Our Outpatient Department Research Articles

MANAGEMENT OF APPENDICITIS THROUGH AYURVEDIC MEDICINES: A CASE REPORT

Appendicitis is inflammation of the vermiform appendix. It has an approximate incidence of 233 per 100,000 people. This is a case of a 7-year-old boy diagnosed with appendicitis and suggested appendicectomy by the modern fraternity. His parents were reluctant to do surgery and took him to our Outpatient Department (OPD). The appendix was distended with a diameter of 7.3 mm in the Ultra Sono Graphy (USG) report. After detailed evaluation and dosha dushya assessment, the treatment adopted was that of Pitta Kapha Gulma and Antar vidradhi and given OP-level treatment. Pathya ahara (appropriate diet regimen) was strictly advised along with medicines. After one month of treatment, the size of the appendix was reduced to 5.3 mm. The medicines were discontinued and Charngeryadi ghrita was given for 2 months. The patient was completely recovered, and no recurrence has been observed.

An observational study to evaluate weight gain of exclusively breastfed infants who feed only while sleeping

Background: We encountered infants in our outpatient department (OPD) who have been breastfeeding normally till 3–6 months of age and stopped feeding while awake without any obvious reason, and continued feeding during sleep. This causes much anxiety and concern to the mother and demands intervention. Objectives: The aim of the study was to compare the weight gain of infants who breastfeed only during sleep, with babies who feed normally. Materials and Methods: An observational study has been carried out in pediatric OPD, at Government Medical College Kannur. Totally 30 breastfeeding mothers were interviewed and data were entered in a proforma. Weight gain was taken from the growth chart beginning from birth to 6 months. Results: Among the 30 breastfeeding mothers interviewed, 12 of them had infants who started feeding only during sleep from around 3 to 4 months of age. On the assessment of growth and development among these infants, it was noted that they were comparable with the infants on exclusive breastfeeding without the problem. No failure to thrive or delayed development was noted in the study group as compared to normal. Conclusion: Growth and development was normally attained in infants who breastfeed only while sleeping. As this matter hasn’t been studied anywhere so far and is a cause for anxiety in mothers, it demands further research and study.

Changing Trends of Cutaneous Lupus Erythematosus (CLE) in a Tertiary Care Hospital in Northern Odisha, India.

Cutaneous lupus erythematosus (CLE) is a chronic autoimmune inflammatory skin disorder. Several studies have been published regarding its prevalence, demographic details, clinical spectrum, and various associated factors. In our out patient department (OPD), we noticed an increase in the number of cases of CLE in our area in the last few years. Therefore, the current cross-sectional study was conducted to assess the trends of CLE among patients who reported to a tertiary care hospital. The current study is a record-based cross-sectional study of 81 patients of CLE, who attended the dermatology OPD of a tertiary care hospital. Data were collected from 2017 to 2022 and were divided into three different periods of time (2017-2018, 2019-2020, and 2021-2022). Demographic details, clinical examination findings, and laboratory investigation reports were also collected. There was a rising trend in the cases of CLE. Females outnumbered males (2:1, 66.67%). The increase in cases from 2017-2018 to 2019-2020 was 157% and from 2019-2020 to 2021-2022 was 204%. In 2021-2022, 52% of cases of chronic CLE (CCLE) were males. Photosensitivity was the most common finding. The majority of patients were addicted to smoking. The current study noticed an increasing trend in all types of CLE. So, this rising trend should be investigated for possible triggering factors like climatic changes,infections, and drug factors with a larger sample size.

#5841 UTILITY AND ACCEPTANCE OF TELENEPHROLOGY AMONG KIDNEY TRANSPLANT RECIPIENTS IN A PUBLIC SECTOR HOSPITAL IN A DEVELOPING COUNTRY

Abstract Background and Aims The importance of telemedicine in delivering renal health care has come to light during the COVID-19 pandemic. Moreover, specialist care to transplant recipients is often limited to urban areas especially in developing countries. Telenephrology offsets this discrepancy enabling quality care to patients in rural areas. But, apart from availability, the true success and future of telenephrology depends primarily on patients’ acceptance. This study was performed to assess the feasibility, patient attitude and acceptance of telenephrology services among renal transplant recipients at our institute, a public sector hospital in a developing country. Methods This single-centre cross-sectional study included renal transplant recipients who availed our telenephrology services for at least 3 months. A total of 100 transplant recipients were selected by stratified random sampling from the list of attendees of telenephrology consultation and included in this study. The study questionnaire was administered in local language by the telephone interview method. Results The mean age of our study cohort was 32.83 ± 9.96 years (16 – 55yrs) and 92% were males. The median number of teleconsultations availed by the patients was 5 (1-20). The questionnaire was answered by the patient himself/herself in 89% cases, spouse in 7% and children in 3% cases. Only thirty-nine (39%) patients were graduates or post graduates. Over one-half (51%) of the patients belonged to the lower-middle socioeconomic class as per the modified Kuppuswamy classification. Prior to initiation of the telenephrology service, the median distance travelled to attend our out-patient department (OPD) was 304.5 Km (6 – 1673 km). Most (87%) of our patients used public transport to attend OPD. Three-fourths (79%) of the patients were accompanied by family members for their OPD visit. Attendees incurred productivity loss due to missed work days in 57% of the cases. The median cost of each OPD visit was 3000 (40-15000) INR. Almost all the transplant recipients felt that Telenephrology service was a right approach during the COVID-19 pandemic. 98% of the patients said that they were confident discussing their complaints over phone while 99% of our patients were comfortable sharing reports over phone. Majority (>90%) of the patients gave a satisfaction score of 4 (out of 5) for their telenephrology experience. The most important benefit (79%) of telenephrology as perceived by the transplant recipients was financial benefit of avoiding travel and workdays saved. Regarding the problems faced during teleconsultation, 22% patients responded that they wish to see the doctor in person to feel satisfied; 5% had problems with availability of investigations locally. Only a small fraction (2%) of patients had difficulty in explaining symptoms over a tele-consult. A significant (97%) patients felt that Telenephrology services should continue in combination with physical OPD services. Conclusion Telenephrology is feasible and acceptable to kidney transplant recipients irrespective of literacy status across all socio-economic classes. In developing countries like India, telenephrology has immense potential to provide quality nephrology care.

Refixation of labrum in pincer type of femoroacetabular impingement

We present the case of a single, retired, 51-year-old Taiwanese female who had left groin pain when squatting, sitting, and walking for months. She visited our outpatient department (OPD) for further evaluation. During physical examination at the OPD, limited hip flexion and abduction were observed in comparison with the contralateral hip in the supine position. Impingement tests including flexion, abduction, and external rotation test and flexion, adduction, and internal rotation test were positive. In addition, the extension external pain and Patrick test results were positive. Pelvis radiography revealed a crossover sign and lateral center-edge angle of 40.6°. Magnetic resonance imaging revealed a degenerative tear of the anterosuperior labrum with a prominent pincer lesion. Consequently, she was admitted for arthroscopy-assisted rim resection of the pincer-type lesion and labral refixation. After surgery, the patient recovered well.

Clinical and Demographic Patterns of Vulval Dermatoses and Their Impact on Quality of Life.

Vulval dermatoses may present with varied manifestations ranging from asymptomatic to chronic disabling conditions. The multifactorial nature of symptoms and physical expression of the disease on the vulva complicate the evaluation and management of genital dermatoses, thereby severely impairing the quality of life of patients. To study the clinical patterns and socio-demographic features of vulval dermatoses and their impact on the quality of life using the dermatology life quality index (DLQI) questionnaire. Female patients of all age groups who attended our outpatient department (OPD) from October 2019 to March 2021 with vulval lesions were included in the study after a detailed history and complete examination. Based on sites of involvement, the lesions were classified as genital lesions alone, genital and skin lesions, oro-genital lesions, and oro-genital and skin lesions. DLQI score was assessed using the DLQI questionnaire. In total, 520 patients were recruited for the study after following the inclusion and exclusion criteria. The most common age group was 31-40 years (33.65%). The majority of the patients were married (91.92%), housewives (82.88%), and illiterate (49.61%) women. The most common presenting symptom was itching (43%). The most common vulval dermatoses were infections, seen in 401 (77.11%) patients, followed by inflammatory diseases in 78 (15%) patients, and immunobullous diseases (1.53%). Patients with genital, skin, and oral involvement showed statistically significant higher DLQI scores (P value < 0.05). Patients with immunobullous disorders had the highest mean DLQI scores. As this study was a hospital-based study, the observations may not represent and reflect the general population. Patients with genital, skin, and oral lesions had the highest DLQI scores, indicating higher impact on the quality of life. Assessment of the disease's impact on the quality of life is essential because it not only aids in early management but also helps in minimizing the duration of the ailment.

EP-422 Operating in the outpatient department: the future of flexor tendon repair?

AimsFlexor tendon injuries are debilitating with rupture of repair leading to significant morbidity. The SARS-CoV-2 pandemic has led to a shift to out-of-theatre operating, with many flexor tendon repairs being performed on the same day as initial assessment in our outpatient department (OPD) procedure room. We aimed to compare the rupture rates before and after the start of the pandemic to assess the safety of this change in practice.MethodsPatients who underwent repair of one or more flexor tendons were included from two six-month periods: July to December 2019 and April to September 2020. Patient records were reviewed to identify operation location, number of flexor tendons repaired per patient and rupture incidence. In the second period, patients whose operation was performed in theatre were excluded.Results28 patients were included for the initial period with a total of 49 flexor tendons injured. All repairs were performed in theatre and 3 ruptures were recorded (6%). 17 patients underwent flexor tendon repair during the second period. 11 patients were operated on in the OPD with a total of 16 flexor tendons injured. 1 rupture was recorded (6%).ConclusionsThe rupture rate of OPD operating is comparable to that of the traditional theatre pathway. OPD operating also allowed us to circumvent theatre waiting lists and thus avoid costly delays to patient care. This project demonstrates maintained safety for patients and offers a platform for further research to confirm OPD operating as a viable and sustainable alternative for future practice.

Clinical and Dermoscopic Evaluation of Periorbital Melanosis.

Background:Periorbital melanosis (POM) describes the light-to-dark-colored, brownish-black pigmentation surrounding the eyelids. It can affect an individual’s quality of life. Dermoscopic features of POM are not frequently reported in the literature.Materials and Methods:This study comprised 100 patients aged above 16 years, who attended our outpatient department (OPD) from November 2018 to October 2019. A detailed history, clinical features, and the dermoscopic study of color, pattern of pigment, and pattern of the blood vessel were recorded with the Dermlite-3N dermoscope (3Gen, San Juan Capistrano, California). On the basis of the eyelids’ pigmentation and involvement, patients were clinically graded as Grade 0 to 4, with 4 being deep dark color extending beyond the infraorbital fold. The clinical patterns and the dermoscopic features were correlated.Results:Most patients were women (76) and the common age group was 16–25 years. Most of the patients had both the eyelids involved (58%), followed by lower eyelids (28%). The majority of the patients were having POM of grade 2 (47%). Seventeen patients (17%) had a positive family history of POM. The most common clinical form of POM observed was constitutional type (77) followed by postinflammatory type (12). Of 100 patients, 52 had pigmentary, 15 had vascular, and 33 had mixed pigmentary-vascular pattern. Cell phone usage (>4 h) and refractory errors (38% each) were the common risk factors observed. Stress and respiratory allergy were significantly associated. In the pigmentation patterns, epidermal (54%), dermal (14%), and mixed (17%) subsets were observed. The reticular pattern was the most common vascular pattern (65%).Conclusion:POM is a multifactorial entity. Multiple risk factors play a role in the pathogenesis and aggravation. Clinical forms did not show any specific dermoscopic patterns. Dermoscopy of POM helps to know the underlying pathology, which in turn paves the way to the effective treatment.

Prevalence of Helicobacter Pylori Infection in Patients with Chronic Dyspeptic Symptoms at Rawal General and Dental Hospital, Islamabad

Background: Helicobacter Pylori infection is the most common cause of chronic dyspeptic symptoms all over the world and covers more than 60% of the out-patient department’s (OPD) registry. That is why we aimed to conduct this study to determine the prevalence of helicobacter pylori infection in patients with chronic dyspeptic symptoms visiting at our out-patient department (OPD) of Rawal General and Dental Hospital.&#x0D; Methods: This was a descriptive cross-sectional hospital based study conducted in the Department of Gastroenterology, Rawal General and Dental Hospital, Islamabad between the periods of two years June 2018 – June 2020 with in patients who presented with a chief complain of dyspepsia through a consecutive sampling technique. Baseline and clinical variables were collected and correlated with the presence and absence of H. pylori infection among 355 finally recruited participants.&#x0D; Results: The overall prevalence of H. pylori infection was 59.71% (n = 212). Among them, married males were more common. Positive H. pylori patients were younger than negative H. pylori patients, 40.24±6.62 vs. 44.9±8.05 (p 0.04). Participants who had a history of NSAIDS intake for past 7 days were significantly associated with positive H. pylori infection, 54.24% (n = 115), p 0.02. While on the other hands, patients who were receiving proton pump inhibitor for the past 4 weeks were significantly associated with absence of H. pylori infection when they presented with chronic dyspeptic symptoms, 65.03% (n = 93), p 0.01.&#x0D; Conclusions: Our study has found that almost two third of the population suffering from chronic dyspeptic symptoms had positive H. pylori infection and these patients are younger than H. pylori negatives. Chronic NSAID users have direct relation in increased prevalence of H. pylori detection while use of PPI plays safety role in prevention and reducing of H. pylori infection.

A Sinister Disease Hides Behind Recalcitrant Mucocutaneous Disorder

Paraneoplastic pemphigus (PNP) is a rare autoimmune disorder associated with underlying benign or malignant neoplasia. Its signs and symptoms may be the first presentation of a concealed malignancy. Due to late diagnosis, prognosis of PNP is not good, so early diagnosis and treatment is of paramount importance. We present a case of 22 years old female who presented to our out patient department (OPD) with history of recurrent, severe, recalcitrant, painful oral ulcers; lichenoid lesions over the hands and feet and widespread blistering and erosions involving the soles. Histopathological examination was consistent with paraneoplastic pemphigus and showed features of lichenoid dermatitis. CT scan revealed retroperitoneal mass suggestive of Castleman disease. The patient was referred to surgical team for further management.

An interesting case of masculine voice in a girl: A case report of 11 beta hydroxylase deficiency

A 7-year-old girl presented to our outpatient department (OPD) with masculine voice, hyperpigmentation of skin, and genital ambiguity. On clinical examination, she had hypertension, hyperpigmentation of skin, pubarche, clitoromegaly, and low-pitched voice. Karyotype was 46 XX and ultrasound showed bilateral enlarged adrenals, uterus, and ovaries. Hormonal workup revealed elevated levels of 17-?-hydroxyprogesterone, testosterone, 11-deoxycortisol, and deoxycorticosterone. Due to the presence of hypertension, genital ambiguity and elevated 11-deoxycortisol, a diagnosis of 11-?-hydroxylase deficiency variant of Congenital Adrenal Hyperplasia was made. The child was started on hydrocortisone and amlodipine after which her symptoms such as hyperpigmentation improved.

CORRELATION OF ORAL HEALTH STATUS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN A TERTIARY CARE HOSPITAL, INDIA

<h3>Background</h3> Oral health is considered to be an important factor in respiratory diseases such as pneumonia and chronic obstructive pulmonary disease (COPD). Poor oral health has been implicated as an independent risk factor for the development of COPD, but few studies have evaluated the association between oral health and COPD. <h3>Objective</h3> To assess the oral health and habits of individuals with COPD visiting our outpatient department (OPD) for regular checkup. <h3>Methods</h3> We performed a case–control study of oral health among patients with COPD exacerbators and healthy non-COPD control subjects. Cases had experienced ≥1 exacerbation in the previous 12 months, and control subjects were healthy patients reporting to the dental OPD for regular dental checkup. We evaluated oral health status, recorded dental symptoms/habits, and performed pulmonary function testing. In a subset, we performed blinded dental examinations to measure bleeding on probing, probing depth, clinical attachment loss, periodontitis severity, plaque index, gingival index, and caries risk. We evaluated associations between oral health and COPD using logistic regression. <h3>Results</h3> Self-reported oral health status and objective dental findings had variations between cases and control subjects. Participants with COPD had multiple missing teeth and a higher amount of plaque and calculus, indicating poor dental health. Oral candidiasis, keratotic white lesions, and oral melanosis were also present. <h3>Conclusions</h3> In the present observational study, we found that participants with COPD had poor oral health that compromised their quality of life, probably precipitating an acute exacerbation. The incidence of COPD can be reduced by good oral hygiene measures.

Adrenal schwannoma: A case report of an unusual incidentaloma.

Introduction and importanceAdrenal schwannomas are extremely rare tumors often misdiagnosed. The patients are usually asymptomatic while some present with non-specific abdominal pain. Only a few cases are reported to date.Case presentationWe here present a case of a 55-year-old Nepalese man presented with nonspecific abdominal pain at our Outpatient Department (OPD) found to have mass on ultrasonography of abdomen. On further investigation with Contrast Enhanced Computerized Tomography (CECT) of the abdomen and pelvis, a well-defined heterogeneous adrenal mass of size (7.8 ∗ 8.3 ∗ 6) cm with foci of calcification was seen in the left retroperitoneum. The intraoperative finding of adrenal mass and histopathology of resected mass was suggestive of schwannoma arising from the adrenal gland which was further confirmed by immunohistochemistry.Clinical discussionAdrenal schwannoma can mimic tumors like pheochromocytoma, adrenal adenoma, cortical carcinoma, neuroblastoma, and other masses. Only 1–3% of schwannomas are retroperitoneal. Radiological findings of this tumor are non-suggestive. The histological section shows spindle cells with Antoni A and Antoni B regions while positive staining of S-100 protein in Immunohistochemistry.ConclusionThe diagnosis of adrenal schwannoma in the retroperitoneum is often challenging. The treatment of choice is surgical resection with a good prognosis.

Pattern of Haematological Malignant Patients Attending OPD in a Tertiary Level Hospital in A Calendar Year

Background: Hematologic malignancies are of diverse incidence, prognosis, and etiology. Dhaka medical college hospital (DMCH) is a tertiary level hospital and dealing with patients attending from all over the country. We have analyzed data of patients present with hematological malignancy in our Out Patient Department (OPD). As Hematology Dept DMCH deal with patients referred from all over the country, its OPD data represents the picture of whole country. Methods: This is a retro-spective study of OPD patients with hematological malignancy in the department of Hematology of DMCH from January 2018 to December 2018. The diseases were diagnosed on the basis of bone marrow morphology or histopathology (Lymphoma) and or immunophenotyping &amp; molecular genetics. Results: Total 5747 patients were treated in 2018 with the complaints related to hematological malignancy of which 4599 (80%) were old patients and 1148 (20%) were new patients. Among all the treated patients 1420 (24.7%) were female and 4327 (75.3%) were male. Among 1148 new cases 37 were AL(3%), 386 were ALL (34%), 265 were AML(23%), 32 were CLL (3%), 126 were CML (11%), 40 were HL (3%), 18 were MDS (1%), 76 were MM (7%), 168 were NHL (15%). Data shows variation in total number of new patients per month- 83 in January (7.23%), 96 in February (8.36%), 140 in March (12.20%), 98 in April (8.54%), 94 in May (8.19), 89 in June (7.75%), 98 in July (8.54%), 66 in August (5.75%), 99 in September (8.62%), 103 in October (8.97%), 98 in November (8.54%), 84 in December (7.31%) But it does not show any statistical significant frequencies of diseases according to months. Conclusion: We deal a lot of patients with hematological malignancy each year in DMCH. A good portion of them are of ALL because of monthly maintenance of ALL protocols. Analysis of new cases shows ALL, AML, NHL is most common three diseases encounter in OPD. OPD patients’ inflow does not show any significant monthly variation for any of the diseases.

The Diagnostic Value of Hysterosalpingography and Hysterolaparoscopy for Evaluating Uterine Cavity and Tubal Patency in Infertile Patients.

Background and objectiveHysterosalpingography (HSG) is a common radiologic modality employed for the initial workup of female infertile patients to evaluate for tubal patency or any gross intrauterine pathology. HSG is a relatively cheap and easily available outpatient procedure but bears the risk of radiation exposure. The purpose of the study was to compare the diagnostic value of HSG with that of diagnostic hysterolaparoscopy in infertile women and to evaluate their role in the diagnosis and management of infertility.MethodologyThis study was carried out from February 2018 to January 2019. All women attending our outpatient department (OPD) for the treatment of infertility who were aged between 20-40 years were included in the study. Those with acute vaginal and cervical infection and those having an allergic reaction to the dye used in HSG were excluded from the study. Known cases of pelvic inflammatory disease and those who achieved pregnancy before the performance of hysteroscopy were also excluded from the study.ResultsA total of 172 women with primary or secondary infertility were enrolled in the study. Out of these, 13 women became pregnant, and two were lost to follow-up and were excluded from our study. Thus, a total of 157 infertile women were analysed. The agreement between HSG and hysteroscopy was 71.3% for the evaluation of the uterine cavity, and this was considered a fair strength of agreement between the procedures (k value=0.302).ConclusionCompared to HSG, the incidental findings detected by hysteroscopy amounted to 19.14%. Our study results depict the advantage of hysterolaparoscopy over HSG. Although the sensitivity of HSG is as good as that of diagnostic hysterolaparoscopy for the detection of tubal patency, a significant number of important incidental findings can be missed by it. Hence, diagnostic hysterolaparoscopy should be offered as the first-line modality for the evaluation of infertility wherever the procedure is available.

Clinical Characteristics of Children Admitted to the Pediatric Emergency Department Referred from Outpatient Departments

Objective: The objective of this study was to describe characteristics of children referred from our outpatient department (OPD) to the pediatric emergency department (PED). Method: All pediatric patient charts from October 2018 to January 2020 who were referred from our OPD to PED were reviewed. The following clinical information was studied: demographics, (age, gender, distribution of patients by month) diagnosis, and disposition (admission, discharge). Results: During the 16-month study period, 867 patients were enrolled, 468 (54%) were discharged from PED, and 399 (46%) were admitted. In this study, 654 (75.4%) of the 867 children were aged <6 years. The three most common referred divisions of OPDs were division of pediatric gastroenterology (412, P = 0.000), division of pediatric infectious disease (182, P = 0.784), and division of pediatric neurology (99, P = 0.000). Conclusion: In this single-hospital study, children referred from OPDs to PED were more likely to be discharged from PED than admitted to the hospital. We suggest that effective communication with parents and well clinical evaluation may reduce unnecessary emergency resource use and inpatient admissions.

Odontogenic Cutaneous Sinus Tracts: A Clinician's Dilemma.

Background:Odontogenic cutaneous sinus tract (OCST) is one of the rare manifestations of chronic dental infections. Although well reported in literature, it is often misdiagnosed or under diagnosed. Apart from isolated case reports especially in dental literature there is a paucity of comprehensive case series on OCST.Aims and Objectives:We undertook this study to observe the prevalence, clinico epidemiological features and management issues in these patients from a dermatological perspective.Methods:A retrospective study was undertaken analyzing the clinical records of patients registered at our outpatient department (OPD) from 2011 to 2018. Cases with a clinical and radiological diagnosis of odontogenic cutaneous sinus were included in the study. We studied the following variables: frequency, gender, age, localization, morphology, mean time of evolution and treatment response.Results:21 patients with OCST were identified from our records. Females outnumbered males; patients in the age group between 31-40 years were more commonly affected. Three morphological presentations were noted in the form of flesh-colored dry nodules with sinus, adherent plaques with mucopurulent discharge and ulcer. Posterior set of teeth were commonly affected and mandible was the commonest site for location of sinus. The time taken for appropriate diagnosis in these cases ranged from 7-16 months. Almost all the patients responded to endodontal or root canal treatment and there were no recurrences.Conclusion:A CST of dental origin is often a diagnostic challenge, especially in cases with minimal or no dental symptoms. A thorough skin and dental examination is required for sinuses on the head and neck area with a high index of suspicion for OCST. Most cases respond to conservative, root canal therapy. An early diagnosis can save the patient from unnecessary and ineffective therapies and sometimes surgeries.

A case of transorbital intracranial injury presenting with subtle neurological deficit.

Ocular trauma is a major cause of visual morbidity. To present a rare case of transorbital intracranial injury extending up to the left internal carotid artery (ICA) with no other systemic neural deficit except for the ocular manifestations. A 14-year-old female presented to our out-patient department (OPD) with the history of trauma to her left eye with stumps of bamboo shoots secondary to a fall injury. Examination and investigations revealed a foreign body extending from left inferior conjunctival fornix into the intracranial cavity, occluding the various segments of left ICA. The patient subsquently underwent craniotomy and foreign body removal by a combined team of neurosurgeons and ophthalmologists. On discharge, the patient had slight improvement in extraocular motility of her left eye. However the trauma rendered the affected eye, non-seeing. The intracranial extent of a foreign body entering the cranium via the transorbital route cannot be judged merely by the clinical findings of the nervous system and ocular examination. These patients need timely management by the combined effort of ophthalmologists, neurosurgeons and radiologists.

Evaluating the Effectiveness of a One Point Psycho-Educational Intervention for Smokeless Tobacco Users Delivered in an Outpatient Department in India

Introduction: In a recent review it was reported that 51.3% people in India consume SLT. This usage is highest in males living in rural areas and the most common forms of SLT consumed are Khani, Gutka, Beetle quid with tobacco and powdered tobacco. Aims and Methods: We aimed at 1) studying the prevalence and understanding the demographic variables associated with SLT consumption in patients presenting to our out patient department(OPD). 2) Evaluating the effectiveness of single psychoeducation session on tobacco cessation. After assessing patients based on our inclusion criteria, we administered a Fagerstorm Nicotine Dependence Test, Smokeless Tobacco (FTND-ST) at baseline. Subsequently they were given a structured session of psycho-education and they were then followed up after a month using the same scale and change in the score was recorded. Results: Our results indicate the following: 1) Maximum SLT consumption was seen in males coming from rural areas. 2) At baseline 39 % were in the category of mild dependence, 41% in moderate dependence and 20% in severe dependence and following up after the single psychoeducation session, 50% were mildly dependent, 47% were moderately dependent and 3% were severely dependent. (p<0.001). 3) Maximum reduction was seen in the time taken to consume SLT after waking up and the number of SLT pouches/cans consumed per day(p<0.001) Conclusions: The problem of SLT consumption is multi-factorial with social, economic and health repercussion. Though we did not see complete abstinence with our intervention, it served the purpose of reducing the consumption of SLT among our participants in a significant manner. There is no gold standard for tobacco cessation including pharmacological interventions. Thus our findings have to be viewed as a part of collective and long-term effort towards de-addiction.

Diabetic Retinopathy

The focus of this article is to discuss the care given to an elderly lady, Mrs Pitt, (a pseudonym) who is suffering from Diabetic Retinopathy (DR) and attending our Out Patient Department (OPD). It will start with a brief description of diabetes and the associated complications, and then give a more in-depth description of DR and the relevant anatomy and physiology. It will then give details of Mrs Pitt's history and her current care and treatment. All information will be supported by current, relevant literature.