Repeat deep anterior lamellar keratoplasty (DALK) for failed primary DALK

Purpose: To evaluate the effectiveness of repeat deep anterior lamellar keratoplasty (DALK) in patients of previous failed DALK. Methods: A retrospective analysis of records of seven patients who had undergone repeat DALK following the failure of the primary DALK was done. The indications for repeat surgery, time elapsed since the first surgery, and pre? & postoperative best?corrected visual acuity (BCVA) were noted for all the patients. Results: The follow?up period ranged between one? to four?year post repeat DALK. The indication of primary DALK was keratoconus with vernal keratoconjunctivitis (VKC) (n = 3), corneal amyloidosis (n = 2), Salzman nodular keratopathy (n = 1), and healed keratitis (n = 1). The need for repeat surgery arose when the BSCVA dropped to less than 20/200. The time interval elapsed since the first surgery ranged from two months to four years. Postoperatively, the BSCVA improved from 20/120 to 20/30 at the end of one?year post repeat DALK in all except one patient. All regrafts were clear at the most recent examination, performed after a mean period of 18 months after the secondary graft. No complication was encountered during the resurgery. The dissection of the host bed was easier in the second surgery owing to weaker adhesions. Conclusion: The prognosis for repeat DALK for failed DALK is excellent, and the outcomes of secondary grafts were comparable to those of primary DALK grafts. Re DALK offers the advantage of an easier dissection and lower chances of graft rejection compared to penetrating keratoplasty.

Assessment of zinc inadequacy among tribal adolescent population of central India - A cross-sectional study

Background & objectives: Zinc is a crucial micronutrient in adolescence, required for promoting growth and sexual maturation. Adolescents of some tribes may be at high risk of zinc deficiency due to dietary inadequacy and poor bioavailability of zinc from plant-based diets. This study aimed to evaluate the risk of zinc deficiency by estimating prevalence of inadequate zinc intake, prevalence of low serum zinc and stunting among tribal adolescents. Methods: A cross-sectional community-based survey was conducted among adolescents (10-19 yr) in three purposively selected districts where Bhil, Korku and Gond tribes were in majority. Structured data collection instrument comprising information about sociodemographic characteristics and dietary recall data was used. Anthropometric assessment was conducted by standardized weighing scales and anthropometry tapes, and blood sample was collected from antecubital vein into trace element-free vacutainers. Serum zinc was estimated using an atomic absorption spectrophotometer. Results: A total of 2310 households were approached for participation in the study, of which 2224 households having 5151 adolescents participated. Out of these enlisted adolescents, 4673 responded to dietary recall (90.7% response rate). Anthropometry of 2437 participants was carried out, and serum zinc was analyzed in 844 adolescents. The overall prevalence of dietary zinc inadequacy was 42.6 per cent [95% confidence interval (CI) 41.2 to 44.1] with reference to the estimated average requirement suggested by International Zinc Nutrition Consultative Group (IZiNCG) and 64.8 per cent (95% CI 63.4 to 66.2) with Indian Council of Medical Research-recommended requirements. Stunting was observed in 29 per cent (95% CI 27.2 to 30.8) participants. According to IZiNCG cut-offs, low serum zinc was detected in 57.5 per cent (95% CI 54.1 to 60.8) of adolescents, whereas it was 34.4 per cent (95% CI: 31.2-37.5) according to the national level cut-off. Interpretation & conclusions: Risk of dietary zinc inadequacy and low serum zinc concentration amongst adolescents of the Gond, Bhil and Korku tribes is a public health concern.

Otitis Media with Effusion in Children with Hearing Loss- A Hospital Based Retrospective Study

Otitis media with effusion is a salient disease and its clinical symptoms are not so obvious to be noticed by parents or even doctors. Therefore early diagnosis and treatment are important as hearing deprivation in children can have effect on linguistic development of child. Methods: This retrospective study was conducted on children with hearing loss aged between 3-15 years presenting to ENT OPD of SMGS Hospital, for a period of 1 year from. Total of 100 children were included. Detailed history aand complete ENT examination was done. PTA and Impendance Audiometry was done. Results: The mean age was 7 years with male: female ratio of 1.8: 1. Hearing loss which was the chief complaint. Other complaints were aural fullness (38%) followed by otalgia (29%), poor attention (17%) and poor acaedemic performance(16%).Higher prevalence in males(59%) of OME as compared to females. About 30% patients showed congested drum suggestive of acute suppurative otitis media. Other findings noted were dull drum (20%), air bubbles (6%) and air fluid level (8%) all were suggestive of otitis media with effusion.. Pure tone audiometry revealed moderate hearing loss in 59% patients of otitis media with effusion whereas it was mild in 14 patients.Impedance audiometry revealed B type graph in 85% patients. Conclusion: To prevent delayed diagnosis which leads to development of this disease, parents must be informed about the preventable risk factors and symptoms of otitis media with effusion.

Clinicopathological Study of Cancer Larynx

Background: In India, laryngeal cancer contributes to approximately 3–6% of all cancers in men.Objective: The aim of this study was to study the clinicopathology of cancer larynx with respect to age, sex, site, complaints,histology, staging, and predisposing factors.Materials and Methods: The study population consisted of 100 patients who were suffering from cancer larynx. A completeclinical history was taken from the patients. After the clinical diagnosis of growth larynx, the patients were prepared for directlaryngoscopy under general or local anesthesia. The lesions were visualized, the extent of growth defined, and biopsy taken andthen sent for histopathological examination. The staging of cancer larynx was done according to tumor, node, and metastasisclassification.Results: There were 80 male (80%) and 20 female (20%) patients. Maximum patients were in the age group of 51–60 years(40%). 54% showed supraglottic cancer, 45% had glottic cancer, and only 1% had subglottic cancer. In cases of supraglotticcancer, the most common complaint was difficulty in swallowing seen in all 54 patients; in cases of glottis cancer, the mostcommon complaint was hoarseness of voice seen in 88.88%. There was only 1 patient of subglottic cancer who presentedwith difficulty in swallowing and difficulty in breathing. Out of 100 cases, there were 99 cases of squamous cell carcinomawhereas there was only 1 case of adenocarcinoma. Out of total 100 patients, overall most common stage was Stage 2 (34%),followed by Stage 3 (25%), Stage 4a (16%), Stage 1 (15%), and Stage 4b (10%). Smoking was found to be the most commonpredisposing factor (92%), followed by alcohol intake (78%) and tobacco chewing (50%).Conclusion: Early diagnosis and treatment of laryngeal cancer is important to reduce the morbidity and mortality of patients.

Low Dose Ketamine in Labour Analgesia

Introduction: Ketamine is dissociative anaesthesia- acombination of profound analgesia with superficial sleep.This state is characterized by spontaneous ventilation, relativepreservation of airway reflexes and hemodynamic stability.The present study was designed to evaluate the efficacy ofprogrammed labour protocol in proving shorter, safer andrelatively pain free deliveries.Material and methods: This study was a randomised controltrial done in The Department of Obstetrics and Gynaecology,Rohailkhand Medical College and Hospital for a span of oneyear (October 2016 to September 2017).Result: In our study, the duration of labour, induction deliveryinterval was significantly reduced. Pain relief was excellent instudy group.Conclusion: Ketamine’s site of action appears to be primarilyin the thalamus and limbic systems, acting as N- methyl Daspartate receptor non- competitive antagonist. It does notsuppress respiratory drive unless high dosage are used, orsmall dosage given rapidly. Intravenous ketamine in low doseappears to be safe laternative to epidural analgesia.

Profile of urinary tract infections in paediatric patients.

Background & objectives: this cross-sectional study was conducted at a tertiary care centre in Puducherry, south India, with the aim of finding the profile of the paediatric urinary tract infection (UTI), bacterial pathogens involved, and also to observe vesicoureteric reflux (VUR) and renal scarring in these patients. Methods: A total of 524 paediatric patients ≤13 yr, suspected to have UTI, were included in the study. Urine samples were collected, processed for uropathogen isolation and antibiotic susceptibility test was performed as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Thirty two culture proven children with UTI underwent micturating cysto-urethrography (MCU) and dimercaptosuccinic acid (DMSA) scanning was done for 69 children. Results: of the 524 children, 186 (35.4%) had culture proven UTI with 105 (56.4%) being infants, 50 (27.4%) between 1-5 yr, 30 (16.12%) between 5-13 yr and 129 (69.35%) males. Posterior urethral valve (PUV) was noted in three, hydronephrosis in one, VUR in 18 and renal scarring in 33. VUR as well as renal scarring were more in males >1 yr of age. A significant association (P=0.0054) was noted with a combined sensitivity and specificity of these investigations being 83 and 90 per cent, respectively of the MCU and DMSA scans for detecting VUR. Escherichia coli was the most common pathogen isolated, sensitive to nitrofurantoin, followed by cefoperazone-sulbactam, aminoglycosides and meropenem. Interpretation & conclusions: Our results indicate that UTI varies with age and gender and extensive evaluation is required in boys under one year of age with UTI. This study also highlights the better efficacy of aminoglycosides, cefoperazone-sulbactam and nitrofurantoin in vitro compared with meropenem in gram-negative uropathogens.