Comparison of stereoacuity in patients of anisometropia, isometropia and emmetropia

Purpose: To compare the stereoacuity in patients with anisometropia, isometropia, and emmetropia. Methods: A cross?sectional study was conducted on 1403 subjects (range: 5–45 years) divided into anisometropes (n = 403), isometropes (n = 500), and emmetropes (n = 500). There were 258 amblyopic eyes among anisometropes and 156 amblyopic eyes among isometropes. Stereoacuity was measured using the Titmus stereo test consisting of a combination of contour targets. Results: There were 675 males and 728 females. A significant (P < 0.001) reduction in stereoacuity was found in anisometropes as compared to isometropes and emmetropes. The stereoacuity was even worse in amblyopes as compared to non?amblyopes. Most patients with anisometropia of <3.0 D had fair stereoacuity. However, as the degree of anisometropia increased to >3.0 D, stereoacuity deteriorated gradually. Marked reduction of stereoacuity was observed in severe degree of anisometropia (>6.0 D). Overall, an anisometropia of ?2.12 D was associated with reduced stereoacuity. Among the anisometropes, it was found to be the poorest in myopia, followed by myopia with astigmatism, hypermetropia with astigmatism, and hypermetropia. Conclusion: The level of stereoacuity was worse in anisometropes as compared to isometropes and emmetropes. Amblyopes had a greater reduction in stereoacuity than non?amblyopes. Stereoacuity decreased as the degree of anisometropia increased. Among the anisometropes, myopes had worst stereoacuity than hypermetropes.

Retinal nerve fiber layer and ganglion cell complex thickness analysis in patients having relative afferent pupillary defect

Purpose: To determine the retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) thickness in patients having relative afferent pupillary defect (RAPD) measured by optical coherence tomography (OCT). Methods: This cross?sectional study was conducted on 30 patients with posterior segment disease and glaucoma presenting with RAPD. The control group comprised 30 patients with the aforementioned diseases without RAPD. RAPD was graded using neutral density filters placed over the unaffected eye. Peripapillary RNFL thickness and macular GCC were measured using the Cirrus HD?OCT machine. Results: There were 45 males and 15 females. There was a statistically significant (P < 0.05) difference in the mean of average RNFL thickness in patients having RAPD (64.73 ± 15.16 ?m in the affected eyes) as compared to sick control (82.73 ± 11.33 ?m in the affected eyes). It was further observed that there was a decrease in RNFL thickness with advancing grades of RAPD. There was a statistically significant (P < 0.05) difference in the mean of average GCC thickness in patients having RAPD (51.57 ± 14.96 ?m in the affected eyes) as compared to sick control (76.36 ± 8.06 ?m in the affected eyes). Conclusion: Our study suggests that there is a significant reduction in RNFL thickness and GCC thickness in RAPD patients as compared to the sick control group

Melanoma of anal canal

Melanomas are primarily tumours of the skin, but rarely occur at other sites like retina and anal canal. Anorectal melanoma is an uncommon condition associated with a very poor prognosis. The patient usually presents with per rectal bleed or mass. These are often misdiagnosed on presentation. Diagnosis is confirmed by biopsy. Treatment is abdominoperineal resection or wide local excision if tumour free margins can be obtained. We present a case of a 60 years old female who presented to the outpatient department with per rectal mass and bleed since 4 to 5 months and was diagnosed with melanoma anal canal on biopsy. CT scan abdomen and pelvis was done. Patient underwent abdominoperineal resection as wide local excision with sphincter saving was not possible due to the location and extent of tumour as seen on CT scan. Patient had an uneventful recovery after the procedure.

Occult papillary carcinoma of thyroid presenting as cervical lymphadenopathy in a young male: case report

Papillary carcinoma of thyroid accounts for 80% of all thyroid malignancies. They tend to have a female preponderance and present in the 4th to 5th decade of life, as a slow growing midline mass. Cervical metastases are common, blood borne being rare. We present a case of a 29 years old who presented with cervical lymphadenopathy that was secondary to an occult papillary carcinoma of thyroid. Patient underwent total thyroidectomy with bilateral neck node dissection for the same.

Adult idiopathic hypertrophic pyloric stenosis: an infrequent cause of gastric outlet obstruction

Hypertrophic pyloric stenosis is a congenital disease, presenting within two weeks of birth. However adult idiopathic hypertrophic pyloric stenosis (AIHPS) presents in middle age, predominantly in males and usually without any antecedent cause. Secondary variant may be due to intra gastric causes or extra gastric post-operative adhesions. Patient presents with symptoms of gastric outlet obstruction. Diagnosis depends on clinical, radiological and endoscopic findings. Treatment is subtotal gastrectomy. Pyloroplasty and endoscopic dilatation may be tried in debilitated patients. We present a case of AIHPS presenting as gastric outlet obstruction in a 16 year old female, that was surgically managed with an antrectomy.

Trichobezoars: a hairy cause of intestinal obstruction

Trichobezoars are an infrequent form of bezoar found in the stomach or intestine, created from ingested hair. Their most frequent location is in the stomach but they may extend through the pylorus into the small bowel. This condition is known as Rapunzel syndrome. Trichobezoar with Rapunzel syndrome is an uncommon diagnosis in children. Authors report 3 cases of Rapunzel syndrome with a large bezoar in paediatric age group that presented with features of acute intestinal obstruction. They were managed with surgical exploration.

Purple urine bag syndrome: an unusual clinical presentation

Purple Urine Bag Syndrome (PUBS) is a rare presentation of urinary tract infection caused by certain bacteria that produce sulphatases and phosphatases that bring about metabolism of tryptophan, leading to production of pigments indigo and indirubin that together impart purple colour of urine. It is a benign condition, most often associated with long term urinary catheterization, renal diseases, chronic constipation and female gender. Commonly implicated organisms include Proteus mirabilis, Klebsiella pneumoniae, Providencia stuartii. Diagnosis is made on urinary culture. Treatment includes reassurance and antibiotics for UTI. We present a case of purple urinary bag syndrome in a female patient of carcinoma stomach presenting with gastric outlet obstruction.

Hydatid cyst of broad ligament: a rare case report

Hydatid cyst is a parasitic disease caused by tapeworm Echinococcus. It affects the liver and lung most commonly, but may rarely affect fallopian tube, broad ligament and other structures. One such peculiar case is where a 17 years old female presented with a rapidly growing cystic mass in lower abdomen, clinically suspicious of ovarian mass or mesentric cyst. Investigations failed to identify the nature. On laparotomy, excision of the mass was done. Suprisingly histopathological examination identified the lesion as hydatid cyst arising from the broad ligament. Patient responded well to surgical excision followed by albendazole administration. Female genital tract hydatidosis is a rare entity and in most cases the involvement is secondary. Primary hydatid disease of female genital tract is even very rarer and generates considerable diagnostic difficulty.

Actinomycosis of male breast: a rare case report

Actinomyces is a commensal of gastrointestinal and genital tract that may cause subacute or chronic granulomatous inflammation. Primary actinomycosis of breast is an extremely rare disease. It may present as a mass or as discharging fistulae. It is often diagnosed after biopsy. It may mimic inflammatory carcinoma or mastitis. Treatment is with a prolonged course of antibiotic. Authors present a case of a 70-year-old male with a palpable breast lump, that was suspected to be malignant. Wide local excision was performed, histopathology confirmed the diagnosis of actinomycoses breast. Patient was given antibiotics post operatively.

Limberg flap for reconstruction after excision of multiple conglomerate epidermoid cysts

Epidermoid cysts are common, subepidermal, keratin containing nodules, found anywhere on the body in 3rd and 4th decade of life. Surgical treatment is by complete excision with wall of cyst intact. Author presents a 40-year-old male with multiple sebaceous cysts in close proximity to one another on his left thigh. Individual cyst excision would have lead to a difficult primary closure, need for multiple incisions, with contracture and poor cosmesis due to the close proximity of the cysts. instead, the cysts were excised in mass and limberg flap was used for reconstruction and primary closure. Patient was followed up for 6 months. The objective of this study was to prove that limberg flap yields superior cosmesis and healing by primary intention in reconstruction after excision of multiple epidermoid cysts.

A Prospective Analysis of Epidemiology and Outcome in Major Burns Patients at a Tertiary Burn Care Center in North India

The incidence of burn injuries varies from country to country. Burn trauma has been one of the most devastating health problems for all the times. It requires a treatment process including a multidisciplinary approach by experienced burn surgeons and health care professionals in a well-equipped burn unit or center. The aim of this study was to ascertain and analyze the epidemiology and outcome in major burns patients at our center. Methods: This prospective study was conducted at Department of Surgery, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi India from April 2017 to july 2019. A total of 627 patients were enrolled in study. The principal investigator obtained the variables of clinical histories from the admission records, case notes, operation details, anesthesia charts, and nursing monitoring charts. Help of a biostatistician was taken for data collection and analysis. The data collected were thoroughly cleaned and entered into MS-Excel spread sheets and analysis was carried out. Results: Patient in age group less than 15 yrs were 76 (12%), majority of the patients i.e. 514 (82%) were in age group between 15 and 45 years and only 37 patients(6%) were of age more than 45 years. Most common area of burn was the upper limb in our patients (39.78%), followed by head and neck (24.21%), lower limbs (26.49%) and anterior trunk (9.52%).Of the 627 patients, 167 patients (26.6%) had ARDS (Acute respiratory distress syndrome), 232 patients (37.0%) had septicemia, 465 patients (74.16%) had wound infection (as diagnosed by wound cultures), 123 patients (19.6%) had urinary tract infection, and 12 patients (1.9%) had clostridium difficile colitis. Total of 232(37%) patients died during their hospital stay. Discussion: Age and sex are essential elements of any epidemiological study.The age distribution seen in our study is in concordance with that seen in other studies . In our study 370/627 (59%) patients were males with a male to female ratio of about 1.5:1. Comparing data regarding the gender preponderance, our observations are in agreement with other authors. In our study most common area of burn was the upper limb in our patients (39.78%), followed by head and neck (24.21%), lower limbs (26.49%) and anterior trunk (9.52%). This finding of our study is similar to that of Sadeghi Bazargani et al. Conclusion: It is a well known fact that burns are serious but preventable accidents and without recognition of affecting factors we cannot plan any preventive program. Most victims of major burns come from poor, underdeveloped areas. These people have little formal education about burns and are either low skilled temporary workers or unemployed. So the knowledge of affecting factors in relation to demography and epidemiology of patients is a must for proper management of burn victims

A Study of Septorhinoplasty by Open Technique

Background: This study aimed to assess the reasons for which patients seek rhinoplasty, viz aesthetic, functional and psychosocial reasons. The study included 20 patients with traumatic, infective and congenital nasal deformities and were taken up for open septorhinoplasty. Methods: This study was carried out in the Department of Surgery at Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi. The duration of study was from April 2017 to May 2018. It was a prospective study. All the patients who underwent open septorhinoplasty were assessed for outcome using Alsarraf questionnaire. Other patient data including demographic data, comorbid conditions etc were considered. Results: After completion of surgeries patients were subjected to the questions of the questionnaire and final results were noted. Results were also assessed on the basis of comparative photographs, both taken pre and post operatively. Conclusions: Based on the conducted studies and after analysis of available literature, it may be concluded that functional and aesthetic results after open septorhinoplasty have an influence on quality of life of the patients. This study includes all the three aspects ie, aesthetic, functional and psychosocial, for which most of the patients seek rhinoplasty and the results of our study is comparable to various other studies.

Comparison of efficacy of buccal versus vaginal misoprostol in first trimester induced abortion

Background: To compare the effectiveness, side effects, and patient satisfaction of buccal versus vaginal misoprostol administration in first trimester abortions.Methods: Women opting for first trimester abortion received oral Mifepristone followed 48 hours latermisoprostol. Group A received Misoprostol via buccal route whereas group B received Misoprostol vaginally. A comparative analysis using SPSS was done.Results: Giving 800µg Misoprostol by either buccal or vaginal route after oral Mifepristone have comparable efficacy in terms of complete abortion rate (96% in buccal group versus 98% in vaginal group; p value = 0.495), failure rate being statistically similar (4% versus 2%). Drug abortion interval was comparable in the two groups. (11.16 hour in buccal group and 12.32 hours in vaginal group). Few side effects like nausea and vomiting, shivering, diarrohea was significantly higher with vaginal Misoprostol while abdominal cramps, altered taste were found more with the buccal group.Conclusions: Buccal Misoprostol is comfortable and easier to administer when compared to other routes and it has potential to be developed as a self-administered regimen. Buccal Misoprostol is as efficacious as vaginal Misoprostol with significantly lesser side effects up to 7 weeks of period of gestation.