Combined trabeculotomy-trabeculectomy with antimetabolite and releasable suture: outcome with primary congenital glaucoma in a north Indian population

OBJECTIVE

To determine the surgical outcomes of combined trabeculotomy- trabeculectomy with mitomycin-C and releasable suture in children with primary congenital glaucoma (PCG) in a North Indian population.

DESIGN

Retrospective, interventional, consecutive, non-comparative case series.

MATERIALS AND METHODS

The medical records of 137 eyes of 77 patients who underwent combined trabeculotomy- trabeculectomy with 0.2 mg/ml mitomycin C (MMC) either bilaterally (49 patients) or unilaterally (28 patients) between January 2004 and March 2012 were reviewed retrospectively. The main outcome measures were postoperative intraocular pressures, corneal clarity and diameter, duration of follow-up, success rate and complications.

RESULTS

The mean preoperative intraocular pressure reduced from 34 ± 7 mm Hg (range 15- 54 mm Hg) to 17 ± 7 mm Hg (range 5 - 32 mm Hg) with a mean reduction of 44 % (P less than 0.001). The mean follow-up period was 24.4 ± 10.3 months (range 6 - 48 months). Complete success defined as intraocular pressure less than 21 mm Hg without any medication and clinically stable glaucoma at last follow-up was achieved in 113 eyes (83 %) while a 'qualified success' of intraocular pressure less than 21 mm Hg with one medication was achieved in ten eyes (7 %). The Kaplan-Meier survival analysis revealed success rates (at 'n' months) of 90 % (6), 85 % (12), 82 % (24), 80 % (36) and 77 % (48). There were no significant intraoperative or postoperative complications.

CONCLUSION

Primary combined trabeculotomy-trabeculectomy with mitomycin-C and releasable suture offers a viable surgical option in Northern Indian infants with primary congenital glaucoma. The use of 0.2 mg/ml mitomycin C for 2 minutes improves the overall success while the releasable suture decreases the risk of postoperative complications especially associated with the use of antimetabolites.

Outbreaks of unexplained neurologic illness - Muzaffarpur, India, 2013-2014

Outbreaks of an unexplained acute neurologic illness affecting young children and associated with high case-fatality rates have been reported in the Muzaffarpur district of Bihar state in India since 1995. The outbreaks generally peak in June and decline weeks later with the onset of monsoon rains. There have been multiple epidemiologic and laboratory investigations of this syndrome, leading to a wide spectrum of proposed causes for the illness, including infectious encephalitis and exposure to pesticides. An association between illness and litchi fruit has been postulated because Muzaffarpur is a litchi fruit-producing region. To better characterize clinical and epidemiologic features of the illness that might suggest its cause and how it can be prevented, the Indian National Centre for Disease Control (NCDC) and CDC investigated outbreaks in 2013 and 2014. Clinical and laboratory findings in 2013 suggested a noninflammatory encephalopathy, possibly caused by a toxin. A common laboratory finding was low blood glucose (<70 mg/dL) on admission, a finding associated with a poorer outcome; 44% of all cases were fatal. An ongoing 2014 investigation has found no evidence of any infectious etiology and supports the possibility that exposure to a toxin might be the cause. The outbreak period coincides with the month-long litchi harvesting season in Muzaffarpur. Although a specific etiology has not yet been determined, the 2014 investigation has identified the illness as a hypoglycemic encephalopathy and confirmed the importance of ongoing laboratory evaluation of environmental toxins to identify a potential causative agent, including markers for methylenecyclopropylglycine (MCPG), a compound found in litchi seeds known to cause hypoglycemia in animal studies. Current public health recommendations are focused on reducing mortality by urging affected families to seek prompt medical care, and ensuring rapid assessment and correction of hypoglycemia in ill children.

Contribution of medical colleges to tuberculosis control in India under the Revised National Tuberculosis Control Programme (RNTCP): lessons learnt & challenges ahead

Medical college faculty, who are academicians are seldom directly involved in the implementation of national public health programmes. More than a decade ago for the first time in the global history of tuberculosis (TB) control, medical colleges of India were involved in the Revised National TB Control Programme (RNTCP) of Government of India (GOI). This report documents the unique and extraordinary course of events that led to the involvement of medical colleges in the RNTCP of GOI. It also reports the contributions made by the medical colleges to TB control in India. For more than a decade, medical colleges have been providing diagnostic services (Designated Microscopy Centres), treatment [Directly Observed Treatment (DOT) Centres] referral for treatment, recording and reporting data, carrying out advocacy for RNTCP and conducting operational research relevant to RNTCP. Medical colleges are contributing to diagnosis and treatment of human immunodeficiency virus (HIV)-TB co-infection and development of laboratory infrastructure for early diagnosis of multidrug-resistant and/or extensively drug-resistant TB (M/XDR-TB) and DOTS-Plus sites for treatment of MDR-TB cases. Overall, at a national level, medical colleges have contributed to 25 per cent of TB suspects referred for diagnosis; 23 per cent of 'new smear-positives' diagnosed; 7 per cent of DOT provision within medical college; and 86 per cent treatment success rate among new smear-positive patients. As the Programme widens its scope, future challenges include sustenance of this contribution and facilitating universal access to quality TB care; greater involvement in operational research relevant to the Programme needs; and better co-ordination mechanisms between district, state, zonal and national level to encourage their involvement.

Emergence of pandemic 2009 influenza A H1N1, India

BACKGROUND & OBJECTIVES

Pandemic H1N1 caused deluge of cases from 74 countries and prompted World Health Organization to raise warning to phase 6. The present study was conducted on throat and nasal swab samples received and tested at National Centre for Disease Control, Delhi, India during 2009-2010 to collect epidemiological and clinical information on positive cases.

METHODS

Throat and nasopharyngeal swabs from category C influenza A H1N1 patients during May 2009-September 2010 along with their clinico-epidemiological details were collected from identified hospitals from Delhi and other States. Samples were tested by Real time reverse transcriptase PCR using primers and probes developed at CDC, Atlanta for four influenza target genes.

RESULTS

A total of 33,751 samples, both throat and nasal swab samples from each patient were tested for H1N1 influenza virus, of which, 7943 (23.5%) were positive for pandemic influenza A H1N1 and 3759 (11.1%) were positive for influenza A (seasonal flu). Maximum number of positive cases (N=2792, 35.1%) were from 20-39 yr age group, comprising 1790 (22.5%) males and 1182 (14.8%) females. Only 2620 (33%) positive cases were close contact of influenza A H1N1 positive patient. Majority cases presented (N=2792, 35.1%) with fever 7005 (88.1%), followed by 6133 cases (77.2%) exhibiting fever and cough, 377 (4.7%) complained of fever, cough, nasal catarrh and 362 (4.5%) cases had fever with shortness of breath.

INTERPRETATION & CONCLUSIONS

The study showed a peak of cases of pandemic influenza A H1N1 in December 2009 and indicated predominance of H1N1 positive cases among 20-39 yr age group and among males compared to females.

Percutaneous transluminal coronary angioplasty experience in qatar: an analysis of more than 600 consecutive procedures

The present study describes the indications and results of 636 Percutaneous Transluminal Coronary Angioplasty (PTCA) procedures that were carried out in 596 patients. Of these, 366 (61.4 %) patients had Single Vessel Disease (SVD), 183 (30.7%) had Two Vessel Disease (2VD) and 47 (7.8%) had all Three Vessels Diseased (3VD). Dilatation of a single lesion was carried out in 564 (93.5%) patients. In another 41 (6.5%) patients, more than one vessel was dilated. The patients were predominantly male (562/596,93%) with a mean age of 46 (7.9 years. The indication for angiography was angina in 65.8% and for recent Acute Myocardial Infarction (AMI) in 34.2%. The number of procedures increased from 106 in 86-89 to 320 in 92-96 (an increase of 280%).

PTCA was carried out in the same session as the angiography in 113/596 (19%). In the remaining 81%, PTCA was planned as an elective procedure with a similar success rate (85% and 87% respectively, p=N.S). Females and Qatari patients had the highest success rates (97.6% and 90.5%) respectively.

The Left Anterior Descending (LAD) was the most frequently tackled vessel (53% of cases), Left Circumflex (LCX) in 20% and Right Coronary Artery (RCA) in 27%. For coronary stenoses, the overall success rate was 89%, being highest in the LAD (89.5%), lowest for LCX (82%) and moderate for RCA (88%). When faced with a total occlusion the overall success rate was 71% and was highest in RCA (84% success) and lowest in LCX (43%) and moderate in LAD (74%). Major complications were rare with only one mortality (1/596, 0.16%) and four emergency CABG is (4/596, 0.7%). Intracoronary stents were used as a bailout device in five patients and to obtain an optimal result in one patient. Stents were technically successful in all but one case.

Midtrimester abortion with prostaglandin and hypertonic saline--a comparative study

This study was conducted in Baroda, India, to evaluate and compare the safety and effectiveness of intraamniotic prostaglandin F2alpha (PGF2alpha) and 20% saline augmented with intravenous oxytocin for terminating 200 pregnancies of 14 to 20 weeks' gestation. While there was no method failure among the group treated with saline, ten method failures were reported for patients treated with the PGF2alpha. The rate of incomplete abortions was significantly lower for the group treated with saline (19.4%) than it was for the group treated with the PGF2alpha (33.7%). The administration of oxytocin after fetal expulsion did not reduce the rate of incomplete abortion. The mean instillation-to-abortion time was significantly lower with saline than with PGF2alpha. The incidence of gastrointestinal side effects and excessive bleeding (less than 200 ml) during the procedure was significantly higher for patients treated with PGF2alpha than for those treated with saline.

Female sterilization in small camp settings in rural India

In an effort to provide female sterilization services in areas that lack modern surgical facilities and highly trained personnel, while avoiding the high complication rates associated with mass sterilization programs, small sterilization camps were held at six rural primary health centers (PHCs) in the Baroda District, Gujarat, India, beginning in 1972. Data collected for 2,009 women undergoing sterilization by the Pomeroy technique at these camps showed an operative and immediate postoperative complication rate of 2.1% and an early postoperative complication rate of 6.7%. These rates compare well with those found in sterilization series performed in modern, well equipped urban settings, further demonstrating that the small camp is an appropriate facility for female sterilization in rural India.