Jammu Hospital

A BSTRACT Laser surgery offers a minimally invasive alternative for common anorectal conditions with reduced pain, quicker recovery, and high patient satisfaction however, long-term results show variable recurrence rates, questioning its standalone efficacy. Hybrid laser procedures appear promising but lack strong evidence to replace established standards. The future of laser use in proctology depends on robust studies, standardized training, and evidence-based application rather than technological enthusiasm.

Abstract A 32-day-old male child was brought by parents with complaints of incomplete eyelid closure, associated with redness and watering. After a thorough ophthalmological and systemic examination, a diagnosis of isolated congenital microblepharon, complicated with exposure keratopathy was made. Prompt surgical correction of bilateral upper and lower eyelids was carried out using full-thickness skin graft and lateral tarsal strip suspension. At last, follow-up to 6 months, there was a good graft uptake with no lagophthalmos and complete correction of keratopathy. Isolated congenital bilateral microblepharon is an extremely rare, but important clinical entity that requires early diagnosis and prompt management to prevent visual morbidity. The use of skin grafts and lateral tarsal strip suspension surgery is an effective surgical strategy with good functional and cosmetic outcome in severe cases. This study is noteworthy for the early diagnosis and extensive surgical correction in a 32-day-old child, making it a strong case in favor of early definitive surgical treatment in such cases.

Bell's Palsy is characterized by sudden onset facial paralysis due to dysfunction of the facial nerve. While conventional treatments exist, the potential of Hyperbaric oxygen therapy (HBOT) in managing this condition remains underexplored. This study aims to evaluate the efficacy of HBOT as an additional intervention in Bell's Palsy cases. Seven individuals with Bell's Palsy were selected for this study and treated with a combination of standard therapy along with sessions of HBOT. The treatment regimen, frequency of HBOT sessions, and follow-up protocols were standardized across all cases. Following the combined therapy approach, significant improvements were observed in all seven cases. Reduction in facial paralysis, improved muscle strength, and enhanced facial mobility were notable outcomes. Furthermore, compared to historical data on Bell's Palsy recovery rates with standard treatment alone, the addition of HBOT seemed to expedite the recovery process. This case series demonstrates promising results regarding the efficacy of HBOT as an adjunct therapy for Bell's Palsy. The findings suggest that incorporating HBOT into the treatment protocol for Bell's Palsy could potentially enhance facial nerve recovery and overall outcomes. Further research with larger sample sizes and controlled studies is warranted to solidify these preliminary findings and establish HBOT's role in the management of Bell's Palsy.

ObjectiveWe report four unique neurological cases that initially presented with ophthalmological manifestations.Case seriesIn the first case, a 36-year-old man came in with a left-sided headache and isolated third nerve palsy. Detailed investigations led to the discovery of a supraclinoid internal carotid artery aneurysm, necessitating prompt neurosurgical intervention. The second case featured a 74-year-old man with complete drooping of his right eyelid. The diagnosis of complete third nerve palsy led to further tests, which uncovered multiple myeloma. The third case involved a 19-year-old girl who had persistent double vision and bilateral ptosis. A collaborative effort between ophthalmologists and neurologists revealed Miller Fisher syndrome, which was successfully treated with intravenous immunoglobulins. Lastly, the fourth case described an 8-year-old girl who presented with optic neuritis. A thorough ophthalmological evaluation led to the diagnosis of Neuromyelitis Optica Spectrum Disorder, enabling early treatment and significant improvement.DiscussionThese cases highlight the crucial role of ophthalmologists in identifying severe systemic and neurological conditions through subtle ocular signs. Each diagnosis—from aneurysms to autoimmune and malignant disorders—was made possible by vigilant ophthalmic evaluation and timely interdisciplinary collaboration. These examples reinforce that the eye often provides the first clue to an underlying disease, and that early recognition by ophthalmologists can be critical to effective, and sometimes lifesaving, intervention.ConclusionThese cases collectively emphasize the critical importance of detailed ocular evaluation in the early detection and management of a wide range of neurological and systemic conditions, highlighting how ocular symptoms can often be the first indication of more serious underlying health issues.

This study investigates the efficacy and safety of two Nd:YAG laser capsulotomy techniques—cruciate and circular—in treating posterior capsule opacification (PCO).Conducted as a prospective,randomized controlled trial at a tertiary eye care center in Jammu & Kashmir from June to August 2024,the study enrolled 50 patients diagnosed with PCO. Patients were divided into two groups:Group A underwent cruciate capsulotomy,while Group B received circular capsulotomy. The results indicated that while the cruciate technique was associated with fewer complications, including intraocular pressure (IOP) spikes,the circular technique yielded superior visual outcomes.Complications such as intraocular lens (IOL) pitting, uveitis, and cystoid macular edema (CME) were more prevalent in the circular group. Statistical analysis revealed no significant association between the pattern of PCO laser and the occurrence of floaters. The findings suggest that both techniques have distinct advantages and disadvantages, emphasizing the need for individualized treatment plans based on clinical judgment to optimize patient outcomes.

Purpose:To study was to study the efficacy of autologous platelet-rich plasma injections (PRPi) in the treatment of dry eyes.Methods:This prospective, interventional study was conducted at a tertiary eye care center, India. One hundred and sixty eyes of 80 patients with newly diagnosed dry eyes were included. One eye received PRPi (cases = 80 eyes), and the other eye of the patient received a lubricating drop (control = 80 eyes). Cases who did not improve at 1-month follow-up (FU) were reinjected with PRP. The outcomes were measured on the basis of ocular surface disease index (OSDI), Schirmer’s test (ST), noninvasive tear breakup time (NIBUT), tear meniscus height (TMH), and ocular surface staining (OSS) score done at baseline and 1-month, 2-month, 3-month, and 6-month FU.Results:Sixty cases showed a significant improvement in all the outcome measures at 1 month (P < 0.001), when compared to controls; whereas, 20 cases had to undergo repeat injections. On FU at 2 months, 16 cases (out of those 20 cases) showed a significant improvement (P < 0.05), while 4 cases still did not improve clinically at 3 months. All the outcome parameters (ST, NIBUT, TMH, and OSS and OSDI scores) maintained a significant improvement at 6-month FU, including those four cases (P < 0.001). All the patients were highly satisfied with the intervention.Conclusion:PRPi, as a monotherapy given on pro-re-nata basis, is a simple and efficacious modality of treatment in dry eyes, verified by improvement in subjective and objective tear film parameters.

Alcohol-related liver disease contributes significantly to global mortality and healthcare costs, underscoring the urgency of early detection and non-invasive diagnostic tools such as transient elastography. This study aimed to investigate the correlation between the severity of alcohol dependence syndrome (ADS) and liver dysfunction assessed via transient elastography in newly diagnosed patients. From October 2019 to September 2021, a cross-sectional observational study was conducted on 58 inpatients diagnosed with ADS according to International Classification of Diseases-10 criteria. The severity of alcohol dependence was assessed using the Severity of Alcohol Dependence Questionnaire (SADQ), serum biochemical markers, and liver stiffness measured by transient elastography within 96 hours of admission and again after four weeks of enforced abstinence. Data were analyzed using Statistical Package for Social Sciences, with descriptive statistics applied to socio-demographic and clinical data. Paired t-tests compared biochemical markers, and Spearman rank correlation analyzed the relationship between SADQ scores and liver stiffness at admission and after abstinence. Initial SADQ scores indicated moderate alcohol dependence in 55% of participants. According to Alcohol Use Disorders Identification Test, 38% had a medium-to-severe risk of harmful alcohol consumption. Liver fibrosis assessment showed that 63.8% had no or mild fibrosis on day 1, increasing to 81.0% by day 28. Moderate to advanced fibrosis (measured above 7.5 kilopascal) decreased from 8.6%, 12.1%, and 15.5% on day 1 to 3.4%, 5.2%, and 10.3% on day 28, respectively. There was a statistically significant (P < 0.05) reduction in serum biochemical markers and mean liver stiffness after four weeks of abstinence. The study underscores that the greater severity of alcohol dependence correlates with more pronounced liver function impairments and stiffness. Transient elastography indicated significant liver fibrosis in actively drinking patients, with notable improvement after one month of abstinence.

Nocardia keratitis is mostly seen in patients with alcoholism, malnutrition, or HIV. Its chronic waxing-and-waning course makes it difficult to diagnose. A 53-year-old male presented with pain and redness in his right eye for the past 3 weeks. The cornea had paracentral ulcer with stromal infiltrates and multiple satellite lesions giving wreath-like appearance suggestive of Nocardia. After corneal scraping, fortified amikacin, moxifloxacin, and cycloplegics were started. Gram stain revealed filamentous, branching Gram-positive bacteria and acid-fast on Ziehl-Neelsen stain confirming our clinical diagnosis. Ulcer completely resolved over 6 weeks. Thus, a high index of clinical suspicion which was further backed by microbiological confirmation aided in expedient management ensuring a successful outcome.