The Rationality of Rage

The  rationality  of rage

    Anger is a primal and destructive  emotion , disrupting rational discourse  and inflaming illogical passions - or so it often seems. Then again , anger also has its upsides.  Expressing anger, for example, is known to be a useful  tool  in negotiations  . Indeed , in the past few years, researchers  have been learning more about when  and  how  to deploy  anger productively.
    Consider a forthcoming paper in the November issue of the Journal  of Experimental Social  Psychology.  Researchers tested the effectiveness of expressing anger in three types  of negotiations;  those that are chiefly cooperative (say, starting  a business with a partner), chiefly  competitive (dissolving  a shared  business )  or balanced  between  the two (selling a business to a buyer). In two experiments, negotiators  made greater  concessions to those  who  expressed  anger -but only in balanced  situations . When  cooperating , hostility seems inappropriate, and when competing , additional  heat only flares tempers. But in between , anger appears  to send a strategically useful signal.
      What does that signal communicate ?  According to a 2009 paper in Proceeding of the National Academy  of Sciences, anger evolved to help us express that  we feel undervalued . Showing  anger signals to others that if we don't get our due, we'll expert harm or withhold benefits. As they anticipated , the researchers  found  that strong men and attractive  women- those who have historically  had the most leverage  in threatening harm  and conferring  benefits, respectively - were most prone to anger.
    The usefulness of angering  extracting better treatment  from  others seems to be something  we all implicitly understand. A 2013 paper in the journal  Cognition  and  Emotion  found that  when people were preparing to enter a confrontational negotiation , as opposed  to a cooperative one, they took steps to induce anger in themselves (choosing music, foe example).
    The study also found that people induced anger in themselves  only if there was an actual  benefit  at stake for them in the negotiation. This qualifications was essential in demonstrating  that it was the perceived  strategic  benefit of being  angry  (and not, say, just a reflex that we have  when entering  any  confrontation ) that  prompted  people  to induce such an unpleasant  mood in themselves.
   Whether induced or not, anger must ultimately be genuine in order to be  useful  in provoking concessions. According to a  2013  paper in the Journal  of Experimental  Social Psychology, faking , anger, compared with playing it cool ,leads  a negotiation partner to see you as less trustworthy, and  actually increases his demands on you.
    There are other important caveats. While expressions of anger can elicit compromises, they can also lead  to covert retaliation, according to a 2012 paper  in Organizational Behaviour and Human  decision Processes. In two  experiments, negotiators overtly made concessions when opponents expressed anger but, evidently feeling mistreated, covertly sabotaged their opponents afterward. Outside the laboratory, this dynamic might  take the form of acquiescing to an angry colleague's demand but then spreading negative gossip about him around the office.
 Anger also works better in negotiations when it's directed at an offer  rather  than  at the person making the offer, according  to a  2011 article in the Journal of Experimental Social  Psychology. Many  of the same researchers also reported, in a 2012 paper in Personality and Social Psychology Bulletin, that expressing anger when you're in a position of low power merely irritates  your  opponent and leads to a backlash. If you have less power than your opponent, they found, showing
disappointment is a better strategy than  expressing anger, as it can induce feelings of guilt in your opponent.
  Expressing  anger can sometimes benefit all the parties involved , not just  one of them, by clarifying boundaries , needs and concerns . Think of the loved one who doesn't realize how strongly you feel  about  the relationship  until you express feelings of frustration  with it. In a 2009 article in Negotiation and Conflict Management  Research , the authors found that anger is more  likely to lead to such mutually positive outcomes when it is low in intensity; expressed verbally rather than physically;  and takes  place in an organization that considers it appropriate  (like a labour union or a university athletic department).
   Finally , anger can also motivate large- scale political progress. Researchers  reported in the Journal of Conflict Resolution in 2011 that among Israeli Jews,  inducing anger at Palestinians  increased  their desire  to make  necessary compromises in upcoming peace talks- as long as the  attitudes of the Israelis toward  Palestinians  were not hateful. This finding suggested that while some angry people may try  to remedy a frustrating situation  with aggression,  others- even those who are just  as angry- may funnel their anger into less antagonistic solutions.
   We tend to associate anger with the loss of control , but anger has clear applications  and obeys  distinct rules.  It may be blunt, but it has  its own  particular  logic. And used judiciously , it can get us better deals, galvanize coalitions and improve all our lives.
   Mattew Hutson  is the author of  " The 7 Laws of Magical Thinking : How Irrational Beliefs Keep Us Happy, Healthy, and Sane"                      

Big Data , Analytics and the Cloud

BIG  DATA  CAN  BE  MINED  FOR  INSIGHTS  TO  IDENTIFY  TRENDS,  PREDICT  BEHAVIOR   , AND  EMPOWER  DECISION MAKING     

  The  Nepal  earthquake  in April claimed more than 9,000 lives and left  crores of property damaged. While an earthquake  is a natural disaster, many of us are wondering  why earth- quakes cannot be  predicted  the same way  as Tsunamis  or  cyclones ? Scientists  say it is possible  to identify the key regions where earthquakes can occur,  but not predict the ex-act time  when  they would occur. This is because  predicting  an earthquake means analyzing  past  data and factors such as high temperatures, gas emissions , strange  animal   and abnormal cloud  formations  - appearing along the traditional fault lines. Bringing  all these diverse parameters together and  analyzing them is a difficult task as the volume and diversity  of data  makes it tough  for analysis.

         However, the  advent of Big  data, has given hope. One  company called Terra Seismic says that earthquakes can be predicted  20 to 30 days  before they occur .  Using  Big Data  and  satellite  technology, the firm claims  to process large  volumes  of satellite  data taken  each day from regions where the probability of an earthquake is huge. This data  is combined  with a huge  number of earthquake precursors ; algorithms  are built  and  analysed to judge the probability of an earthquake.

     

        This means Big data is not  just about the data ; the real value is in the analytic  and the ability to use that intelligence to gain a desired outcome .  Big data can be mined for insights to  identify trends, predict  behavior , and empower decision  making. As we move into an era of the  Internet  of Everything (IOE) organisations that can find the intelligence in data resulting from numerous new connections can create new sources of  competitive advantage. As big data grows, the  challenge to achieve  better business outcomes  will become  more complex.  Smart  organisations  in both  the  public  and  private sectors must leverage the power of data and analytic to improve processes  and profits  or to reduce costs and risk.

       Going  back to the Nepal  earthquake  one  interesting  observations  is that  big data was used to help  folks  outsides  of  Nepal  locate  missing  loved  ones  and  to direct disaster  aid  and supplies to where  and  when  needed.  What  may  be even  more  interesting,  is how  ' the crowd ' utilized  big  data to become a factor  in disaster  response. Cloud  based  data  companies  such  as Google  and  Facebook  which generate   huge  data  have also  developed   specific  tools that  helped  to trace  and contact   people  in disaster areas.

   

     

       Talking  of cloud  based  data  and  analytic,  in today's  era  of increasing  connectivity,  businesses are using the web , social, mobile and other platforms  to share  their  data (read information )  and  gather  data to understand  their  standing  in the market .  Social  media platforms like  Twitter and  Facebook provide  several   real  time  analytic capabilities  leveraging  big data  running  within their  cloud  environment  for users  to gain  real time  insights.

 

    

   Likewise  several  organisations  today  run  their  websites  on cloud, weblogs are generated  in the   cloud  and analytic can  also  be done via Had don  on the  cloud  itself.   More  and more  mobile  applications  now  typically  have  their  back end processing  in the  cloud.  As a result ,  the data  that is  being   collected  from  the  mobile  app  is in the  cloud  where   the  mobile  back end  resides,  and  consequently analyzing  that  data  can be easily  done there as well.

    

       Clearly  several  new  sources of data to be  analysed  are  already  in the cloud.  Organisations  going   forward  might  actually   need  to  combine  their  data  sitting  in different  clouds to generate  new  insights.  Technologies  concepts  like  Cisco's  Inter  cloud  which helps  connect  various  clouds  will  be an  integral  part  of that  next step.

    

Meaning of Management Accounting

Meaning  of Management Accounting

Management Accounting is the presentation of accounting information in such a way as to assist management in the creation of policy &day to day operation of an undertaking. Thus, it is related  to the use  of accounting data collected with the help of financial & cost accounting for the purpose of policy formulation, planning, control,& decision making by the management. Some leading definition of management accounting are given below:

Institute of cost & Management Accountants, U.K, defines -"Management Accounting is the application of professional knowledge & skill in the preparation of accounting information  in such a way as to assistant management in the formulation of policies & in the planning & control of the operation of the undertaking,"

According to American Accounting Association - "Management Accounting is the application  of appropriate techniques & concept in processing historical & projected economics data of an entity to assist management  in establishing plan foe reasonable economics objectives & in the making of rational decisions with a view towards these objectives."

In R.N Anthony's view American Accounting Association -"Management Accounting is concerned with accounting information that is useful of management."

According to saying forwarded by  Bostock," Management Accountancy can be defined as the art of  presenting to management such figures, whether in terms of money or other units, as well assist  management to do its job."

On the basis of the above mentioned definitions, it can be concluded that management accountancy is regarded as the information that is collected, reported & defined in detail by an accountant. These financial informations & reports are properly utilised by an efficient manager to fulfil the objectives of an organisation.Thus, Management Accounting is concerned with reframing the accounting  information  to make it useful  for the management. The above definitions also clearly indicate that any system of accounting  which assist management in carrying out its functions more efficiently may be termed as management accounting.

Functions of Management Accounting

All  activities related to collecting , processing , interpreting & presenting  information to the management are included in the functions of management accounting. The main functions are:

1)Organising

 The management accountant helps the management in organising the human & non- human resources of the business by analysing different functions & assigning specific responsibility. He/ She tries to organise the accounting & finance function of the business on the modern lines.

2) Controlling Performance

The management accountant helps in controlling the performance of the organisation by using standard costing , budegetary control , accounting ratios, cash & fund flow statement, cost  reduction programmes & evaluating the capital expenditure proposals & return on investment.

3)Co-Ordinating

The management accountant increases the efficiency of organisation & maximises its profits by providing different tools of co- ordination as budgeting ,financial reporting, financial analysis & interpretation  e.t.c .It helps the management by reconciling the cost & financial accounts, by preparing budgets & setting the standard  cost & analysing  variances in costs to facilitate management by exception.

4 ) Communication

The management  accountant prepares various reports in order to communicate the result to the superiors, to motivate the employees, to exercise effective control on their activities & to about the progress of business through published accounts & returns.

5) Forecasting & Planning

 Management accounting is to provide necessary information & data for making short-term& long -term forecasts & planning operations of business, For doing this, the management accountant uses techniques of statistics, like profitability, trend study of correlation & regressions, budgeting & standard costing , capital budgeting, marginal costing & funds flow statement e.t.c

These are  important tools in the hands of management accountant for the planning of the business.

6) Financial Analysis & Interpretation

The management accountant analyses the data & presents it before the management in non- technical manner along with his comments & suggestions so that the owners & the top personnel  in the management may understand it & take decision without any difficulty.

7) Special Studies

The management  accountant tries to maximise the profits of the concerns by conducting various cost & economics studies on regular basis. He tries to determine the needs of long-term & short- term capital, recommends appropriate capitalisation for the enterprises, evaluation of alternative capital expenditure proposals & their impact  on the return & profits of the concern.

8)  Miscellaneous Functions

 Besides the above functions, the management accountant supplies useful information to different functionals  authorities, provides necessary accounting information & advice for price determination & pricing decisions & helps to make strategic decision as seasonal or temporary suspension of production ,makes or buys decisions, replacement decisions, & expansions or closure of particular division or department  e.t.c .

Scope of Management Accounting

The scope of management is very wide & broad-based. It includes all information which is provided to the management for financial analysis & interpretation of the business operation. The following fields of activities are included in the scope of this subject.

1) Financial Accounting

Financial Accounting provides historical information which is very useful for future  planning & financial  forecasting. Financial accounting system is a must for obtaining full control & co-ordination of operation of the business.

2) Cost Accounting

It provides  various techniques of costing like marginal costing ,standard  costing, differential & opportunity cost analysis ,e.t.c, which play a useful role in the operation & control of the business undertaking.

 3) Cost Control Procedures

These procedures are intergral parts of the management  accounting process & include inventory control, time control, budgetary control & variances analysis, e.t.c.

4) Tax accounting

It is an integral part of management accounting & includes  preparation of income statement,determination of  taxable income & filing up the return of income ,e.t.c.

5) Reporting

The management accountant is required to submit reports to the management on the various aspects of the undertaking. While  reporting , he may use statistical tools for the presentation of information as graphs, charts , index numbers & other devices in order to make the information more impressive & intelligent.

 6) Internal Financial Control

Management accounting includes the internal control method like internal audit, efficient office management e.t.c.

7) Budgeting & Forecasting

Forecasting on the various aspects of the business is necessary for budgeting. Budgeting controls the activities of business through the operation of budget by comparing the actuals  with the budgeted figures, finding out the deviations, analysing the deviations in order to pin out the responsibility & take  remedial action so that adverse things may not happen in future. Both techniques are necessary for the management accountant.

8) Interpretation

Management accounting is closely related  to the interpretation of financial data to the management & advising them on decision making.

9) Methods of procedures

In  this  study it includes all those methods & procedures which help the concern to use its resources in the most efficient & economical manner. It undertakes special cost studies & estimations , report on cost volume profit relationship under changing circumstances.

10) Offices Services

The management accountant may be required to maintain & control office services in some organisations. This function includes data processing, reporting on best use of mechanical & electronic devices ,communications e.t.c .

Characteristics of  Management  Accounting

Management Accounting is a technique of selective nature. It takes into consideration only that data from the income statement  & position  statement which is relevant & useful to the  management. Only that information is communicated to the management which is helpful  for taking decisions on various aspects of business.

1) Concerned with Future

Management accounting unlike the financial accounting deals with the forecast with the future. It helps in planning the future  because decisions are always  taken  for the future course of action.

2) Provides Data & not the Decisions

The management accountant is  taking any decisions but provides data which is  helpful to the management in decisions making. It can inform but not prescribe . It is just like map which guides the traveller where he will be if travels in one direction or another. Much depend on the efficiency & wisdom of the management for utilising the information provided by the management accountant.

3) Analysis of different Variable

Management  accounting helps in analysing the reasons as to why the profit or loss is more or less as compared to the past period. Moreover , it tries to analyse the effect of different variables on the profits & profitability of the concern.

4 ) No Set Formats For Informations

Management accounting will not provide information in a prescribed proforma like that of financial accounting . It provides the information to the management  in the form which may be more useful to the management in taking various decisions on the various aspects of the business.

FOVEOLA

FOVEOLA

The bouquet of central cones is surrounded  by the  fovea  bottom, or foveola ,which measures 350 um in diameter and 150 um in thickness. This  avascular area consists of densely packed cones that are elongated and connected by the external limiting membrance. as a result of the elongation of the outer segments,the external limiting membrance is bowed vitreally, a phenomenon that has been  fovea  externa.

Both umbo and foveola represent the most visible part of the outer retina ; however , to the level of the external limiting membrance , all cones and their axons are  enveloped by the processes of Muller cells, which form the vitreal  inner  layer and  elaborate and support  the internal limiting membrance.  Thus, the apex-to  apex arrangement of the optic cup is maintained by the processes of mullerian glia  that face the apices of the pigment epithelial cells in the foveola. The high metabolic demands of the central cones are met by direct contact with the pigment epithelium , as well as through the processes of glia whose nuclei lie peripheral  in the  inner nuclear layer and  closer to the perifoveal vascular arcades.

FOVEA

The fovea consists of the thin bottom a 22 declivity ( the clivus ) and a thick margin . The bottom , or foveola , was described earlier.  The declivity of 22 denotes the lateral displacement of the second and third neurons in the inner nuclear  layer, which includes most of the nuclei of its mullerian glia . The avascular  foveola is surrounded by the vascular arcades, a circular system of capillaries. These vessels are located at the level of the internal nuclear  layer and leave an avascular zone of 250- 600 um between them. The declivity also is associated with an increase in basement membrance thickness, which reaches a maximum at the foveal margin.  Internal limiting membrance thickness and strength of of vitreal attachment are inversely proportional :  that is , adhesions are strongest  in the foveola.

PARAFOVEA

The parafovea is a belt that measures 0.5 mm in width and surrounds the foveal margin.

At the distance from the centre, the retina features a regular  architecture of layers, which includes 4-6 layers of ganglion cells and 7-11 layers of bipolar cells.

PERIFOVEA

The perifovea  surrounds the parafovea as a belt that measures 1.5 mm wide. The region is characterized by several layers of ganglion cells and six layers of bipolar cells .

MACULAR OR CENTRAL  AREA

The umbo, foveola , fovea parafovea , and perifovea together constitute the macula , or central area . The central area can be differentiated from the extra-areal periphery by the ganglion cell layer . In the macula ,  the ganglion cell layer is several cells thick: however, in the extra- areal periphery, it is only one cell thick . The macular border coincides with the course of the major temporal arcades and has an approximate diameter of 5.5 mm . As measured along the outside of the sclera, the centre of the macula lies 4.5 mm temporal to the centre of the optic nerve and 3.0 mm temporal to the  temporal margin of the optic nerve. The surface landmark of the macula  is in  close proximity to the insertion of the inferior oblique muscle , being 1 to 2 mm posterior and 1 mm above the nasal limit of insertion of the muscle into sclera.  

 FOVEOLA

The bouquet of central cones is surrounded  by the  fovea  bottom, or foveola ,which measures 350 um in diameter and 150 um in thickness. This  avascular area consists of densely packed cones that are elongated and connected by the external limiting membrance. as a result of the elongation of the outer segments,the external limiting membrance is bowed vitreally, a phenomenon that has been  fovea  externa.

Both umbo and foveola represent the most visible part of the outer retina ; however , to the level of the external limiting membrance , all cones and their axons are  enveloped by the processes of Muller cells, which form the vitreal  inner  layer and  elaborate and support  the internal limiting membrance.  Thus, the apex-to  apex arrangement of the optic cup is maintained by the processes of mullerian glia  that face the apices of the pigment epithelial cells in the foveola. The high metabolic demands of the central cones are met by direct contact with the pigment epithelium , as well as through the processes of glia whose nuclei lie peripheral  in the  inner nuclear layer and  closer to the perifoveal vascular arcades.

FOVEA

The fovea consists of the thin bottom a 22 declivity ( the clivus ) and a thick margin . The bottom , or foveola , was described earlier.  The declivity of 22 denotes the lateral displacement of the second and third neurons in the inner nuclear  layer, which includes most of the nuclei of its mullerian glia . The avascular  foveola is surrounded by the vascular arcades, a circular system of capillaries. These vessels are located at the level of the internal nuclear  layer and leave an avascular zone of 250- 600 um between them. The declivity also is associated with an increase in basement membrance thickness, which reaches a maximum at the foveal margin.  Internal limiting membrance thickness and strength of of vitreal attachment are inversely proportional :  that is , adhesions are strongest  in the foveola.

PARAFOVEA

The parafovea is a belt that measures 0.5 mm in width and surrounds the foveal margin.

At the distance from the centre, the retina features a regular  architecture of layers, which includes 4-6 layers of ganglion cells and 7-11 layers of bipolar cells.

PERIFOVEA

The perifovea  surrounds the parafovea as a belt that measures 1.5 mm wide. The region is characterized by several layers of ganglion cells and six layers of bipolar cells .

MACULAR OR CENTRAL  AREA

The umbo, foveola , fovea parafovea , and perifovea together constitute the macula , or central area . The central area can be differentiated from the extra-areal periphery by the ganglion cell layer . In the macula ,  the ganglion cell layer is several cells thick: however, in the extra- areal periphery, it is only one cell thick . The macular border coincides with the course of the major temporal arcades and has an approximate diameter of 5.5 mm . As measured along the outside of the sclera, the centre of the macula lies 4.5 mm temporal to the centre of the optic nerve and 3.0 mm temporal to the  temporal margin of the optic nerve. The surface landmark of the macula  is in  close proximity to the insertion of the inferior oblique muscle , being 1 to 2 mm posterior and 1 mm above the nasal limit of insertion of the muscle into sclera.  

Factors influencing the Natural course of Diabetic Retinopathy and macular oedema

Factors  influencing  the Natural  course  of Diabetic  Retinopathy  and  macular oedema

a)  Duration  of diabetes

All  people with diabetes  mellitus  are at risk - those  withType I  diabetes  and  those  with Type II diabetes. The longer  a person has diabetes, the higher the risk of developing  some  ocular problem. Between  40 to 45 percent of Americians  diagnosed with diabetes have some stage of diabetic retinopathy.  After 20 years of diabetes , nearly 99% of patients with type I and 60% with type2 had some degree of diabetic  retinopathy and 3.6% of younger - onset patients (aged < 30 years at diagnosis, an operational definition of type J diabetes ) and 1.6% of older onset patients ( aged < 30 years at diagnosis , an  operational  definition of type 2 diabetes ) were found to be legally blind. In the younger - onset group, 86% of blindness was attributable to diabetic retinopathy .  In the  older- onset  group, where other eye diseases were  more common , one third of the cases of legal blindness were the result of diabetic  retinopathy.

b)  Glycaemic  Control

There is an  indirect relationship between the glycaemic controls and the development and   progression of DR. DCCT and Early Treatment of Diabetic  Retinopathy Study (ETDRS ) have convincingly shown the reduction  in risk of progression of  DR with intensive treatment. Decrease  in glycosylated  haemoglobin  levels was associated with a significant decrease  in the  progression of DR as well as the incidense of PDR . Intensive  diabetic  control leads to reduction in the development  and progression  of all diabetic complications.

c)  Age and Sex

The prevalence and severity of DR  increases  with  increasing  age  in type I  DM but donot  increase in  type II  DM.

d) Hypertension

Studies, such as WESDR  and  UKPDS , suggest that hypertension  increases the risk and progression of  DR  and  DME.  In  UKPDS , tight control of blood pressure  resulted  in  34% reduction in progression  of retinopathy with 47% reduced risk  of deterioration  in  visual  acuity  of three lines.

e)   Nephropathy

The  presence  of  gross  proteinuria  at  baseline  has  been  reported  to  be associated  with  95% increased  risk  of developing  DME  among  type I  patients  in  the  WESDR .  The  prevalence  of  PDR  was  much  higher  in  patients  with  persistent    microalbuminuria .

f)   Genetics

In  WESDR ,  patients  with  HLA  DR4  and  absent  HLA  DR3  were  found  to be at  a greater  risk  of  having  PDR. Data  from  the  DCCT  also  suggested  genetic  predisposition   diabetes .  However , it  is probable  that  both  genetic  and environmental  factors  play  a role  in  the  expression  of DR .

g )  Serum  Lipid

In  WESDR ,  higher  total  serum  cholesterol  was  associated  with  increased  risk  of having  retinal  

hard  exudates.  ETDRS  has  reported  a positive  correlation  between  serum  lipids  and risk  of  retinal  hard  exudates in  type 2 DM  .  Recently ,  Gupta et al.  have reported  reduction  in  oedema  , severity  of hard  exudates  and  subfoveal  lipid  migration  in patients  with  type 2  diabetes  and dyslipidaemia ,  using  a lipid - lowering  drug , atorvastatin ,  as  an  adjunct  to  macular  photocoagulation.

h )   Anaemia

In  ETDRS ,  low  hematocrit  levels  At  baseline  were  identified  as  independent  risk  factor  for  the  development  of  high - risk PDR  and  severe  visual  loss.  It  showed  an increased  risk  of  retinopathy  in patients  with  the  haemoglobin  level  of less  than  12 g/ dl .  Anaemia  -induced   retinal  hypoxia  is  speculated   as  cause  of   development  of  microaneurysms  and  other  retinopathy  changes.

i )  Puberty

In the  WESDR , younger  on set  subjects who were post-menarchal  stood  a 3.2  times  greater  risk  of developing  DR as  compared  to  pre- menarchal subjects.  Those  who were older than 13 years at the time of diagnosis were  likely  to have retinopathy  than  those who were younger.  The  exact  mechanism  by  which  puberty  might  exert  its effect  on the  development  of early  retinopathy  is  not yet  understood ,  but  a possible  role  of hormonal  factors  is suspected.

j )  Socioeconomic  Status

Although  educational   attainment  was  inversely  associated   with  retinopathy  in women  in  the WESDR , socioeconomic  status  was  not  associated  with  increased  risk  of  worsening  of  retinopathy.  Once  the  level  of  glycaemia  is  accounted  for ,  social  factors  have  little  or  no influence  on this   complication   of  diabetes .

k)  Pregnancy

Pregnant  women  with  type  1  diabetes  have  twice  the  risk  of  developing  PDR  than  non-  pregnant  women .  Ideally , young mothers  should  be  examined  for  retinopathy  before  the  onset  of  pregnancy.  The  cause of  acceleration  of DR  may  be  a  simple  reflection  of  long  duration of  diabetes  or  there  may  be factors ,  both  metabolic  and  hormonal ,  that  contribute   to  the  overall  deterioration  of  DR  in  the  pregnant  patient .

Ocular  conditions  are :  Status  of  posterior  vitreous ,  intraocular   pressure,  Ocular  perfusion  pressure,  Refractive  error ,  intraocular surgery  like  cataract  and  glaucoma ,  intraocular  infection  and  inflammation .

Acute Pain in Female Patient

Acute  Pain  in  a  Female  Patient

INTRODUCTION 

    

Large number of patients with abdominal and pelvic pain are reffered to both the gynecologists and surgeons .  The vast majority of cases will be found to have no organic basic and will be categorized as irritable bowel syndrome,  spastic  colon,  pelvic  inflammatory disease or even  "psychosomatic".

 

  The current view is that pains are pains are real and that doctors should not adopt  a dismissive attitude. Several factors including infections , endocrine disorders,pregnancy,childbirth,previous surgery could all be implicated. In addition there could be a psychological overlay with stress and social problems.

  In the chapter we hope to address the differential diagnosis, discuss the recent investigative modalities and the most appropriate treatment for acute pain from reproductive and intestinal tract.

Most causes of pain fit into three categories :

1 .  Causes that originate  in the reproductive tract.

 2.  Causes that originate in the intestinal tract.

3.  Causes that originate in the urinary tract.

THE  ORIGINS   OF  PELVIC  PAIN

  THe  rectum,  lower  colon , cecum, appendix,  terminal  ileum , bladder  and  gynecological organs  are so closely  related and the localization of visual pain so poor that it is not  surprising that pelvic pain could be seen by a variety of specialists . Pain from these areas is largely perceived via the sympathetic nervous  system and there is shared innervations of the vagina cervix inner third of fallopian tubes broad ligament , upper bladder , terminal ileum and large bowel. The  pain travels via the hypogastric  plexus and hypogastric  nerve to the lower thoracic  and lumbar sympathetic chain . The  afferents  enter the cord  between T10 -L1. Pain  from the colon also travels via the parasympathetics to the pelvic plexus , pelvic nerves and enters the cord at S 2-4. The outer third of the fallopian  tube and urethra  are innervated  differently and the afferents enter the cord between T 9 and T10. The  lower vagina , lower bladder and rectosigmoid  junction are innervated  by sacral afferents. The localization of pain is dependent upon convergence of visual and somatic nerves within the central nervous  system in the anterior  horn .  Referred  pain is thought to be due  to the shared  connections of the afferent nervous system  in the posterior root ganglia. Reffered patterns may lead to quite unusual  and  unexpected  sites of pain.

ECTOPIC GESTATION

·         It  is necessary  to exclude an ectopic  pregnancy  in all women of reproductive age group married or otherwise.  The patient's last menstrual  period  and sexual activity pattern are useful but do not eliminate the need to do a pregnancy test. A simple urine pregnancy  test will detect BhCG of even  20 mIU/ml. If inconclusive a serum BhCG should be done . In subacute presentations when diagnosis is not obvious non- invasive  tests namely high resolution transvaginal  scan and serial BhCG estimations  are useful. Normally developing intrauterine pregnancies will have a characterstic doubling rate of BhCG of 1.98 days . When the BhCG does not double it is suggestive of a falling intrauterine pregnancy or an ectopic gestation. If subsequent BhCG values show a declining  trend,one can wait without surgery or medical treatment. Often several  BhCG  estimations and ultrasound have to be performed before a definitive diagnosis is made . Laparoscopy which used to be the gold standard for diagnosis is made.  Laparoscopy  which used to be the gold standard for diagnosis is seldom needed to diagnose  an ectopic gestation . Generally , one  should  be able to see a  gestational sac with a quant of  1000 miu/ mi. Identifying an intrauterine sac does not exclude a co-existing ectopic pregnancy , defined as  heterotopic pregnancy . This is rare , 1 in 5000 pregnancy but is increasing  with more women undergoing treatment with artifical  reproductive techniques (ART) and  pelvic  inflammatory  disease(PID) .

·         Once an  ectopic pregnancy  is diagnosed further  management  depends on the level of BhCG and the size   of the  ectopic  gestational  mass.

Risk Factor Analysis of Diabetic Macular Oedema

RISK FACTOR ANALYSIS OF DIABETIC MACULAR OEDEMA

Background : Diabetic retinopathy is the most common cause of newly diagnosed legal blindness amongst the working population in the industrialized world today.The common cause of visual impairment in diabetic retinopathy include macular oedema & complication due to proliferative retinopathy. The majority of diabetics have type II disease, wherein macular oedema is commoner, it follows that overall, macular oedema accounts for more vision impairment  than proliferative retinopathy. Hence evaluating possible relationship between diabetic macular oedema & various risk factor helps as preventive measure for progression of disease.

Methodology:

Eyes were diagnosed with diabetic macular oedema according to ETDRS guidelines. Best corrected  visual acuity with Smelled vision drum, slit lamp examination of anterior segments, and fund us evaluation with slit lamp bio microscopy  using + 90 Volk lens was done. Fasting plasma samples after at least an 8 -h overnight fast were collected for lipid analysis in blood . Other  investigation  blood sugar, haemoglobin, serum creatinine were assessed. Existing of hypertension noted. Ocular risk factor like cataract surgery was included.

Results: Most cases presented with vision between 6/18 to 6/60 constituting 35 eyes (43.75%) followed by 22 eyes (27.5%) had normal vision 6/6 to 6/18 , 10 eyes (12.5%) low vision  category 2, 6/60 to 3/60 and remaining 13 eyes (16.25%) were in blindness category 3, 3/60 to 1/60 . Males  37 (74 % ) were affected more than females 13 (26%) . Mean duration  of DM was 9.28=6.15 years. The P value of 0.019 for serum cholesterol to diabetic macular oedema is statically significant . P value  for LDL , HDL ,triglycerides,  haemoglobin  serum creatinine and surgery was not significant . Chi square test was used to see the association between groups for categorical variables. Results were considered significant at 'p' < 0.05 .

Conclusions:

Total serum cholesterol appears as an important risk factor for incidence and progression of diabetic macular  oedema. Most of the cases were in age group of 51 to 60 years. Male were predominantly affected .The maximum patient had low vision  category 1 constituting 35 eyes (43.75%) . Duration of diabetes  mellitus and diabetic macular oedema  was not related indicating perhaps DME can occur at any stage of diabetic retinopathy. Cataract surgery , hypertension , serum  creatinine, haemoglobin were not significantly related to diabetic macular oedema. As the study was carried out in small number of patient , further study with large number of patient  is needed .