several autoimmune diseases. We report an atypical initial feature of rheumatoid arthritis in a middle-aged male. This case will raise awareness among generalists to recognize this disease early.

PURPOSE: To estimate concurrent changes in Central Corneal Thickness (CCT) and Intraocular pressure (IOP) during normal pregnancy. METHODS DESIGN: Prospective cohort study of changes in Central Corneal thickness and Intraocular pressure in 45 pregnant women during third trimester and six weeks postpartum in a tertiary care hospital in Western Maharashtra, India. The change in Central Corneal thickness was measured by ASOCT in third trimester of pregnancy and six weeks postpartum. The change in Intraocular pressure was measured by Noncontact tonometer in units of mm of Hg in third trimester of pregnancy and six weeks postpartum. Correlation analysis was performed between the change in CCT and IOP. RESULTS: Results of our study suggest a signicant increase in CCT accompanied by a decrease in IOP in the same eyes during the third trimesters of normal pregnancy compared to six weeks postpartum. CONCLUSION: Due consideration should be given while diagnosing glaucoma during pregnancy and initiating treatment in view of physiological variance in IOP. Novel spectacle prescription and refractive surgeries must be circumvented during pregnancy owing to erroneous results due to these physiological changes in pregnancy.

BACKGROUND: Pseudoexfoliative material is being implicated in causing tear film abnormalities, and the aim of the present study was to prove it and to compare with the normal healthy participants. METHODS: A total of 398 eyes of 200 participants were studied, and two groups were formed. The first, pseudoexfoliation syndrome (PEXS) group, included 198 eyes of 100 patients, and the second, age-matched control group, included 200 eyes of 100 participants. Tear film abnormalities were compared in the two groups by tear meniscus height (TMH), Schirmer test I, Schirmer test II and tear film break-up time (TBUT). RESULTS: On comparing the two groups using independent t-test, a significant difference was found in Schirmer test I, Schirmer test II, and TBUT between the PEXS group (Schirmer test I: 23.98 ± 10.68 mm, Schirmer test II: 17.11 ± 8.78 mm, and TBUT: 9.778 ± 5.54 s) and the age-matched control group (Schirmer test I: 27.08 ± 9.58 mm, Schirmer test II: 19.98 ± 8.48 mm, and TBUT: 13.495 ± 5.65 s) (p = 0.003 [Schirmer test I]; p = 0.001 [Schirmer test II]; and p

Highlights • Noonan syndrome is the second most common syndromic cause of CHD. • We present a rare case of Noonan syndrome having a combination of ASD, PS and HCM. • Patient underwent balloon valvotomy for pulmonary stenosis. • The patient is under regular follow-up and awaiting heart transplant., Introduction Noonan syndrome is the second most common syndromic cause of congenital heart disease. Most patients have an autosomal dominant inheritance, but some cases may be sporadic. Pulmonary stenosis is the most common cardiac manifestation in Noonan syndrome, associated with the atrial septal defect and hypertrophic cardiomyopathy. A combination of these three is present only in 5% of patients. Presentation of case We report a case of a 21-year-old female who presented to our hospital concomitant cardiac lesions associated with pulmonary stenosis, atrial septal defect, and hypertrophic cardiomyopathy. This combination of cardiac defects is an infrequent manifestation of Noonan syndrome. The patient presented with complaints of exertion syncope over the past two years. 2D-Echocardiography showed biventricular hypertrophy, dysplastic pulmonary valve, severe pulmonary stenosis, asymmetric septal hypertrophy and large atrial septal defect. The genetic analysis report showed autosomal dominant inheritance with Ras/MAPK (mitogen-activated protein kinase) Positive. Discussion Due to the wide spectrum of symptoms and presentations in Noonan cases, accurate clinical and genetic diagnosis, and comprehensive management of the disorder are strongly recommended. Conclusion We have described a case of rare combination of cardiovascular defects in Noonan Syndrome with a view to achieve better insight into the disease course and advantages of timely treatment and follow up. Our patient is currently in follow-up after treatment with percutaneous balloon pulmonary valvuloplasty, has improved symptoms, and is awaiting heart transplant.

Background Association of keratoconus with vernal keratoconjunctivitis is well known, but there are few topographic studies describing actual prevalence especially in India where it is a common condition. There is also scarce literature on the topographic patterns and subclinical topographic anomalies in cases of vernal catarrh and their relationship with various subtypes. This study was conducted to estimate the prevalence of subclinical keratoconus among Indian subjects with vernal keratoconjunctivitis and describe the various topographic abnormalities which can help in screening for these cases. Methods In the cross-sectional study conducted at a tertiary care center, 76 established cases of vernal keratoconjunctivitis were evaluated with placido disc–based videokeratography for topographic abnormalities and early keratoconus based on modified Rabinowitz–McDonnell criteria. Results Seventeen (11.2%) eyes satisfied both the modified Rabinowitz–McDonnell criteria of keratoconus. Corneal topographic pattern analysis showed asymmetric bowtie with inferior steepening in 17.11% of the patients. None of these patients had clinical evidence of keratoconus. Conclusions The study showed 11.2% prevalence of keratoconus in patients suffering from vernal keratoconjunctivitis. The findings highlight the importance of using a simple placido disc–based corneal topography system for screening the patients with vernal keratoconjunctivitis for keratoconus. This can help in early detection and preventive intervention.

This paper reviews the literature available on the subject of the durability of concrete sewer pipes and the corresponding rehabilitation technologies. An introduction related to the importance of the sewer system in urban life and its durability issues was first discussed as most people did not recognise the scale and complexity of the underground sewer system. Then the recent development of alternative binder materials or filler materials to improve the acid resistance of concrete was specified. For instance, the effects of alternative binders on the hydration products and the mechanism of biogenic corrosion were discussed in detail. The paper ends with the current rehabilitation technologies and the structural performance of rehabilitated sewer pipes. Also, some suggestions associated with future research were made. Refereed/Peer-reviewed

Anomalous coronary artery origins are not common in routine clinical practice. The incidence of coronary anomalies in patients undergoing coronary angiography is less than 1%. The greatest challenges faced in the management are delays in identification and difficulty engaging the anomalous coronary artery. Operator experience in promptly identifying the anomaly and selection of the appropriate catheter is critical for successful intervention. We are presenting a case of acute inferior and posterior wall myocardial infarction (MI) with an anomalous origin of the left circumflex artery from the right coronary sinus. Learning objective is that percutaneous coronary intervention (PCI) in an anomalous left circumflex can be technically difficult because selective cannulation of the vessel may not be easy. An anomalous left circumflex artery has a rare presentation of ST-elevation myocardial infarction (STEMI). Complicated STEMI with cardiogenic shock is not commonly seen in anomalous coronary artery origin from the right sinus. Percutaneous intervention in patients with STEMI with an anomalous left circumflex artery has a high risk and is technically challenging. J Med Cases. 2020;11(2):41-43 doi: https://doi.org/10.14740/jmc3429

Background: TB has been found to coexist with malnutrition among patients at diagnosis in both developed and developing countries. Malnutrition is considered as an important risk factor for tuberculosis and it is also a common consequence of tuberculosis. Aims: To estimate the proportion of malnutrition among tuberculosis (TB) patients at diagnosis and to determine factors associated with malnutrition.Materials and methods: It's a Cross sectional study conducted in a slum under one of the Tuberculosis Units, of Malvani, Mumbai for the duration of 9 months in total 200 diagnosed tuberculosis patients fulfilling inclusion criteria. An interviewer administered schedule consisting of questions regarding their socio-demographic status, economic status, body mass index (BMI) and type of tuberculosis at diagnosis.All responses tabulated in Microsoft-Excel 2010 Software. Data is analysed using Epi data analysis Version 2.2.2 build 177.Results: The mean body mass index was 16.8 Kg/m2. Malnourished patients were 79%, including 35% having severe thinness (

Background/aimsTo evaluate the corneal endothelial changes in patients with alcohol dependence syndrome (ADS).MethodsA total of 322 corneas of 322 subjects were studied, and two groups were formed. The first, the ADS group, included 161 corneas of 161 patients and the second, the age-matched control group, was composed of 161 corneas of 161 healthy subjects. Both the groups were examined by specular microscope and the endothelial parameters were compared. The endothelial parameters were also compared before and after the abstinence of alcohol in the former group. The ADS group was further analysed to assess the influence of life time alcohol consumption, years/pattern of drinking, levels of Liver enzymes, levels of mean corpuscular volume, screening questionnaires and stages of fatty liver on corneal endothelium.ResultsOn comparing the two groups using Mann-Whitney U test, a significant difference was found in central corneal thickness (CCT) and endothelial cell density (CD) between the ADS (CCT: 529±29 µm, CD: 2571±236 cells/mm2) and control groups (CCT: 510±32 µm, CD: 2752±291 cells/mm2) (PConclusionsCorneal endothelial alteration is present in patients with ADS, more marked in patients with an increase in stage of fatty liver.

Thirty-two years old male patient presented with four day history of mild redness, pain and blurring of vision of the left eye. He gave history of similar episode 4-5 months back and it subsided with treatment. Visual acuity on presentation was 6/6 RE and 5/60 → 6/12 with -1.5 DSph/-2.75 D Cyl at 110o (left eye). Anterior segment was normal in the right eye. In the left eye, fine keratic precipitates on cornea and trace anterior chamber cells and flare were noted. Pigments were seen on anterior capsule of lens. Dilated fundus examination revealed a normal appearing disc with no cup in right eye and pale disc with C:D ratio 0.8 with a thin neuro-retinal rim in the left eye. Colour vision was normal. Intraocular pressure (IOP) was 14 and 35 mm Hg by applanation in the right and left eyes, respectively. On gonioscopy ciliary body band was visible for 360 degree without any peripheral anterior synechiae or inflammatory deposits. Automated perimetry revealed full visual field in the right eye and a dense scotoma with central island of field in the left eye. He was treated with oral and topical antiglaucoma medications along with topical steroids. On follow up, his vision was 6/6 (right eye) and 6/12 (left eye) with IOP of 12 and 16 mm Hg.

This study investigated the effect of dietary supplemented synthetic, and shrimp shell meal (SSM) derived natural astaxanthin combination on growth, digestive and metabolic enzyme activities, antioxidative status, physio-metabolic responses, and skin colouration of high valued discus (Symphysodon aequifasciatus) advanced juveniles reared in captive condition. Four isonitrogenous (50 % crude protein), isolipidic (9% ether extract), and isocaloric (around 400 kcal digestible energy/100 g) experimental diets viz. Control (only synthetic astaxanthin, without SSM), T1 (15 % SSM + synthetic astaxanthin), T2 (20 % SSM + synthetic astaxanthin), T3 (25 % SSM + synthetic astaxanthin) were prepared and fed to satiation level twice daily for 90 days. Results indicated significantly (P

Carotenoprotein, a complex of carotenoids and protein, extracted from shrimp shell waste can be an effective source of carotenoid as well as antioxidant in fish diets. In the present study, the nutritional potential of carotenoprotein extracted from shell wastes of Parapeneopsis stylifera on growth, physiometabolic changes and coloration in high-value ornamental fish, oscar (Astronotus ocellatus) was assessed in a 120 days feeding trial. Four iso‑nitrogenous (30–31% CP) and isolipidic (11.34–11.55% CL) diets were formulated with graded levels of carotenoprotein inclusion like 0%, 5%, 10% and 15% and designated as Control, T1, T2 and T3 respectively. At the end of the feeding trial, growth indices such as final body weight, weight gain, and specific growth rate indicated that fish fed with 10 and 15% levels of carotenoprotein incorporated diet showed higher growth compared to control and T1. Oxidative stress enzymes like SOD and Catalase were lower in 15% and 10% carotenoprotein incorporated diets respectively in both gills and liver. Stress indicators like serum glucose and cortisol activity were found to be higher in control than in diets with 10% (T2) as well as 15% (T3), suggesting the stress-reducing ability of the carotenoprotein in fish feed. Relatively higher respiratory burst activity in fishes of T3 group indicated higher immunity status of the fish. Quantitative colour values in terms of redness, chroma in the fin region as well as carotenoid content in scale, skin and muscle of fish were higher in T2 (10% carotenoprotein incorporated diet) as compared to T3 (15% carotenoprotein incorporated diet). Overall, this study clearly showed that dietary incorporation of as little as 10% carotenoprotein is advisable to ornamental fish farmers for enhanced growth, colouration, as well as antioxidant activity in this popular high value ornamental fish for maximizing their profit.

PURPOSE To evaluate the corneal endothelial changes in patients with chronic renal failure. METHODS A total of 128 corneas of 128 subjects were studied, and 3 groups were formed. The first, the dialyzed group, composed of 32 corneas of 32 patients; the second, the nondialyzed group, composed of 34 corneas of 34 patients; and the third, the age-matched control group, composed of 64 corneas of 64 healthy subjects were examined by a specular microscope and the endothelial parameters were compared. The dialyzed group (enhanced level of toxins in the blood) was further analyzed to assess the influence of blood urea, serum creatinine, serum calcium, and serum phosphorus including the duration of dialysis on corneal endothelium. RESULTS On comparing the 3 groups using analysis of variance and posthoc tests, a significant difference was found in the central corneal thickness (CCT) and endothelial cell density (CD) between the control (CCT: 506 ± 29 μm, CD: 2760 ± 304 cells/mm) and dialyzed groups (CCT: 549 ± 30 μm, CD: 2337 ± 324 cells/mm) [P < 0.001 (CCT); P < 0.001 (CD)]; control and nondialyzed groups (CCT: 524 ± 27 μm, CD: 2574 ± 260 cells/mm) [P = 0.023 (CCT); P = 0.016 (CD)]; and dialyzed and nondialyzed groups [P = 0.002 (CCT); P = 0.007 (CD)]. Using the linear generalized model, a significant correlation was found between the endothelial parameters and blood urea only [P = 0.006 (CCT), 0.002 (coefficient of variation), 0.022 (CD), and 0.026 (percentage of hexagonality)], although the correlation was poorly positive for CCT but poorly negative for the remaining endothelial parameters. CONCLUSIONS Corneal endothelial alteration is present in patients with chronic renal failure, more marked in patients undergoing hemodialysis and with raised blood urea level.

Background Retinopathy of prematurity (ROP) is a preventable cause of childhood blindness. Without treatment, over 45% of eyes can develop permanent visual loss. Hyperglycaemia has recently been described as a risk factor for the development of retinopathy of prematurity (ROP), a proliferative vascular disease of the retina that primarily affects premature infants. The characteristic neoproliferative growth of blood vessels in the retina is very well under stood with the clinical and experimental experiences with Diabetic retinopathy. The purpose of this study was to evaluate a possible relation between glucose levels in VLBW (Very Low Birth Weight) infants and development of ROP. Method All at risk infants of a Neonatal Intensive Care Unit (NICU) of a tertiary care centre in western India were included in the study. The blood sugar values of the neonates were recorded at multiple times during their first week of life. On completion of 31 weeks of gestational age or 04 weeks of birth age, the neonates were subjected to ROP screening as per standard protocols. Result A total of 103 neonates were included in the study and were subjected to ROP screening. A total of 32 neonates developed ROP at the end of the study. It was found with statistical significance that the neonates with higher average blood glucose values in the initial period of life had higher incidence of ROP at the time of screening with a Relative Risk of 2.506 (CI = 1.287, 4.882). Conclusion A high average blood glucose level in neonates during the first week of life is an indicator for developing ROP at a later date. These neonates should be kept under close follow up in order to facilitate timely detection and prompt intervention.

Risk taking is the foundation of business activity. Quantifying it in an accurate manner such that the magnitude, impact, and point in time effect is recognized financially is critical for efficiency in business. Both unhedged and mispriced risk, while opposites in terms of the cost of doing business, have similar effects of loss of capital for the entire community an entity operates with. In this paper, we examine the list of known risks which need to firewalled against for a business to survive as well as thrive. Costing risks and derivatives in a similar manner allows for representing the health of a business in relation to its impact in the reassuringly standardized form of a balance sheet.

Sudden onset myopia is seen in several local or systemic conditions.1 Local conditions include blunt ocular trauma and ocular inflammation. Systemic conditions include diabetes, pregnancy and certain drugs like hydrochlorothiazide and topiramate.1 However Systemic Lupus Erythematosus (SLE) as a cause of transient myopia is so rare that it has not been reported in these articles. Neither has sudden onset transient myopia been included in the ocular manifestations of SLE.2, 3 A case of SLE which presented with acute myopia is presented herewith.

Purpose: To compare Endothelial cell(EC) loss following Phacoemulsification (PKE) in pupils of different sizes. Methods: A prospective double masked observational study in which a total of 150 eyes of 150 patients between 50 & 70 years of age with senile cataract of nuclear sclerosis grade II were enrolled. Patients were allocated into three groups of 50 eyes each in Group A (pupil size 7 mm). Pupillary size was measured by determining the height of slit on slit-lamp biomicroscope examination. PKE was done by the same expert surgeon using vertical chop technique and a foldable intraocular lens was implanted in the capsular bag. Corneal EC count and pachymetry were performed twice and average of 2 readings was taken for the purpose of this study. Measurements were taken preoperatively and postoperatively on day 1, day 7 and day 30. Results: The mean EC count loss on postoperative day 1 in Group A was 19.45%, Group B 14.89%, Group C 10.19% with statistical significant difference between Group A and Group B, as also Group A and Group C. The difference was not significant between Group B and Group C, though there was a fall in EC count in Group C as well. Increase in corneal thickness on postoperative day 1 in group A was 5.43%, Group B 3.55%, Group C 2.14% with statistical significant difference between Group A and Group B, as also Group A and Group C with no difference in Group B and Group C. Conclusion: PKE done in eyes with maximal pupillary dilatation of 5 mm at the end of one month.

Background The donor lenticule insertion techniques play a crucial role in outcomes following descemet stripping endothelial keratoplasty (DSEK) and the current study is aimed to compare two of the commonly performed donor lenticule insertion techniques in DSEK. Method Descemet stripping endothelial keratoplasty was performed in 48 eyes of 48 patients at two tertiary eye care centers from January 2014 to December 2016. At one center (Group 1), 26 patients had Sheets glide-assisted lenticule insertion whereas at other center (Group 2), 22 patients had Busin glide-assisted insertion of donor lenticule. Best corrected visual acuity (BCVA), manifest spherical equivalent, manifest cylinder, endothelial cell density (ECD) and percentage of endothelial cell loss (ECL) were compared between the two groups at 6 months after DSEK. In addition, intraopertaive and postoperative complications were also compared. Results At 6 months after DSEK, an insignificant difference was observed in BCVA [Group 1: 0.48 logarithm of the minimum angle of resolution (log MAR); Group 2: 0.50 log MAR (p = 0.74)], mean manifest spherical equivalent [Group 1: 0.64 diopter (D); Group 2: 0.59 D (p = 0.74)], mean manifest cylinder [Group 1: 1.35 D; Group 2: 1.32 D (p = 0.92)] and mean ECL [Group 1: 26.75%; Group 2: 28.76 (p = 0.44)] between the two groups. In addition, the rate of complications is similar between the two groups. Conclusions Both Sheets glide-assisted and Busin glide-assisted donor lenticule insertion techniques are associated with similar surgical outcomes after DSEK.

Introduction: India is presently facing an epidemic of diabetes mellitus and the risks of chronic complications from the disease are associated with the duration of the disease as well as the degree of hyperglycaemia. Diabetic retinopathy is a known microvascular complication of diabetes mellitus and is the most common cause of blindness in the western countries. Apolipoproteins are the protein component of lipoproteins. Apart from acting as structural proteins, they also act as cofactors to various enzymes. Aim: To measure the levels of serum apolipoproteins and glycated haemoglobin in cases of diabetic retinopathy and to assess their association with the stages of diabetic retinopathy. Material and Methods: The 135 diabetic cases [with (110) and without (125) retinopathy] attending the Ophthalmology OPD of this tertiary care hospital were included in the present study. Following retinoscopy, the patients were classified as Non-Proliferative Diabetic Retinopathy (NPDR) (n=75) and Proliferative Diabetic Retinopathy (PDR) (n=35). The controls (n=100) were age and sex matched patients who did not have diabetes. The cases and controls were assessed for HbA1c, total cholesterol, triglycerides, HDL cholesterol, Apo A-I and Apo B-100. Results: The HbA1c was found to be higher in diabetics without retinopathy (7.02%) as compared to controls (5.58%) (p

Carotenoproteins from four different shrimp shell wastes Penaeus monodon, Parapenaeopsis stylifera, Metapenaeus affinis and Nematopalemon tenuipes were extracted with the aid of papain enzyme and characterized by their protein, amino acid and carotenoid content of the shell wastes and the antioxidant activities like DPPH, FRAP, ABTS radical scavenging activity and reducing power assay of the carotenoprotein. Higher protein content of 9.8 g 100 g−1 and 9.2 g 100 g−1 was recovered from shell waste of Penaeus monodon and Parapenaeopsis stylifera respectively along with highest carotenoid content of 114 ± 0.02 μg g−1 in Parapenaeopsis stylifera followed by 100.6 ± 0.02 μg g−1 from the shell waste of Metapenaeus affinis. Highest antioxidant activity was found in the carotenoprotein extracted from the shell waste of P. stylifera which suggest that the antioxidant activity of carotenoids followed a concentration dependent pattern. The amino acid profile showed that carotenoprotein is a rich source of essential amino acids such as glutamic acid, aspartic acid, lysine and leucine. Among shell wastes, P.stylifera shell waste was calculated to be superior as it contained higher amount of essential amino acids and exhibited higher antioxidant activity in terms of protein, carotenoid as well as radical scavenging and reducing power and it could serve as a supplementary nutritive feed ingredient in animal diets. This would help in utilization of crustacean (shrimp) shell waste for formulating low cost feed for ornamental fish and also encourage shrimp processing industries to utilize of the same in order to control pollution of land and water.

Our aim primarily was to compare the recurrence rate with three techniques of conjunctival fixation (suture versus fibrin glue versus autologous in situ blood coagulum) over bare sclera following pterygium excision. Ninety eyes of 90 patients with primary pterygium were randomly divided into three groups: group I (30 eyes) underwent autografting and fixation with 8-0 vicryl sutures, group II (30 eyes) with fibrin glue and group III (30 eyes) with autologous in situ blood coagulum. The patients were reviewed on 2nd day, weeks 1 and 4, and at every 3 months till 12 months after surgery. Rate of recurrence was similar (p = 0.585) across the three groups. Time taken for surgery for Group 1 was more as compared to group 2 (p < 0.001) and group 3 (p < 0.001). Also, group 2 cases took significantly more time as compared to group 3 (p < 0.001). Postoperative patient discomfort (foreign body sensation, epiphora, pain and irritation) was more in suture-assisted autografting as compared to the other two groups. However, at some points along the time line, patient discomfort was significantly more in group III as compared to group II. Complications like graft retraction, graft displacement and cyst formation were seen in a few patients but were not statistically significant across the three groups. All three techniques were found to be useful methods and were associated with similar rate of recurrence.

The prevalence of obesity (body mass index >30) is increasing in both the developed and developing countries. In India, the prevalence of overweight individuals is reported from 20-40% in various studies with over 5-10% being obese [1, 2]. Obesity is associated with increased mortality and morbidity. Direct association between obesity and several diseases, including diabetes mellitus, hypertension, coronary artery disease, obstructive sleep apnoea, gastroesophageal reflux disease, osteoarthritis and various malignancies is well recognized. In addition to increased risk of coronary artery disease, obesity is associated with heart failure, sharing a complex relationship [3]. In the Framingham Study, almost 6000 individuals without a history of heart failure (mean age 55 years) were followed for a mean of 14 years. The risk of developing heart failure was two-fold higher in obese individuals, as compared to the subjects with a normal body mass index (BMI). Individuals with obesity have a form of cardiomyopathy attributed to chronic volume overload, characterized by left ventricular dilatation, increased left ventricular wall stress and compensatory left ventricular hypertrophy. Most studies have reported abnormal diastolic function without abnormal systolic function. Does presence of left ventricular (LV) dysfunction translate into a bad prognosis? Reports involving stable outpatients suggest that obesity is associated with improved survival after the development of heart failure. This finding is paradoxical because obesity increases the risk and worsens the prognosis of other cardiovascular diseases. This is called the obesity paradox [4]. In this issue, Chadha et al have analysed the impact of BMI on LV function [5]. In this cross sectional study of 51 overweight/obese and 25 normal individuals, various echocardiographic parameters of systolic and diastolic dysfunction were studied. Subclinical LV diastolic dysfunction was found in all grades of obesity that correlated with the BMI. The authors have defined obesity on the basis of BMI alone. However the Asian Indian phenotype implies higher percentage body fat and abdominal adiposity at lower or similar BMI levels as compared to white Caucasians. Even “non obese” Indians have higher abdominal obesity and use of various anthropometric parameters like waist hip ratio and waist circumference might have been better predictors [6]. The definition of overweight and obesity in the present study is based on western recommendations while more stringent cut off points of anthropometric parameters are emerging for Indian population [7]. The duration of obesity is also an important factor and has not been looked into. Limitations notwithstanding, the study highlights the presence of LV dysfunction amongst overweight and obese individuals. Most importantly, to the long list of illnesses that are predisposed to by obesity, we have an addition in the form of heart failure. We have one additional reason to shed weight by a judicious combination of diet and exercises.

Cavernous sinus thrombosis (CST) is a life-threatening entity with a high rate of mortality and lifelong morbidity. A strong clinical suspicion of the complication, early radiological detection and institution of timely, aggressive treatment are required to prevent permanent neurological disability. We present a 12-year-old girl with bilateral CST following unilateral pansinusitis. Clinical symptoms of headache and retro-orbital pain out of proportion to clinical signs on presentation prompted a suspicion of something beyond sinusitis and raised the clinical suspicion of cavernous sinus involvement. In spite of institution of an early medical treatment, she progressed to develop bilateral cranial nerve paresis. However, with the persistence of antibiotics and anticoagulation therapy, she was successfully managed with no residual neurological sequelae. The aim of this presentation is to highlight the grave consequences of cavernous sinus involvement following infections of paranasal sinus and the rare complete recovery from disability in this case.