The Role of Transesophageal Echocardiography in Evaluation and Management of Hypoxia Following Lung Transplantation

Pulmonary vein thrombosis (PVT) is a potentially fatal complication following lung transplantation (LT). The clinical presentation of PVT is nonspecific and mimics other common postoperative complications such as reperfusion injury, infection, and rejection. Transesophageal echocardiography (TEE) plays a pivotal role in detecting abnormalities of the pulmonary venous anastomosis in the perioperative period. Echocardiographic findings that warrant concern include a visible thrombus in pulmonary vein, pulmonary vein diameter <5mm, turbulence on color Doppler, and peak systolic velocity >100 cm/s.Transplant centers should strongly considerTEE in individual patients with unexplained graft failure.

Reasons for under-reporting of paraquat poisoning in India

BACKGROUND Paraquat is an inexpensive herbicide used in agriculture because it is easily available and the cost of labour for manual clearance of weeds is prohibitive. Paraquat is toxic to human beings and is also used for committing suicide. We studied the reasons for under-reporting of paraquat poisoning including those related to the training of doctors. METHODS In this mixed-methods study, we describe a series of patients with paraquat poisoning. We recorded their demographic data, clinical features, treatment and outcome with an intention to explore the reason for an initial misdiagnosis. We also explored whether deficiencies in curricula contributed to the misdiagnosis. RESULTS The patients of paraquat poisoning (n=28) were mostly young illiterate men driven by impulsive behaviour rather than chronic depression. Paraquat was consumed by patients from non-agricultural background as well, implying easy access to the poison. Many patients could not name the agent and so initial treatment was directed at organophosphorus poisoning. The diagnostic signs included paraquat tongue, renal failure and jaundice. Most of the casualty medical officers and residents were unfamiliar with the symptoms and signs of paraquat poisoning as was evident by their answers to the questionnaire. Knowledge of medical students about paraquat poisoning was not assessed in the theory examinations and viva. CONCLUSION Factors contributing to the limitation in establishing the diagnosis are illiteracy and ignorance of the patients, lack of specific signs and lack of training of medical officers in treating patients with paraquat poisoning.

Anthropometric Evaluation of Foramen Ovale in Adult Dry Skulls of theMysuru-based Population

Introduction The greater wing of sphenoid presents various foramina, of which the foramen ovale is one important foramen through which advanced surgical therapeutic and diagnostic procedures related to the middle cranial fossa are performed. Materials and Methods A total of 40 dried adult skulls of unknown gender and age, obtained from the Department of Anatomy of the JSS medical College, Mysuru, Kamakata, India. The length and the width of the foramen ovale were measured using digital sliding calipers (tiny deal 150 mm SS digital caliper with LCD display, Kristeel- Shimwa industries, Bombay, India). Results Themean length of the foramen ovale was 0.745 0.31 cm on the right side (RS), and 0.68 0.15 cmon the left side (LS). The mean width was 0.6 0.17 cm on the RS, and 0.56 0.14 cm on the LS. Conclusion The knowledge of variations in the length and breadth of the foramen ovale is of immense importance in neurosurgery during various invasive surgical procedures, such as percutaneous trigeminal rhizotomy, and in the biopsy of cavernous sinus tumors and of Meckel cave lesions.

Clinical and biochemical profile of malaria: retrospective observational study from a tertiary centre

Background: Malaria is one of the common causes of acute febrile illness in tropical countries. Malaria presents with varied manifestations. This retrospective study carried to know the clinical profile and laboratory abnormalities seen in malaria patients.Methods: The data was collected retrospectively from 1st January to 31st December 2017. Inclusion criteria: all fever cases above 15 years of age of both the sexes diagnosed as malaria by peripheral smear examination and malaria card test. Exclusion criteria: combined malaria with other fevers such as dengue, chikangunya. Fever cases negative for malaria tests. Malaria cases with history of chronic kidney disease, chronic liver disease such as cirrhosis of liver, chronic viral hepatitis, liver abscess, and chronic illness such as rheumatoid arthritis, diabetes, and hypertension. The data regarding the clinical presentation of patients and laboratory values such as hemoglobin, total leukocytecount, platelet count, total bilirubin, SGOT, SGPT, albumin values collected and analyzed with tables and percentage.Results: A total of 57 malaria cases were analyzed, 71.9 % males, 28.1% were females. The commonest age group was between 15- 30 years (61.4%). 29 patients (50.9%) had P. vivax, 20 patients (35.1%) P. falciparum and 8 patients (14%) mixed infection. The most common clinical presentation was fever with chills (100%) followed by vomiting (68.4%), splenomegaly (56.1%), headache (45.6%), pain abdomen (43.9%).19 cases (33.3%) had hemoglobin less than 10gm/dl; 42 cases (73.6%) had thrombocytopenia; 46 cases (80.7%) had urea ≥30mg/dl; 14 cases (24.6%) had creatinine ≥1.4; 26 cases (45.6%) had total bilirubin >1.2mg/dl ; 17 cases (29.8%) had SGOT >45 IU; 33 cases (57.9%) had SGPT > 45 IU and 32 cases (56.1%) had albumin level ≤3.5gm/dl.Conclusions: In the study malaria due to P. vivax was more common than P. falciparum, malaria affected young adults, males more than females. Reduced hemoglobin and platelet count, deranged liver and renal function and reduced serum albumin seen commonly in malaria.

Variations in the branching pattern of the celiac trunk and its clinical significance / 대한해부학회지

Celiac trunk is the artery of foregut, arising from the abdominal aorta at the level of T12/L1 vertebral body. It extends approximately 1.5 to 2 cm horizontally forwards before dividing into three branches: left gastric, common hepatic, and splenic arteries. Out of the three ventral branches of abdominal aorta, celiac trunk is more prone to have variations. During routine dissection of abdomen for undergraduate students we found some rare variations in the branching pattern of the celiac trunk. Absence of celiac trunk with hepatomesenteric trunk, quadrifurcation with dorsal pancreatic artery arising from it, quadrifurcation with middle colic artery arising from it, left inferior phrenic artery arising from celiac trunk, highly tortuous splenic artery supplying distal 1/3rd of transverse colon and hepatosplenic trunk. Knowledge of such variations is essential for liver and pancreas transplantations, pancreaticoduodenectomy, radiological abdominal interventions, laproscopic surgeries, and in trauma of the abdomen.

Epidemiological and clinical pattern of dermatomycoses in rural India.

Superfi cial fungal infections are most common in tropical and subtropical countries. In this study, 297 suspected superfi cial fungal infection cases were identifi ed among 15,950 patients screened. The collected samples (skin, nail, and hair) were subjected to direct microscopy with potassium hydroxide and cultured on Sabourauds dextrose agar to identify the fungal species. The prevalence of superfi cial fungal infection was 27.6% (82/297), dermatophytosis was 75.6% (62/82), and non-dermatophytosis was 24.4% (20/82). Among the isolated dermatophytes, Trichophyton rubrum was the commonest species (79%) and Candida (60%) the commonest non-dermatophytic species. Tinea corporis was the commonest (78%) clinical presentation.

Antidiarrheal Activity of Methanolic Extract of Leaves of Gymnosporia Emerginata.

The methanolic leaf extract of Gymnosporia emerginata showed significant antidiarrheal activity on castor oil induced diarrheal model in rats. These results obtained revealed that the leaf extract possess pharmacological activity against diarrhea and may possibly explain the use of the plants in traditional medicine.

Anthelmintic activity of methanolic extract of rhizomes of picrorrhiza kurroa royal ex. Benth.

The objective of this study is to evaluate and compare the Anthelmintic activity of methanolic extract of Picrorrhiza kurroa Royle ex. Benth (Scrophhulariaceae). Picrorrhiza kurroaia a small perennial herb growing in the hilly parts of the North-western Himalayan region in India and Nepal. Earth worms were used for Anthelmintic activity. Piperazine citrate was used as standard drug. Time required for paralysis and death of the earth worms were noted for each sample.

Toric implantable collamer lens for keratoconus.

Keratoconus is a progressive non-inflammatory thinning of the cornea that induces myopia and irregular astigmatism and decreases the quality of vision due to monocular diplopia, halos, or ghost images. Keratoconus patients unfit for corneal procedures and intolerant to refractive correction by spectacles or contact lenses have been implanted toric posterior chamber phakic intraocular lenses (PC pIOLs) alone or combined with other surgical procedures to correct the refractive errors associated with keratoconus as an off label procedure with special informed consent from the patients. Several reports attest to the safety and efficacy of the procedure, though the associated corneal higher order aberrations would have an impact on the final visual quality.

The medical, functional and social challenges faced by older adults with intellectual disability

<p><b>INTRODUCTION</b>Little is known about the sociodemographic and clinical profile of older adults with intellectual disabilities (ID) in Singapore. We studied the sociodemographic and clinical profile of older adults with ID and investigated factors associated with caregiver availability and identity in this population.</p><p><b>MATERIALS AND METHODS</b>The study population involved all adults with ID aged ≥40 years receiving services from the Movement for the Intellectually Disabled of Singapore (MINDS), the largest such provider in Singapore. Information on sociodemographic and clinical profiles, functional status, and availability of caregivers were collected via interviewer-administered questionnaires from guardians of older adults with ID. Descriptive characteristics were computed and chi-square and logistic regression identifi ed predictors of caregiver availability and identity.</p><p><b>RESULTS</b>Participation was 95% (227/239). There were differences in client age, gender, and caregiver availability between recipients of residential and non-residential services (all P <0.05). Common comorbidities included hyperlipidaemia (17.6%), hypertension (15.9%), psychiatric diagnoses (16.3%) and epilepsy (10.6%). The majority were fully independent in basic activities of daily living, but only 21.1% were fully communicative. Only a small minority (9.4%) were exercising regularly. The majority (73.5%) of clients had a primary caregiver; almost equal proportions relied on either parents or siblings. Older client age was associated independently with the lack of a primary caregiver, independent of greater functional dependence and presence of medical comorbidities in the client.</p><p><b>CONCLUSION</b>Older adults with ID have multiple medical, functional, and social issues. More can be done to support the care of this unique group of adults with special needs.</p>

Therapeutic efficacy and safety of propylthiouracil in psoriasis: An open-label study.

Background: Psoriasis is a common hyperproliferative disorder of the skin associated with significant morbidity. Most of the drugs used in psoriasis provide only a temporary relief, whereas they are riddled with potential toxicities and cost concerns. Hence, there is a constant need to explore newer, effective, orally administered, and cost-effective drugs with minimal adverse effects. In this scenario, propylthiouracil (PTU), an antithyroid thioureylene has been shown to be effective in psoriasis which satisfies the above criteria. Aim: The objective of our study is to assess the clinical efficacy of PTU in psoriasis. Methods: A total of 25 patients with plaque psoriasis were treated with oral PTU for 12 weeks. Clinical response was assessed using the "Psoriasis Area and Severity Index" (PASI) score. Routine blood analyses and thyroid function tests were carried out periodically during the study. Results: Oral PTU produced significant clearing of lesions at 6 weeks and 12 weeks of the study period in all patients, as demonstrated by the reduction in PASI scores (33.9% in 6 weeks and 74.1% reduction in 12 weeks). Four patients experienced near complete clearing of the lesions. One patient developed mild elevation of liver enzymes which reversed on withdrawal of PTU. None of the patients had hypothyroidism or cytopenias. Conclusion: PTU significantly clears the lesions in psoriasis with minimal adverse effects. Hence, it can be considered as a therapeutic option in psoriasis, especially when the standard drugs cannot be used due to their toxicities or forbidding cost.

Impact of propylthiouracil on quality of life in psoriasis patients.

Background: Psoriasis greatly impacts the quality of life (QOL) of patients including several dermatological conditions that are listed in the Dermatology Life Quality Index (DLQI). Decrease in psoriatic lesion as measured by Psoriasis Area Severity Index (PASI) score is associated with improvement in QOL. Propylthiouracil (PTU) was found to be clinically efficient in clearing psoriatic lesions. Our objective is to find the extent of improvement in QOL in psoriatic patients treated with PTU. Materials and Methods:Twenty-three psoriatic patients who were taking 300 mg PTU/day were involved in the study. Clinical improvement was assessed by PASI score and QOL was assessed by DLQI questionnaire at baseline, 6 th and 12 th week of PTU treatment. Results: Psoriatic patients before treatment showed significantly increased DLQI score when compared with 6 and 12 weeks of PTU treatment which was found to be decreased significantly (P < 0.001) after PTU treatment. There was a positive correlation between DLQI and PASI score at all three intervals of treatment period at P < 0.001 (r = 0.793, r = 0.834, r = 0.801), respectively. Conclusion: Since PTU was found to improve the QOL of psoriasis patients, this study adds an advantage of using it as treatment option in psoriasis.

Effect of Iron and Zinc Deficiency on Short Term Memory in Children.

Objective: To evaluate the effect of iron and zinc deficiency on short term memory of children in the age group of 6-11 years and to assess the response to supplementation therapy. Design: Interventional study. Setting: 100 children in the age group of 6-11 years (subdivided into 6-8 yr and 9-11 yr groups) from an urban corporation school. Methods: After collection of demographic data, the study children underwent hematological assessment which included serum iron, serum zinc, and hemoglobin estimation. Based on the results, they were divided into Iron deficient, Zinc deficient, and Combined deficiency groups. Verbal and nonverbal memory assessment was done in all the children. Intervention: Iron (2mg/kg bodyweight in two divided doses) and zinc (5mg once-a-day) supplementation for a period of 3 months for children in the deficient group. Results: All children with iron and zinc deficiency in both the age groups had memory deficits. Combined deficiency in 9-11 years group showed severe degree of affectation in verbal (P<0.01) and non-verbal memory (P<0.01), and improved after supplementation (P = 0.05 and P<0.01, respectively). In 6-8 years group, only non-verbal form of memory (P =0.02) was affected, which improved after supplementation. Conclusion: Iron and zinc deficiency is associated with memory deficits in children. There is a marked improvement in memory after supplementation. Post supplementation IQ scores do not show significant improvement in deficient groups in 6-8 year olds.

The Chennai glaucoma study: Prevalence and risk factors for glaucoma in cataract operated eyes in urban Chennai.

We report the prevalence and risk factors for glaucoma among aphakes and pseudophakes in 3850 subjects who participated in a population-based study in urban south India. The subjects underwent an ophthalmic examination including applanation tonometry, gonioscopy, optic disc evaluation and frequency doubling perimetry. Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. Thirty eight, 15 aphakes and 23 pseudophakes (0.99% of 3850 subjects) of the 406 persons who had undergone cataract surgery were diagnosed with glaucoma. Aphakes/pseudophakes were at higher risk of glaucoma as compared to the phakic population (Odds Ratio: 2.71, 95% CI: 1. 94, 3.38, p=0.001). On multivariate analysis, older age and higher intra ocular pressure were risk factors for glaucoma. Blindness attributable to glaucoma was detected in 20% of aphakic and 4.3% of pseudophakic eyes. Glaucoma was a significant cause of morbidity in those who had undergone cataract surgery in this urban population.

Outcomes of cataract surgery in a rural and urban south Indian population.

Purpose: To assess the visual outcome after cataract surgery in a south Indian population. Materials and Methods: Population-based cross-sectional study of subjects aged 40 years or more. Three thousand nine hundred and twenty-four rural subjects from 27 contiguous villages and 3850 urban subjects from five randomly selected divisions were studied. All subjects underwent a comprehensive ophthalmic examination that included visual acuity, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, and dilated retinal examination. Statistical Analysis: Chi square test, t test and multivariate analysis were used. Results: Five hundred and twenty-eight (216 males, 312 females, 781 eyes) rural subjects (13.5%, 95% confidence interval (CI) 12.4% to 14.6%) and 406 (197 males, 209 females, 604 eyes) urban subjects (10.5%, 95% CI 9.6-11.5%) had undergone cataract surgery. Outcome of cataract surgery was defined based on visual acuity. Using best-corrected visual acuity for classification, the single most important cause for visual impairment was cystoid macular edema in the aphakic group and posterior capsule opacification in the pseudophakic group. Aphakia (visual acuity of <20/60 to ≤20/400 - odds ratio (OR) 1.8; 95% CI 1.3 to 2.6%, visual acuity of <20/400 - OR 6.2; 95% 4.0 to 9.8%), rural residence (visual acuity of <20/60 to ≤20/400 - OR 3.2; 95% CI 2.2 to 4.5% and visual acuity of <20/400 - OR OR 3.5; 95% CI 2.3 to 5.5%) were associated with visual impairment. The urban cataract-operated population had significantly more pseudophakics (P < 0.001), men (P = 0.02) and literates (P < 0.001). In the rural group the prevalence of cataract surgery (13.5% vs. 10.5%, P < 0.001) and number of people that had undergone cataract surgery within three years prior to examination (P < 0.001) were significantly greater. In 30% of rural and 16% of urban subjects uncorrected refraction was the cause of visual impairment. Conclusions: Surgery-related complications were major causes for visual acuity of <20/60.

Determinants of glaucoma awareness and knowledge in urban Chennai.

Aim: To assess the awareness and knowledge levels about glaucoma and its determinants in an urban population of Chennai in south India. Materials and Methods: Chennai glaucoma study (CGS) was a population based prevalence study to estimate the prevalence of glaucoma in a rural and urban south Indian population. A total of 3850 subjects aged 40 years or above participated in the urban arm of CGS. A systematic random sample of 1926 (50.0%) subjects completed a questionnaire that assesses their awareness and knowledge level of glaucoma. Respondents “having heard of glaucoma” even before they were contacted/recruited for the study were defined as “aware” and respondents having some understanding of the eye disease were defined as “knowledgeable”. Results: Overall 13.5% were aware of glaucoma, the age-gender adjusted rate for awareness was 13.3% (95% CI: 11.57 to 15.03). Two clinicians graded knowledge on glaucoma, based on the subject's knowledge of risk factors, definitions and treatment aspects of glaucoma. Overall 8.7% had some knowledge about glaucoma. Among those who had knowledge 0.5% had good knowledge about glaucoma, 4% had fair knowledge and 4.2% had poor knowledge. We observed a very good agreement between the clinicians in grading knowledge (k =0.92). Determinants of glaucoma awareness and knowledge were higher levels of education, females, age, religion and family history of glaucoma. Conclusion: Awareness and knowledge about glaucoma was very low among the urban population of Chennai. We have found that younger subjects and men were less aware of glaucoma. Subjects with lower levels of education were less aware and knew less about glaucoma than their counterparts. The study findings stress the need for health education for effective prevention of blindness due to glaucoma.

Comparison of Humphrey MATRIX and Swedish interactive threshold algorithm standard strategy in detecting early glaucomatous visual field loss.

Purpose: The aim of this study was to compare the Humphrey MATRIX visual field (frequency doubling technology threshold) and Swedish interactive threshold algorithm (SITA) standard strategy white on white perimetry in detecting glaucomatous visual field loss. Material and Methods: Twenty-eight adult subjects, diagnosed to have glaucoma at a tertiary eye care hospital, who fulfilled the inclusion criteria, were included in this prospective study. All subjects underwent a complete ophthalmic examination. Subjects with glaucomatous optic disc changes underwent repeat perimetric examination on the same day with the Humphrey visual field analyzer (HFA II) and Humphrey MATRIX, the order of testing being random. Only reliable fields, where the HFA results corresponded to the disc changes were considered for analysis. A cumulative defect depth in each hemifield in both HFA and MATRIX reports was calculated. Results: Thirty-seven eyes of 24 subjects had reliable fields corresponding to optic disc changes. The mean age of the subjects was 56 +/- 12 years. There were 12 males and 12 females. The test duration was significantly less on the MATRIX, mean difference in test duration was -81 +/- 81.3 sec ( p p = 0.55, p = 0.64 respectively) and a positive correlation coefficient of 0.63 and 0.72 respectively. Poor agreement was found with the glaucoma hemifield test. Conclusion: The Humphrey MATRIX takes less time in performing the test than SITA Standard and shows good correlation for mean deviation and pattern standard deviation. However, the glaucoma hemifield test showed poor agreement. The Humphrey MATRIX diagnoses were similar to established perimetric standards.

Agreement between two Goldmann type applanation tonometers.

The aim of the study was to assess agreement between two commercially available applanation tonometers for the measurement of intraocular pressure (IOP). Forty subjects underwent IOP measurement on two accurately calibrated Goldmann type applanation tonometers (Zeiss AT 030 (GATZ) and Inami L-5110(GATI)). The order of examination was randomized and observers were masked to the IOP recorded. The mean of two consecutive readings, from a randomly selected eye for each subject, was used for analysis. Agreement was assessed using the Altman and Bland plot. The mean (SD) IOP readings on GATZ was 15.32 (+/-6.80) mm Hg and on GATI was 13.52 (+/-5.65) mm Hg (p< 0.001, 95% CI of the difference: -2.48 to -1.11). The 95% limits of agreement on the Altman and Bland plot were:-2.47 to 6.16 mm Hg). There was significant inter-instrument variability between the two accurately calibrated Goldmann type applanation tonometers studied.

Comparison of refractive errors and factors associated with spectacle use in a rural and urban South Indian population.

Purpose: To compare the prevalence of refractive errors and factors associated with spectacle use in a rural and urban south Indian population. Materials and Methods: Four thousand eight hundred subjects (age> 39 years) each from rural and urban Tamil Nadu were enumerated for a population-based study. All participants underwent a complete ophthalmic evaluation including best-corrected visual acuity (BCVA), objective and subjective refraction. Out of 3924 rural responders 63.91% and out of 3850 urban responders 81.64% were phakic in the right eye with BCVA of 20/40 or better and were included in the study. Association of spectacle use and refractive errors with different parameters were analysed using logistic regression. Statistical Analysis: Chi square, t test, Chi square for trend and Pearson's correlation coefficient were used for analysis. Results: Spectacle use was significantly higher and positively associated with literacy and employment in the urban population. The age and gender-adjusted prevalence of emmetropia, myopia of spherical equivalent (SE) </=-0.50 diopter sphere (DS), high myopia (SE </=-5.00DS), hyperopia (SE> 0.50DS) and astigmatism ≤ 0.50 diopter cylinder (DC) were 46.8%, 31.0%, 4.3%, 17.9% and 60.4% respectively in the rural population and 29.0%, 17.6%, 1.5%, 51.9%, 59.1% respectively in the urban population. The prevalence of emmetropia decreased with age ( p p = 0.001) and were associated with nuclear sclerosis ( p = 0.001) in both populations. Hyperopia was commoner among women than men ( p = 0.001); was positively associated with diabetes mellitus ( p = 0.008) in the rural population and negatively with nuclear sclerosis ( p = 0.001) in both populations. Conclusion: Spectacle use was found to be significantly lower in the rural population. The pattern of refractive errors was significantly different between both populations.

evolving role of the histopathologist in colorectal carcinoma

Evidence based and effective management of colorectal cancer [CRC] requires the involvement of the histopathologist at various stages of the treatment pathway. The detailed final histopathology report should include information crucial to predicting prognosis and determining therapy. Standardised methods of specimen processing and the provision of information for the use of the surgeon and the oncologist are fundamental to this. This review article examines the role of the histopathologist in several important areas related to CRC. Special emphasis is placed upon the colorectal minimum dataset [MDS] and the role of the multidisciplinary team [MDT]