Doppler evaluation of ocular vessels in patients with primary open angle glaucoma.

PURPOSE: To assess ocular blood flow in patients with primary open angle glaucoma (POAG) with or without progressive visual field loss in comparison with controls. METHODS: Color Doppler imaging was performed on 78 eyes with established POAG (25 with progressive visual field loss and 53 with stable visual field) and 78 control eyes. Peak systolic velocity, end diastolic velocity (EDV), and resistance index (RI) were measured in the ophthalmic (OA), central-retinal, and medial and lateral posterior ciliary arteries. RESULTS: Peak systolic velocity and EDV were lower and RI was higher in the ocular vessels of eyes with POAG (p < .01). The OA and medial posterior ciliary arteries RI was higher, and the OA EDV was lower in glaucomatous eyes with progressive than with stable visual field loss. The receiver operating characteristic curve showed the optimal cutoff RI to be 0.847. CONCLUSIONS: Ocular blood flow appears compromised in eyes with POAG, particularly in those with progressive visual field loss.

Depression, Anxiety, Stress and Workplace Stressors among Nurses in Tertiary Health Care Settings.

BACKGROUND: Chronic job stress adversely impacts both mental health of nurses and patient care. There is paucity of data regarding workplace stressors and negative emotions among nurses. AIMS: To assess depression, anxiety and stress among nurses and analyse their association with workplace stressors. SETTINGS AND DESIGN: A hospital based cross-sectional study was conducted in two tertiary care hospitals. METHODS AND MATERIAL: Four hundred and thirty one nurses completed nurses rated depression, Anxiety and Stress instrument (DASS-21) and a questionnaire probing perceived workplace stressors on a 4 point Likert scale . The stressors across subgroups of workareas were compared. SATISTICAL ANALYSIS: Association between stress, anxiety or depression and workplace stressors were analysed using binary logistic regression. RESULTS: 50.8% of nurses had stress; 74% had anxiety; 70.8% had depression. 79.1% had at least one of them. Stressed, anxious or depressed nurses were more concerned about lack of job satisfaction and conflicts with supervisors. Work-place stressors varied with work areas: private hospital, no job satisfaction, conflicts with doctors and patients; government hospital, acquiring infectious diseases; ICUs, inadequate salary; non-ICUs, odour and sounds in workplace and conflicts with patients. CONCLUSIONS: Prevalence of depression, anxiety and stress was high. Workplace stressors varied across different working areas. Interventions need are to be tailored accordingly.

Comparison of pituitary stalk angle, inter-neural angle and optic tract angle in relation to optic chiasm location on 3-dimensional magnetic resonance imaging.

Optic chiasm location is critical in sellar surgeries and may be obscured by tumor invasion. This study evaluates inter-neural angle, pituitary stalk angle, optic tract angle in prefixed, normal and post fixed optic chiasms using 3-dimensional constructive interface in steady state (CISS) sequences of magnetic resonance imaging (MRI) in essentially normal studies. MRI Brain studies of 154 patients were retrospectively evaluated. Location and height of optic chiasm was noted. Interneural angle between intracranial segments of bilateral optic nerves, pituitary stalk angle between pituitary stalk and optic chiasm, optic tract angle between optic tracts were measured and compared in prefixed, normal and post fixed chiasms using ANOVA test. Optic chiasm was prefixed in 33 (21.4%) cases, normal in 111 (72.1%) cases and postfixed in 10 (6.5%) cases with mean height of optic chiasm of 3.33 mm. There was no statistically significant difference in height and type of optic chiasm between age groups and genders. Statistically significant difference between location of optic chiasm was seen with interneural angle (p = 0.013), was highly significant with pituitary stalk angle (p < 0.001) and was not seen in optic tract angle (p = 0.455). Optic chiasm location was divided into nine groups with frequency being highest in intermediate height, normal fixed chiasms (n = 62, 40.26%) and least in post fixed high, post fixed low groups (n = 1, 0.006%). A wider interneural angle, wider pituitary stalk angle with a more anteriorly placed stalk indicates a prefixed chiasm. 3-dimensional MRI is an effective tool in assessing the optic chiasm location, when its invaded by sellar and suprasellar tumours.

Surgically Relevant Bony Anatomical Variations in Paraclinoid Aneurysms-Three-Dimensional Multi-Detector Row Computed Tomography-Based Study.

OBJECTIVE: To evaluate the proportion of surgically relevant anatomical variations such as caroticoclinoid foramen, interclinoid osseous bridge, and anterior clinoid pneumatization in patients with paraclinoid aneurysms based on computed tomography (CT) cerebral angiography studies. MATERIALS AND METHODS: Fifty-four CT cerebral angiography studies showing paraclinoid aneurysms involving the cavernous, clinoid, and supraclinoid internal carotid artery (ICA) were retrospectively evaluated. Source images were processed for three-dimensional reconstructions to evaluate the presence and type of caroticoclinoid foramen, interclinoid osseous bridge, and multiplanar reconstructions with bone algorithm to study the type of pneumatization. RESULTS: The study included 30 female and 24 male patients with mean age of 45.61 (10.47) years. Among the 108 sides studied in 54 patients, caroticoclinoid foramen was seen in 24 cases (22.22%), interclinoid osseous bridge was seen unilaterally in 1 case (0.9%), and pneumatization of anterior clinoid process occurred in 12 cases (11.11%). Incomplete caroticoclinoid foramen (11 cases) and Type I pneumatization (7 cases) were seen to be predominant subtypes. There was no statistically significant gender difference in the occurrence of caroticoclinoid foramen and anterior clinoid pneumatization. Seventy-four aneurysms were detected in 54 patients. Based on their location, 46 aneurysms involved supraclinoid ICA, 18 aneurysms in the clinoid segment, and 10 aneurysms in the cavernous segment. Caroticoclinoid foramen was most prevalent in clinoid aneurysms with 12 cases occurring in the clinoid segment. CONCLUSION: Notable proportions of caroticoclinoid foramen and pneumatization occur in cases of paraclinoid aneurysm. Radiological reports should emphasize on these surgically relevant bony anatomical variations.

Wine Glass Sign and Empty Delta Sign: A Rare Imaging Presentation of Postpartum Encephalopathy in Dehydration.

Rapid correction of hyponatremia is a well-known cause of central pontine and extrapontine myelinolysis. But uncommonly seen and rarely reported in Hypernatraemia. We report a rare case presenting as postpartum psychosis, wherein imaging revealed myelinolysis of corticospinal tracts in wine glass distribution and empty delta sign due to cortical venous thrombosis. At follow-up 3 months later, revealed significant neurological improvement. Concurrance occurrence of this dual pathology is not been described, which in our case was due to high serum sodium levels at presentation and dehydration.

Optic Strut and Para-clinoid Region - Assessment by Multi-detector Computed Tomography with Multiplanar and 3 Dimensional Reconstructions.

PURPOSE: To evaluate thickness, location and orientation of optic strut and anterior clinoid process and variations in paraclinoid region, solely based on multidetector computed tomography (MDCT) images with multiplanar (MPR) and 3 dimensional (3D) reconstructions, among Indian population. MATERIALS AND METHODS: Ninety five CT scans of head and paranasal sinuses patients were retrospectively evaluated with MPR and 3D reconstructions to assess optic strut thickness, angle and location, variations like pneumatisation, carotico-clinoid foramen and inter-clinoid osseous ridge. RESULTS: Mean optic strut thickness was 3.64mm (±0.64), optic strut angle was 42.67 (±6.16) degrees. Mean width and length of anterior clinoid process were 10.65mm (±0.79) and 11.20mm (±0.95) respectively. Optic strut attachment to sphenoid body was predominantly sulcal as in 52 cases (54.74%) and was most frequently attached to anterior 2/5(th) of anterior clinoid process, seen in 93 sides (48.95%). Pneumatisation of optic strut occurred in 23 sides. Carotico-clinoid foramen was observed in 42 cases (22.11%), complete foramen in 10 cases (5.26%), incomplete foramen in 24 cases (12.63%) and contact type in 8 cases (4.21%). Inter-clinoid osseous bridge was seen unilaterally in 4 cases. CONCLUSION: The study assesses morphometric features and anatomical variations of paraclinoid region using MDCT 3D and multiplanar reconstructions in Indian population.