Greetings from Chettinad Health City Medical Journal! It gives me immense pleasure and privilege in writing the editorial for this issue of the journal which focuses on the field of Ophthalmology. The perspective article on Bayesian medicine enlists the importance of scientific diagnosis based on notion of probability and evidence based approach. The other perspective article on glaucoma screening focuses on various modalities and importance of glaucoma screening from community level to advanced hospital based investigations for early glaucoma diagnosis.

The oral cavity is an entry of other systems of the body; it should not be viewed as an isolated area. Diseases that it lays down can have systemic impact and significantly affect the quality of life of individuals who suffer them. Periodontal disease is one of the oral health problems that most often affect the global population, lack of treatment leads to loss of tooth organs and consequently alters the digestion and nutrition, without considering other relevant aspects as phonation, aesthetics and social or emotional impact. The importance of periodontal disease has raised possible bidirectional relationships with systemic diseases such as diabetes, metabolic syndrome and cardiovascular disease. We address herein the role of oxidative stress in the pathogenicity of periodontal disease. In the same context, another disease that has become relevant in our days is the oral cancer. Detection of the reactive oxygen species in the periodontitis patients and oral cancer patients reveal the relationship between the oxidative stress in periodontitis and oral cancer patients.

Glaucoma is one of the leading causes of blindness. Various studies have highlighted the lack of awareness among general population which leads to non-diagnosis or late diagnosis of glaucoma. Very few studies have been done among medical professionals. The present study was conducted to evaluate the level of awareness and knowledge about glaucoma among the doctors in a medical college and tertiary care hospital.

The objective of the study was to observe the thickness of endometrium on HCG trigger day during Assisted Reproductive Technology (ART) cycles and correlating it with pregnancy outcome.

To analyse the various features (categorical and variables) associated with low responders in Assisted Reproductive Technology (ART).

Subhyaloid hemorrhage is usually a benign condition which does not cause much vision loss and usually will resolve spontaneously. Long standing premacular subhyaloid hemorrhage cause permanent loss of visual acuity as it involves the fovea. The aim of this study is to investigate the effects of drainage of premacular subhyaloid hemorrhage into the vitreous with Argon Green laser treatment.

29 year old healthy female came with complaints of defective vision in left eye for one week duration along with pain, redness and floaters. On examination, patient was found to have pan uveitis, retinal vasculitis, vitritis and necrosis of the peripheral retina in the left eye. A diagnosis of acute retinal necrosis was made. PCR analysis of aqueous and vitreous revealed Herpes Simplex Virus type 2 which is a rare cause for acute retinal necrosis.

A 68 year old female patient presented to ophthalmology OPD with recurrent episodes of anterior uveitis in both eyes since 2 years. Routine uveitis work-up was found to be within normal limits except elevated ESR and CRP levels. The patient had been taking oral alendronate 150 mg every two weeks for the past two years, which correlated with the duration and onset of uveitis. Uveitis improved drastically on stoppage of the drug with no further evidence of uveitis for past 6 months in both eyes. Patient is currently on follow up.

Myathenia gravis , an acquired auto immune disease of the neuromuscular junction, has ophthalmic manifestations as integral part. Herewith we report a rare uniocular involvement of the eye in a 38yrs old male. He presented with the drooping of right upper eye lid since two years, worsening by evening and after exertion. Though the blood investigations and Ach antibody titres were normal, he responded well to 1.5mg neostigmine intramuscularly.

We present here a case of thoracic aortic dissection requiring complex open and endovascular repairs in a 41 year old male bodybuilder in the context of recreational use of a sports supplement, Res 100, which is marketed as an anabolic steroid agent. He did not suffer from hypertension, aortic coarctation or atherosclerosis. He did not have any pre-existing aortic aneurysm or congenital aortic valve defects and had neither evidence of Marfan’s nor Turner’s syndrome. Genetic testing for chromosomal abnormalities was negative. Laboratory testing did not support inflammatory or infectious conditions. Additionally, the mean age of patients with acute aortic dissection is 62 years old as per the International Registry of Acute Aortic Dissection, which is in contrast with our patient’s 41 years of age. However, anectodal reports of dissection in bodybuilders feature ages ranging from 19 to 53 years old. These reports also found strenuous activity to precede dissection, our case demonstrates symptom onset during minimal exertion and a potential link to performance enhancing drugs. This case highlights the variability in the risk factor profile for aortic dissection pathology.

We describe here a case of spontaneous recanalization of a left occluded Internal Carotid Artery (ICA) on the background of a previous Carotid Endarterectomy (CEA) on the contralateral symptomatic side. This rare event with only anectodal evidence describing its incidence and natural history was picked up with ultrasound scanning. Initially, only trickle flow was demonstrated and after 12 months, the stenosis in the left internal carotid artery was graded as less than 50% on ultrasound. Our report highlights the importance of following up carotid system lesions and contributes to the discussion of how such events should be managed.

Vascular endothelial growth factor1 antagonists play an important part in treatment of retinal disorders. To know more about this, a brief explanation of what is vascular endothelial growth factor is necessary. VEGF is a protein which causes vasculogenesis and angiogenesis. Vasculogenesis is important in development of vessels in embryo whereas angiogenesis plays a part in formation of collateral circulation in ischaemia.

Human crystalline lens is a transparent structure in eye, which along with cornea helps in focusing of light on retina. As ageing occurs this transparency is lost leading to formation of cataract. Even though cataract surgery was practiced 2000 years ago, modern cataract surgery started only 50 years back. In the past opaque cataractous lens was removed leaving the patient with compro mised vision after surgery. Italian scientist Tadni in 18th century first considered intra ocular lens implantation. In 1795 Casamata implanted an glass intraocular lens with poor outcome.

The following are the uniform requirements for manuscripts submitted to the Chettinad Health City Medical Journal, which are in accordance with “Uniform requirements for Manuscripts submitted to Biomedical Journal” developed by International Committee of Medical Journal Editors (October 2001).

Otitis media and middle ear effusion are major health care burden across the globe. The prevalence in developing countries mostly exceeds the WHO stipulated emergency level of 4 %. Failure of Eustachian tube function is key pathogenic element of effusion in middle ear cavity involving complex pathophysiology. Acute otitis media accompanies upper respiratory infection or allergy. Its acute symptoms almost always attract treatment yet, on resolution of acute stage effusion over brief period, occurs in middle ear cavity. Recurrences are driven by risk factors. Chronic effusion is not symptomatic but impairs hearing function that adversely affects intellectual and behavioural development of children. Untreated infection coupled to risk factors would cause suppurative otitis media and perforation of ear drum. The later accompanies purulent ear discharge, and threatening complication s for middle ear integrity and intracranial abscess and thrombosis. The narrative attempts to overview approaches to timely diagnosis and medical and surgical management in current practice for spectrum of the disease.

Calcium hydroxide has been used in dentistry for almost a century. Its mechanism of actions are achieved through the ionic dissociation of Ca(2+) and OH(-) ions and their effect on vital tissues, the induction of hard-tissue deposition and the antibacterial properties. Some of its indications include inter-appointment intracanal medicaments, endodontic sealers, pulp capping agents, apexification, pulpotomy and weeping canals. The purpose of this article is to review the properties, mechanism of action, applications, advantages, disadvantages and various indications for the use of calcium hydroxide in endodontics.

Faulty diagnosis is often at the heart of medical treatment gone wrong. The root cause of this is that the medical practitioner is averse to a lengthy diagnosis process and relies exclusively on intuition and prior experience to arrive rapidly at a diagnosis. The purpose of this article is to advance a method of scientific diagnosis that would yield the highest probability of success. The method relies on a notion of probability that was introduced a few centuries ago. Using this method, it is possible to quantitate the degree of confidence in one diagnosis relative to the degree of confidence in another differential diagnosis. The method provides an objective metric to differentiate between two competing diagnoses and select the correct diagnosis based on the strength of the evidence and findings. Adoption of the method would potentially improve the standards of medical treatment available in our country.

Glaucoma is one of the leading causes of preventable blindness. Due to the asymptomatic nature in early stages, the diagnosis is missed quite often. This leads to irreversible loss of vision, thereby reduction in quality of life. As per estimation there are more than 60 million cases of glaucoma worldwide and 20 million more are expected to get added by 20201 . Approximately 12% of total blindness is due to glaucoma2 . Around 50% of glaucoma cases are ndetected3 . Chennai glaucoma study has observed that more than 90 % of the cases are unidentified. As of now glaucoma has no cure. Hence early detection and treatment is the main stay in management of glaucoma and prevention of blindness.