Shaping Inclusive Markets: How Funders and Intermediaries can Help Markets Move toward Greater Economic Inclusion

Positive progress toward worldwide economic inclusion is not only possible, but can also be made more possible. In Shaping Inclusive Markets, we draw lessons from history on how more inclusive markets have been achieved and highlight ways in which funders and intermediaries can strengthen the conditions for change

Hypersonic vitrectomy in intraoperative posterior capsular rupture with retained nuclear fragments

In our report, we present the hypersonic vitrectomy (Vitesse, Bausch and Lomb) being employed for anterior vitreous liquefaction and removal in posterior capsular rupture. The capsular tear with nucleus drop during conventional phacoemulsification was managed by vitrectomy using the hypersonic vitrector after posterior-assisted levitation followed by intraocular lens (IOL) implantation. The minimal cortical and epinuclear lens particles in the anterior chamber and vitreous were also liquefied with a stoke length of 30 to 40 μm and aspirated via the Vitesse vitrectomy system. The same probe performs the vitrectomy and the nucleus removal. The postoperative period was uneventful with clear cornea, normal fundus, and 20/20 best-corrected visual acuity (BCVA). The hypersonic vitrectomy utilizes the ultrasound power of 29.5 kHz and a stoke length of 0 to 60 μm for liquefaction of the vitreous. It can be a safe alternative for vitrectomy and lens removal in a single setting

A study on co-relation of Infertility and Female Genital Tuberculosis

Introduction: Tuberculosis (TB) is an increasing public health problem worldwide, with about six million new cases a year. It is a major socio-economic burden in India, afflicting about 14 million people. Female Genital Tuberculosis (FGTB) is an important cause of sub fertility. It can cause tubal obstruction and dysfunction, impair implantation due to endometrial involvement and rarely lead to ovulatory failure secondary to ovarian involvement. OBJECTIVE-To evaluate the rate of female genital tuberculosis and its presentational symptoms in patients of infertility, to study the genital tuberculosis by hystero-laparoscopy and different methods available for its diagnosis including PCR technique and histo-pathological examination and to study conception rate after ATT( Anti tuberculosis treatment) in positive cases of PCR. METHOD- This was a prospective observational study conducted in the Department of Obstetrics and Gynecology, Surat Institute of Medical Education and Research, SMIMER, Surat, on 54 subjects from May 2007 to December 2009.Patients included were in the reproductive age group from 18 years to 36 years and in whom the duration of infertility was more than 2 years. OBSERVATION-Out of 54 subjects, maximum number of patients was in 20-25 year age group i.e. 25 (46.3%) and the mean age was 26.33 years. The cases of primary infertility were 44 (81.5%) and secondary infertility were 10 (18.5%) in this study. Chronic pelvic pain in 16 patients (29.6%) and irregular menses in 15 patients (27.7%) were the most common complaint in majority of our patients apart from infertility. Among the 54 subjects suspected of suffering from FGTB, 19 cases were positive by PCR alone from endometrial biopsy specimen and 22 cases (40.7%) were positive in laparoscopy. Only 2 cases (3.7%) were diagnosed by histology and 3 cases (5.6%) were diagnosed by hysteroscopy. In our study 19 cases were given ATT, out of those 6 cases (31.6%) had conceived, of which 4 cases became pregnant within 6 months of starting ATT. Conception rate was very poor in cases of tubal damage found on laparoscopy and/ or dye test, but the patient of genital TB found in early stages by PCR of endometrial biopsy and where the laparoscopy and dye test were normal, conception rate was comparatively good. CONCLUSION-Infertility is one of the most common symptoms of FGTB and more cases of genital TB would be diagnosed if this disease is considered in evaluation of every patient of infertility in areas where TB is endemic. [Natl J Med Res 2016; 6(2.000): 151-154

Stab incision glaucoma surgery: A modified guarded filtration procedure for primary open angle glaucoma

Purpose. To describe a modified guarded filtration surgery, stab incision glaucoma surgery (SIGS), for primary open angle glaucoma (POAG). Methods. This prospective, interventional case series included patients with POAG (IOP ≥21 mmHg with glaucomatous visual field defects). After sliding superior conjunctiva down over limbus, 2.8 mm bevel-up keratome was used to create conjunctival entry and superficial corneoscleral tunnel in a single step starting 1.5 mm behind limbus. Lamellar corneoscleral tunnel was carefully dissected 0.5-1 mm into cornea and anterior chamber (AC) was entered. Kelly Descemet's punch (1 mm) was slid along the tunnel into AC to punch internal lip of the tunnel, thereby compromising it. Patency of ostium was assessed by injecting fluid in AC and visualizing leakage from tunnel. Conjunctival incision alone was sutured. Results. Mean preoperative IOP was 27.41±5.54 mmHg and mean postoperative IOP was 16.47±4.81 mmHg (n=17). Mean reduction in IOP was 38.81±16.55%. There was significant reduction of IOP (p<0.000). 64.7% had IOP at final follow-up of <18 mmHg without medication and 82.35% had IOP <18 mmHg with ≤2 medications. No sight threatening complications were encountered. Conclusion. Satisfactory IOP control was noted after SIGS in interim follow-up (14.18±1.88 months)

Pre-Descemet's endothelial keratoplasty (PDEK)

A new surgical technique for endothelial keratoplasty is described, in which the composite of pre-Descemet's layer (Dua's layer) with Descemet's membrane and endothelium is transplanted subsequent to the removal of the recipient's Descemet's membrane. The technique was performed in five eyes of five patients, with successful attachment of the graft and good postoperative visual recovery in all cases. Postoperative optical coherence tomography showed good graft attachment without interface abnormalities and a mean graft thickness was 28±5.6 μm. This study demonstrates the practicality of the technique, termed pre-Descemet's endothelial keratoplasty (PDEK), which can be a viable option in endothelial keratoplasty with some potential advantages

Comparative Analysis of 10-2 Test on Advanced Vision Analyzer and Humphrey Perimeter in Glaucoma

Purpose: To evaluate diagnostic precision and prove equivalence of 2 devices, Advanced vision analyzer (AVA, Elisar Vision Technology) and Humphrey field analyzer (HFA, Zeiss) for the detection of glaucoma on 10-2 program. Design: Prospective, cross-sectional, observational study. Participants: Threshold estimates of 1 eye each of 66 patients with glaucoma, 36 control participants, and 10 glaucoma suspects were analyzed on 10-2 test with AVA and HFA. Methods: Mean sensitivity (MS) values of 68 points and central 16 test points were calculated and compared. Intraclass correlation (ICC), Bland–Altman (BA) plots, linear regression of MS, mean deviation (MD), and pattern standard deviation (PSD) were computed to assess the 10-2 threshold estimate of the devices. Receiver operating characteristic curves were generated for MS and MD values, and the area under the curve (AUC) was compared with assessing diagnostic precision. Main Outcome Measures: Mean sensitivity values of 68 points and central 16 points, AUC for MS and MD values, ICC values, BA plots, and linear-regression analysis. Results: Bland–Altman plot showed significant correlation for MS, MD, and PSD values for both devices. For MS, the overall ICC value was 0.96 (P 0.05). The AUC for MS values for AVA was 0.89 and for HFA was 0.92 (P = 0.188); whereas it was similar at 0.88 for MD values (P = 0.799). Advanced vision analyzer and HFA identically discriminated between healthy and patients with glaucoma (P 0.05). Conclusions: Statistical results denote adequate equivalence between AVA and HFA because threshold estimates of AVA strongly correlate with HFA for 10-2 program. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references