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Diabetic myonecrosis is an underreported complication of long-standing, poorly controlled diabetes mellitus which is usually self-limiting and responds well to conservative management. Patients frequently have microvascular complications, and although short-term prognosis is good, the long-term prognosis is poor. We report four cases of diabetic myonecrosis admitted in a tertiary care hospital.

Background: The objectives of study were to find out the different types of refractive errors in children between seven to fifteen years age group and the cause of uncorrected defective vision.Methods: A prospective study was designed of two thousand children aged between seven to fifteen years, attending outpatient department. Study period was one year. Consent was obtained from their guardian. Inclusion criteria were children with refractive errors. Children presenting with organic defects of ocular structures, infections, corneal opacity, cataract, choroid and retinal disorders were excluded from study. Data were collected by history taking and comprehensive ocular examination, visual tests for both near and distant vision. Refractive error assessed by cycloplegic drug with one percent Homatropine eye drops, by streak retinoscopy. Objective refraction were carried out and documented. Subjective refraction was done after one week. Both BCVA and uncorrected refractive errors were ascertained and recorded.Results: Out of two thousand children examined, myopic = 34%, hypermetropic = 11%, and astigmatic = 55%. M: F = 900:1000. Study showed headache as the commonest symptom. 17% of the patients had positive family history. Correctable errors constitute 91% of the total cases.Conclusions: Myopic astigmatism was found to be the most frequent refractive error in children. Mass screening is required for early diagnosis of refractive error. Prescribing corrective glasses for children with refractive errors at an early age will prevent childhood morbidity.

OBJECTIVES:Pelvic MRI is a useful tool for assessing patients with anorectal malformations before and after operation. The images obtained after PSARP can be reviewed for quality and shape of the sphincter muscle, position of the rectum, shape of the sacrum, and associated pelvic abnormalities related to the initial operation. These were then correlated with the clinical status of the patient during follow-up after colostomy closure. MATERIALS AND METHODS: Twenty six male patients with intermediate or high anorectal malformation were included in the study between January 2012 to December 2013. The findings thus obtained in the MRI were correlated clinically with the Kelley's scoring system. RESULTS: A total of 26 post-PSARP patients were included in the study. Eighteen of them were also selected for clinical correlation after colostomy closure. According to MRI findings, 2 patients had good degree of development of the pelvic floor muscles, 11 of them had fair amount of muscles and the rest 13 of them had significantly thinned out muscles. Four patients showed well-developed external sphincter muscle, 15 of them were having fair degree of development and in the rest 7 of them it was poorly-developed. Our study also showed that only 3 patients were showing symmetrical development of the sphincter complex whereas in the rest 23 of them it was asymmetrical. Eighteen patients had centrally-placed pulled-through rectum, whereas in the rest 8 of them the colon was located away from the center of the sphincter complex. Sixteen patients had mesenteric fat inadvertently pulled along with the bowel during PSARP; and in this same study, 58% of our patients were also having associated anomalies detected by MRI. On clinical correlation, it was found that external sphincter muscle and fat interposition play an important role in the overall clinical status of the patients after colostomy closure. CONCLUSION: Pelvic MRI is a useful tool for assessment of anorectal malformation after PSARP. Our study shows that development of the external sphincter muscle and the presence of mesenteric fat interposition has significant impact on the overall clinical status of the patient; however, other factors like operative technique and muscle innervations may also play important role in the overall continence of the patients.

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