Vacuum rhexis � A novel capsulorhexis technique for white cataracts

Capsulorhexis in white intumescent cataract is often associated with extension leading to radial tears or biradial extension 揂rgentinian flag sign� and associated complications. We describe a novel technique of managing this situation. Vacuum rhexis is performed with a 24 G bent cannula attached to a 10-ml syringe. The flap is lifted and then caught using 24 G cannula. The suction is manually controlled by the surgeon, and the rhexis is completed using circumferential movement. The chamber stability is well maintained as there is no leakage, and the bent tip gives excellent fulcrum for movement. The advantage of this technique is that a single port is used for maintaining the chamber stability and it needs no special surgical instruments. Vacuum rhexis is a novel surgical technique used for performing successful continuous curvilinear capsulorhexis (CCC) of adequate size in white and intumescent cataracts, with a consistent and predictable outcome.

Six-Minute Walk Test Outcomes in Patients with Diffuse Parenchymal Lung Disease

The 6-minute walk test (6MWT) is used to measure exercise capacity and assess prognosis in diffuse parenchymal lung disease (DPLD). Although the 6MWT is usually considered to be a test of submaximal exercise capacity in DPLD, the physiological load imposed by this test is not well described and 6MWT outcomes are poorly understood. This study aimed to compare cardiorespiratory responses to 6MWT in people with DPLD. Methods: An observational crosssectional study was carried out in a single tertiary care center in northern India which included 50 consecutive subjects (age >12 years) who had diffuse parenchymal lung diseases. In this study, the clinical, radiological and histological data subjects was collected. 6MWT was done of all the patients and results tabulated. Result: Desaturation on 6MWT (SPo2 <88% or fall of 4% from baseline) were seen in total of 33(66%) patients with most cases being IPF in which 17 patients (89.47%) out 19 cases showed desaturation. This was followed by NSIP with 4(67%) of of 6 cases and CTD-ILD having 7(53.8%) out of 13 cases showed desaturation. More studies are required from developing countries to ascertain the spectrum of DPLDs in different geographic. Conclusion: On average, the 6MWT elicits a high but submaximal oxygen uptake in people with DPLD. Fibrosis is associated with maximum destauration in 6MWT. However the physiological load varies between individuals, with higher peak VO2 in those with more severe disease that may match or exceed that achieved on CPET. The 6MWT is not always a test of submaximal exercise capacity in people with DPLD.

A Case of Asthma COPD Overlap

Asthma and COPD are the pulmonary diseases most frequently encountered in clinical practice. Usually, each disease is caused by a different etiology and shows a different clinical picture and course. However, these two diseases sometime present within the same patient, and it is now recognized that asthma and COPD can coexist as asthma COPD overlap (ACO), which is clinically important for several reasons. First, it is estimated that the number of patients with ACO will increase significantly together with the recent increase in numbers of patients with asthma and COPD. Secondly, patients with ACO are prone to experience more frequent and severe exacerbations. Patients who have asthma with a COPD component tend to present with severe hypoxia because of Irreversible/fixed airway obstruction and impairment of the alveolar diffusion capacity by emphysematous changes. In contrast, patients with COPD who have an asthma component not only have exertional dyspnea but also develop paroxysmal wheezing or dyspnea at night or in the early morning. Here we report a case of 60 yr old male diagnosed as a case of asthma COPD overlap.

To Determine the Percentage of Isoniazid Monoresistant Tubercular Mutations Via Kat G V/S INH A Genes

Some important challenges for TB control strategies include the increasing prevalence and rapid distribution of drug-resistant TB. Recently, this concern has been further intensified by reports of multi drug resistant (MDR) and extensively drug resistant-TB (XDR-TB). Although resistance to first and second line drugs poses the important risk to patients, resistance to isoniazid (INH) alone is also important. INH is the most potent anti-TB drug and is the main part of any first-line treatment regimen for TB. Our objective is to determine the percentage of isoniazid monoresistance mutations via Kat G v/s Inh A gene. Methods: We conducted a retrospective record review of 100 INH monoresistant TB patients without rifampicin resistance registered during Feb 2017 - March 2018. Results: Of the 100 INH monoresistant patients taken in a year, 82% were found to be resistant via Kat G gene and only 18% were found to be resistant for Inh A gene. Conclusion: In conclusion, our study showed increased prevalence of isoniazid resistance via Kat G gene mutation than with Inh A gene.