Context:Correcting hypovolemia is extremely important. Central venous pressure measurement is often done to assess volume status. Measurement of inferior vena cava (IVC) is conventionally done in the subcostal view using ultrasonography. It may not be possible to obtain this view in all patients.Aims:We therefore evaluated the limits of agreement between the IVC diameter measurement and variation in subcostal and that by the lateral transhepatic view.Settings and Design:Prospective study in a tertiary care referral hospital intensive care unit.Subjects and Methods:After Institutional Ethics Committee approval and informed consent, we obtained 175 paired measurements of the IVC diameter and variation in both the views in adult mechanically ventilated patients. The measurements were carried out by experienced researchers. We then obtained the limits of agreement for minimum, maximum diameter, percentage variation of IVC in relation to respiration.Statistical Analysis Used:Bland–Altman's limits of agreement to get precision and bias.Results:The limits of agreement were wide for minimum and maximum IVC diameter with variation of as much as 4 mm in both directions. However, the limits of agreement were much narrower when the percentage variation in relation to respiration was plotted on the Bland–Altman plot.Conclusions:We conclude that when it is not possible to obtain the subcostal view, it is possible to use the lateral transhepatic view. However, using the percentage variation in IVC size is likely to be more reliable than the absolute diameter alone. It is possible to use both views interchangeably.
BACKGROUND:Ptosis is derived from the greek word for falling and is the medical terminology describing a drooping or abnormal lowering of an anatomical area. Ptosis that obstruct the pupil may interfere with the normal development of vision, resulting in amblyopia in children2 .In adult it may impair the field of vision and interfere with activities of daily living Ptosis is broadly classified into congenital and acquired,based on age of onset of the ptosis.Ptosis that is present at birth or within the first year of life is called congenital ptosis. Ptosis that presents after the age of one year is termed acquired ptosis. The treatment of ptosis depends upon the underlaying etiology. Ptosis usually does not improve over time and nearly always require corrective surgery. Depending upon the severity of congenital ptosis ,patients should be monitored every 3-12 months for sign of amblyopia due to congenital ptosis. In mild cases of congenital ptosis observation is sufficient ,if no sign of amblyopia, strabismus and abnormal head posture are present. METHODS:This study was conducted in the Upgraded Department of Ophthalmology,LLRM Medical College,Meerut during 2018–2019. Study design-A Population based Prospective interventional study was done on patients selected from OPD and camps during 2018-2019. Plan & Work: All patients with ptosis who are attending ophthalmology OPD and admitted in eye wards were included in the study provided they fulfill the inclusion criteria. RESULTS AND CONCLUSION: The subjects in our study were more males 12(66.66%) than females(33.33%). In our study there were 12(66.66%) patients of myogenic ptosis,out of them 11(61.11%) had frontalis sling surgery and 1(5.55%) had levator resection surgery. There was 2(11.11%) cases of neurogenic ptosis which was congenital in nature and in which 1(5.55%) is operated with frontalis sling &1(5.55%) with levator resection surgery. Most commonly performed surgery was frontalis sling 14(77.77%) followed by levator resection 2(11.11%) and 2(11.11%).
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