Utilization of dental health services and its associated factors among adult population in Ernakulam district, Kerala, India: A mixed-method analysis.

Background: There exists a high burden of oral diseases. Yet, the utilization of oral health care remains low. Understanding how, when, and why/why not individuals utilize dental healthcare resources is essential for planning health services and developing policies as it reflects the population's oral health needs, helps allocate resources efficiently, and formulate policies that are tailored to address their needs. Objectives: To assess the utilization of dental health services and its associated factors along with barriers and facilitators among adults residing in Ernakulam district, Kerala, using the Anderson healthcare model for healthcare utilization. Methods: A mixed-method study was conducted among adults aged 18 years and above in urban and rural wards of Ernakulam district using the cluster sampling method. Univariate and multivariate analysis were used for the quantitative part, and thematic analysis was used for the qualitative aspect. The total sample size was 544. Results: The dental healthcare utilization was 15.4 ± 2.9 % among the study participants. Age and education were associated with dental healthcare utilization. The level of education, pain, and self-consciousness of oral diseases were independent predictors. Barriers identified were negative attitudes, financial restraints, and difficulty in access, while facilitators were trust in service providers, availability of services, and a positive attitude. Conclusion: Utilization was poor despite the perceived need for oral health care. This was affected by several personal and system-level facilitators and barriers.

Ocular surface changes in patients who have undergone head and neck radiation therapy.

PURPOSE: Dry eye syndrome (DES) is a familiar sequelae of radiation therapy (RT) for head and neck cancers (HNC). Ocular surface changes such as DES occur due to injury to the conjunctival epithelium, goblet cells, corneal surface, lacrimal glands, and meibomian glands. This study aimed at the evaluation and early detection of changes in ocular surface parameters in patients receiving RT for extraocular HNC. METHODS: Forty-two eyes of 21 patients undergoing HNC RT were evaluated. Radiation technique and dose of radiation to the lens and eye were recorded. Subjects were evaluated for meibomian gland changes by meiboscore grading, ocular surface disease index (OSDI) questionnaire, Schirmer's test, tear film break-up time (TBUT), and slit-lamp examination before RT, immediately post RT, and 6 weeks post RT. A comparison of the ipsilateral eye on the irradiated side to the contralateral eye was done. RESULTS: A significant reduction in TBUT was seen immediately post RT and 6 weeks post RT ( P < 0.001 and 0.008, respectively), with an increase in meiboscore at both visits ( P < 0.001). An OSDI score of >13 was seen in 23.80% of patients post RT, with a significant difference from baseline ( P < 0.001). On comparing ipsilateral and contralateral eye groups, a significant difference from baseline was seen in TBUT ( P < 0.001 and 0.033, respectively) and meiboscore ( P < 0.001 for both eyes). A significant change of >1 second in TBUT and >1.7 in meiboscore was seen with a mean dose of around 8 Gy to the lens. CONCLUSION: All patients undergoing HNC RT should be followed up for ocular surface and meibomian gland changes. The contralateral eye should also be evaluated. Patients receiving lower doses to the ocular structures should also be kept under follow-up.

Association between resistivity index of central retinal artery and severity of diabetic retinopathy.

Purpose: Diabetic retinopathy (DR) is a leading cause of ocular morbidity. Its progression depends mainly on retinal vasculature and ocular blood flow. Color Doppler imaging (CDI) is a noninvasive imaging technique that measures blood flow velocity. The resistivity index (RI), calculated by the CDI, reflects the vascular resistance distal to the measuring location. RI is independent of the doppler angle and position of the patient, making it a reliable and reproducible parameter. To the best of our knowledge, there is only one study in literature studying the association between resistivity index (RI) of the central retinal artery (CRA) and severity of DR. Aim: To determine the association between RI of CRA and severity of DR. To determine the association between RI of CRA and spectral-domain optical coherence tomography (SD-OCT) biomarkers for DR. Methods: Type II diabetics visiting our OPD underwent DR screening and were graded into three categories according to ETDRS classification which include Group A-No diabetic retinopathy (No DR), Group B-Nonproliferative diabetic retinopathy (Moderate-Severe-Very Severe NPDR), and Group C-Proliferative diabetic retinopathy (PDR). SD-OCT was performed. Ultrasonic color doppler imaging was done. RI of the CRA was noted. It was compared between the three groups and its association with severity of DR and OCT biomarkers (central subfield thickness, cube average thickness and ellipsoid zone disruption) was studied. Results: 56 eyes of 28 patients were included in our study with 20 in Group A,14 in Group B, and 22 in Group C. RI of CRA compared within groups showed statistically significant association with severity of DR (P < 0.001). The presenting BCVA (LogMar) showed positive correlation with RI in all groups. OCT biomarker central subfield thickness showed a positive correlation with RI in Groups A (P < 0.001) and B. Ellipsoid zone (EZ) disruption showed a statistically significant association with RI in Group C (P < 0.001). Conclusion: The RI of CRA is a reliable biomarker for the assessment of the severity of DR. Patients with high RI of CRA had higher chances of EZ disruption and presented with poor visual acuity.

Influence of climate on semen quality: A retrospective study.

INTRODUCTION: World over studies are being done by different group of workers to understand the time of deliveries conducted. Surprisingly majority of deliveries were following a pattern, seasonally. Today in this busy world, couples choose comparatively a free time for delivery and preparation for conception is done accordingly. Apart from these, it is clearly shown majority of deliveries are conducted during a particular season. We hypothesised that the change in semen quality during different seasons is responsible for this phenomenon. MATERIALS AND METHODS: Present study conducted on semen quality included 12,408 semen samples collected from different laboratories of Bangalore city during 8 years (2000-2007) period of time and were analysed season wise. RESULTS: Results showed sperm concentration was significantly lower in monsoon than in winter season. Humidity and pressure influenced sperm count. Forward moving sperms were influenced by temperature and pressure. SUMMARY: The study concludes the change in birth rates seen during different season in a year is due to the quality of semen responsible for conception.

Effect of dexamethasone implant on intraocular cytokines in diabetic macular edema.

Purpose: Our primary aim was to evaluate intraocular cytokines (IC) before and after dexamethasone in diabetic macular edema (DME). Our secondary aim was to study the early and late effects of single dexamethasone implant in DME. Methods: This before and after comparative study was conducted at the Department of Ophthalmology and Centre for Nanosciences at a quaternary referral center in Kerala, India, from September 2016 to September 2018. Patients underwent complete ophthalmological examination and cytokine analysis before and after dexamethasone implant. Levels of cytokines at baseline and repeat sample were studied. Results: Twenty-seven eyes (21 patients) were divided into two groups depending on time from baseline to second injection. Group 1 included patients with <3 months between the two samples - 12 (44.4%). Group 2 included patients with >3 months between the two samples -15 (55.6%). Best corrected visual acuity (BCVA) and central macular thickness (CMT) improved significantly post-dexamethasone in group 1, but not in group 2. Interleukin (IL)-4, IL-6, IL-10, vascular endothelial growth factor (VEGF), IL-1ß, interferon-gamma inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1), and IL-2 decreased post-injection in group 1. But cytokines increased post-dexamethasone in group 2, except IL-10. When compared to baseline, IL-6 reduced to half in group 1 (P-value 0.814) and it tripled in group 2 ( P-value 0.009). The level of VEGF in the first and second samples was not different in either group. Conclusion: Our study suggests that dexamethasone acts more on IC than VEGF in DME. This is significant in the first 3 months with a rebound effect on IL-6 after 3 months. Our study also suggests that repeat injection of DEX in DME should be done at 3 months to prevent deterioration of visual acuity (VA) and worsening of CMT.

Retraction: Comparison of Two Stump Closure Techniques in Laparoscopic Appendicectomy: A Single-Centre Prospective Cohort Study.

[This retracts the article DOI: 10.7759/cureus.21796.].

Comparison of Two Stump Closure Techniques in Laparoscopic Appendicectomy: A Single-Centre Prospective Cohort Study.

Introduction Acute appendicitis is a frequent illness that manifests as an emergency and most of the cases necessitate surgical intervention. One of the most critical processes in a laparoscopic appendicectomy is the closure of the appendicular stump. For the closure of the stump of the appendix, several approaches have been employed and explored, but the one with the best outcomes has yet to be proved. The purpose of this study was to evaluate the medical results and cost analyses of laparoscopic appendicectomy with two of the commonly used stump closure techniques - ENDOLOOP® and Hem-o-lok®. Materials and methods A two-year prospective hospital-based cohort study was conducted from June 2019 to July 2021. All the patients in the study were randomly assigned to one of two experimental arms (ENDOLOOP® and Hem-o-lok®). The clinical and follow-up data of these patients were collected and tabulated into a data sheet and analyzed. Results In total, 180 individuals were included in the research (90 in each arm). No statistically significant difference was found in comparing the age, gender or diameter of the appendix among the two groups. The time taken for surgery showed significant differences among the two study groups. The time taken for the procedure in the Hem-o-lok® group was significantly lower than the ENDOLOOP® group (40.3 ± 12.3 minutes vs 50.83 ± 10.5 minutes, p < 0.001). No intraoperative or immediate postoperative complications were noted in either of the groups. The average duration of hospital stay was 2.7 ± 0.9 days in the Hem-o-lok® group, while it was 3.1 ± 0.8 days in the ENDOLOOP® group (p = 0.986). The material cost for the stump ligation with Hem-o-lok® was Rs. 310 ± Rs. 76 while that using ENDOLOOP® was Rs. 630 ± Rs. 118 (p < 0.001). In the Hem-o-lok® subset of patients, the mean direct expenses of laparoscopic appendicectomy were considerably lower. During the 12-week follow-up period, none of the patients had any post-operative complications. Conclusion According to the results of this study, both the technical variations of appendix stump closure are equal in terms of postoperative complications. When compared to the ENDOLOOP® group, the Hem-o-lok® group had a shorter duration of surgery and ended up spending less money. Hem-o-lok® clips have the potential to become the preferred way of anchoring the appendix base during laparoscopic appendicectomy.

Serum TSH Level as a Simple Efficient Tool to Assess the Risk of Thyroid Malignancy in Euthyroid Patients with Indeterminate Cytology - A Cohort Study.

Context: A significant number of fine-needle aspiration cytology (FNAC) for thyroid nodules is reported as indeterminate. Expensive molecular testing can give a clue to the possibility of malignancy in this group. The effectiveness of serum thyroid-stimulating hormone (TSH) levels as a diagnostic tool in euthyroid patients with indeterminate cytology has not been previously studied, especially in the Indian population. Aims: This study was conducted to evaluate the predictive efficacy of serum TSH in the early diagnosis and treatment of malignancy. Settings and Design: This is a retrospective cross-sectional study on a cohort of patients who presented to our department with complaints of thyroid swelling and underwent thyroidectomy. Methods and Material: Euthyroid patients who underwent thyroid surgery for newly diagnosed thyroid nodules with FNAC reported as indeterminate cytology were included in our study. Based on the histopathological report, the patients were divided into two groups and into quartiles based on TSH values. Statistical Analysis Used: The mean difference in the numerical variables between groups was compared using the independent two-sample 't' test for parametric data and Mann-Whitney 'u' test for non-parametric data. A logistic regression analysis was done with age, sex, TSH level and nodule size as dependant variables and malignancy as the independent variable. Results: There were 211 patients in group A and 93 in group B. Patients with malignancy confirmed on final histopathology showed higher serum TSH levels compared to benign nodules (2.93 ± 1.067 vs 1.73 ± 1.051, P = <0.001). The mean TSH levels of all types of malignant nodules correlated with our test model (>2.185 mIU/L). Conclusions: Serum TSH above 2.185 mIU/mL is a good predictor of malignancy in indeterminate nodules. It is an inexpensive, safe and reliable diagnostic screening test for the risk of malignancy in an indeterminate nodule.

Validation of MuLBSTA score to derive modified MuLB score as mortality risk prediction in COVID-19 infection.

COVID-19pandemic was started in December 2019. It has variable presentation from mild sore throat to severe respiratory distress. It is important to identify individuals who are likely to worsen. The Research question is how to identify patients with COVID-19 who are at high risk and to predict patient outcome based on a risk stratification model? We evaluated 251 patients with COVID-19 in this prospective inception study. We used a multi-variable Cox proportional hazards model to identify the independent prognostic risk factors and created a risk score model on the basis of available MuLBSTA score. The model was validated in an independent group of patients from October2020 to December 2021. We developed a combined risk score, the MuLBA score that included the following values and scores: Multi lobar infiltrates (negative0.254, 2), lymphopenia (lymphocytes of <0.8x109 /L, negative0.18,2), bacterial co- infection (negative, 0.306,3). In our MuLB scoring system, score of >8 was associated with high risk of mortality and <5 was at mild risk of mortality (P < 0.001). The interpretation was that The MuLB risk score model could help to predict survival in patients with severe COVID-19 infection and to guide further clinical research on risk-based treatment.

Impact of Intraoperative Tumor Spillage in Uterine Leiomyosarcoma: a Retrospective Single-Institution Analysis.

Uterine leiomyosarcoma is a rare female reproductive system tumor which is difficult to distinguish from uterine leiomyoma preoperatively. Manual and power morcellation are used to remove the large uterus through the vagina or small abdominal incision. Worse outcome with use of power morcellation is now clear but impact of manual morcellation on survival outcome not established till date. The objective of the present study was to find impact of tumor spillage and to evaluate influencing factors for oncological outcome and prognosis in uterine leiomyosarcoma patients. This is a single-institutional retrospective cohort study including all uterine leiomyosarcoma patients from January 2005 to December 2017. Role of intraoperative tumor spillage and other influencing factors on oncological outcome were assessed. Thirty-three patients with median follow-up period of 49.7 months were evaluated. Stage 1 and absence of tumor spill had significant association with prolonged progression-free survival. Stage 1 uterine leiomyosarcoma (56.8 vs 6.8 months, p = < 0.001), intraoperative tumor spillage (p = 0.03) and progression-free survival > 15 months (68.5 vs 12.2 months, p = < 0.001) were favourable prognostic factors to predict better survival outcome but unable to establish significance on multivariate analysis. Survival plot did not reach median limit for stage I uterine leiomyosarcoma patients with preoperative suspicion. Age, site of recurrence and mitotic index had no significant association with better survival in the present study. Stage I disease and absence of tumor spillage during surgery improved progression-free survival but did not affect overall survival. Progression-free survival more than 15 months can predict better overall survival.

Relationship between diabetic retinopathy and diabetic peripheral neuropathy - Neurodegenerative and microvascular changes.

PURPOSE: To determine the relationship between diabetic retinopathy (DR) and diabetic peripheral neuropathy (DPN), and their associated risk factors. METHODS: We conducted a cross-sectional analysis on 500 patients who attended the Endocrinology department at a quaternary health care center in Kerala between November 2017 and April 2018. Patients above the age of 30 years with type 2 diabetes mellitus (DM) were included. They underwent a detailed medical history, dilated fundus examination for DR, assessment and grading of DPN, and blood investigations. Among these, 49 randomly selected patients without DR had peripapillary retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) assessed by optical coherence tomogram. RNFL and GCIPL changes in different grades of neuropathy were evaluated. RESULTS: Out of 500 patients, 303 (60.6%) were males and 197 (39.4%) were females. Prevalence of DR was 48% and DPN 71.8%. Risk factors for the development of DR included duration of DM >15 years, HbA1c (glycated hemoglobin) greater than 6.5%, serum creatinine more than 1.5 mg/dl, and the presence of DPN. There was a statistically significant association between DR and DPN. There was significant thinning of GCIPL in patients with moderate to severe neuropathy without DR. CONCLUSION: There is a significant association between DR and DPN and their severities. There are early changes in inner retinal layers of diabetic patients without microvascular changes of DR. These neurodegenerative changes parallel DPN in the course of DM. Our study stresses the importance of multidisciplinary approach in the management of diabetes and its complications.

Accuracy in the Execution of Pre-operative Plan for Limb Alignment and Implant Positioning in Robotic-arm Assisted Total Knee Arthroplasty and Manual Total Knee Arthroplasty: A Prospective Observational Study.

AIM: The objective of the study is to compare the accuracy of implant positioning and limb alignment achieved in robotic-arm assisted total knee arthroplasty(RATKA) and manual total knee arthroplasty(MTKA) to their respective preoperative plan. PATIENTS AND METHODS: This was a prospective observational study conducted in a tertiary care centre between August 2018 and January 2020. 143 consecutive RATKA(105 patients) and 151 consecutive MTKA(111 patients) performed by two experienced arthroplasty surgeons were included. Two independent observers evaluated the accuracy of implant positioning by measuring the radiological parameters according to the Knee-Society-Roentgenographic-Evaluation-System and limb alignment from postoperative weight-bearing scanogram. Outcomes were defined, based on the degree of deviation of measurements from the planned position and alignment, as excellent(0-1.99°), acceptable(2.00-2.99°) and outlier(≥ 3.00°). RESULTS: There were no systematic differences in the demographic and baseline characteristics between RATKA and MTKA. Statistically significant outcomes were observed favouring robotic group for postoperative mechanical axis (p < .001), coronal inclination of the femoral component (p < 0.001), coronal inclination of tibial component (p < 0.001), and sagittal inclination of tibial component (p < 0.001). There was no significant difference in the sagittal inclination of the femoral component (p = 0.566). The percentage of knees in the 'excellent' group were higher in RATKA compared to MTKA. There was absolutely no outlier in terms of limb alignment in the RATKA group versus 23.8% (p < 0.001) in the MTKA group. All the measurements showed high interobserver and intraobserver reliability. CONCLUSION: Robotic-arm assisted TKA executed the preoperative plan more accurately with respect to limb alignment and implant positioning compared to manual TKA, even when the surgeons were more experienced in the latter. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-020-00324-y.

Helical tomotherapy for prostate cancer radiation therapy: An audit of early toxicity and quality of life.

BACKGROUND: Radiation plays a major role in the management of localized prostate cancer (CaP). There are limited studies reporting the quality of life (QOL) and toxicity with CaP tomotherapy. MATERIALS AND METHODS: This is a single-institutional prospective observational study evaluating the acute toxicity and QOL of patients with CaP receiving tomotherapy from May 2018 to October 2019. Toxicity assessed using radiation therapy oncology group toxicity grading. QOL assessed using International Prostate Symptom Score (IPSS) and QOL score. RESULTS: A total number of 74 patients received radiation therapy (RT), of which 25 had postoperative RT and 49 had radical RT. The median age was 71 years. During RT, 8 (10.8%) had Grade 2 gastrointestinal (GI) and 4 (5.4%) had Grade 2 genito urinary (GU) toxicities. At 3 months, 1 (1.4%) had Grade 2 GI, 1 (1.4%) had Grade 2 GU, and 1 (1.4%) had Grade 3 GU toxicities. At 6 months, 1 patient had Grade 2 GU and no Grade 2 GI toxicity noted. In postoperative RT Group, 2 (8%) Grade 2 GI and 1 (1.4%) Grade 2 genitourinary toxicity reported during radiation. At 3 months, 1 (1.4%) Grade 2 GI, 1 (1.4%) G2 GU, and 1 (1.4%) G3 GU toxicities noted. At 6 months, no ≥ Grade 2 noted. In radical RT group, during radiation 6 (12.2%) Grade 2 GI and 3 (6.1%) Grade 2 GU recorded. At 3 and 6 months, no ≥ Grade 2 GI/GU toxicity was recorded. No Grade 3/Grade 4 observed in radical RT group. One patient in radical RT and one in postoperative RT had severe IPSS symptom score. Results are comparable to reported studies. CONCLUSION: Our initial clinical experience with helical tomotherapy in CaP confirms lower rate of toxicities and no significant worsening of QOL with RT.

Prevalence of the use of traditional complementary and alternative medicine amongst cancer patients in a tertiary care center in Kerala, India.

BACKGROUND: Unmet needs of cancer patients prompt them to seek care from Traditional, Complementary and Alternative Medicine (TCAM) practitioners. OBJECTIVE: To investigate the prevalence of TCAM use in a multi-specialty tertiary cancer center in South India. MATERIALS AND METHODS: A cross-sectional survey of cancer patients who used TCAM during the study period. The patients were recruited based on covenience sampling method. RESULT: 320 cancer patients were approached, out of which 279 (87.2%) patients responded, and the prevalence of TCAM use was 34.4%. Home remedies (36%) figure prominently, with family advice (40%) being the primary influence for the TCAM use. The key expectation was an improvement in the quality of life (49%). TCAM use was pronounced during the chemotherapy phase (50%). Most patients (76%) using TCAM reported satisfaction with the treatment. Majority of the patients did not disclose concomitant use of TCAM to their treating physicians (71%). CONCLUSION: TCAM use by cancer patients is prevalent in Kerala. The study results point towards a need for large scale surveys, implementation of pharmacovigilance, patient education and research to identify and integrate TCAM interventions in cancer care that are safe and have beneficial effects.

Effect of Injection Speed of Heavy Bupivacaine in Spinal Anesthesia on Quality of Block and Hemodynamic Changes.

Background and Aims: Spinal anesthesia is a technique widely used for gynecological, lower abdominal, pelvic and lower limb procedures. Even though it causes a profound nerve block, it is associated with profound hypotension. Aims of the Study: To assess the effect of the speed of injection of heavy bupivacaine on quality of block and hemodynamic changes in patients undergoing gynecological surgeries under spinal anesthesia. Methods: This was a prospective randomized study conducted on 40 patients. Group F patients were given 3.2 mL of 0.5% heavy bupivacaine intrathecally in 15 s and Group S patients were given the same drug over 60 s. The time to achieve T10 dermatomal block, maximum block height, block height at 5 min were recorded. Heart rate (HR), systolic, diastolic blood pressures, and mean arterial pressures (MAP) were also recorded at different time points. Results: HR, systolic BP, diastolic BP, and MAPs and mean block height at 5 min were comparable between the two groups at all time points. The time to achieve T10 dermatome block was significantly faster in Group F (1.85 ± 1.14 min) as compared to Group S (3.98 ± 1.58 min). Majority of patients in Group F (65%) had a maximum block up to T6 and those in Group S (45%) had a block upto T4. The usage of vasopressors was found to be significantly higher in Group F compared to Group S with P = 0.041. Conclusion: Using faster speed of injection of heavy bupivacaine during spinal anesthesia can lead to faster achievement of blockade but with significantly higher usage of vasopressors.

Outcome of TRUS Biopsy with Limited Cores in Patients with PSA More Than 50 ng/dL: Can We Reduce the Number of Cores Without Affecting Outcomes?

The aims of our study were to see outcomes of limited core biopsy and compare its outcomes with standard 12-core biopsy in patients with PSA more than 50 ng/dL. We did a retrospective analysis of 149 patients undergoing prostatic biopsy with PSA more than 50 ng/dL between January 2014 and December 2018. Out of 149 patients, 49 underwent limited core (2 to 6 cores) TRUS biopsy with no systemic 12-core biopsy. Other 100 patients underwent standard 12-core biopsy under TRUS guidance. Total of 149 patient's records were analyzed and were included in the final analysis. There was no significant difference in demographics and prostate-specific antigen among the cohorts. All 49 patients in limited core TRUS biopsy had a positive biopsy with no need of re-biopsy. Fourteen out of 100 patients in TRUS biopsy had a negative biopsy. All 14 patients with negative biopsy had an average follow-up of 3.8 years with no conversion to positive biopsy. Patients with PSA more than 50 ng/dL and high clinical suspicion of prostate cancer can undergo limited core biopsy without systemic 12-core biopsy. In patients with no clinical evidence of prostate cancer, 12-core biopsy remains the gold standard for evaluation of prostate cancer.

Outcomes of standard 12-core transrectal ultrasound-guided prostate biopsy in biopsy naive Indian men -single center experience.

INTRODUCTION: Prostate cancer is now the second-most common cancer in many parts of India. Despite being the second-largest population in the world, data regarding outcomes of biopsy in Indian men are limited. We report the correlation of biopsy finding with prostate-specific antigen (PSA) level in Indian men undergoing biopsy for either elevated PSA and/or abnormal digital rectal examination (DRE) findings. MATERIALS AND METHODS: We retrospectively analyzed data of 853 men who underwent TRUS-guided prostate biopsy in a single institution from January 2014 to October 2019. The biopsy was performed when serum PSA was more than 4.00 ng/mL and/or DRE findings were suspicious for malignancy. RESULTS: Overall cancer detection rate was 38.8%. Patients were classified in five groups based on PSA levels, irrespective of DRE findings (0-3.99 ng/mL, 4.00-9.99 ng/mL, 10.00-19.99 ng/mL, 20.00-39.99 ng/mL, and ≥40 ng/mL). Overall prostate cancer detection rates at corresponding at PSA levels were 3/23 (13%), 62/282 (21.9%), 86/226 (38.05%), 66/126 (52.3%), and 165/196 (84.18%), respectively. 331 (38.8%) patients of the total 853 had suspicious DRE, the cancer detection rate in corresponding PSA groups, based on DRE alone was 3/23 (13.04%), 23/42 (54.76%), 39/56 (69.64%), 43/52 (82.69%), and 157/160 (98.13%), respectively. CONCLUSION: The overall prostate cancer detection rate at our center was 38.8%, which is much higher as compared to other Indian data. Our study also emphasizes the role of DRE in Indian men presenting with elevated PSA.

Clinical profile and outcome of endogenous endophthalmitis at a quaternary referral centre in south India.

Purpose: The purpose of this study is to evaluate the clinical profile, visual, anatomical and survival outcome of patients with endogenous endophthalmitis. Methods: Retrospective chart review of consecutive cases with endogenous endophthalmitis presenting from 2009-2016. Results: In our study, 41 eyes of 34 patients were included. Most common co-morbidity associated with endogenous endophthalmitis was Diabetes Mellitus (70.7%) and most common infective foci was UTI (73.2%). Among the culture positive cases, fungi and bacteria were evenly distributed, 76.93% were Gram positive bacteria and 23.07% were Gram negative. Fungal endogenous endophthalmitis was more commonly seen in immunosuppressed state (72.7%) and bilateral cases (66.7%). The mean presenting vision (log MAR) of patients who died during the study were poor compared to those who survived (P = 0.014) Poor mean visual acuity at presentation was associated with more death (P = 0.014). Eyes with poor presenting vision, fungal isolates, culture positivity and immune suppression had poor visual and survival outcome. Poor visual outcome was observed more frequently in eyes with Aspergillus infection (85.7%) compared to Candida (75%) and bacteria (58.3%). Evisceration was done for 5 out of 41 eyes (12.2%). Vitrectomy rate was 53.7% in our study, with 40% of them showing overall improvement in vision. Conclusion: Endogenous endophthalmitis is a sight threatening condition associated with high mortality particularly when caused by Aspergillus spp. in immunocompromised patients. Contrary to the prior published reports of endogenous endophthalmitis outside India, we found an equal distribution of fungal and bacterial organisms among our cases, with predominance of Aspergillus among fungal isolates and Gram-positive organism among bacteria. Fungal infections, especially with Aspergillus spp., resulted in poor visual and survival outcome.