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Narang S.,Government Medical College Hospital | Mashayekhi A.,Thomas Jefferson University | Rudich D.,Thomas Jefferson University | Shields C.L.,Thomas Jefferson University
Clinical and Experimental Ophthalmology | Year: 2012

Background: To determine the predictors of long-term visual outcome after chemoreduction for management of intraocular retinoblastoma. Design: Retrospective case series. Participants: One hundred and forty eyes of 96 new retinoblastoma patients. Methods: The clinical records were reviewed for demographical profile, tumour characteristics, treatment methods, treatment side effects and final visual outcome. Multivariate analysis was used to evaluate factors predictive of final visual acuity. Main Outcome Measure: The clinical data were analysed for main outcome measures of good vision (visual acuity ≥6/12) or ambulatory vision (visual acuity ≥6/60). The correlation among predictor variables was determined using Pearson's product moment correlation for continuous variables, and t-test and analysis of variance test for categorical baseline variables. Results: Follow-up ranged from 2years to 14years (median 75months). The final mean logarithm of minimum angle of resolution visual acuity was 0.79. Ambulatory vision (≥6/60) was achieved in 100 of 140 (71%) eyes, and vision of ≥6/12 was seen in 52 eyes (37%). Extrafoveolar tumour and greater number of tumours in the eye were the only predictors of visual acuity ≥20/40. Greater number of tumours correlated with smaller mean basal tumour diameter. The mean basal tumour diameter was 9.8mm in eyes with multiple tumours and 12.2mm in eyes with single tumours (P=0.03). Conclusion: Long-term ambulatory vision (≥6/60) was achieved in the majority (71%) of retinoblastoma containing eyes not requiring enucleation after treatment with chemoreduction and adjunctive therapy. Absence of foveolar involvement and greater number of tumours were the predictor of long- term visual outcome of 6/12 or better. © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists. Source


Suryalatha K.,Cholera and Biofilm Research Laboratory | John J.,Government Medical College Hospital | Thomas S.,Cholera and Biofilm Research Laboratory
Future Microbiology | Year: 2015

Wohlfahrtiimonas chitiniclastica is a rare pathogen that was first isolated from a parasitic fly, Wohlfahrtia magnifica. It is a very rare but an emerging human pathogen reported only in Europe and South America. Recently, it is reported to be an egressing zoonotic pathogen from different geographical locations. The present case represents the first report of this pathogen from a patient suffering from osteomyelitis from India and so far no reports are available regarding the W. chitiniclastica associated infections in Asian countries. Clinical awareness of such emerging human pathogens is crucial for the infectious disease containment. © 2015 Future Medicine Ltd. Source


Bhala S.,Government Medical College Hospital
Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH | Year: 2012

Endophthalmitis is the most dreaded complication of ocular trauma and knowledge of the microbial contaminants is essential to start empirical antibiotic therapy. To determine incidence of contamination after open globe injuries (OGI) in our setup and to identify the spectrum of microorganisms contaminating open globe injuries. A prospective study including 50 consecutive eyes of open globe injury over a period of two years was conducted. Intra-operatively, 4 - 5 samples were taken from the inferior conjunctival sac and anterior chamber at the beginning and end of the open globe injury repair. Any abscised tissue or foreign body was also sent for culture sensitivity. A vitreous tap was taken from eyes with posterior segment trauma with signs of endophthalmitis. Microbial cultures were positive in13 eyes (26 %). The microbial spectrum included Aspergillus species in 45.6 %, Alternaria in 15.2 %, Curvularia in 15.2 %, Staphylococcus aureus in 7.6 %, Bacillus species in 7.6 %, and Streptococcus pneumoniae in 7.6 %. Of these 13 eyes, nine eyes developed clinically evident frank endophthalmitis during follow-up. Overall, endophthalmitis developed in 20 eyes (40 %). There was a significant association between the initial contamination and development of endophthalmitis (p less than 0.05). 53 % of culture positive cases achieved ambulatory vision compared to 73 % of culture-negative cases. Initial contamination was seen in 26 % of OGI cases. Aspergillus (fungus) was the commonest contaminant. There was a strong correlation between the initial contamination and development of endophthalmitis. Culture-negative cases had a trend towards better final visual outcome than culture-positive cases. Close follow up of cases showing contamination following OGI is recommended. © NEPjOPH. Source


Vadivelu N.,Yale University | Mitra S.,Government Medical College Hospital | Kaye A.D.,Louisiana State University | Urman R.D.,Harvard University
Best practice & research. Clinical anaesthesiology | Year: 2014

The epidemic use of illicit drugs has led to an increasing number of patients with drug addiction and dependence presenting for perioperative care. There are a wide variety of drugs commonly abused including opioids, such as heroin and prescription drugs; stimulants, such as amphetamine and cocaine; depressant drugs, such as alprazolam and diazepam; and hallucinogens, such as lysergic acid diethylamide, phencyclidine, and marijuana. Treatment of opioid dependence by office-based buprenorphine and methadone maintenance programs has expanded opportunities for therapy. Treatment of these patients in the perioperative period is challenging. In addition to pain control, management of anxiety, psychological states, and hemodynamic control are the factors to be considered to provide optimum treatment. Although opioids are the mainstay for the control of acute pain, other therapeutic options include alternative routes of administration of local anesthetic, ketamine infusion, and the use of regional anesthesia. We discuss optimum perioperative management, the role of perioperative urine testing, and special considerations in patients on methadone and buprenorphine. Copyright © 2014 Elsevier Ltd. All rights reserved. Source


Narang S.,Government Medical College Hospital
Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH | Year: 2012

Lipid-lowering drugs preserve vision and reduce the risk of hard exudates in clinically-significant macular edema(CSME) in diabetics with an abnormal lipid profile. But their role in reducing CSME in diabetics with a normal lipid profile is not yet known. To evaluate the role of atorvastatin in CSME in diabetics with a normal lipid profile. A prospective, randomized clinical trial was carried out. Thirty CSME patients with a normal lipid profile were randomly divided into Group A and B. Atorvastatin had been started in Group A four weeks prior to laser treatment. The main outcome measures were any improvement or deterioration in visual acuity and macular edema and hard exudates at six months follow-up. Both the groups were compared using unpaired t test for quantitative parameters and chi-square test for qualitative parameters. A p value of less than 0.05 was taken as significant. Visual acuity, macular edema and hard exudates resolution was not significantly different in the two groups (P = 0.14, 0.62, 0.39 respectively). Atorvastatin does not affect treatment outcome in CSME with a normal lipid profile over a short term follow-up. © NEPjOPH. Source

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