AIM: To evaluate the role of different treatment methods (intravitreal antibiotics and vitrectomy) for endogenous endophthalmitis and assess the outcome. Materials and0 METHODS: This is a retrospective observational case study. Sixteen cases of endogenous endophthalmitis noted in 14 patients between October 2000 and April 2004 were reviewed. Two patients had bilateral disease. Patients were followed up for a mean of 3 months (range, 1-12 months). RESULTS: Vitreous and aqueous cultures were positive in 8 (66%) cases and 3 (75%) cases respectively. Fungal isolates occurred in 4 (33%) cases, out of which 3 were due to candida, gram-positive isolates occurred in 2 (16%) and gram-negative isolates in 2 (16%) of the cases. Initial treatment included vitreous tap and injection of intravitreal medication in 12 (75%) cases and pars plana vitrectomy with injection of intravitreal medication in 3 (19%) cases. Final visual outcomes were obtainable for13 cases (1 patient died and 1 patient was lost to follow-up and 1 eye was eviscerated). Five (43%) of these cases achieved visual acuity of 6/60 or better and 8 (56%) eyes achieved a visual acuity less than 6/60. Risk factors mainly associated with the disease were uncontrolled diabetes mellitus, chronic renal failure, renal transplant, abdominal surgeries and septicemia. CONCLUSION: Our experience suggests that endogenous endophthalmitis is generally associated with poor visual outcome. Prompt treatment with intravitreal antibiotics and vitrectomy can result in improvement in ocular signs and visual acuity in majority of the patients. The patients with culture-positive endogenous endophthalmitis are more likely to have fungal isolates with a predominance of candida. Fungal endopthalmitis has a poor visual outcome as compared to bacterial endophthalmitis.

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RESEARCH QUESTION: Whether socio-demographic factors are associated with initiation of breast-feeding in urban slums of Chandigarh. OBJECTIVES: (1) To study the prevailing breast-feeding practices adopted by mothers, (2) To study the socio-demographic factors associated with initiation of breast-feeding. STUDY DESIGN: Cross-sectional. PARTICIPANTS: Mothers of infants willing to participate in the study in the selected area. SAMPLE SIZE: A total of 270 respondents. STUDY VARIABLES: Social and demographic characteristics like age, socioeconomic status, educational level, birth interval, parity, gender preference, natal care practices, etc.; and variables related to various aspects of breast-feeding practices like prelacteal feed, initiation of feeding, colostrum feeding, reasons of discarding colostrum, etc. STATISTICAL ANALYSIS: Chi-square test and odd ratios along with their respective 95% confidence intervals, multiple logistic regression analysis. RESULTS: Out of all 270 respondents, 159 (58.9%) initiated breast-feeding within 6 h of birth, only 43 (15.9%) discarded colostrum and 108 (40.0%) mothers gave prelacteal feed. Illiterate/just literate mothers who delivered at home were found at significantly higher risk of delay in initiation of breast-feeding on the basis of multiple logistic regression analysis. SUGGESTIONS: Promotion of institutional deliveries and imparting health education to mothers for protecting and promoting optimal breast-feeding practices are suggested.

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BACKGROUND: Dyslipidemia, diabetes and obesity are all potent cardiovascular risk factors that tend to cluster in women with polycystic ovary syndrome (PCOS). Metabolic disorders in patients with PCOS cannot be explained solely by the presence of obesity. OBJECTIVE: To study the correlation between insulin resistance and serum lipid profile in Indian women with PCOS. SETTING: Gynecology clinic of a tertiary care hospital. MATERIALS AND METHODS: In this prospective study done from April 2004 to December 2004, 65 women with PCOS had their body mass index (BMI) and waist hip ratio calculated. Fasting glucose, insulin and lipid profiles were also estimated in each case. Insulin resistance was defined by fasting glucose-to-insulin ratio £ 4.5. The association of obesity markers and insulin resistance with lipid parameters was then studied. Statistical analysis using student 't' and Mann Whitney U tests was done as indicated. RESULTS: Insulin resistance was seen in 50 of the 65 PCOS women. There was no correlation seen between markers of obesity such as BMI and waist/hip ratio with various lipid parameters. But in PCOS women with insulin resistance, the lipid profile was significantly different [high triglycerides, total cholesterol and lower high-density lipoprotein (HDL)] compared to insulin-sensitive women. The difference between the two groups for total cholesterol (P = 0.002), triglycerides (P = <0.001) and HDL (P = <0.001) was statistically significant but that for low-density lipoprotein (LDL) (P = 0.07) was not statistically significant. CONCLUSION: Insulin resistance is associated with dyslipidemia in women with PCOS, independent of obesity.

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Intestinal pseudoobstruction has been reported as a paraneoplastic manifestation of several cancers, including those of gastrointestinal tract. Octreotide, a somatostatin analogue, has been used successfully in the treatment of idiopathic and scleroderma-associated intestinal pseudoobstruction. We report a 65-year-old man with carcinoma stomach presenting with intestinal pseudoobstruction, which responded to octreotide.

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India is facing an explosion of diabetes and related diseases. Health infrastructure in rural India is very poor. A large number of rural Indians are below poverty line. To overcome the problem of insulin resistance in rural India, the authors conducted studies with nutraceuticals and came across many sociocultural, socio-political and socioeconomic constraints to faithfully following ethical guidelines of Indian Council of Medical Research (ICMR). This paper deals with some of the constraints and it is strongly felt that the ICMR should review its guidelines in the context of the existing situation.

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