Natural Physiological Changes During Pregnancy.

Pregnancy causes physiological changes that support the growing fetus and get the mother ready for labor and delivery. Some of these modifications affect biochemical levels; they are normally stable, while others could imitate symptoms of illness. It is critical to distinguish between pathology associated with disease and typical physiological changes. This review article focuses on the significant changes that occur throughout a typical pregnancy.

Preoperative Ultrasonographic Evaluation of Subclavian Vein and Inferior Vena Cava for Predicting Hypotension Associated with Induction of General Anesthesia.

Introduction: Induction of general anesthesia is often associated with hypotension and is a common scenario faced by anesthesiologists. Intraoperative hypotension can have detrimental effects and cause various adverse effects leading to an extended hospital stay. Patients' preinduction volume status can have an effect on postinduction blood pressure. Ultrasonography is a useful tool for measuring intravascular volume status. We studied the ability of ultrasonographic measurement of subclavian vein (SCV) and inferior vena cava (IVC) diameter, collapsibility index (CI) to predict hypotension after induction of general anesthesia. Materials and Methods: We included 120 patients in our study. SCV measurements during spontaneous and deep inspiration and IVC measurements were taken before induction and postinduction blood pressure was monitored. Patients with mean arterial blood pressure <60 mmHg or with a 30% decrease from baseline were considered to be having hypotension. Results: The CI of IVC with a cutoff 37% showed sensitivity of 94% and specificity of 84% which was statistically significant. The CI of 36% of SCV during deep breathing was found to have high sensitivity and specificity of 90% and 87%. Conclusion: Our study in spontaneously breathing preoperative patients shows that SCV CI in deep breathing and IVC CI is very sensitive and reliable in predicting postinduction hypotension. Bedside ultrasound measurements can be easily done to obtain valuable information to recognize patients who could be at risk from postinduction hypotension.

Switching of majority charge carriers by Zn doping in NdNiO3 thin films.

We have studied the effects of Zn doping on the structural and electronic properties of epitaxial NdNiO3 thin films grown on single-crystal LaAlO3 (001) (LAO) substrates by pulsed laser deposition. The films are deposited in two sets, one with variation in Zn doping, and another with variation in thickness for undoped and 2% Zn doping. The experimental investigations show that Zn occupies Ni-site and that the films are grown with an in-plane compressive strain on LAO. All the films show metal-to-insulator transitions with a thermal hysteresis in the temperature-dependent resistivity curves except 5% Zn-doped film, which remains metallic. The theoretical fits show non-Fermi liquid behaviour, which gets influenced by Zn doping. The Hall resistance measurements clearly show that Zn doping causes injection of holes in the system which affects the electronic properties as follows: i) the metallic conduction increases by two factors just by 0.5% Zn doping whereas, 5% doping completely suppresses the insulating state, ii) a reversal of the sign of Hall coefficient of resistance is observed at low temperature.

Off-Flavours and Unpleasantness Are Cues for the Recognition and Valorization of Organic Wines by Experienced Tasters.

The drivers of consumer acceptance concerning organic wines are not well understood. In particular, among wine professionals, there are anecdotal evidences claiming that consumers accept off-flavours that would not be tolerated if the wines were conventionally produced. Therefore, the aim of this study was to shed further light on this issue by tasting blind wines of both types of production using a tasting panel comprised by experienced individuals of several nationalities. The tasted wines were both conventional and organic and were with and without off-flavours. The same wines were evaluated in three tasting sessions where the given information was: (1) all wines were conventional, (2) all wines were organic, and (3) tasters were asked to guess the mode of production. A group of untrained tasters also rated the same organic wines in an informed session. The results showed that wines were significantly better scored and were given a higher willingness to pay value in the "organic" session. In addition, the experienced tasting panel produced a list of the most frequent sensory descriptors. When tasters were asked to guess the mode of production, wines that were supposed to be organic received a higher citation of off-flavours, such as "oxidized", "reductive", and "animal/undergrowth". Moreover, an overall emotional response of unpleasantness was associated with the recognition of organic wines in the "guess" session. Untrained tasters rated the same organic wines with lower liking scores and were willing to pay less. In conclusion, off-flavours and their unpleasantness worked as a cue to identify wines supposed to be organic by experienced tasters. Their corresponding higher valorization could be explained by the psychological halo effect induced by the organic label. Contrarily, consumers did not show this halo effect, depreciating wines with unpleasant flavours irrespective of their mode of production.

Role of internal limiting membrane peeling in the prevention of epiretinal membrane formation following vitrectomy for retinal detachment: a randomised trial.

AIM: To study the role of internal limiting membrane (ILM) peeling in the prevention of macular epiretinal membrane (ERM) formation following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). METHODS: In a randomised trial, patients with macula-off RRD (duration ≤3 months) with proliferative vitreoretinopathy grade ≤C1 and absence of pre-existing maculopathy were recruited from June 2016 to May 2018. Patients were randomised into two groups: group 1 (conventional treatment) underwent PPV alone, while group 2 underwent PPV with macular ILM peeling. The main outcome measures were macular ERM formation (detected on optical coherence tomography), corrected distance visual acuity (CDVA), retinal attachment and central macular thickness (CMT) at last follow-up (minimum 6 months). RESULTS: Sixty patients (30 in each group) completed the required follow-up. The two groups were comparable in sex distribution, age, duration of RRD, baseline CDVA and duration of follow-up (median 15.5 vs 14 months). Macular ERM developed in 20% (n=6) and 0% of eyes in groups 1 and 2, respectively (p=0.002). Retinal reattachment was attained in all eyes. There was no statistical difference in final CDVA between the groups (p=0.43). Dissociated optic nerve fibre layer (DONFL) was found in 0% and 40% (n=12) of eyes in groups 1 and 2, respectively (p=0.0001). However, DONFL did not significantly affect the final CDVA (p=0.84). The final CMT was 266.0±37.5 µm and 270.0±73.7 µm in groups 1 and 2, respectively, with no statistical difference (p=0.62). CONCLUSIONS: ILM peeling prevents macular ERM formation following PPV for RRD but provides similar visual outcomes as compared with conventional treatment. TRIAL REGISTRATION NUMBER: CTRI2018/04/012978.

Electrochemical Properties of Na0.66V4O10 Nanostructures as Cathode Material in Rechargeable Batteries for Energy Storage Applications.

We report the electrochemical performance of nanostructures of Na0.66V4O10 as cathode material for rechargeable batteries. The Rietveld refinement of room-temperature X-ray diffraction pattern shows the monoclinic phase with C2/m space group. The cyclic voltammetry curves of prepared half-cells exhibit redox peaks at 3.1 and 2.6 V, which are due to two-phase transition reaction between V5+/4+ and can be assigned to the single-step deintercalation/intercalation of Na ion. We observe a good cycling stability with specific discharge capacity (measured vs Na+/Na) between 80 (±2) and 30 (±2) mAh g-1 at current densities of 3 and 50 mA g-1, respectively. The electrochemical performance of Na0.66V4O10 electrode was also tested with Li anode, which showed higher capacity but decayed faster than Na. Using density functional theory, we calculate the Na vacancy formation energies: 3.37 eV in the bulk of the material and 2.52 eV on the (100) surface, which underlines the importance of nanostructures.

Comparison of ranibizumab alone versus ranibizumab with targeted retinal laser for branch retinal vein occlusion with macular edema.

Purpose: To determine the effect of ultra-widefield fluorescein angiography (UWFFA)-guided targeted retinal photocoagulation (TRP) in branch retinal vein occlusion (BRVO) with macular edema after intravitreal Ranibizumab (RBZ). Methods: 33 eyes of 32 treatment naïve patients diagnosed as BRVO with macular edema were prospectively randomized to 0.5 mg Ranibizumab only (RBZ group) (n = 17) or Ranibizumab with UWFFA-guided laser (RBZ + TRP group) (n = 16). Both groups received three injections at monthly intervals and PRN henceforth. RBZ + TRP group additionally underwent UWFFA-guided TRP of peripheral capillary nonperfusion areas 1 week post injection. Outcome measures included improvement in visual acuity, central subfoveal thickness (CST), and the number of injections required with a minimum follow-up of 9 months. Results: Both groups showed significant improvement in mean BCVA (25.7 ± 8.19 letters, P < 0.001 vs. 23.38 ± 7.56 letters, P < 0.001; in RBZ and RBZ + TRP group, respectively) and reduction in mean central subfoveal thickness (379.12 ± 242.7 µm, P < 0.001 vs. 253.75 ± 137.9 µm, P < 0.001 in RBZ and RBZ + TRP group, respectively) at 9 months. The number of injections in the RBZ group (5.76 ± 1.3) was significantly greater than RBZ + TRP (4.06 ± 0.99) (P < 0.001). Both groups had significant improvement in contrast sensitivity and mean deviation on visual fields; however, the difference between the groups was not significant (P = 0.62 and P = 0.79, respectively). Conclusion: UWFFA-guided TRP reduced the number of injections of Ranibizumab in patients having BRVO with macular edema, while maintaining similar benefits in the improvement of BCVA, central subfoveal thickness without deleterious effect on the visual field, and contrast sensitivity.

Detection and monitoring of subclinical ocular siderosis using multifocal electroretinogram.

BACKGROUND: Although full-field electroretinogram (ffERG) is the gold standard test to detect physiological dysfunction in siderosis, it measures overall retinal function. This study aims to determine if multifocal electroretinogram (mfERG) can detect subclinical siderosis in eyes with an iron intraocular foreign body (IOFB). METHODS: Twenty eyes of 20 patients with retained iron IOFB, clear ocular media and good visual acuity (≥20/120) were enroled in this prospective case-control study. The fellow eyes served as control. These were evaluated with ffERG and mfERG at baseline. Serial mfERG was done till six months after pars plana vitrectomy with IOFB removal. Primary outcomes measures were amplitude and peak time of P1 and N1 wave of mfERG. RESULTS: The median age was 25 years (range 18-55). Most patients (n = 14/20) presented within a month of trauma. Baseline ffERG showed no difference in either 'a' or 'b' wave amplitude or peak time between cases and controls. However, on mfERG, there was a significant decrease in P1 and N1 wave amplitude and delay in P1 wave peak time in <2° retinal ring in cases as compared to controls (p = 0.001, 0.001 and 0.02 respectively) despite variability in results. At 6 months, P1 amplitude showed significant improvement from baseline in cases (p = 0.010). However, P1 peak time did not show significant recovery (p = 0.65). CONCLUSIONS: mfERG may reveal subclinical electrophysiological retinal dysfunction in eyes with iron IOFB in cases with normal ffERG. P1 peak time may serve as an electrophysiological marker for past retinal damage.

Choroidal thickness in normal Indian eyes using swept-source optical coherence tomography.

PURPOSE: The purpose of this study is to provide normative database for subfoveal choroidal thickness in Indian eyes using swept-source optical coherence tomography. METHODS: This is a cross-sectional study based at a tertiary eye care center in Northern India. Two hundred and thirty eight eyes of 119 healthy subjects were examined in terms of axial length, spherical equivalent, and choroidal thickness. Inclusion criteria included age 19-60 years, no retinal or choroidal disorder, and patients with clear media and good fixation. Patients with high hypermetropia (>4 D) or myopia (>6 D) or any systemic disease likely to affect choroidal thickness were excluded. Twelve radial line scans were obtained centered on the fovea that were used to calculate choroidal and retinal thickness in 9 early treatment diabetic retinopathy study (ETDRS) zones. RESULTS: The mean age of all the subjects was 28.70 ± 11.28 years; mean axial length was 23.63 ± 1.96 mm, and mean spherical equivalent was - 0.92 ± 3.08 D. The mean subfoveal choroidal thickness was 299.10 ± 131.2 µ and mean foveal thickness was 239.92 ± 48.16 µ. A negative correlation was found between subfoveal choroidal thickness and age (r = -0.0961, P = 0.1392) and axial length (r = -0.3166, P < 0.001). A statistically significant positive correlation was found between subfoveal choroidal thickness and refractive error (r = 0.2393, P = 0.0002). CONCLUSION: This study provides normative database for subfoveal choroidal thickness and foveal thickness using swept-source optical coherence tomography. The choroidal thickness measured with swept-source platform is slightly higher than that reported with spectral domain platforms.

ß-Selinene-Rich Essential Oils from the Parts of Callicarpa macrophylla and Their Antioxidant and Pharmacological Activities.

Background:Callicarpa macrophylla (Varbenaceae) is a medicinal shrub and is traditionally used in India, China, and South Asia. Methods: The plant material was collected from lower Himalayan region of Uttarakhand in India. The essential oils from three different aerial parts were analyzed by GC-MS. Antioxidant activity, phenolic assay, and various pharmacological activities were determined by using existing methods which are generally practiced widely. Results: Over 51, 53, and 40 compounds were identified in C. macrophylla leaves essential oil (CMLEO), C. macrophylla pre mature seeds and fruits essential oil (CMEO-I) and C.macrophylla mature seeds and fruits essential oil (CMEO-II), respectively. These oils differ in relative contents of major compounds viz; ß-selinene (37.51% in CMLEO, 44.66% in CMEO-I and 57.01% in CMEO-II), phyllocladene (9.76% in CMLEO, 5.80% in CMEO-I and 12.38% in CMEO-II), caryophelline oxide (7.34% in CMLEO, 8.74% in CMEO-I and 5.0% in CMEO-II), 9E-epi-caryophelline (6.23% in CMLEO, 1.27% in CMEO-I and 3.43% in CMEO-II), longipinocarvone (4.96% in CMLEO, 1.17% in CMEO-I and 2.0% in CMEO-II), and 1,8-cineole (2.23% in CMLEO, 3.10% in CMEO-I and 1.62% in CMEO-II). The oils exhibited good in vitro antioxidant activity. The maximum activity was found in CMEO-II with IC50 values 7.37 ± 0.11, 11.49 ± 0.87, 14.59 ± 0.18, 15.66 ± 0.03, and 17.49 ± 0.13 µl/mL. The essential oils showed qualitative and quantitative diversity in the makeup of essential oils constituents. The oils were found to exhibit anti-inflammatory, analgesic, and antipyretic activity on swiss albino mice compared to the standard drugs, viz; ibuprofen, paracetamol and indomethacin. Conclusion: It is inferred from the study that the plant parts can be used scientifically in traditional systems as folk herbal medicine. Furthermore, we have generated a database for future reference and judicious exploitation of these oils from their natural setting.

Influence of Brettanomyces ethylphenols on red wine aroma evaluated by consumers in the United States and Portugal.

Brettanomyces may add complexity to wine at low concentrations but at high concentrations, can result in objectionable wines. The objective of this study was to determine the concentrations at which consumers from two different locations were able to detect Brettanomyces volatile compounds present in a red wine. A red wine blend, used in both countries, was spiked to create five treatments containing different concentrations of 4-ethylphenol (4-EP), 4-ethylguiacol (4-EG), and 4-ethylcatechol (4-EC) in a 5:1:1 ratio, respectively. These treatments were evaluated by consumers in the United States and Portugal (n=121) using a difference from control test. Consumers were also classified as having low, medium, or high wine knowledge. Among the spiked samples, the greatest degree of difference was found between the second and third treatments, corresponding to reported detection and recognition threshold ranges of 4-EP and 4-EG. For some treatments, consumers from Portugal classified in the medium or high knowledge level reported significantly higher mean differences from the control than those in the low knowledge group (p<0.05). Results demonstrated consumers' ability to detect differences in red wines due to Brettanomyces volatile compounds. Results provide useful context on how wine knowledge and cultural variants may affect the detection of Brettanomyces.

Clinical profile of the patients with pediatric epiphora in a tertiary eye care center.

PURPOSE: To study the clinical profile of children aged <10 years presenting with epiphora at a tertiary eye care center, to compare the clinical profile between the early onset (<3 years) and the late-onset (≥3 years) group, and to study the success of different treatment modalities. MATERIALS AND METHODS: A prospective nonrandomized observational study was conducted in 209 eyes of 167 patients (42 bilateral cases). The main outcome measure was postoperative relief of presenting symptoms and signs at 3 months follow-up. RESULTS: Fifty-five percent cases (92 of 167) were early-onset cases, and 45% (75 of 167) were late onset. The male:female ratio was 1.9:1. Seventy-five percent cases were unilateral. The etiological profile was -76% cases of congenital nasolacrimal duct obstruction (NLDO), 18% traumatic/surgical, 4% acquired NLDO, and 2% punctal causes. The overall success rate of all the treatment modalities in our study was 80% (167/208) -82% for sac massage, 77% for probing, 79% for intubation dacryocystorhinostomy, and 100% for punctal surgery. A significant association was noted between the treatment outcome and laterality (P = 0.04), presence of infection (P = 0.032), symptom severity (P = 0.027), history of previous treatment (P = 0.024), and age. No significant association was found between the treatment outcome and gender (P = 0.73), socioeconomic status (P = 0.43), etiology (P = 0.45), and treatment modality (P = 0.33). CONCLUSION: This study describes the complete range of causes and treatment modalities for pediatric epiphora and highlights the etiology, signs and symptoms, treatment, and the comparative outcome between the early versus the late-onset group and analyses the factors predictive of the outcome.

Clinical implications of microbial biofilms in chronic rhinosinusitis and orbital cellulitis.

BACKGROUND: Discovery of sessile mode of microbial existence (Biofilm state) focussed much interest, during the recent years, on the study of biofilms in many recurring and chronic infections. However, the exact role of microbial biofilms in chronic rhinosinusitis and orbital cellulitis were not elucidated earlier. The purpose of the present study was to look for the adherent property and biofilm producing ability of the clinical isolates in chronic rhinosinusitis and orbital cellulitis, and to look for the effects of antimicrobial agents on these biofilms by colorimetric assay and ultrastructural analysis. METHODS: Organisms were isolated and identified from various clinical samples in patients with chronic sinusitis and orbital cellulitis. Antimicrobial sensitivity testing was carried out by the standard protocol. Biofilms were developed; quantified and antimicrobial drug perfusion through the biofilm model was evaluated by the earlier devised procedure. Electronmicroscopic study of the biofilm was performed by the recommended technique. RESULTS: Of the total of 70 clinical samples processed, 48 i.e. 68.5 % grew bacteria and 13 i.e.(18.6 %) fungi. Staphylococcus aureus (20), S epidermidis (16) and Pseudomonas aeruginosa (6) accounted for the majority of the bacterial isolates. Aspergillus flavus (8), however was the commonest amongst the fungi. A total of 40 bacteria and 8 fungi could be tested for biofilm production. Eighteen (45 %) of the 40 bacterial isolates and 4(50 %) out of the 8 A flavus isolates were found to be biofilm producers. In vitro adherence testing revealed that majority i.e. 16 (88.8 %) of the 18 biofilm positive bacteria were adherent to artificial surfaces. Antimicrobial drug perfusion through the biofilm model was poor. Antimicrobial treatment was totally ineffective against strong biofilm producers, whose electron microscopic picture was quite similar to that observed for biofilm producers without any antimicrobial pre-treatment. CONCLUSIONS: Filamentous fungi, like bacteria were capable of forming biofilms, which could be one of the important virulence factors in determining the pathogenic potential of these organisms in causing chronic rhinosinusitis and orbital cellulitis.

Effect of Ethanol, Sulfur Dioxide and Glucose on the Growth of Wine Spoilage Yeasts Using Response Surface Methodology.

Response surface methodology (RSM) was used to study the effect of three factors, sulfur dioxide, ethanol and glucose, on the growth of wine spoilage yeast species, Zygosaccharomyces bailii, Schizosaccharomyces pombe, Saccharomycodes ludwigii and Saccharomyces cerevisiae. Seventeen central composite rotatable design (CCRD) trials were designed for each test yeast using realistic concentrations of the factors (variables) in premium red wine. Polynomial regression equations were fitted to experimental data points, and the growth inhibitory conditions of these three variables were determined. The overall results showed Sa. ludwigii as the most resistant species growing under high ethanol/free sulfur dioxide concentrations, i.e., 15% (v/v)/20 mg L-1, 14% (v/v)/32 mg L-1 and 12.5% (v/v)/40 mg L-1, whereas other yeasts did not survive under the same levels of ethanol/free sulfur dioxide concentrations. The inhibitory effect of ethanol was primarily observed during longer incubation periods, compared with sulfur dioxide, which showed an immediate effect. In some CCRD trials, Sa. ludwigii and S. cerevisiae showed growth recovery after a short death period under the exposure of 20-32 mg L-1 sulfur dioxide in the presence of 11% (v/v) or more ethanol. However, Sc. pombe and Z. bailii did not show such growth recovery under similar conditions. Up to 10 g L-1 of glucose did not prevent cell death under the sulfur dioxide or ethanol stress. This observation demonstrates that the sugar levels commonly used in wine to sweeten the mouthfeel do not increase wine susceptibility to spoilage yeasts, contrary to the anecdotal evidence.

Evaluation of antimicrobial efficacy of garlic, tea tree oil, cetylpyridinium chloride, chlorhexidine, and ultraviolet sanitizing device in the decontamination of toothbrush.

OBJECTIVE: To assess and compare the efficacy of 3% garlic extract, 0.2% tea tree oil, 0.2% chlorhexidine, 0.05% cetylpyridinium chloride, and ultravoilet (UV) toothbrush sanitizing device as toothbrush disinfectants against Streptococcus mutans. MATERIALS AND METHODS: A double blind randomized controlled parallel study was done on 210 dental students. The subjects were divided into one control group using distilled water and five study groups representing 0.2% tea tree oil, 3% garlic extract, 0.2% chlorhexidine gluconate, 0.05% cetylpyridinium chloride and UV toothbrush sanitizing device. Participants were provided with new toothbrushes and toothpastes for both baseline and intervention phases. The toothbrushes were collected after two weeks for microbial analysis in both phases. The data were analysed and compared using appropriate statistical analysis. RESULTS: On comparing pre- and post-intervention, S. mutans colony counts, a highly significant (P < 0.001) difference was observed in all the groups. Differences of 77.74 colony forming units (CFU) in tea tree oil group, 102.87 CFU in garlic group, 68.13 CFU in chlorhexidine group, 82.47 CFU in cetylpyridinium group and 42.67 CFU in UV toothbrush sanitizer group were observed. Garlic group showed the highest reduction (100%) whereas UV toothbrush sanitizer group showed the least reduction (47.4%) in S. mutans colonies. CONCLUSIONS: The antimicrobial agents used in this study effectively reduced the S. mutans counts and hence can be considered as toothbrush disinfectants to prevent dental caries. The 3% garlic was the most effective among the antimicrobial agents.

Clinicopathologic review of epithelial tumors of the lacrimal gland.

OBJECTIVE: To study the clinicopathologic features of epithelial tumors of the lacrimal gland diagnosed at a tertiary care center in India during a 10-year period. METHODS: Medical records of cases with histopathologically proven epithelial tumors of the lacrimal gland were reviewed for demographic details and clinical features at the time of presentation. For histopathologic findings, slides with hemotoxylin and eosin-stained sections of the tumors were reviewed. Special stains, including histochemical and immunohistochemical stains, and additional sections were studied, whenever needed. RESULTS: Of 66 cases with epithelial tumors of the lacrimal gland identified during the study period, 50 (76%) cases were benign and 16 (24%) cases were malignant tumors. Histopathologic examination was consistent with the diagnosis of pleomorphic adenoma (PA) in all 50 cases of benign tumors. The mean age at diagnosis in PA cases was 37.7 years. Microscopic examination of PA tumors showed cystic degeneration in 18 (36%) cases, squamous metaplasia in 16 (32%) cases, calcification in 6 (12%) cases, and ossification in 1 (2%) case. Among malignant tumors, adenoid cystic carcinoma (ACC) was the most common tumor (n = 12, 18%), with an average age at diagnosis of 32.4 years. Microscopic examination of ACC revealed that most cases were grade I tumors. Solid areas were noted in 4 (33.3%) cases and perineural invasion was identified in 2 (16.7%) cases. Other malignant tumors included 1 case each of carcinoma ex-PA (1.5%), lacrimal duct carcinoma (1.5%), mucoepidermoid carcinoma (1.5%), and basal cell adenocarcinoma (1.5%). CONCLUSIONS: As far as the authors are aware, this is the largest series on clinicopathologic features of epithelial tumors of the lacrimal gland from South Asia. The incidence of PA was significantly higher in this study than reported in the Caucasian population. Among malignant tumors, ACCs were the most common, although rare tumors were also identified.

Conjunctivodacryocystorhinostomy using a high-density porous polyethylene-coated tear drain tube.

To evaluate the outcome of conjunctivodacryocystorhinostomy using a high-density porous polyethylene (HDPP)-coated tear drain tube. Patients with epiphora due to a proximal lacrimal system block were included in a prospective interventional case study. A total of 22 eyes were treated with lacrimal bypass surgery using the HDPP-coated tube. On follow-up (12-41 months), 21 eyes had a patent well-positioned tube with subjective relief of epiphora. In one eye, a loose sleeve was noted during surgery. The tube dislodged postoperatively and was removed. A high success rate with only a few minor complications is achievable using a HDPP-coated tear drain tube for lacrimal bypass surgery. Long-term follow-up is required to look for tube blockage due to conjunctival or nasal mucosal overgrowth.

Role of oral corticosteroids in orbital cellulitis.

PURPOSE: To evaluate the role of oral corticosteroids as an anti-inflammatory adjunct in the treatment of orbital cellulitis. DESIGN: Prospective, comparative, single-masked, interventional clinical study. METHODS: setting: Tertiary eye care center (All India Institute of Medical Sciences). study population: Patients with acute onset (within 14 days) of orbital cellulitis with or without abscess. intervention: Patients were randomized into 2 groups in the ratio of 1:2. Both groups received initial intravenous antibiotics. In Group 2, oral steroids were added after an initial response to intravenous antibiotics. main outcome measures: Resolution of signs and symptoms, duration of intravenous antibiotics, length of hospital stay, and sequelae of disease (ptosis, proptosis, and movement restriction) were evaluated and compared between the 2 groups. RESULTS: A total of 21 patients (age range, 11-59 years) with orbital cellulitis were studied. There were 7 patients in Group 1, who received standard intravenous antibiotics, and 14 in Group 2, who received adjuvant steroids. Patients in Group 2 showed an earlier resolution of inflammation in terms of periorbital edema (P = .002 at day 7), conjunctival chemosis (P < .001 at day 10), and pain (P = .012 at day 7). They also attained vision of 0.02 on logMAR earlier than Group 1 patients. Decrease in proptosis and improvement in extraocular movements were also significantly better with the use of steroids (P = .027 at day 10, P = .003 at day 14, respectively). While a significant number of patients in Group 1 had mild residual ptosis, proptosis, and movement restriction at 12 weeks, none of the patients treated with steroids had any residual changes (P = .023, P = .001, and P = .001, respectively). The durations of intravenous antibiotics and hospital stay were significantly less in Group 2. CONCLUSION: Use of oral steroids as an adjunct to intravenous antibiotic therapy for orbital cellulitis may hasten resolution of inflammation with a low risk of exacerbating infection.