Retinopathy of prematurity: incidence and risk factors: a hospital based study from Shimla, Himachal Pradesh, India

Background: The blindness due to retinopathy of prematurity (ROP) is avoidable, if it is detected in time by screening. With increasing survival of preterm and low birth weight newborns in neonatal units, who are on prolonged oxygen therapy and mechanical ventilation; ROP is bound to affect these babies. This study was planned to investigate the incidence and the risk factors of ROP in a tertiary care institute in Himalayan region of north India.Methods: This was a hospital based prospective study, conducted at neonatal intensive care units at IGMC, Shimla, from June 2011 to July 2012. 64 premature and low birth weight neonates born or admitted for neonatal intensive care unit (NICU) were screened for ROP using indirect ophthalmoscope. Cases found positive for ROP were closely followed up and managed as per international guidelines.Results: Out of 64 neonates, 14 were lost to follow up and 50 babies were enrolled in the study. Out of them 21 were males and 29 were females. Among them 3 male and 5 female newborns developed ROP. Mean gestational age of babies with ROP was 30.63 weeks. ROP was significantly associated with oxygen administration (p=0.027), RDS (p=0.003), septicaemia (p=0.028) and exchange transfusion (p=0.003). Apneic spells, surfactant administration, hyperbilirubinemia, phototherapy, blood transfusion and maternal factors were not associated with increased risk of ROP.Conclusions: For premature infants with birth weight less than 1200 grams, who has received prolonged oxygen therapy, associated respiratory distress and had received exchange transfusion the screening of ROP should be done at most appropriate time that is 32 - 40 weeks of gestational age. Timely referral of detected ROP cases for early treatment prevents blindness. There is a need for the obstetricians, neonatologist and ophthalmologist to work in close co-operation to prevent blindness due to ROP

A comparative study of low dose vaginal misoprostol and dinoprostone gel for induction of labour at term of pregnancy

Background: The aim of this study was to compare the low dose of vaginal misoprostol and dinoprostone gel for the induction of labour at term of pregnancy.Methods: The study was conducted on 90 women, randomized into two groups, each group having 45 women. First group received misoprostol per vaginally and second group received the dinoprostone gel. The duration of induction to delivery interval, mode of delivery and complications related to labour or foetus were recorded.Results: The mean induction to delivery interval in the misoprostol group was 11.68 ± 4.49 hours and in the dioprostone gel group was 14.85 ± 7.08 hours. Applying the modified t-test, this difference is statistically significant (P value 0.004). Thus misoprostol leads to early labour and early delivery as compared to dinoprostone gel.Conclusions: As shown in this study, vaginal misoprostol is highly effective induction agent with no adverse effect on the outcome of labour as compared to dinoprostone gel

Chemoresistance of Lung Cancer Cells: 2D and 3D In Vitro Models for Anticancer Drug Screening

Chemoresistance of lung cancer cells is a key factor that limits the treatment of lung cancer patients. Patients may initially respond to standard chemotherapy, but this is often followed by rapid development of drug resistance and disease progression. Tumor heterogeneity and the presence of putative cancer stem-like cells (CS-LCs) provide a viable explanation for the chemoresistance of several types of tumors. In this book chapter, we will first describe the current knowledge of the role of both tumor heterogeneity and CS-LCs in lung cancer chemoresistance, tumor progression and metastasis. Next, we will discuss ongoing strategies at the in vitro level to screen for more effective anticancer drugs. We will specifically focus in three-dimensional (3D) culture systems (Spheroids and tumorspheres) and their application in anticancer drug discovery for lung cancer

Retinopathy of prematurity: incidence and risk factors: a hospital based study from Shimla, Himachal Pradesh, India

Background: The blindness due to retinopathy of prematurity (ROP) is avoidable, if it is detected in time by screening. With increasing survival of preterm and low birth weight newborns in neonatal units, who are on prolonged oxygen therapy and mechanical ventilation; ROP is bound to affect these babies. This study was planned to investigate the incidence and the risk factors of ROP in a tertiary care institute in Himalayan region of north India.Methods: This was a hospital based prospective study, conducted at neonatal intensive care units at IGMC, Shimla, from June 2011 to July 2012. 64 premature and low birth weight neonates born or admitted for neonatal intensive care unit (NICU) were screened for ROP using indirect ophthalmoscope. Cases found positive for ROP were closely followed up and managed as per international guidelines.Results: Out of 64 neonates, 14 were lost to follow up and 50 babies were enrolled in the study. Out of them 21 were males and 29 were females. Among them 3 male and 5 female newborns developed ROP. Mean gestational age of babies with ROP was 30.63 weeks. ROP was significantly associated with oxygen administration (p=0.027), RDS (p=0.003), septicaemia (p=0.028) and exchange transfusion (p=0.003). Apneic spells, surfactant administration, hyperbilirubinemia, phototherapy, blood transfusion and maternal factors were not associated with increased risk of ROP.Conclusions: For premature infants with birth weight less than 1200 grams, who has received prolonged oxygen therapy, associated respiratory distress and had received exchange transfusion the screening of ROP should be done at most appropriate time that is 32 - 40 weeks of gestational age. Timely referral of detected ROP cases for early treatment prevents blindness. There is a need for the obstetricians, neonatologist and ophthalmologist to work in close co-operation to prevent blindness due to ROP

Prevention of postoperative infections in ophthalmic surgery

Postoperative endophthalmitis is a serious, vision-threatening complication of intraocular surgery. Better instrumentation, surgical techniques, prophylactic antibiotics and better understanding of asepsis have significantly reduced the incidence of this complication. Postoperative endophthalmitis may occur as an isolated event or as a cluster infection. Topical antibiotics, preoperative periocular preparation with povidone-iodine combined with a sterile operating room protocol significantly reduce the incidence of isolated postoperative endophthalmitis. The role of antibiotics in the irrigating fluid and subconjunctival antibiotics remains controversial. Cluster infections on the other hand are more likely to occur due to the use of contaminated fluids/viscoelastics or a breach in operating room asepsis. Prevention of postoperative endophthalmitis requires strict adherence to operating room norms, with all involved personnel discharging their assigned roles faithfully