Severe Ocular Surface abnormalities in a child and Ectodermal Dysplasia: A Case Report.

Ectodermal Dysplasia is a disorder that occurs due to abnormal development of at least two major ectodermal derivatives in the developing embryo. Author report the case of a 10 year old male child who was referred to our department with complaints of absent sweating, foreign body sensation and watering in both eyes for past few months. The family history could be traced to four generations and there was an observed trend of increase in severity of signs and symptoms occurring at younger age.  The purpose of this case report is to create awareness in the Ophthalmic community about the diagnosis and clinical manifestations of the disorder. This case highlights the role of multidisciplinary approach for management of systemic disease, genetic evolution of affected individual and carriers and genetic counseling

An unusual case of Waardenburg syndrome in a female child

Ocular albinism is characterized by congenital nystagmus, reduced visual acuity, hypopigmentation of the iris pigment epithelium and the ocular fundus and foveal hypoplasia. We report a case with clinical manifestations consistent with the phenotypes of WS1. The differentiating feature from uniocular albinism is the presence of dystopia canthorum

Pattern of mechanical ocular injuries in patients visiting a rural referral centre

AIM: To study the pattern of mechanical ocular injuries in patients visiting a rural referral center.METHODS: The study was conducted in the department of Ophthalmology, Dr. Rajendra Prasad Government Medical College(RPGMC), Kangra(Himachal Pradesh)for a period of 12mo from 1st Jan 2013-31st Dec 2013 which included data collection, data organization, presentation, data analysis and data interpretation followed by a period of follow up extending to a period of 1mo. A total of 200 patients were studied which included all patients of mechanical ocular injuries that visited our department either directly or were referred from other public or private institutions during the study period. It was a prospective study in which all the patients were interviewed with the aid of a questionnaire and underwent a detailed ocular examination. The injuries were classified according to the international ocular trauma classification into open globe and closed globe injuries. The injuries of the lid and adnexa and the cranial nerve palsies were considered as separate entities and data analysis was done with MS Excel 2007 worksheet using the Epi info7 software.RESULTS: A total of 21,710 patients attended the out-patient department(OPD)during the study period out of which 200 patients were of mechanical ocular trauma which formed 0.921% of the total OPD attendance. The patients ranged in age from 1-80y with a mean age and standard deviation of 33.12±20.48y. In those patients 151 patients(75.5%)were males and 49(24.5%)were females. The male to female ratio was 3:1. Out of the 200 patients studied, 100 were injured at home, 19 in the playground, 29 had occupational injuries, 38 were injured in road side accidents, 10 were injured due to assault, 3 at school and 1 patient was injured during a stampede that occurred in a religious camp. The visual acuity at presentation was upto 6/12 in 47%, CONCLUSION: Ocular injuries are common and preventable causes of monocular blindness

In the era of OCT, is detection of early papilledema using Frisen scale grading valid? A study to evaluate the role of spectral domain-OCT in papilloedema among the population of hilly areas of Northern India

Context: Papilloedema is defined as optic disc oedema secondary to raised intracranial pressure (ICP). Grading the degree of oedema using only subjective, examiner-dependent and non-quantitative fundoscopic classification like Modified Friesen Clinical Scale (MFS), may be subject to errors even when used by experienced examiners. The use of spectral-domain optical coherence tomography (SD-OCT), a non-invasive imaging technique, for early identification of raised ICP even before the clinical appearance of papilloedema by quantifying the thickness of the peripapillary retinal nerve fibre layer (ppRNFL) is crucial for such patients. Aims: To evaluate the ppRNFL using SD-OCT in patients with papilloedema. Settings and Design: Hilly North Indian population, Prospective case-control study. Methods and Material: From January 2018 to December 2018, a total of 45 patients diagnosed with papilloedema were included. Age and sex-matched controls were recruited. Detailed demographic information and the history of study subjects were noted. All subjects underwent systemic and detailed ophthalmic examination. Disc photographs were graded as per Modified Frisen Criteria (MFS). SD-OCT of the optic nerve head was done to provide a mean peripapillary RNFL thickness parameters in the different quadrants of the disc in each eye. Statistical Analysis Used: For analysis, statistical software SPSS version 23 and appropriate statistical tests were applied. P value < 0.05 was considered significant. Results: The median age of presentation was 36 years (Range 10–68 years). The male to female ratio was 1:1.3. The mean ppRNFL thickness of both right and left disc in all quadrants was significantly higher in cases in comparison to controls (P-value < 0.05 is significant). The average ppRNFL thickness in all the quadrants of both eyes was significantly higher in the mild grade of papilloedema in comparison to controls (P-value < 0.05 is significant). Conclusions: SD-OCT can be ordered as a routine important non-invasive investigation in addition to basic fundoscopic examination in all patients with papilloedema or suspected to have papilloedema

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways