An ophthalmology professionalism survey tool: outcomes from a multi-center study in Central India.

Purpose: To describe a professionalism survey tool and its use to assess knowledge of medical professionalism in ophthalmology training programs in Central India. Settings and Design: Multi-center survey study. Methods: A validated 33-question, scenario-based survey addressing professionalism attributes was administered at five centers in central India. The attributes tested included "personal characteristics," "physician-patient relationships," "workplace practice and relationships," and "socially responsible behaviors." A mean attribute score (%) was calculated and compared to "gold standard" responses by a group of expert senior ophthalmologists (100% agreement for responses). Results: A total of 225 participants completed the survey; 124 residents, 47 fellows, and 54 consultants (98.4% response rate). The total mean attribute score was 80.7 ± 9.1 (min 16.67, max 100). There was variation in the mean attribute score by professionalism attribute (P < 0.001), and a trend toward higher mean attribute scores for consultants compared to trainees across all attribute groups. The scores for "personal characteristics" (93 ± 9.7) and "physician-patient relationship" (82 ± 15.8) were the highest, whereas scores for "socially responsible behaviors" (73.9 ± 18.6) and "workplace practices" were low (72 ± 13). Conclusions: There is a generally high level of professionalism knowledge among ophthalmologists in central India. The results suggest that experience does impact knowledge of professionalism. Potential for improvement in professionalism exists in around "workplace practices", and around "socially responsible behaviors". These findings may serve as a valuable discussion starter and teaching tool to enhance professionalism in ophthalmology training programs.

Evaluation of complications and visual outcome in various nucleus delivery techniques of manual small incision cataract surgery.

Purpose: To evaluate various methods of nucleus delivery in manual small incision cataract surgery, with reference to visual outcome, intraoperative, and postoperative complications. Methods: In this prospective randomized interventional study, five groups of 40 cases each were constituted, with reference to nucleus delivery technique: (a) phacosandwich, (b) fishhook, (c) irrigating vectis, (d) viscoexpression, and (e) anterior chamber maintainer (ACM). Visual outcome, intraoperative, and postoperative complications were evaluated in detail. Follow-up was done on first and seventh postoperative days (PODs) and then at fourth and eighth postoperative weeks. Results: The most common intraoperative complication was intraoperative miosis, followed by intraoperative hyphema, seen more in phacosandwich and irrigating vectis groups. The most common postoperative complication was striate keratopathy followed by transient postoperative corneal edema and AC inflammatory response, seen more in phacosandwich and fishhook groups. With reference to visual acuity, on the first POD 95% cases of ACM group achieved visual acuity >+0.5 logMAR unit. The difference in the visual outcome among groups was statistically significant. On fourth and eighth postoperative weeks, best-corrected visual acuity among various groups was comparable. Conclusion: ACM and viscoexpression are effective techniques for early visual rehabilitation. Fishhook has limited utility in softer nuclear grades and black cataracts. Phacosandwich is more suitable for nuclear sclerosis Grades 3-4. Irrigating vectis, viscoexpression, and ACM technique are effective techniques for all grades of nucleus Postoperative surgical-induced astigmatism was comparable in all techniques.

The Effect of Preoperative Weight Loss before Gastric Bypass: A Systematic Review.

Background. Many insurance companies require obese patients to lose weight prior to gastric bypass. From a previous study by the same authors, preoperative weight at surgery is strongly predictive of weight loss up to one year after surgery. This review aims to determine whether preoperative weight loss is also correlated with weight loss up to one year after surgery. Methods. Of the 186 results screened using PubMed, 12 studies were identified. A meta-analysis was performed to further classify studies (A class, B class, regression, and rejected). Results. Of all 12 studies, one met the criteria for A class, six were B class, four were regression, and one was rejected. Six studies supported our hypothesis, five were inconclusive, and no study refuted. Conclusions. Preoperative weight loss is additive to postsurgery weight loss as predicted from the weight at the time of surgery.

Cardiovascular actions of selective estrogen receptor modulators and phytoestrogens.

Cardiovascular disease is the leading cause of death among men and women in Western societies. Over the past decade, interest in a better understanding of gender differences in cardiovascular disease has heightened. Concomitantly, the use of hormone therapy for cardiovascular risk reduction in postmenopausal women has come into question in light of recent landmark clinical studies casting doubt on the benefits of this therapy. As a consequence, alternatives to conventional hormone replacement, including selective estrogen receptor modulators and phytoestrogens, have attracted considerable attention. The authors provide an up-to-date review of the clinical actions of selective estrogen receptor modulators on cardiovascular disease. The actions of tamoxifen, raloxifene, droloxifene, and soy phytoestrogens are discussed in the context of cardiovascular disease epidemiology, coronary events, clinical markers of cardiovascular risk, and vascular function. In addition, the authors' current understanding of the mechanism of action of these agents is discussed and recommendations for clinical practice are reviewed.

Soy protein with isoflavones has favorable effects on endothelial function that are independent of lipid and antioxidant effects in healthy postmenopausal women.

BACKGROUND: Controversy exists about the ability of soy protein and isoflavones to modulate vascular reactivity and biochemical cardiovascular disease risk markers in healthy, normolipidemic postmenopausal women. OBJECTIVE: The objective was to investigate whether the consumption of soy protein with isoflavones would result in improved vascular reactivity and decreased biochemical markers of endothelial dysfunction and inflammation, independent of enhanced lipid and antioxidant effects. DESIGN: Healthy postmenopausal women (n = 28) were enrolled in a randomized, double-blind, crossover study, and they consumed 25 g of 3 protein products/d for 6 wk each, with intervening washout periods. The products were isolated soy protein with isoflavones, ethanol-washed isolated soy protein with trace isoflavones, and total milk protein, which supplied 107, 2, and 0 mg total isoflavone (aglycone) units/d, respectively. We studied vascular function by using brachial artery reactivity values, plasma concentrations of vasoactive factors, endothelial inflammatory markers, and plasma isoflavone concentrations. The resistance of whole plasma and isolated LDL to copper-mediated oxidation was measured by conjugated diene formation. RESULTS: Postocclusion peak flow velocity of the brachial artery was significantly (P = 0.03) lower after treatment with isolated soy protein with isoflavones, which is consistent with a vasodilatory response, than after treatment with total milk protein. Plasma isoflavones and metabolites were significantly (P < 0.01) higher after treatment with isolated soy protein with isoflavones. There were no significant changes in biochemical cardiovascular disease risk markers or conjugated diene formation between the 3 dietary groups. CONCLUSION: Daily consumption of soy protein with isoflavones can result in positive vascular effects that are independent of lipid and antioxidant effects in healthy postmenopausal women.

Unusual presentation of an acute inferior myocardial infarction.

There is a paucity of data on pseudoaneurysms of native coronary arteries; however, several reports exist on coronary artery aneurysms, which occur in approximately 1.5% of patients studied at autopsy or during cardiac catheterization. Patients can present with a wide range of symptoms from asymptomatic to sudden death. Complications include angina, myocardial infarction, fistula formation, spontaneous rupture, and distal embolization as a result of thrombus formation within the aneurysm. Treatment options include surgical ligation with coronary artery bypass surgery and implantation of a covered stent. Coronary anomalies and nonatherosclerotic coronary artery diseases should be suspected when a young patient presents with a myocardial infarction. Additionally, coronary aneurysm or pseudoaneurysm should be considered in patients with connective tissue disorder or the suggestion of connective tissue disorder. These entities may present as masses radiographically or echocardiographically. A high clinical suspicion is required for appropriate diagnosis and treatment.