Electrocardiographic findings in COVID-19 patients

Background: Severe acute respiratory syndrome coronavirus 2 (SARS CoV2) has caused the global pandemic, COVID-19. Though predominantly a respiratory illness, cardiac manifestations of COVID-19 significantly contribute to mortality. We wanted to determine whether admission electrocardiographic (ECG) characteristics provide prognostic information in COVID-19.Methods: We performed a retrospective, cross-sectional observational study in a designated District COVID hospital. COVID-19 patient’s medical records were converted into an electronic database which included demographic data, clinical characteristics and electrocardiogram recorded at/near the time of admission. Primary outcome assessed was the occurrence of severe COVID-19.Results: Of 180 patients, the majority were males (67.8%) and aged 31-50 years (38.9%). The predominant comorbidity among patients who were discharged (non-severe COVID-19 disease) and those who got referred (severe COVID-19 disease) was hypertension (56.5% vs 43.3%), followed by diabetes mellitus (37.7% vs 36.7%). Fatigue (41.9%) and cough (18.5%) were the most frequent symptoms among non-severe cases. Of 32.8% of the patients with abnormal ECG, abnormal axis (25.5%), poor R wave progression (23.5%), T inversion (15.3%), left ventricular hypertrophy (12.2%) followed by ST segment depression (8.3%) were the frequent findings. Logistic regression analysis revealed that elderly patients (>60 years) (β=2.276, OR=9.737, p=0.002), Heart rate (β=0.191, OR=1.211, p=0.045) and ST segment depression (β=9.986, OR=21725.39, p=0.022) showed statistically significant positive association with Severe COVID-19.Conclusions: ST segment abnormalities on admission ECG are markers of cardiac injury and may assist in prognostication of COVID-19. Early identification of these findings might play a crucial role in identifying patients likely to progress to severe COVID-19

Practices and perceptions of online teaching among faculty of medical colleges

Background: COVID-19 pandemic has enormously impacted the medical education system owing to a nationwide lockdown. The faculty of medical colleges had to face an abrupt switch from traditional classroom teaching to online teaching methods, which proved challenging. We aimed to evaluate the practices and perceptions of online teaching among faculty of medical colleges. Methods: An online survey tool consisting of socio-demographic variables, teaching experience details, online teaching practices, perceived self-efficacy and training and support received was used. Results: Only 89 of 108 faculty members participated were eligible for the survey. Majority (69.7%) belonged to the age 25-40 years, were Assistant Professors (44.9%) and from Private medical colleges (79.8%) and used Zoom application (71.6%) as their teaching tool. About 16.9% had previous experience of online teaching. Among the teaching practices, content related practices were frequently utilised by the faculty followed by effective communication practices. The overall responses for perceived self- efficacy were above neutral. The faculty received highest and least training/support in content specific knowledge and online classroom management respectively. Linear regression analysis revealed statistically significant positive association of perceived professional and technological self-efficacy with effective communication [(β=0.238, p=0.05), (β=0.510, p<0.001)] and content related practices [(β=0.309, p=0.007), (β=0.477, p<0.001)]. Conclusions: Addressing faculty concerns and appropriate training in the use of digital platforms can help improve online teaching practices thus facilitating effective e-learning. Post-pandemic, a blended classroom and online teaching curriculum would probably provide a better learning environment

Transient Solution of an M/M/1 Retrial Queue with Reneging from Orbit

In this paper, the transient behavior of an M/M/1 retrial queueing model is analyzed where the customers in the orbit possess the reneging behavior. There is no waiting room in the system for the arrivals. If the server is not free when the occurrence of an arrival, the arriving customer moves to the waiting group, known as orbit and retries for his service. If the server is idle when an arrival occurs (either coming from outside the queueing system or from the waiting group), the arrival immediately gets the service and leaves the system. Each individual customer in the orbit, retrying for his service, becomes impatient and starts reneging from the orbit. Here the reneging of customers is due to the long wait in the orbit. Using continued fractions, the transient probabilities of orbit size for this model are derived explicitly. Average and variance of orbit size at time t are also obtained. Further, numerical illustrations of performance measures are done to analyze the effect of parameters

EFFECT OF MYOPIA ON PRIMARY OPEN ANGLE GLAUCOMA

Objective: It is a retrospective study to evaluate the effect of myopia on primary open-angle glaucoma by classifying the eyes into NMG (non-myopic glaucoma), HMG (highly myopic glaucoma) And MMG (mild to moderate myopic glaucoma). Methods: The study was performed on 120 patients with primary open-angle glaucoma who were medically treated. Any participant who had surgery done was excluded from the study. The relation between glaucoma and different myopia and progression were assessed on the basis of age, gender, risk factors. Results: Out of the 120 cases assessed, 46 [38 percent] were female and 74 [62 percent] were males. On the basis of age there were 9 cases between 31-40 y, 30 cases between the ages 41-50, 40 cases between 51-60, 32 cases between 61-70 and 9 cases between 71-80, on the basis of myopia 59 [49 percent] were NMG 47 [39 percent] were MMG and 14 [12 percent] were HMG. On the basis of risk factors,12 of them had Diabetes Mellitus, 7 had Hypertension, 7 had a history of steroid use, 3 had a history of migraines and 6 of them had a family history of glaucoma. In the observed one year period 73 percent if the cases were not progressive while 27 percent were progressive. In this study, it has been observed that the males are more commonly affected and the age group with the most cases was the 51 to 60 age group. The majority of the cases showed no risk factors though Diabetes Mellitus is the most common. The progression of the disease is seen more frequently in cases associated with Diabetes Mellitus and Hypertension. In MMG 12 out of the 47 cases were progressive and in NMG 15 out of the 59 cases were progressive. Conclusion: Though high myopia is important in the pathogenesis of glaucoma there was no evidence that high myopia increases the progression of the disease of the 14 cases, only 5 were progressive

ASSESSMENT OF THE INCIDENCE AND PREVALENCE OF DRY EYES IN DIABETIC INDIVIDUALS AND IT’S EFFECT ON VISUAL ACUITY

Objective: To find out the incidence and prevalence of Dry Eyes in Diabetic patients and find out its effect on visual acuity. Methods: A prospective study was conducted in Saveetha Medical College and Hospital. Schirmer’s test was done for 100 diabetic patients taking part in the research. Those with dry eyes were tested for their visual acuity and were asked to fill a questionnaire based on associated ocular symptoms. The collected data were analysed using Microsoft Excel. Results: There is about an incidence of 82% of dry eyes in diabetic patients. It’s more prevalent among elderly women. There seems to be a significant effect of dry eys on visual acuity as 31% of those tested with dry eyes have a moderate visual impairment. Conclusion: People with diabetes are at a higher risk of developing dry eye. So diabetic patients should undergo regular ocular examination and must be screened for dry eyes. Early diagnosis and treatment of dry eyes is the best choice to prevent ocular complications in the future

RETINAL CHANGES IN PREGNANCY INDUCED-HYPERTENSION

Objective: The aim is to determine the prevalence of retinal changes in Pregnancy Induced Hypertension (PIH) and its association with age, parity, proteinuria, blood pressureand severity of PIH. Methods: This is a tertiary hospital based Cross-Sectional study including all patients, clinically diagnosed with Pregnancy Induced Hypertension. General demographic details along with age, gravida, gestation period, proteinuria, blood pressure and severity of PIH were noted. Ophthalmic examination was performed and detailed fundus examination was done. Results: A total of 52 patients were included in this study. Their mean age was 24.9 y; 32 out of 52 patients were primigravida (61%) and 20 patients were multi gravida (39%). Out of 52 patients 34 (65.38%) had Gestational Hypertension, 16 (30.76%) had preeclampsia, and 2 (3.8%) had eclampsia. 3 (5.76%) out of 29 patients with BP&lt;160/100 mmHg and 10 (19.23%) out of 23 patients with BP&gt;160/100 mmHg had developed Hypertensive Retinopathy. Hypertensive Retinopathy was seen in 13 (25%). Proteinuria was seen in 10 (19.23%) patients ranging between+to+++on the dipstick. Conclusion: Statistically significant correlation between retinal changes and proteinuria, blood pressure and severity of Disease.The most important requisite in a case of Pregnancy Induced Hypertension is Fundoscopic examination of retina. The retinal vessels during PIH form a gateway to visualize changes in the body and placental vessels, and may play a key role in early detection and treatment of PIH for protection of the mother as well as the fetus

COMPARISON OF POSTOPERATIVE CORNEAL ASTIGMATISM IN PHACOEMULSIFICATION AND MANUAL SMALL INCISION CATARACT SURGERY

Objective: Globally a significant proportion of treatable blindness is caused by cataract, especially in India and southeast Asia. Treatment of cataract is surgical correction with intraocular lens implantation. The main drawback of surgical correction is induction of postoperative astigmatism in patients. The aim of this study was to compare the degree of astigmatism in manual small incision cataract surgery and phacoemulsification 3 mo postoperatively Methods: The study was a retrospective case study on postoperative corneal astigmatism after cataract surgery. It was conducted in a tertiary care hospital in Thandalam, Tamil Nadu. A total of 100 patients were selected and divided into two groups, group A (=50) underwent phacoemulsification and group B (=50) underwent manual small incision cataract surgery. Preoperative astigmatic status of the patients was noted from patient records. Both groups were evaluated 3 mo postoperatively using automated keratometry. The data collected was analyzed using Microsoft Excel Independent T test, p&lt;0.05 was considered statistically significant. Power of the study was 80% with an alpha error of 5%. Results: Mean postoperative astigmatism at 3 mo was 0.91±0.255D and 0.34±0.110D due to manual small incision cataract surgery and phacoemulsification, respectively. Conclusion: Postoperative astigmatism was greater in manual small incision cataract surgery than phacoemulsification. Improvement in preoperative astigmatism was seen in patients who underwent superotemporal incision phacoemulsificatio

A COMPARATIVE STUDY OF CONJUNCTIVAL AUTOGRAFT AND BARE SCLERA TECHNIQUES IN THE TREATMENT OF PTERYGIUM

Objective: Pterygium is a fibrovascular growth encroaching from the conjunctiva into the cornea. This study deals with the comparison of conjunctival autograft and bare sclera technique as treatment options for pterygium. Methods: This study was done in the ophthalmology department of Saveetha Medical College, Thandalam, Chennai. A total of 100 patients were diagnosed of pterygium was taken for the study, out of which 60 patients were operated on with conjunctival autograft and 40 patients were operated with bare sclera technique. Patients with hypertension, diabetes mellitus were excluded. Post-operative complications and recurrence were noted. All the patients were between the age group of 20-65 y. Results: The mean age of patients operated with conjunctival autograft was 43.6, whereas in bare sclera technique was 46.625. The maximum age was 63 and the minimum age was 23 in conjunctival autograft whereas in bare sclera technique, the maximum age was 64 and the minimum age was 22. The recurrence rate of pterygium in conjunctival autograft was 1 and the recurrence rate of pterygium in bare sclera technique was 4. Conclusion: The present study revealed that conjunctival autograft was a better treatment option compared to the bare sclera technique for excision of pterygiu

A STUDY TO ASSESS THE CONTRAST SENSITIVITY OF THE HUMAN VISUAL SYSTEM IN PATIENTS WITH OR WITHOUT DIABETES IN A TERTIARY CARE HOSPITAL

Objective: The objective of our study was to assess the variations in contrast sensitivity values of normoglycemic subjects and that of type II diabetic subjects of the same age group. It was also aimed at finding the visual acuities and study the associations of it with contrast sensitivity if any. Methods: It was a hospital-based comparative cross-sectional descriptive study conducted in the out-patient department of the Department of Ophthalmology, Saveetha Medical College, Hospital, Chennai. Visual Acuity and Contrast Sensitivity of 50 Type II Diabetic individuals and 50 age-equivalent control group subjects were measured using the Snellen’s chart and Pelli-Robson chart, respectively, during the months of January to March 2020. Results: Contrast Sensitivity measurements from 50 subjects with Non-Insulin dependent Diabetes Mellitus (NIDDM) were obtained. The subjects were the ones who had minimal or no diabetic retinopathy. It was observed that there is a significant association between reduced contrast sensitivity and Diabetes (P value&lt;.00008). We also noted that CS may be reduced without corresponding loss of Visual Acuity. Hence, both visual acuity and contrast sensitivity measurements are helpful in the assessment of visual impairment due to diabetic eye disease. Conclusion: The contrast sensitivity can be seen as an early marker for visual impairment in diabetic eye care

Clinical profile of patients with hypertensive emergencies in a tertiary care hospital

Background: Hypertensive emergency is defined by systolic blood pressure (SBP) ≥180 mmHg and/or diastolic blood pressure (DBP) ≥120 mmHg with acute target organ damage. Hypertensive emergencies can be life threatening and fatal unless timely treated. In the present study we aim to study the clinical profile and outcome of patients admitted with hypertensive emergency in the medical intensive care unit in our hospital. Methods: A cross-sectional observational study of all cases with hypertensive emergency admitted in Medical Intensive care unit (ICU) in Government General Hospital, Srikakulam during the study period was conducted. The clinical profile and outcome of the patients were assessed. Results: Out of the fifty patients in the present study, about 36 (72%) were males and 14 were females (28%) and about one third of the patients (36%) belonged to the age group of 60-69 years. Diabetes mellitus (30%) and dyslipidemia (40%) were the commonly encountered comorbidities in the study population. Most frequent presenting symptoms were neurological deficits (50%) followed by dyspnoea (32%) and chest pain (24%). Intracerebral haemorrhage was the commonest target organ damage found in 30% of the patients. Patients presenting with hypertensive emergencies with neurological target organ damage had statistically significant increased chance of mortality (p=0.007). Conclusions: As hypertension emergencies are consequence of uncontrolled hypertension, it is important to educate and bring awareness among public regarding the screening, early detection, and adherence to prescribed medication for hypertension to avoid adverse clinical outcomes