BACKGROUND: Osteopetrosis is a collective term used for a pathological condition with defective function of osteoclasts presented with range of sclerosing bone diseases along with skeletal, renal, haematological & neurological manifestation. It may be autosomal recessive (ARO), autosomal dominant (ADO) and X-linked. It presents with hydrocephalus, short stature and anaemia, involvement of ocular nerve or facial nerve. Hypocalcemia, tetany, seizures & secondary hypoparathyroidism is known to occur. CASE REPORT: Two patients of osteopetrosis were posted for orthopaedic surgery. Both patients were operated under combined spinal epidural anaesthesia. 2ml of 0.5%Bupivacaine+30mcg clonidine was given intrathecally & epidural supplementation was given with Bupivacaine 3 cc increments after two segment regression of sensory level. Postoperative analgesia was provided by epidural Bupivacaine 0.125% along with Inj. Tramadol 50 mg on patient's request. CONCLUSION: Even if administration of anesthesia is a challenge in patients of Osteopetrosis, regional anaesthesia can be given safely with proper preoperative preparation & intraoperative care. KEY WORDS: osteopetrosis, femur fracture, combined spinal & epidural anaesthesia INTRODUCTION: Osteopetrosis is a collective term used for a pathological condition with defective function of osteoclasts presented with range of sclerosing bone diseases along with skeletal, renal, haematological & neurological manifestation. It is classified as Infantile malignant or (ARO), Intermediate type or (ARO) , Adult onset or (ADO)&X-linked Osteopetrosis. ARO is a life threatening condition manifests in first few months with life span of 6 to 10 yrs present with seizures with normal Calcium levels, renal tubular acidosis, cerebral calcification, developmental delay, hypotonia, retinal atrophy & sensorineural deafness. ADO is type I and type II. Type I is associated with reduced number & size of osteoclasts & involvement of ocular nerve while type II is associated with proliferation of large & multinucleated osteoclasts, involvement of facial nerve , bony sclerosis, renal tubular acidosis & cerebral calcification. In X-linked Osteopetrosis severe immunodeficiency is observed with ectodermal changes. The difficulties faced by Anaesthetists are difficult intubation due to facial deformities, head & mandibular involvement cervicomedullery stenosis may lead to cord trauma during intubation difficult spinal & epidural anaesthesia due to scoliosis and short stature. Leucoerythroblastic anaemia, pancytopenia, thrombocytopenia leading to excessive bleeding

Introduction :Bupivacaine is local anaesthetic drug consist of R & S enantiomers. Levobupivacaine a cardiostable S enantiomer of Bupivaciane. Magnesium sulphate a promising noncompititive blocker of NMDA receptor by inhibition calcium Inux in cell. We want to study addition of Magnesium Sulphate to both Bupivacaine 0.5% & Levobupivacaine 0.5% for epidural anaesthesia in lower limb surgeries. to compare efcacy of epidural Inj. Bupivac Aims & Objectives: aine 0.5% plus Magnesium sulphate with Inj. Levobupivacaine 0.5% plus Magnesium Sulphate on onset of sensory & motor blockade, intraoperative hemodynamics , requirement of rst analgesiac & side effects in elderly patients posted for lower limb surgeries. A randomised prospective double blind Material and Method: study in 60 geriatric patient posted for lower limb surgeries. After epidural space identication Inj. Bupivacaine 0.5% 14 ml + 50mg MgSo4 in 1 ml NS in group B or Inj. Levobupivacaine 0.5% 14 ml + 50mg MgSo4 in 1 ml NS in group L. Onset of sensory blockade and motor blockade, two segment regression, demand of rst analgesic, intraoperative hemodynamics and postoperative complications were documented and compared Observation: Mean time required for onset of sensory block was 6.27±1.48 min in Group B and 6.3±1.76 min in group L respectively. onset motor block times of 7.43±1.38 in group B while 8.13±1.81 mins in group L which were No statistically signicant difference. Group L required 20.1±4.87 mins for reaching maximum sensory block compared to 13.33±2.17 mins in group B which was statistically signicant difference with early achievement of higher sensory level in group B. The time required for two segment regression was longer, at 133±19.01 minutes in group B compared to 114.47±10.28 minutes in the group L which found statistically signicant difference. Group B required rst analgesics quite latter 241.33±29.39 at mins compared to 203±20.54 mins in group L. This was found to be statistically signicant difference indicating that Bupivacaine is having longer duration of analgesia compared to Levobupivacaine. 3 patients had hypotension in group while 1 in group L. Shivering noticed 6 in Group L compared to 3 in group B. vomiting in 3 patients in each group.only 1 patient had itching in group b. Intraoperative hemodynamic parameters were having statistically insignicant difference. Conclusion: We can conclude that effect of Magnesium sulphate as an additive to Levobupivacaine and Bupivacaine provide good haemodynamic and respiratory stability, Comparable onset of sensory and motor blockade with prolongation of postoperative analgesia in bupivacaine group indicating that Bupivacaine with Magnesium sulphate provides prolonged analgesia as compared to Levobupivacaine with Magnesium Sulphate.

PURPOSE: To determine, the epidemiological characteristics and risk factors predisposing to fungal keratitis in Hubli, south India. To know the importance of KOH wet mount for rapid detection of fungal keratitis for institution of antifungal therapy as earliest possible. To know the statistical significance regarding the common type of fungi that involves the cornea and prognosis with regard to the available mode of therapy and their results. METHOD: In one year period, out of 112 patients presented with corneal ulcer, 48 (42.85%) were clinically suspected as having mycotic keratitis. Sensitivity of KOH wet mount preparation in our study is 96.25% in our study. Fusarium (53.84%) was most commonly isolated fungus. In our study all 48 cases were treated with Monotherapy, in that 28 cases patients deep stromal involvement were treated with combined therapy. About 15 patients received surgical treatment. 17(35.41%) cases had only HM positive and one case (2.08%) with only perception of light. and 2(6.25%) cases with no perception and rest had fairly good vision. CONCLUSION: These findings have important public health implications for the early diagnosis in suspected cases of mycotic keratitis and institution of specific therapy at earliest to avoid hazardous effects on cornea. INTRODUCTION:corneal blindness accounts for 20-30 % of all blindness in developing countries of the world. Suppurative keratitis is the leading cause with mycotic keratitis constituting half of the cases in north Karnataka. Morbidity in mycotic infection tends to be higher compared to bacterial keratitis because diagnosis is often delayed due to negligence towards ocular trauma, inappropriate treatment and wide spread use of topical antibiotics and steroids for any case of corneal ulcer.KIMS Hubli, being tertiary care hospital and major referral center, we get more than twothree cases of mycotic keratitis per OPD. Considering its prevalence it is thought worthwhile to take up clinical study of mycotic keratitis to diagnose the case on suspicion with laboratory investigation and to start antimycotic treatment early for better results. AIMS AND OBJECTIVES:Clinical study of mycotic keratitis concerns with: 1.To know the incidence of mycotic keratitis.

Introduction: In literature there are very few studies regarding use of Etomidate as an inducing agent in patients of PIH and eclampsia. So, we want to study and compare haemodynamic effects of Inj. Etomidate in normotensive and PIH patients at our tertiary hospital. Our aim was to study of effects of Inj. Etomidate in normotensive and PIH patients posted for LSCS under general anaesthesia. Present study was a prospective, comparative & interventional study conducted in department ofMaterial and methods: anaesthesiology of a tertiary care teaching hospital. Study duration was of 2 years (September 2018 to August 2020). Institutional ethical committee approval was taken prior to start of study. All pregnant females belonging to ASA Grade 1-3 undergoing elective or emergency caesarean section under general anaesthesia. Total 60 subjects were recruited & divided into two groups i.e. 30 subjects in each group. Results: In the normotensive group, mean arterial pressure values were signicantly (p < 0.05) higher as compared to start values after scoline , immediately after intubation and at 3 min, 4 min, 20 min, 25 min, 30 min and 45 min values were signicantly reduced. In the hypertension group, mean arterial pressure values at 1 min,2 min, 3 min, 4 min, 5 min, 10 min, 15 min, 20 min, 25 min, 30 min and 45 min were signicantly reduced compared to start values (p<0.001). APGAR score was excellent (7-10) in 27 patients (90%) from normotensive group &in 28 patients (93.33%) from patients with hypertensive disorders of pregnancy group. Etomidate provides a better haemodynamic stability inConclusion: normotensive as well as hypertensive patients posted for LSCS under general anaesthesia. Thus, etomidate can be recommended to use as an induction agent in normotensive as well as hypertensive patients posted for LSCS under general anaesthesia.

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