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Background and aim While the prevalence of celiac disease (CD) is increasing globally, the prevalence of tropical sprue (TS) is declining. Still, there are certain regions in the world where both patients with CD and TS exist and differentiation between them is a challenging task. We conducted a systematic review of the literature to find out differentiating clinical, endoscopic, and histological characteristics between CD and TS. Methods Medline, PubMed, and EMBASE databases were searched for keywords: celiac disease, coeliac, celiac, tropical sprue, sprue, clinical presentation, endoscopy, and histology. Studies published between August 1960 and January 2018 were reviewed. Out of 1063 articles available, 12 articles were included in the final analysis. Results Between the patients with CD and TS, there was no difference in the prevalence and duration of chronic diarrhea, abdominal distension, weight loss, extent of abnormal fecal fat content, and density of intestinal inflammation. The following features were more common in CD: short stature, vomiting/dyspepsia, endoscopic scalloping/attenuation of duodenal folds, histological high modified Marsh changes, crescendo type of IELosis, surface epithelial denudation, surface mucosal flattening, thickening of subepithelial basement membrane and celiac seropositivity; while those in TS include anemia, abnormal urinary D-xylose test, endoscopic either normal duodenal folds or mild attenuation, histologically decrescendo type of IELosis, low modified Marsh changes, patchy mucosal changes, and mucosal eosinophilia. Conclusions Both patients with CD and TS have overlapping clinical, endoscopic, and histological characteristics, and there is no single diagnostic feature for differentiating CD from TS except for celiac specific serological tests.

Objective To evaluate the efficacy of selective laser trabeculoplasty (SLT) among patients with juvenile-onset primary open-angle glaucoma (JOAG). Methods Patients diagnosed with JOAG who were not controlled on medical therapy were offered a trial of SLT. The patients were followed up prospectively for 1, 3, 6, and 12 months postlaser to evaluate the efficacy of SLT as second-line therapy. Success was defined as an intraocular pressure (IOP) reduction of ≥20% at 12 months without the need for further medication, laser, or surgery. Factors associated with success/failure, prelaser IOP, age, and angle dysgenesis on gonioscopy were analysed. Results The average prelaser IOP in these JOAG eyes (n = 30) was 25.3 ± 6.5 mm Hg, which reduced to 17.3 ± 5.8 mm Hg at 12 months ( p = 0.01). All patients were of Indian ethnicity. Out of 30 eyes, at 12 months post-SLT, 13 (43%) eyes had at least a 20% reduction in IOP. In the eyes that achieved success, the average reduction of IOP was 37.6%. There was no difference in the prelaser IOP between those with success (25.5 ± 5.6 mm Hg) and those that failed (25.1 ± 8 mm Hg; p = 0.8), nor was there a difference in the mean age between successful cases (34.4 ± 9.4 years) and failures (31.6 ± 8.9 years; p = 0.4). However, those without angle dysgenesis were 4 times (CI 1.1–15.2) more likely to succeed with SLT than those with angle dysgenesis ( p = 0.03). Conclusions A significant proportion of patients with JOAG can benefit from an IOP reduction after SLT. Those with gonioscopically normal-appearing angles are more likely to respond to SLT.

AIM The aim of this study was to evaluate specular microscopy of chronic primary angle-closure glaucoma (CPACG) eyes at least 1 year after Nd:YAG iridotomy, and compare them with CPACG eyes without an iridotomy and age-matched, normal eyes. PATIENTS AND METHOD Consecutive patients of CPACG at the Glaucoma service were screened. All patients underwent slit-lamp biomicroscopy, +90 D examination, and applanation tonometry. A total of 100 eyes of 100 consecutive patients of CPACG with an Nd:YAG iridotomy performed ≥1 year before, who met all inclusion/exclusion criteria, 60 consecutive CPACG eyes without an iridotomy, and 60 age and refraction-matched control eyes were enrolled. A specular microscopy was performed in one eye of each patient by an observer masked to diagnosis. RESULTS CPACG patients had a mean age of 62±8 years, a mean intraocular pressure of 18±5.3 mm Hg, a mean specular count of 2536±224 cells/mm, and mean duration after iridotomy of 3.2±2 years. There was a significant correlation of specular endothelial counts with age (r=-0.39; P

Objectives: Studies on older patients undergoing primary Fontan operation (FO) are limited, with conflicting results. We review our experience with these patients beyond the first decade of life. Patients and Methods: Between January 2000 and December 2014, a total of 105 patients ≥10 years of age (mean 15.6 ± 4.9, range 10-31, median 15 years) underwent primary FO without a prior bidirectional superior cavopulmonary anastomosis (Bidirectional Glenn [BDG]). Mean preoperative New York Heart Association (NYHA) class was 2.2 ± 0.57. Results: Operative procedure was extra-cardiac FO in 62 patients (8 were fenestrated). Forty-three had a lateral tunnel FO (26 were fenestrated). There were 11 (10.5%) early deaths. Fourteen of the 94 early survivors experienced prolonged pleural effusions, 7 had arrhythmias, and 2 had thromboembolic events. Two patients underwent Fontan takedown. On univariate analysis, NYHA functional class III, mean pulmonary artery (PA) pressure ≥15 mm Hg, hematocrit ≥60%, preoperative ventricular dysfunction, and atrioventricular valve regurgitation (AVVR) were associated with early mortality. Median follow-up was 78 (mean 88.9 ± 6.3) months. In 94 survivors, 6 (6.4%) late deaths were encountered. At last follow-up, 81 (86.2%) survivors were in NYHA class I. Actuarial survival was 84.7% ± 3.7% at 5, 10, and 15 years. Conclusion: Carefully selected adolescents and young adults can safely undergo the primary FO. However, persistent pleural effusions, arrhythmias, thromboembolic events, and the need for reoperation mandate regular follow-up in such patients. Preoperative NYHA functional class III, mean PA pressure ≧ 15 mm Hg, hematocrit ≥ 60%, ventricular dysfunction, and AVVR were associated with early mortality, suggesting that primary FO should be avoided in such patients.

To evaluate long-term success of the Ahmed glaucoma valve (AGV) for refractory glaucoma after vitreoretinal surgery with silicone oil insertion. Prospective non-comparative evaluation of patients who underwent AGV insertion for management of post-vitreoretinal surgery glaucoma, post-silicone oil removal. Intraocular pressure (IOP), visual acuity, and glaucomatous neuropathy status were evaluated preoperatively and at multiple follow-up visits postoperatively. Success, using Kaplan–Meier analysis, was determined at the 12-month follow-up visit and at the last follow-up. Factors associated with failure were analysed. Twenty-seven eyes of 27 patients with a mean age of 28.3 ± 15.2 years underwent a superior AGV implantation. The average follow-up after AGV implantation was 17.11 ± 8.36 months (range: 9–60 months). Kaplan–Meier survival analysis revealed a 62 % success at 12 months and 37 % at 5 years. A 48 % rate of complications was noted, 22 % of which were vision-threatening. Factors analysed, including patient age, interval between vitreoretinal surgery and silicone oil removal, interval between vitreoretinal surgery and AGV implantation, and phakic status, were not found to be associated with higher failure rates. Long-term success of AGV implantation for glaucoma after vitreoretinal surgery with silicone oil insertion is better than that reported for trabeculectomy, though complication rates remain high.

BACKGROUND To determine the prevalence of peripheral retinal degenerations (PRD) and rhegmatogenous retinal detachment in patients with primary congenital glaucoma (PCG). METHODS Records of all patients with PCG operated from year 2000 onwards were evaluated to look for the prevalence of rhegmatogenous retinal detachment. Of these, those children who were old enough to cooperate and had sufficient medial clarity were screened with an indirect ophthalmoscopy in a cross-sectional evaluation from 2010 to 2014. Peripheral retina was examined, and prevalence of PRD was estimated in this subset. For statistical purposes, only one eye of each patient was considered in this cross-sectional analysis. RESULTS Of the 310 eyes (180 patients with PCG) operated from the year 2000 onwards, a rhegmatogenous retinal detachment was noted in 13 eyes (4%). Mean axial length of these eyes was 26.3 ± 3.2 mm (range, 19.8-34.7 mm). Among the eyes screened for PRD (n = 60), prevalence of pathologic PRD (lattices with/without atrophic holes and isolated holes/tears) was 15%. The average follow-up between glaucoma filtering surgery and the date of last examination was 8.55 ± 3.98 years (range, 5-20 years) in this subset. Mean axial length was significantly greater in eyes with pathologic PRD than in those without (28.1 ± 3.3 mm vs. 25.8 ± 2.6 mm; P = 0.01). For axial length ≥ 26 mm, the odds of having a pathologic PRD were 14.4 times more than those with axial length < 26 mm (P < 0.001; 95% confidence interval, 1.7-120.5). CONCLUSION Prevalence of PRD among eyes with PCG is high. Peripheral retinal screening should be performed in eyes with PCG, especially those with axial lengths ≥ 26 mm.

Study design Prospective cohort study along with questionnaire. Purpose To measure the correlation of the visual analogue score (VAS), with (Oswestry disability Index [ODI], version 2.1a) in English, and modified ODI (English and Hindi version). To validate translated version of the modified ODI in English version to Hindi. Overview of literature Conflicting evidence in literature regarding the ability for existing ODI score to accurately measure the pain associated disability. Methods One hundred and three patients conservatively treated for low back pain were enrolled in the study. The Pearson correlation coefficient for VAS and ODI along with the Cronbach α and test-retest reliability for Hindi version using the intraclass correlation coefficient was recorded. The new proposed translated Hindi version of ODI was carried out with established guidelines. Results The mean age in English and Hindi version of ODI was 53.5 years and 58.5 years, respectively. The gender ration was 21:24 in the English version and 35:23 in the Hindi version. The mean follow-up in English and Hindi version of ODI was 3.4 months and 50.27 months, respectively. The Cronbach coefficient α=0.7541 for English ODI and 0.9913 for Hindi ODI was recorded for the both modified versions. Conclusions The new modified ODI is time saving and accurate, and it avoids the need to measure other scores and has stronger correlation with VAS score compared to the previous scores. We recommend this version for both English and Hindi speaking population as an assessment tool to measure the disability related to pain.

To determine the safety, efficacy, and feasibility of propofol-based anesthesia in gynecological laparoscopies in reducing incidences of postoperative nausea and vomiting compared to a standard anesthesia using thiopentone/isoflurane.Randomized single-blind (for anesthesia techniques used) and double-blind (for postoperative assessment) controlled trial.Operation theater, postanesthesia recovery room, teaching hospital.Sixty ASA (American Society of Anesthesiologists) I and II female patients (aged 20-60 years) scheduled for gynecological laparoscopy were included in the study.Patients in Group A received standard anesthesia with thiopentone for induction and maintenance with isoflurane-fentanyl, and those in Group B received propofol for induction and maintenance along with fentanyl. All patients received nitrous oxide, vecuronium, and neostigmine/glycopyrrolate. No patient received elective preemptive antiemetic, but patients did receive it after more than one episode of vomiting.Assessment for incidence of postoperative nausea and vomiting as well as other recovery parameters were carried out over a period of 24 hours.Six patients (20%) in Group A and seven patients (23.3%) in Group B experienced nausea. Two patients (6.66%) in Group B had vomiting versus 12 (40%) in Group A (p0.05). Overall, the incidence of emesis was 60% and 30% in Groups A and B, respectively (p0.05). All patients in Group B had significantly faster recovery compared with those in Group A. No patient had any overt cardiorespiratory complications.Propofol-based anesthesia was associated with significantly less postoperative vomiting and faster recovery compared to standard anesthesia in patients undergoing gynecological laparoscopy.

Background: Juvenile onset open angle glaucoma (JOAG) due to its rarity is not well characterized. We aimed to assess the extent of interocular asymmetry of baseline intraocular pressure (IOP), disc morphometry and visual field defects at presentation in patients with primary JOAG. Design: Retrospective, single-centre, hospital-based study. Participants: Fifty-two consecutive JOAG patients who presented with glaucomatous optic neuropathy in at least one eye, without any secondary causes of glaucoma. Methods: Participants were evaluated for baseline clinical features. The optic disc parameters were measured using scanning laser ophthalmoscopy (Heidelberg Retina Tomograph). Reliable and reproducible visual field tests using standard 30-2 Humphrey automated perimetry were analysed. Main Outcome Measures: Interocular asymmetry of baseline IOP, vertical cup:disc ratio and mean deviation. Results: Fourteen patients (27%) had glaucomatous optic neuropathy in only one eye at initial presentation; the fellow eyes of which had IOP 21 mmHg. In 20 out of 52 patients (39%) one eye remained perimetrically unaffected. Patients presenting with bilateral optic neuropathy were found to be significantly younger (24.4 ± 10.6 years) in age compared to those with unilateral optic neuropathy (32 ± 8.2 years) (P = 0.02). Conclusions: One-fourth of primary JOAG patients present as a unilateral optic neuropathy with 60% of these having normal IOP in the fellow eyes. Primary JOAG may present with considerable asymmetry with a small proportion presenting as a unilateral disease.

Background Box trainers are ideal simulators, given they are inexpensive, accessible, and use appropriate fidelity. Objective The development and validation of an open-source, partial task simulator that teaches the fundamental skills necessary for endonasal skull-base neuro-endoscopic surgery. Methods We defined the Neuro-Endo-Trainer (NET) SkullBase-Task-GraspPickPlace with an activity area by analyzing the computed tomography scans of 15 adult patients with sellar suprasellar parasellar tumors. Four groups of participants (Group E, n = 4: expert neuroendoscopists; Group N, n =19: novice neurosurgeons; Group R, n = 11: neurosurgery residents with multiple iterations; and Group T, n = 27: neurosurgery residents with single iteration) performed grasp, pick, and place tasks using NET and were graded on task completion time and skills assessment scale score. Results Group E had lower task completion times and greater skills assessment scale scores than both Group N and R (P ≤ 0.03, 0.001). The performance of Groups N and R was found to be equivalent; in self-assessing neuro-endoscopic skill, the participants in these groups were found to have equally low pretraining scores (4/10) with significant improvement shown after NET simulation (6, 7 respectively). Angled scopes resulted in decreased scores with tilted plates compared with straight plates (30° P ≤ 0.04, 45° P ≤ 0.001). With tilted plates, decreased scores were observed when we compared the 0° with 45° endoscope (right, P ≤ 0.008; left, P ≤ 0.002). Conclusions The NET, a face and construct valid open-source partial task neuroendoscopic trainer, was designed. Presimulation novice neurosurgeons and neurosurgical residents were described as having insufficient skills and preparation to practice neuro-endoscopy. Plate tilt and endoscope angle were shown to be important factors in participant performance. The NET was found to be a useful partial-task trainer for skill building in neuro-endoscopy.

The purpose of our study was to compare respiratory-triggered and breath-hold diffusion-weighted liver MRI and to assess the agreement in the apparent diffusion co-efficient (ADC) values between the two sequences.Forty-eight patients (27 men, 21 women; mean age, 45.2 years) with focal liver lesions underwent respiratory-triggered and breath-hold diffusion-weighted MRI (DWI) in addition to routine MRI. Both sequences had identical imaging parameters except for signal averages, which were 6 in respiratory-triggered and 2 in breath-hold sequences. A total of 92 lesions (maximum of three lesions per patient; 37 benign, 55 malignant) were evaluated. Lesions were confirmed by typical imaging appearance, histopathology, or follow-up. Signal-to-noise ratio (SNR) of the liver, contrast-to-noise ratio (CNR), and relative contrast ratio of the lesions were measured in each DWI sequence and were statistically compared using the Mann-Whitney U test. The ADC values of normal liver and each category of liver lesions in the two sequences were compared for agreement using Pearson's coefficient and reliability analysis scale.The SNR of the normal liver was significantly better on respiratory-triggered DWI than on breath-hold DWI. The mean CNR of metastases, hepatocellular carcinomas, and abscesses was significantly better in the respiratory-triggered DWI than in the breath-hold DWI sequences. The ADC values of liver and focal lesions measured by the two techniques showed good agreement. The SDs of the ADC values of normal liver were similar in the two sequences.Respiratory-triggered DWI should be preferred over breath-hold DWI for the evaluation of focal liver lesions because it provides better image quality and SNR without any compromise in the calculated ADC values.

The aim of this study was to compare the long-term efficacy of bimatoprost 0.03% monotherapy in primary open angle glaucoma (POAG) versus primary chronic angle closure glaucoma (PCACG) eyes.A total of 55 consecutive primary adult glaucoma patients on bimatoprost monotherapy were prospectively evaluated in this 3-year, open-labeled, uncontrolled study. The primary outcome was the evaluation of a difference in the response to therapy of POAG eyes, as compared to PCACG eyes over a follow-up of 3 years.In the POAG group, the mean intraocular pressure (IOP) at the 36-month followup was found to be increased by 2.10 (+/-3.90) mmHg (confidence interval [CI], 0.975-4.185), compared to the mean IOP at 1 month (P = 0.047). In the PCACG group, the mean IOP at the 36-month follow-up was increased by 3.66) (+/- 3.34) mmHg (CI, 6.241-1.092), compared to the mean IOP at 1 month (P = 0.011). This upward drift in IOP was higher in the PCACG group, compared to the POAG group, but this was not statistically significant (P = 0.54). Patients with POAG and PCACG showed a 50% and 40% chance of having an IOP of18 mmHg with bimatoprost monotherapy (P = 0.23), respectively, at the 3-year follow-up.This study showed that bimatoprost 0.03% monotherapy significantly lowers IOP in both POAG and PCACG eyes over a period of 3 years, though its efficacy appeared to decrease over time, to a similar extent, in both groups.