Lakshmi K

Diabetic retinopathy is a disorder where the perfusion of the retina may be affected owing to the microvascular changes taking place in the retinal blood vessels due to hypergycemia. D-dimer level has been used as a biomarker of hypercoagulability and fibrinolytic activity since it is a product of fibrin degradation. D-dimer level (as a marker of coagulation cascade/fibrinolysis activation) assessment in type 1 and type 2 diabetics and its correlation with diabetic retinopathy stages have shown positive correlation. The findings in present study endorse the view that Elevated D dimer levels in severe forms of diabetic retinopathy. 26.9% patients with D dimer values more than 1000 have had severe NPDR to proliferative diabetic retinopathy, while 80% patients with normal values have shown to have no diabetic changes in fundus. Poor glycemic control (>6.5%) becomes a strong predictor for occurrence of severe form of diabetic retinopathy. 92.3% patients have shown the same. Hence, this study showed a positive correlation between increased blood sugar levels, elevated glyco Hb levels and severity of diabetic retinopathy. Hence, prompt understanding and treatment of hyperglycemia may prevent complications of diabetic retinopathy. The levels of Plasma D dimer is higher in type 2 diabetes mellitus complicated with microangiopathy. D-dimer is an important marker for thrombus formation hence may play an important role in the pathogenesis of diabetic microangiopathy. Prophlylactic anticoagulant therapy and strict diabetic control can help in halting the progression of diabetic retinopathy.   Keywords: Diabetic retinopathy, D Dimer, Glycosylated hemoglobin.

Introduction: Acute febrile illness is region specific, has similar clinical presentations but with varied aetiologies. This study done over a period of 7 years is indented to give an insight in to the diseases endemic to this region so that the irrational use of drugs and diagnostic can be prevented. Objective: To identify the etiology of fever cases admitted to a rural hospital in the last 7 years. Materials and methods: Case records of 2589 cases comprising all adult patients (18 years) admitted to the hospital with temperature 38ºC, less than 14 days duration with no specific foci of infection by history or physical examination were included. Diagnosed cases of fever due to other causes were excluded. Results: Of the 2589 cases 64.73% were due to Dengue virus, 24.4% were of Plasmodium vivax etiology. 4.17% were of plasmodium falciparum etiology. In 3.01% both plasmodium falciparum and plasmodium vivax were positive.1.54% were due to hepatitis A, 1 % were due to leptospirosis, 0.03% were due to measles and 0.07% was due to tuberculosis. The etiological profile has changed from malaria being the most common cause of fever in the year 2013, 2014 to dengue from January 2015 to December 2019. Conclusion: In our study dengue was seen to be the most common etiology, followed by malaria, leptospirosis, hepatitis A and tuberculosis were the less common causes for acute febrile illness. Understanding the local prevalence of the disease will be helpful in diagnosis and treatment of febrile cases. Keywords: Acute febrile illness, Tropical infectious disease.

Glaucoma is the second leading cause of world blindness. There are many risk factors influence development of POAG. Systemic hypertension is one of the risk factors and is one of cause for gradual progressive loss of vision in old age. A hospital based study of prevelence of POAG was carried out as hospital bases study on systemic hypertensive patients attending DM WIMS hospital from 01/07/2017 to 30/06/2018. A total of 400 patients with systemic hypertension between 50-80 years of age attending department of Ophthalmology, DM WIMS hospital are evaluated for POAG and complete ocular and clinical examination were performed. The significance of study parameters between two or more groups was determined by Chi square test and correlation coefficient analysis done to find out relation between intraocular pressure (IOP) and blood pressure level. In this study -3.75% of POAG cases were presenting the systemic hypertensive population (as compared to 2.56% in normal population) and IOP was found to be significantly correlated with blood pressure levels. Among the cases diagnosed as POAG, 4.05% were males and 3.27% were females. Hence, patients of systemic hypertension should be screened for POAG and monitoring of IOP and blood pressure levels to be done at regular intervals. Keywords: Systemic hypertension, Intraocular pressure, Primary open angle glaucoma, Tonometry, Blood pressure.

The goals of safe, effective anaesthesia is to achieve good surface anaesthesia, akinesia, hypotony, analgesia. Peribulbar anesthesia is a safer to minimize complications of retrobulbar anesthesia. Hyaluronidase is used to aid in the better diffusion of anaesthetic solution. The cost, limited shelf life, risk of anaphlylaxsis are its limiting factors. Hence the need for studying the efficacy of sodium bicarbonate as an alternative to hyaluronidase. Materials and Methods: Prospective randomized study on 100 patients who underwent cataract surgery. Group A was injected with an anaesthetic mixture containing 0.5% bupivacaine, lignocaine with adrenaline with 1ml hyaluronidase. Group B was injected with an anaesthetic mixture of 0.5% bupivacaine and lignocaine 2% to which 7.5% sodium bicarbonate was added. Results: Group A onset of anaesthesia 5 minutes 46(92%), 50(100%) of group B five minutes. Akinetic action of agent 1 better than agent 2., chemosis 16 (32%) in group A,18 (34%) group B. Lid edema nil group A, 17 (34%) of group B. Subconjunctival hemorrhage 3(6%) group A, 4(8%) group B. Peribulbar hemorrhage nil group A, 2(4%) group B. Globe perforation none. Raised IOP 1(2%) group A, 12(24%) group B Overall effective anaesthesia, akinesia achieved in 49 patients (98%) of group A, 43 (86%) of group B. Systemic complication in 1(2%) of group B. Conclusion: The present study showed that sodium bicarbonate is a effective alternative to hyaluronidase in peribulbar anaesthesia. Keywords: Cataract surgery, Hyaluronidase, Peribulbar anaesthesia, Sodium bicarbonate.

Introduction: Hydrocephalus is a known sequelae in traumatic brain injury patients. It may occur early or late and presents with dementia, urinary incotinence and difficulty in walking as described by Hakim and Adams. There are two distinct types of normal pressure hydrocephalus one is idiopathic most commonly seen in the elderly age groups and the other is secondary due to a cerebro vascular accident, trauma or surgery. The idiopathic type may not respond to the CSF diversion procedure, but the secondary type which responds to CSF diversion procedure. Our study aims at exploring the option of ETV in these patients not making them shunt dependent. Materials and Methods: The patients with traumatic brain injury admitted in the dept. of neurosurgery between January 2012 and January 2018 were included into the study. Congenital hydrocephalus and secondary hydrocephalus due to spontaneous SAH and tumours were excluded. 14 patients were identified and if there was some improvement in their condition after CSF tap test were planned for endoscopic third ventriculostomy. Results: Out of the 14 patients 2 were females and the remaining 12 were males. 2 did not improve at all. 12 had some improvement out of which 3 had a failure and underwent a v-p shunt. Hence there were 5 failures out of 14 which made 35.7%. Mitchel et al and Michelangelo et al reported 72-75% success rates in their study which is similar to our results. Conclusion: ETV is an option which can be offered to patients with secondary hydrocephalus. The chances of failure though present the procedure is minimally invasive and improves CSF dynamics. Keywords: Secondary hydrocephalus due to trauma, Endoscopic third ventriculostomy, Trauma induced hydrocephalus.