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Background: Acute respiratory infections (ARI) comprising of a group of respiratory diseases of varying etiology and severity is being increasingly recognized as a major public health problem particularly amongst children below five years of age. In all countries ARI is a leading cause of hospitalization and death. Therefore ARIs represent a large challenge in field of communicable diseases. The study was conducted with the objective to assess the socio-demographic, epidemiological and clinical profile of ARI cases.Methods: A descriptive cross sectional, hospital based study was conducted at Government Medical College and Hospital. All children admitted with ARI in the paediatric ward during the study period of one calendar year.Results: Maximum (53.13%) cases of ARI were from the age group <1 year. Males (60.80%) outnumbered the females (M:F ratio was 1.5:1). Month wise and season wise distribution of ARI cases showed that, most of the cases were admitted in the month of December (13.35%), followed by January (12.78%) and November (10.80%).Conclusions: Prevalence of ARI cases as well as severity of the disease was more in participants less than 1 year of age.
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Purpose: To evaluate the accuracy of Spot photoscreener (PS) as a noncycloplegic photorefractor in detecting amblyopia risk factors (ARFs) in preschool children in an Indian eye clinic setting. Also, to derive appropriate cutoff values for screening to obtain maximum sensitivity and specificity of the device in detecting ARF. Methods: This was a cross-sectional study conducted in the outpatient pediatric eye clinic at a tertiary eye care institute. A Spot PS was used to screen all the children between the ages of 6 months and 5 years that presented to the eye clinic from August 2018 to October 2018. This screening was followed by a complete eye examination, including cycloplegic refraction by a masked examiner. The 2013 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines were considered the standard cutoff values for clinically significant refractive error in children younger than 5 years of age. Results: The study comprised of 219 children. The Spot PS diagnosed 135 (61.64%) children with ARF as compared with 124 (56.62%) children detected by clinic examination. For ARF detection, the Spot photoscreeneer had 85.48% sensitivity, 69.47% specificity, 78.52% positive predictive value and 78.57% negative predictive value. The sensitivity for detection of strabismus and hypermetropia was very low (42% and 36%, respectively). The 95% limits of agreement ranged from ?5.48 to +5.59 diopters (D) with a bias of 0.06 D for spherical equivalent between noncycloplegic photorefraction and cycloplegic refraction. Conclusion: The Spot PS may be used as a screening tool to detect ARF in children younger than 5 years of age keeping its limitations in consideration. However, the performance can be improved by modifying the cutoff values for the referral.
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Background: Nasal and non-nasal symptoms in allergic rhinitis (AR) can be assessed by measuring health related quality of life (HRQOL). Present study was to assess the impact of use of antihistaminic in AR which will affect the work productivity, sleep, frequent visits to health care professional and expenditure on medicines. For this evaluation, Rhinoconjuctivits Quality Of Life Questionnaire (RQLQ) has been used.Methods: In this study 52 patients with AR were randomized in an open-label, 4-arm, parallel group, single center study. Questionnaire information was obtained about allergy-related RQLQ. Subjects received either Tablet Cetirizine 5 mg, Levocetirizine 5 mg, Loratidine 5 mg or Fexofenadine 120 mg. Changes from baseline until the end of study visit (1 week following) were evaluated by RQLQ.Results: When compared between treatment groups using one-way ANOVA it was observed that there is no variation in RQLQ overall Score in all the four treatment groups and there is no difference from treatment to treatment. Overall RQLQ score was reduced maximum in Levocetirizine group. Individual symptoms of RQLQ that is sleep score, non-hay fever, practical problem, nasal symptom score, Eye symptom Score, activities Score, and emotion score were also improved in the Levocetirizine group.Conclusions: Patients of all four study groups showed an improved perception of their HRQL according to the RQLQ. Significant improvements are reported in nasal symptoms, daily activities, sleep and psychological impact. Our results provide support for an AR and its impact on quality of life. Our recommendation stipulating that levocetirizine is superior to rest drug group for the treatment of AR with safety and tolerability.
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A 54-year-old patient presented with cataract, 5 years after undergoing SMILE for high myopia in both eyes. He was motivated in achieving spectacle free vision and his post SMILE-induced aberrations were minimal, due to which he was found suitable for a trifocal IOL implant. Of the various methods considered, the IOL power predicted by a novel combined telecentric keratometry and swept source OCT-based method was finally selected. One month post-operatively, the patient achieved a binocular UDVA of 20/20p and near vision of N.6, suggesting that newer IOL formulae could be superior in providing satisfactory outcomes in post refractive patients.
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Purpose: Our study aims at evaluating the efficacy and safety of botulinum toxin A in the early treatment of sixth nerve palsy in type 2 diabetic patients. Methods: This study is a prospective and interventional clinical case series of patients presenting with acute onset of sixth cranial nerve palsy, who received injection botulinum toxin A. Results: Thirty-one cases were included in the study. 58% of the study subjects had incomplete palsy at presentation (abduction deficit -1 to -3) and 42% had complete palsy (-4 and -5). The median dosage of injection was 5 U (range 3--6 U). The median follow-up period is 2 months. The P value shows that there is statistically significant improvement in head turn, ocular deviation in primary position, and improvement in abduction between baseline and 1 week (P-value <0.001), 1 month (P-value <0.001) and 2 month (P-value <0.001) postinjection follow-up visits. 90.3% of patients had full resolution of symptoms in the last follow-up visit. 83.9% of patients were successfully treated. Conclusion: Early injection of botulinum toxin A in select patients with acquired sixth nerve palsy due to diabetes is a safe and efficient treatment option in alleviating symptoms, restoring function and quality of life and reducing need for surgical interventions in future.
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Purpose: Ocular morbidities like high refractive error, strabismus, and amblyopia are common among laser-treated retinopathy of prematurity children (ROP). Long-term optical status and refractive outcomes including the sensory outcomes were less investigated in these children from this region. The purpose of our study is to evaluate the long-term outcome (refractive, biometric profile, sensory) of treatment for ROP using laser. Methods: This study is a retrospective, cross-sectional, observational, and intervention research among 6–15-year-old children who underwent laser for ROP with a minimum of 6-year follow-up. Results: Eighty lasered eyes of 41 children were assessed. Mean age was 9.71 years (±3.39). Seventy-three eyes (91.2%) achieved visual acuity better than 20/40. The mean visual acuity in LogMAR was 0.18 (20/30). The mean spherical equivalence was ?5.29 D ± 4.9. Mean astigmatism measured was ?1.53 DC (range: +0.50 DC to ?4.5DC). Fifty-three eyes (66.25%) had significant astigmatism. The mean axial length was 23.5 ± 1.35 (21–26) mm. Mean lens thickness was 3.76 ± 0.30 (3.03–4.34) mm. Correlation analysis among the low and high spherical equivalent group signified that axial length (P value = 0.001), visual acuity (P value = 0.0002), and myopic shift (P value = 0.0006) were found to be statistically significant. Stereopsis better than 480 s of arc for near was observed in 41% children. Structural posterior pole sequelae developed in 3 eyes (3.75%). Conclusion: A significant number of children with high myopia, astigmatism, and strabismus had satisfactory visual outcome observed at long-term follow-up after treatment for ROP using laser. Our study revealed that myopia was influenced by an increase in axial length than the lens thickness.
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To report case of bilaterally symmetrical choroidal coloboma within posterior staphyloma with MHRD. This is a case report of a 50year old female presented with diminished vision in both eyes. On examination, she had Bilateral High Myopia with recent onset MHRD associated with symmetrically bilateral Choroidal Coloboma within posterior staphyloma and was operated for MHRD in left eye. Presence of choroidal coloboma within posterior staphyloma is rare and with coexisting macular hole makes pathophysiology of RD challenging to understand.
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Background: Amongst the common problems facedglobally, Allergic Rhinitis (AR) is very distressing attimes. This is an inflammatory response to either knownor unknown allergen. The symptomatic relief in ARusing topical steroid Fluticasone propionate andantihistaminic Azelastine Hydrochloride in acombination has been studied. Very few studies showingcomparison between these two drugs in a combinationand steroid alone are available in the literature. Aim andObjectives: To study the effectiveness of topicaltreatment using corticosteroid Fluticasone propionateand antihistaminic in a combination versus Fluticasonepropionate alone in patients of AR. Material andMethods: The cases presented with symptoms ofallergic rhinitis were randomized in two groups at startof treatment. All cases of Group I were treated withFluticasone propionate whereas of Group II withFluticasone propionate and Azelastine hydrochloridecombination. In each group, the individual symptomscores were recorded pre-treatment and post-treatmentat the end of four weeks with the help of symptomevaluation scale. Based on these individual symptomscores, the Total Symptom Score (TSS) was calculated.The effectiveness of group specific drugs was evaluatedby comparing individual and TSS. Results: After fourweeks, both TSS and individual symptom score werereduced in either group (p<0.05). Further, Group IIspecific drug was found more effective than Group-I inrelieving symptoms of AR. Conclusion: TSS decreasedby an average of 84.14% in Group-I (i.e. treated withFluticasone propionate) and by 91.16% in Group–II (i.e.treated with Fluticasone propionate and Azelastinehydrochloride I in a combination).
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The purpose of the study is to report the feasibility of implantation of a new design of anterior capsule-fixated intraocular lens (IOL). The new IOL design is a foldable, hydrophilic, open-loop posterior chamber IOL with two extra polymethyl methacrylate swivel haptics created on the optic surface to capture the anterior capsulotomy after the IOL is implanted in the bag. In the pilot phase, the new IOL was implanted in 10 eyes of 10 patients of which 8 eyes underwent phacoemulsification and 2 eyes had laser cataract surgery. The mean spherical equivalent changed from *1.75 D to ?0.75 D at 6 months. Postoperatively, from 1 week to 6 months, all eyes showed stable refraction and anterior chamber depth with no evidence of decentration. Subjective questionnaire revealed high patient satisfaction with no complaints of dysphotopsia. No intra- or postoperative complications such as swivel haptic breakage, iris chafing, pigment dispersion, postoperative uveitis, or endophthalmitis occurred in any of the eyes necessitating explantation of the IOL. The new IOL design was feasible to implant and provided satisfactory outcomes in terms of no dysphotopsias and stable effective lens position.
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Background: This study was to assess the usefulness of nasal smear as a quick, easy and inexpensive diagnostic method for allergic rhinitis and for assessment of the cost effectiveness of antihistaminics.Methods: This study was conducted in rural setting of tertiary care hospital. Nasal smears were taken from 52 patients with a clinical history of nasal allergy having nasal congestion score of at least 3 or more. Nasal smears were stained with Hematoxilin-Eosin and examined by pathologists.Results: A total of 52 patients 13 in each groups of the age group 18 to 65 years (Mean age, 33.73±10.23 years); 48.08% are Female and 51.92% are Male were randomized and received either Cetirizine, Levocetirizine, Loratadine, or Fexofenadine over a period of one week. The association of eosinophil before and after the treatment was obtained using logistic regression analysis for each treatment separately. Eosinophil is marginally associated with Cetirizine before and after treatment.Conclusions: Evaluation of eosinophils in nasal smear is an insensitive but cheaper test for the diagnosis of allergic rhinitis and use as a simple tool for comparison of cost effectiveness among commonly used oral antihistaminics. pharmacoeconomic analysis of present comparative clinical study shows that cetirizine is a better choice in comparison with levocetrizine, loratidine and fexofenadine due to its cost effectiveness.
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Purpose: The aim of this study was to compare noncycloplegic refraction performed in school camp with that performed in eye clinic in children aged 6� years. Methods: A prospective study of children with unaided vision <0.2 LogMAR who underwent noncycloplegic retinoscopy (NCR) and subjective refraction (SR) in camp and subsequently in eye clinic between February and March 2017 was performed. A masked optometrist performed refractions in both settings. The agreement between refraction values obtained at both settings was compared using the Bland朅ltman analysis. Results: A total of 217 eyes were included in this study. Between the school camp and eye clinic, the mean absolute error � standard deviation in spherical equivalent (SE) of NCR was 0.33 � 0.4D and that of SR was 0.26 � 0.5D. The limits of agreement for NCR were +0.91D to ? 1.09D and for SR was +1.15D to -1.06D. The mean absolute error in SE was ?0.5D in 92.62% eyes (95% confidence interval 88%�%). Conclusion: A certain degree of variability exists between noncycloplegic refraction done in school camps and eye clinic. It was found to be accurate within 0.5D of SE in 92.62% eyes for refractive errors up to 4.5D of myopia, 3D of cylinder, and 1.5D of hyperopia.
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Purpose: To study the time course of interface healing and its correlation with visual acuity, modulation transfer function (MTF), and aberrations after myopic small-incision lenticule extraction (SMILE) correction. Methods: Seventy-eight eyes of 78 patients (1 eye per patient) with a mean age of 25.7 years and mean spherical equivalent (SE) of ?3.74D, undergoing bilateral SMILE procedure, were included in this study. On postoperative day 1, 2 weeks, and 3 months, dilated retroillumination photographs were taken and morphology of corneal interface was graded by comparing them with 5 standard templates representing 5 grades of interface roughness (IRG): IRG � 0 (clear), IRG � 1 (mild), IRG � 2 (moderate), IRG � 3 (severe), and IRG � 4 (severe IRG with Bowman's folds in visual axis). Pearson's correlations were computed to study correlation associations, and Wilcoxon signed-rank test was used for intragroup comparison of means. P ? 0.05 was considered statistically significant. Results: At 3 months, 90.70% eyes were Grade 0 while 9.30% eyes still had Grade 2 interface granularity. Mean IRG significantly improved from 2.47 � 0.57 at day 1 to 0.62 � 0.53 at 3 months (P = 0.00). At day 1, pre-SE showed a significant positive correlation with IRG; however, mean postoperative corrected distant visual acuity (CDVA, in decimal), corneal Strehl ratio (SR), and MTF showed weak but significant negative correlation with IRG (r2 = 0.28 for SE, ?0.052 for CDVA, ?0.017 for SR, and ?0.39 for MTF, respectively, P < 0.05 for all correlations). At 2 weeks and 3 months, corneal MTF continued to show a significant negative correlation, whereas other parameters did not show any correlation with IRG. Conclusion: Visual quality and corneal MTF may be significantly affected by the IRG in the immediate postoperative period after SMILE and may take 3 months or more for complete recovery.
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Small incision lenticule extraction (SMILE), a variant of refractive lenticule extraction technology is becoming increasingly popular, as a flapless and minimally invasive form of laser vision correction (LVC) for the treatment of myopia and myopic astigmatism. This review aims at summarizing the principles, surgical technique, and clinical outcomes in terms of visual and refractive results, safety, efficacy, postoperative dry eye, aberrations, and biomechanics of SMILE and its comparison with other conventional techniques of LVC, such as laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Recent advancements in the laser frequency and energy delivery patterns, instrumentation, and surgical techniques have shown significant improvement in the visual recovery and outcomes after SMILE, compared to the initial results published by Sekundo and Shah et al. Most of the recently published literature on long-term outcomes of SMILE shows excellent stability of the procedure, especially for higher myopia. In terms of the postoperative dry eye, SMILE shows a clear advantage over LASIK as numerous studies have shown significant differences about the Schirmer's, Tear film break up time, corneal sensitivity, and corneal nerve regeneration to be better following SMILE compared to LASIK. There is some evidence that since the Bowman's membrane (BM) and the anterior lamellae remain intact after SMILE, this may be a potential advantage for corneal biomechanics over LASIK and PRK where the BM is either severed or ablated, respectively, however, the data on biomechanics are inconclusive at present. Overall, this procedure has proved to be promising, delivering equivalent, or better visual and refractive results to LASIK and providing clear advantage in terms of being a flapless, minimally invasive procedure with minimal pain and postoperative discomfort thus offering high patient satisfaction.
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OBJECTIVE To study the bioactive phytochemicals in the leaves of A.ilicifolius against Hepatocellular carcinoma (HCC) through in silico, in vitro and in vivo studies. METHODS A. ilicifolius leaves were collected from Cuddalore District,Tamil Nadu,India.Authenticated by the Botanical Survey of India. The fresh leaves of A. ilicifolius were washed and shade dried at room temperature (28 ± 2)℃. The dried leaves were powdered by electrical blender.25 gms of A.ilicifolius leaf powder was used for methanol extraction in the Soxhlet apparatus.The Phytochemical compounds were analyzed by GC-MS and the structure was retrieved from PubChem.Totally,seven HCC target proteins were collected from literature, ligand and proteins were prepared for in silico molecular docking. HepG2 cell lines were used for in vitro (MTT assay). BALB/c mice were used for in vivo studies, the biochemical parameters and histopathological studies were carried out with standard procedure. RESULTS The phytochemical 26.27-Di (nor)-cholest-5, 7, 23-trien-22-ol, 3-methoxymethoxy exhibited maximum docking score against the HCC target protein C-Jun N-terminal kinase 1 (JNK 1) (-6.839798). MTT assay revealed that the extract at a concentration of 200 μg·mL-1,caused 60% cell death in HepG2 cell lines.Further animal studies using to injecting HCC induced BALB/c mice,restoration of haematological parameters and cells to normal was observed after 15 days of oral administration of the extract.These findings suggest the possibility of using A.ilicifolius leaves in the treatment of HCC.CONCLUSION The in silico,in vitro and in vivo studies indicated that the A.ilicifolius leaves had anticancereous activity against Hepatocellular carcinoma.There can be a possibility of synergistic activity of phytochemicals together against HCC.
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Scleroderma is a chronic systemic autoimmune disease of unknown origin characterized by excessive collagen deposition and autoantibodies. Patients with autoimmune diseases are known to develop infections like tuberculosis due to the disease per se and also secondary to immunosuppressive treatment. Mycobacterial infections are also known to induce the development of autoantibodies. We present a case of simultaneous occurrence of interstitial lung disease and pulmonary tuberculosis (BAL positive for AFB) in a patient with features of systemic sclerosis. Antibody profile was done were found to be positive for ANA. She also had most of the classical features of scleroderma on clinical examination thus confirming the diagnosis. A detailed history, clinical examination, radiological examination, bronchoscopy and immunological test helped in the diagnosis of the patient. We highlight the importance of suspicion, careful general examination, radiological assessment and screening tuberculosis patients for autoantibody profile in presence of a multisystem involvement.
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Tracheal bronchus is an aberrant bronchus that arises most often from the right tracheal wall above the carina and is the result of an additional tracheal outgrowth early in embryonic life. The incidence of tracheal bronchus is approximately 0.1-2%. The presence of congenital anomaly of the central airway can be of great significance to anaesthesiologist and though a rare anomaly it can still be a challenge for proper positioning of DLT and establishing OLV in the hands of junior anaesthesiologists. We report a case with tracheal bronchus arising from right tracheal wall diagnosed when we had difficulty in placing the left DLT. Identification of tracheal bronchus on the chest radiograph and CT-scan of chest before surgery is useful. We do strongly recommend as in other reports, giving the patient an alert card indicating the diagnosis of tracheal bronchus.
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Bacterial DNA topoisomerases are unique in maintaining the DNA topology for cell viability. Mycobacterium tuberculosis [MTB] DNA gyrase, a sole type II topoisomerase has a larger scope as a target for developing novel therapeutics. In this study, an effort was made towards the design and synthesis of benzothiazinone-piperazine hybrid analogues to obtain the possibility of it to lead development through the molecular hybridization technique. A five-step scheme was followed to obtain a series of 36 benzothiazinone-piperazine derivatives and to evaluate them for MTB DNA gyrase inhibition, antimycobacterial and cytotoxicity studies. Compound N-[4-chlorophenyl]-4-[6-nitro-4-oxo-4H-benzo[e][1,3]thiazin-2-yl]piperazine-1-carbothioamide [18] showed greater inhibitory potential with an IC50 of 0.51 +/- 0.16 microM in the DNA supercoiling assay of MTB with a moderate anti-tubercular activity of 4.41 microM. The compound even passed the safety profile of eukaryotic cell cytotoxicity with a 1.81% inhibition in the RAW 264.7 cell line at 100 microM concentration. This study describes the discovery of benzothiazinone as gyrase inhibitors with potent MTB MIC and inhibitory profiles of the gyrase enzyme with less cytotoxic effect. Furthermore, it is believed that this class of compounds has the potential to be further developed as an anti-TB drug candidate
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Context: Antimicrobial resistance showed by different uropathogens is one of the barricades that might hinder a successful treatment. Detection of extended spectrum beta-lactamase (ESBL) production among uropathogens is an important marker of endemicity. Aims: The present prospective study was done to identify the trends of uropathogens, to find the prevalence of ESBL isolates and to study the antibiotic resistance profile of the ESBL and non-ESBL uropathogenic isolates. Materials and Methods: This study was conducted in the Department of Microbiology of a teaching tertiary care hospital from July 2013 to September 2013. All the uropathogenic isolates were identified up to species level by conventional methods. The prevalence of potential ESBL producers was explored. Antibiotic resistance test of the urinary isolates was done by disc-diffusion method and the results were interpreted according to Clinical Laboratory Standards Institute-2013 guidelines. Results: A total of 670 urine samples from male and female patients visiting the outpatient department (OPD) and inpatient department (IPD) of our hospital were collected. A significantly higher number of IPD and OPD males (55.1% and 55.5%) were found to be culture positive. Escherichia coli (55.3%) was the most frequently isolated uropathogen followed by Klebsiella pneumoniae (23%). However, strains of Escherichia coli (41.6%) were the highest ESBL producing isolates followed by Pseudomonas aeruginosa (36.1%). ESBL producing isolates were found to be multidrug-resistant when compared to non-ESBL producers. However, excessive drug-resistance among non-ESBL producing isolates can’t be ignored. Conclusion: Our study confirms a global trend toward increased resistance to beta-lactam antibiotics. We emphasize on the formulation of antibiotic policy for a particular geographical area.
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India was certified polio free on 27 March 2014. Supplementary immunization activities, in the form of national immunization days, is one of the core strategies for eradication, where oral polio vaccine is administered to children aged under 5 years throughout the country. Oral polio vaccine is heat sensitive and requires maintenance of a stringent cold chain. Therefore, vaccine carriers with ice packs are used in the Pulse Polio Immunization (PPI) programme. This study assessed whether the cold chain is maintained during National Immunization Day in Beed district. A cross-sectional study was conducted at six randomly selected booths, one each from six primary health centres in Georai block of Beed district in Maharashtra. Electronic data loggers, configured to measure half-hourly temperatures, were kept in vaccine carriers throughout the day of PPI. The vaccine carrier temperature was below 8 °C at all six booths; minimum temperature recorded was –9.5 °C, while the maximum was 4.5 °C. The vaccine vial monitor did not reach discard point in any booth. A vaccine carrier with four ice packs very effectively maintains the cold chain required for oral polio vaccine.