A bony hard choroid A 48-year-old female patient came for a regular eye checkup. On examination, the best corrected visual acuity was 6/6, N6 in both eyes. Fundus examination of the left eye showed an oval-shaped, orange-red choroidal lesion in the peripapillary area with well-defined smooth margins; the fovea was spared. Peripapillary chorioretinal atrophy was noted nasal and inferior to the disk [Fig. 1a]. What is your next step? A) B-scan B) OCT C) Fundus autofluorescence D) All of the above. Findings Ultrasound B scan showed peripapillary high reflective plaque-like lesion at the level of choroid persisting in lower gain, suggesting calcification. Optical coherence tomography (OCT) showed lesion sparing the fovea, schitic separation of the inner nerve fibers at the optic disk, and cavitation at the level of choroid corresponding to the peripapillary atrophy. OCT through the lower part showed hyporeflective areas giving intrinsic sponge-like appearance in the deossified area and lamellar appearance and posterior shadowing at the ossified area [Fig. 1b].Figure 1: (a) Fundus shows orange red lesion in the peripapillary area sparing the fovea. Inset picture: B scan shows high reflective plaque echo at the level of choroid, suggestive of calcification. (b) OCT shows the lesion sparing the fovea (a), schitic separation of the inner nerve fibers at the optic disk, and cavitation at the level of choroid corresponding to the peripapillary atrophy (red star). OCT through the lower part shows hyporeflective areas giving sponge-like appearance in the deossified area (yellow star) and lamellar appearance and posterior shadowing in the ossified area (white star). OCT = optical coherence tomographyDiagnosis Choroidal osteoma of the left eye Correct answer: D. All of the above. Discussion Choroidal osteoma is rare benign ossifying tumor characterized by mature cancellous bone involving the choroid.[1] It presents with blurred vision (due to Choroidal neovascular membrane (CNVM) or retinal pigment epithelium atrophic changes), metamorphopsia, photophobia, and visual field defects. It is seen as a yellow white to orange elevation of choroidal mass with well-defined, irregular scalloped, or geographic borders in the juxtapapillary, peripapillary, and macular regions. It may be associated with depigmentation of overlying Retinal pigment epithelium (RPE) and with multiple small vascular networks on the tumor surface.[23] Differential diagnosis includes choroidal metastasis, sclerochoroidal calcification, amelanotic choroidal nevus, serpiginous choroiditis, choroidal hemangioma, choroidal granuloma (tuberculosis, sarcoidosis), and metastatic and dysmorphic calcification. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

This chapter discusses the extent of contamination and pollution of groundwaterGroundwater pollution in India from the point of view of using it for human consumption and highlights the emerging problem of microbial and nitrateGroundwater pollution pollution of groundwaterGroundwater pollutionnitrate pollution due to on-site sanitation through millions of toilets in rural areas. It also discusses the issues and challenges in tackling groundwater contamination and pollution from technical and institutional perspectives, particularly the dispersed microbial and nitrate pollution from rural latrines and non-point pollution from agricultural practices, for protecting it as the source water for domestic supplies. While discussing the technologies to treat poor-quality groundwater to reduce the adverse health impacts of using it, it makes a case that preventing microbial and nitrate contamination of groundwater would require surveillance of drinking water sourcesDrinking water sourcescontamination based on risk assessment. Finally, the emerging challenges with regard to the management of the treatment systems are discussed.

This study examines the importance of generating proper water accounts for large gravity-based irrigation schemes in order to assess scheme performance. It shows how the use of simplistic criteria used to assess the performance of gravity-based irrigation schemes can lead to an underestimation of the role they play in enhancing food security and agricultural production in countries such as India, which has established a huge network of irrigation canals. The paper offers specific suggestions on improving irrigation statistics that, in turn, can help in better evaluation of the returns on investments of public surface irrigation schemes.

This chapter, following a review of the available studies on theRural domestic water supply schemesperformance performance of rural water supply schemesWater supply schemesperformance, presents the findings of field studies carried out on the performance of rural water supply schemes in different geological settings of MaharashtraMaharashtra. A total of 12 schemes and 255 households were surveyed. For the performance assessmentPerformance assessment, various data on water supply schemeWater supply schemes characteristics and their operation and maintenance were analysed. These include scheme type, its coverage, planned and actual supply, qualityWater supplyquality of water suppliedQuality of water supply, access and frequency of water supply, maintenance of the system, water tax recovery, and adoption of improved sanitation facilities by the households. The assessment covered the physical, economic, and financial performanceRural domestic water supply schemesperformance of the rural water supply schemesWater supply schemesperformance. The study shows that the overall performance of water supply schemesWater supply schemesperformance based on surface reservoirs and direct lifting from rivers was better than that of schemes based on groundwater on the parameters analysed.

A comprehensive and scientific approach to water quality monitoringWater quality monitoring that can ensure the protection of drinking water sources from pollutionDrinking waterpollution is absent in India. This leads to ineffective and inefficient surveillance of drinking water qualityDrinking water quality. An attempt is made to develop a composite index, which would provide indications as to where the water supply surveillance—in relation to the quality of water—has to be more frequent to avert any public health hazards, and where regular monitoring of certain basic parameters would be sufficient. The index helps assess the public health risks associated with poor quality of water resourcesWater resourcesquality in an area. This composite index has three dimensions: threat, exposure, and vulnerability. The indices corresponding to these attributes have seven sub-indices in total, viz. (1) availability of drinking water resourcesWater resourcesquality in terms of quantity and quality; (2) accessibility of water; (3) infrastructure characteristics; (4) public health outcomes; (5) water quality indexWater quality index; (6) institutions and management index; and (7) climate, population density and flood proneness. The number of ‘minor’ factors which together are considered to have an influence on the measure of these sub-indices, the underlying assumptions, the methods for methods and procedure to compute, and the data sources are also discussed. The values of the index are computed for all the blocks of MaharashtraMaharashtra state, which face several issues with regard to monitoring of drinking water qualityDrinking water quality, and the variations are explained.

Wastewater treatment and reuse practices are limited in India despite the known benefits of preventing water resources pollution and contributing to sustainable production and consumption systems. We identify the perceived key drivers and barriers to wastewater treatment and reuse governance in a two-round Delphi study, including literature and case study analyses and consultation with 75 panelists. Panelists indicated that the most significant driver for wastewater treatment and water reuse is persistent water scarcity that necessitates diversification to alternative water supplies. In contrast, the most significant barriers are the lack of enforcement of pollution monitoring and control, the lack of an umbrella directive for integrated water resources management, and insufficient collaboration between responsible governmental organizations, central and state water authorities. Given the absence of central guidelines, only a few Indian states such as Maharashtra, Gujarat or Punjab have adopted effective governance structures. These states showcase that defined reuse standards can create successful wastewater treatment and reuse practices but require target-based regulations which are enforced and regularly monitored and financing mechanisms for their long-term operation. The new effluent discharge standards by the National Green Tribunal, the government support programmes, and increasing water scarcity in many parts of India will supposedly drive innovative wastewater treatment and reuse structures. Panelists agreed that efforts are needed to develop technology guiding frameworks following the fit-for-purpose principle and that strengthening institutional and monitoring capacity is crucial to increase confidence in the quality of recovered water resources, create demand, and ultimately safeguard human health and the environment.

The article discusses a statistical model to explain the varying performance of water supply schemes under different physical environments in the state of Maharashtra in India, characterized by high spatial and temporal variability in rainfall and climate, and heterogeneity in geological and geomorphological conditions. The factors that enhance the performance of the schemes are effective utilizable recharge rates, extent of surface irrigation, and aquifer storage space. The factors that adversely affect the performance are the extent of the population covered by groundwater-based schemes and irrigation water demand per unit area. Subsequently, the districts in Maharashtra where groundwater-based schemes are likely to succeed were identified. The article also explains the practical and policy relevance of the model results for rural water supply planning.

The chapter describes the development of a statistical model to explain the varying performance of water supply schemesWater supply schemesperformance under different physical environments. For this purpose, a regression analysis was undertaken using parameters such as monsoon rainfall, pre-monsoon depth to water levels, recharge potentialGroundwaterrecharge potential, irrigation demand, extent of dependence of groundwater-based schemesGroundwater-based schemes, extent of gravity surface irrigationSurface irrigation, geomorphology, and aquiferAquifer characteristics. The regression result (model) was used to determine the factors that would likely lead to the success of rural water supply schemes in each district of MaharashtraMaharashtra. Based on this assessment, four typologies of districts were identified, each requiring a certain type of intervention to improve the sustainability of water supply schemes. The chapter also explains the practical and policy relevance of the model results in rural water supply planningWater supply planningMaharashtra.

This chapter analyses the macro-level conditions that exist in India vis-à-vis the key attributes that have bearing on the type of water supply schemesWater supply schemes that would be sustainable in a rural area. The attributes considered are: surface hydrologySurface hydrology; topography; geology and geohydrology; groundwater chemistryGroundwater chemistry; and nature and degree of over-exploitationGroundwaterexploitation of groundwaterGroundwater exploitation. Subsequently, the hydroclimatic zones in India, where groundwater-based schemesGroundwater-based schemes are unlikely to be sustainable, are identified and the reasons explained. Further, strategies for the provision of rural drinking water supplyDrinking water supply in those regions from surface water resources are evolved, based on consideration of surface hydrologySurface hydrology and topography. The key institutional and policy reformsGroundwater policy reforms that are required to manage rural water supply on a sustainable basis are also discussed.

This chapter sets the overall context of the book. It briefly describes India’s rural domestic water supply situation. It discusses the technological, institutional, and policy reforms undertaken in the country’s rural water supply sector since independence and tracks the progress made by various Indian states in terms of improving the coverage, reliability, adequacy, and quality of water supply in rural areas in the light of these changes. It also briefly discusses the new challenges facing the sector, from the points of view of physical sustainability of the services, equity in access to supplies and financial sustainability. The chapter also discusses the objectives and scope of the book and presents the outline of other chapters in the book.KeywordsRural domestic water supplyDrinking water securityGroundwaterSurface waterIndiaInstitutional reformSustainability

This chapter systematically examines which regions of MaharashtraMaharashtra state will be able to provide sustainable rural water supplyWater supplyMaharashtra based on local groundwater-based sources, which regions would require augmentation of the existing sources from surface water from within the region or outside, and which regions would need to depend entirely on bulk water imports for ensuring drinking water security. For the analysis, it develops four regional typologies based on certain physical (hydrologicalHydrological features, geohydrological, climatic, and geomorphological features) and socio-economic (gross and net cropped area, the total area under gravity irrigationGravity irrigation systems, and extent of dependence of the population on groundwater-based schemesGroundwater-based schemes for rural water supply provisioning) characteristics of each district, and uses the ‘effects’ these characteristics have on the performance of existing rural water supply schemes to identify the types of schemes that will be sustainable for each typology. It then presents the tentative cost of implementing the augmentation schemes and also examines the cost-effectiveness of the interventions against tanker water supplyTanker water supply.

Many coastal cities in developing countries are at the risk of flooding due to a progressive increase in the built-up areas and poor management of storm water. The flooding situation in coastal cities gets accentuated further due to climate-induced natural disasters such as cyclones and climate change-induced sea-level rise that adversely impact the city's natural drainage potential. This study developed a composite urban flood risk index consisting of three sub-indices and 20 key natural, physical, social, and economic influencing variables for a coastal city (i.e., Cuttack) in eastern India, the intensity of storm run-off being one among the many. The intensity–duration–frequency curve developed shows that the city can experience floods with a peak discharge of 1320 cubic metre per second every alternate year for a rainfall intensity of 2-h duration. The urban flood risk index computed for all the city wards shows that out of the 59 wards, only one ward has low flood risk (index value < 0.40) and 20 wards are at high risk (index value 0.55 and above) from the urban flood. Thereafter, factors leading to high risk due to urban floods were identified and the institutional capacities available with the urban utility for fighting floods analysed.

Conventional Austempered Ductile Irons (ADI) are lacking in adequate wear resistance. Introduction of hard alloy carbide phase in the microstructure by strong carbide formers imparts wear resistance. Deep cryogenic treatment subsequent to austempering is another way to improve the wear resistance without a major reduction in toughness. The present study encompasses the microstructural evolution following deep cryogenic treatment and the resultant bulk hardness, Charpy impact toughness and dry sliding wear of two vanadium contained (0.1% and 0.3%) carbidic austempered ductile irons. The irons were austempered at two temperatures viz. 300(0) C and 350(0) C for 30, 45, and 60 minutes and which is accompanied at -196(0) C either by deep cryogenic treatment or air-cooled. EDS & XRD (X-ray Diffraction), Optical and Scanning Electron Microscopy analysis have characterized the microstructural features. Increase in vanadium content and cryo-treatment result in a prominent combination of wear resistance and impact toughness.

Findings Fundus evaluation showed peripapillary reddish‐white lesion bilaterally, with well‐defined irregular geographic borders forming pseudopodia and sparing the fovea [Fig. 1a]. Ultrasound scan showed high‐reflective plaque echoes in peripapillary area of both eyes suggestive of calcification [Fig. 1c]. CT orbit showed hyperdense lesion suggestive of calcification [Fig. 1e]. Optical coherence tomography (OCT) showed choroidal lesion causing shadowing with subretinal fluid (SRF) [Fig. 1d]. Fundus fluorescein angiography (FFA) of both eyes showed early intense hyperfluorescence with staining [Fig. 1b]. Indocyanine green angiography did not show any features of active choroiditis or choroidal neovascular membrane (CNVM). In the absence of CNVM and the tumor edge being very close to fovea, it was decided to observe the condition rather than consider anti‐ vascular endothelial growth factor (VEGF) or photodynamic therapy. In such eyes with SRF, anti‐VEGF is the preferred treatment in the presence of CNV, while observation is the norm without CNV. At 1 and 3 months follow‐up, both fundi were stable without CNVM.

Epidemiological evidence suggests that intake of high amount of non-vegetarian diet is associated with increased risk of chronic diseases including atherosclerosis, hyperlipidemia and cancers. But, the research study on the effect of functional meat product in physiological functions of health is still pending. Therefore, the aim of this study was to elucidate effect of whole grain cereal flours and some plant derived bioactive compounds intake on antioxidant activity, MDA content, serum lipid profile, hepatic and renal functions and tissue histopathology of vital organs were examined in mice model study. For this, a total thirty six adult male Swiss albino mice were randomly divided into three groups (3×12): one group fed control diet (vegetarian diet, CD), another group fed control wafers (CW) and the third group fed functional wafers (FW). The FW contained whole grain oat and sorghum flours, apple peel paste, oregano, aloe vera gel and vitamin E. Result indicated that FW lowered overall serum total cholesterol (TC) and LDL-C levels but HDL-C remain unchanged. Compared with control group, the TC and LDL-C in FW group were lowered by 15.61 and 16.51 mg/dL, respectively. The TGL was lowest in mice received CD. The serum glucose level was decreased in CW and FW fed mice. The activity of hepatic and renal enzymes were lowered (P<0.01) with the feeding of FW. The antioxidant enzymes viz., CAT and GSH-Px, however increased in the FW group by 14.0 and 2.27 U/mL respectively (P<0.05). The antioxidant enzymes in FW group mice decreased the MDA formation. This it was concluded that FW intake could greatly help in amelioration of oxidative stress related chronic diseases besides improving most of the lipid profile parameters.

For choledocholithiasis, endoscopic management is the first line of treatment. Both Dormia basket and balloon catheter are used to retrieve common bile duct (CBD) stones. Here we present a case of impaction of the Dormia basket during an endoscopic procedure. The patient was managed through laparoscopic choledochotomy, and the basket was found to be impacted with a common bile stone of size 18 mm. The stone was disengaged from the basket and, by holding the tip of the basket, was removed through one of the laparoscopic ports.

ObjectiveTo study the outcome and complications of sutured scleral fixated intraocular lenses (SSFIOL) in children.DesignRetrospective study.SubjectsA total of 279 eyes of 230 children who underwent SSFIOL at ≤18 years of age in a tertiary eye care centre in India.MethodsTreatment-naive children having traumatic cataract or subluxated lens underwent a single-sitting lensectomy and pars plana vitrectomy (PPV), along with SSFIOL insertion. Children with aphakia underwent PPV with SSFIOL, and vitrectomized eyes underwent only SSFIOL implantation. Fixation of SSFIOL was done by the 4-point ab externo fixation technique using 10-0 prolene suture.Main outcome measuresPreoperative and postoperative visual acuity, as well as intraoperative and postoperative complications.ResultsThe mean age at which SSFIOL was performed was 10.8 ± 4.22 years. The most common indication of SSFIOL in our study was traumatic subluxation of lens (47.63%; n = 133 patients), followed by congenital subluxation in 38.7% (n = 108). Best-corrected visual acuity was maintained or improved from the preoperative visual acuity in 93.19% of eyes. The complications included choroidal detachment in 2.86% (n = 8), dispersed vitreous hemorrhage in 2.86% (n = 8), endophthalmitis in 0.72% (n = 2), raised intraocular pressure in 12.54% (n = 35), diplopia in 0.72% (n = 2), retinal detachment in 5.73% (n = 16), and dislocation of the SSFIOL in 4.6% (n = 13). The mean follow-up after SSFIOL implantation was 39.68 months.ConclusionsSSFIOLs are effective in correcting aphakia in children; long-term follow-up of these children is, however, necessary.

AIM:To evaluate the efficacy of combination therapy of argon laser photocoagulation and intravitreal antivascular endothelial growth factor (VEGF) injection in idiopathic polypoidal choroidal vasculopathy (PCV) involving macula. MATERIALS AND METHODS:A retrospective interventional study involving 12 eyes of 11 patients diagnosed with PCV involving the macula on indocyanine green angiography (ICGA). Intravitreal anti-VEGF was given in eyes with significant subretinal/sub retinal pigment epithelium hemorrhage or exudation. ICGA-guided focal laser was done to extrafoveal leaking polyps. Mean change in best-corrected visual acuity (BCVA) and regression of polyp as seen on ICGA were evaluated at the final follow-up. STATISTICAL ANALYSIS:It was done using SPSS 17.0. - Mann-Whitney test. RESULTS:12 eyes of 11 patients underwent argon laser with intravitreal anti-VEGF injection. Ten patients were males and one female. Mean age was 65.75 ± 5.2 years. The mean number of injections given was 3.66 ± 1.5 (2-6) per eye. Mean number of laser sessions required was 1.33 ± 0.65 (1-3) per eye. BCVA improved in 25% (n = 3), remained stable in stable in 50% (n = 6) eyes, and decreased in 25% (n = 3) eyes. The regression of polypoidal lesions on ICGA was seen in 75% (n = 9) of eyes. Persistent subretinal fluid seen in 25% (n = 3) of eyes. The mean duration of follow-up was 15.41 ± 10.27 (3-36) months. CONCLUSION:Combined argon laser photocoagulation with intravitreal anti-VEGF injection helps in decreasing exudation and results in stabilization of the disease with visual improvement in eyes with PCV involving macula.