Changes in visual acuity using low vision devices in patients with Leber hereditary optic neuropathy: A retrospective study

Purpose: This study was conducted to estimate the visual acuity improvement in patients with Leber hereditary optic neuropathy (LHON) with the help of low vision devices (LVDs) and to analyze the types of distant and near LVDs prescribed to the patients with LHON. Methods: A retrospective case review of 74 subjects with LHON who were referred to a low vision care clinic at a tertiary eye center from 2016 to 2019 were recruited. The reason for referral was assessed from the patients’ electronic medical records (EMR). Demographic data of the patients, visual acuity status, type of LVD prescribed, and visual acuity improvement with LVD were documented. Results: Out of 74 patients, 91.9% (n = 68) were male, and the median age of patients was 21 (16) years. A 4× monocular telescope was prescribed for 2.7% of patients (n = 2) and SEETV binocular telescope for 1.4% (n = 1) was advised for distance. The most commonly prescribed near LVD was the 6× cutaway stand magnifier for 22 patients (29.7%). Four patients (5.4%) were prescribed with Notex, the most commonly prescribed non?optical LVD. Niki CCTV (12.2%, n=9) was the most commonly prescribed assistive device. The subjects were divided into three groups based on age: group I consisted of those <18 years of age, group II 18–40 years, and group III >40 years for the interpretation of visual improvement. There was a statistically significant improvement (group I: P < 0.001, group II: P < 0.0001, group III: P < 0.003) in near vision with help of LVDs in all three groups. Conclusion: The use of LVDs and rehabilitation can help patients with LHON to lead a better life and will be more beneficial

Open injury, robotic repair—moving ahead! Total robotic Roux-en-Y hepaticojejunostomy for post-open cholecystectomy Bismuth type 2 biliary stricture using indocyanine green dye

Hepaticojejunostomy is currently the best treatment for post-cholecystectomy biliary strictures. Laparoscopic repair has not gained popularity due to difficult reconstruction. We present case of 43-year-old-female with Bismuth type 2 stricture following laparoscopic converted open cholecystectomy with bile duct injury done elsewhere. Position was modified Llyod-Davis position and four 8-mm robotic ports (including camera) and 12-mm assistant port were placed. The procedure included noticeable steps such as adhesiolysis, identification of gallbladder fossa, identification of common hepatic duct, lowering of hilar plate etc. Operating and console time were 420 and 350 minutes and blood loss was 100 mL. Patient was discharged on postoperative day 4. Robotic repair (hepaticojejunostomy) of biliary tract stricture after cholecystectomy is safe and feasible with good outcomes.

Laparoscopic Witzel feeding jejunostomy: a procedure overlooked!

Purpose@#Feeding jejunostomy (FJ) is a critical procedure to establish a source of enteral nutrition for upper gastrointestinal disorders. Minimally invasive surgery has the inherent benefit of better patient outcomes, less postoperative pain, and early discharge. This study aims to describe our total laparoscopic technique of Witzel FJ and to compare its outcome with its open counterpart. @*Methods@#A retrospective database analysis was performed in patients who underwent laparoscopic (n = 20) and open (n = 21) FJ as a stand-alone procedure from July 2018 to July 2022. A readily available nasogastric tube (Ryles tube) and routine laparoscopic instruments were used to perform laparoscopic FJ. Perioperative data and postoperative outcomes were analyzed. @*Results@#Baseline preoperative variables were comparable in both groups. The median operative duration in the laparoscopic FJ group was 180 minutes vs. 60 minutes in the open FJ group (p = 0.01). Postoperative length of hospital stay was 3 days vs. 4 days in the laparoscopic and open FJ groups, respectively (p = 0.08). Four patients in the open FJ group suffered from an immediate postoperative complication (none in the laparoscopic FJ group). After a median follow-up of 10 months, fewer patients in the laparoscopic FJ group had complications such as tube clogging, tube dislodgement, surgical-site infection, and small bowel obstruction. @*Conclusion@#Laparoscopic FJ with the Witzel technique is a safe and feasible procedure with a comparable outcome to the open technique. Patient selection is vital to overcome the initial learning curve.

Stroke – A Rare Initial Presentation of Takayasu Arteritis

Introduction: Now-a-days, young people below age of 40 years without known risk factors are presenting with stroke. The cause of stroke should be found so that recurrence and other complications can be prevented. Case description: An 18-year-old female presented with holocranial headache, focal seizures with impaired awareness and left hemiparesis. The upper limb pulses were absent on both sides, while pulses in lower limbs were present. MRI scan of brain revealed infarct in right middle cerebral artery territory. CT angiography brain showed luminal narrowing in upper limb arteries, carotid artery and vertebral artery. She was treated with antiplatelet drug, tablet carbamazepine, tablet methotrexate with folinic acid and she improved. Discussion: Takayasu arteritis is an inflammatory vasculitis disease causing stenosis in medium and large sized arteries. It can present as stroke, myocardial infarction, aortic insufficiency, retinal ischemia, renal failure and hypertension. Conclusion: Takayasu arteritis is one of the rare causes of stroke, which when detected should be promptly treated to prevent further episodes of stroke and other system complications.

Visual outcomes of toxic optic neuropathy secondary to Ethambutol: A retrospective observational study from India, an endemic country

Purpose: Ethambutol (EMB) is one of the first?line drugs used for treating tuberculosis. Vision loss due to optic nerve toxicity is a well?known potential side effect of the drug. Our aim was to evaluate the clinical features and visual outcomes of patients with EMB optic neuropathy (EON). Methods: A retrospective, observational, single?center study of all patients who were diagnosed to have EON during January 2017–December 2019 was done. All these patients were screened in the Department of Neuro?ophthalmology at a referral tertiary eye care institution in India. Clinical features, visual outcomes, and neuroimaging findings of these patients were analyzed. Results: Two hundred and fifty?six eyes of 128 patients were included. Of these, 73 were male and 55 were female. Mean age was 50.55 ± 15 years. Mean visual acuity at presentation was 1.12 ± 0.45 logarithm of the minimum angle of resolution (logMAR). One hundred and forty three eyes had normal optic disk on presentation, 111 had disk pallor, and two eyes had disk edema. The most common field defect was central/paracentral scotoma (26.2%) followed by temporal defects (24.6%). Magnetic resonance imaging (MRI) brain and orbit showed optic nerve signals in 19.6% and chiasmal signals in 5.2%. At the final follow?up, a ?2?line vision improvement was noted in 161 eyes (62.9%), which was statistically significant. Conclusion: Multiple prognostic factors were analyzed to predict the visual recovery of EON. We observed that patients presenting with visual acuity worse than 6/60 had poor visual outcome and long duration of follow?up showed better visual recovery, proving the possibility of a gradual recovery pattern of EON. Interestingly, we found in our study that the chances of favorable visual outcome were directly proportionate to early diagnosis and cessation of EMB.

Ocular features of patients with Parkinson’s disease examined at a Neuro-Optometry Clinic in a tertiary eye care center

Purpose: To report the ocular features of patients with PD who presented with visual complaints to a tertiary eye care center. Methods: This was a retrospective study carried out between January 2015 and March 2020 at the Neuro?Optometry clinic of a tertiary eye care center in Southern India. All PD patients with ocular complaints examined by the neuro? ophthalmologists were referred to Neuro? Optometry Clinic for detailed evaluation. Patients with other neurodegenerative disorders, brain injury, and other causes of vision loss or extraocular motility disorders were excluded. Results: A total of 43 patients (7 females, 36 males) between 50 and 86 years of age (mean: 70 ± 8.9 years) with a mean duration of PD of 4.5 ± 4.5 years were studied. Decreased vision associated with reading difficulty (40%) was common in PD patients. In terms of gaze restriction, vertical gaze involvement (35%) was more than horizontal involvement (7%). Convergence insufficiency (CI) was the most common binocular vision dysfunction (30%), followed by CI with oculomotor dysfunction (14%) and vertical gaze palsy (18%). Ground prisms were recommended for 26 patients (61%) and home vision therapy for 5 patients (12%) as corrective measures. Conclusion: Binocular vision dysfunction is highly prevalent among PD patients. This could potentially contribute to the reading difficulties and double vision encountered by these patients. Assessment of binocular vision and oculomotor parameters thus becomes important to understand and manage the reading difficulties in patients with PD

Predominancyof Coping Styles in Patients with Type II Diabetes in Low Socio Economic Status Groups

Background: Coping style is a person抯 characteristic strategies used in response to life problems or traumas. Coping serves a protective function .This study aims to examine the impact of coping styles predominance in the training programme given to patients with type II diabetes of low socioeconomic status group.30 patients with type II diabetes of low socioeconomic status group were selected using purposive sampling from the diabetic clinic for the assessment of coping style. Coping style was assessed using 揅oping styles of adults with Type 1 and Type 2 diabetes� by Karlsen and Bru (1998). Paired t-test was used to assess the effectiveness of coping styles enhancement training programme for patients with type II diabetes. The study revealed that there is significant increase in the level of coping styles of patients with type II diabetes due to coping styles enhancement training programme.Methods:?.Results:?.Conclusion:?.

Clinical profile, imaging features and short term visual outcomes of Indian optic neuritis patients with and without seromarkers for myelin oligodendrocyte glycoprotein and neuromyelitis optica

Purpose: To analyze clinical profile, imaging features, and short?term visual outcomes of optic neuritis patients in Indian population with and without seromarkers for myelin oligodendrocyte glycoprotein (MOG)/neuromyelitis optica (NMO). Methods: Electronic medical records of 203 optic neuritis patients who presented between June 2018 and December 2019 to the Neuro?ophthalmology services of a tertiary care center in India were retrospectively analyzed. Results: Of 203 patients, 57 patients (28.08%) were positive for MOG?antibody and 20 patients (9.85%) were positive for NMO antibody. 114 patients (56.16%) were double?negative (negative for both antibodies) and 12 patients (5.91%) were diagnosed as multiple sclerosis (MS). None of the patients had both antibodies. Mean age of presentation was 31.29 ± 1.035 years. There was female preponderance in NMO?optic neuritis (NMO?ON) and MS?optic neuritis (MS?ON) groups (1:5). Mean vision on presentation was worse (logMAR 1.570 ± 0.863) in NMO?ON group. The mean visual acuity showed statistically significant recovery (logMAR 0.338 ± 0.639) in the final follow?up in MOG?optic neuritis (MOG?ON) group. Multivariate logistic regression analysis revealed poor visual outcome in patients presenting with retrobulbar neuritis, optic disc pallor, bilateral sequential optic nerve involvement, and with positive NMO antibody. Optic neuritis patients presenting with disc edema associated with pain and positive for MOG antibody were found to have a better visual outcome. Conclusion: In this Indian optic neuritis cohort, the prevalence of MOG?ON was higher than NMO?ON. MOG?ON had a better visual outcome than NMO?ON. The incidence of MS?ON was less compared to the western literature. A significant number of patients (114 patients, 56.16%) were double negative for both seromarkers and yet had presented with optic neuritis with no clinical or imaging features suggestive of MS/MOG associated disease (MOG AD)/NMO spectrum disorder (NMO SD).

Robotic-assisted resection of proximal jejunal ischemic stricture and intracorporeal robot-sewn anastomosis

With the advent of robotic surgery as an effective means of minimally invasive surgery in the last decade, more and more surgeries are being performed robotically in today’s world. Robotic surgery has several advantages over conventional laparoscopic surgery, such as three-dimensional vision with depth perception, magnified view, tremor filtration, and, more importantly, degrees of freedom of the articulating instruments. While the literature is abundant on robotic cholecystectomy and highly complex hepatobiliary surgeries, there is hardly any literature on robotic small bowel resection with intracorporeal anastomosis. We present a case of a 50-year-old male patient with a symptomatic proximal jejunal ischemic stricture who underwent robotic-assisted resection and robot-sewn intracorporeal anastomosis in two layers. He did well in the postoperative period and was discharged on postoperative day 4 with uneventful recovery. We hereby discuss the advantages and disadvantages of robotic surgery in such a scenario with a review of the literature.

Reinventing nano drug delivery systems for hydrophilic active ingredients in Ayurvedic lipid based formulations containing poly herbal decoction

Background: Anu Tailam, an Ayurvedic medicated oil where ‘anu’ meant for atom and ‘tailam’ meant foroil and virtually meant for ‘oil of subtle or atomic size particles’. Since the major active ingredients in thisformulation are incorporated from the polyherbal decoction, it is expected to contain predominantlywater soluble ingredients.Objectives: It is hypothesized that these polar active botanical ingredients are present in the formulationshould be either suspended in the form of submicron particles or entrapped in the submicron vesicularstructures since the formulation did not show any precipitation or phase separation instead showed amonophasic oily liquid with very little moisture.Materials and Methods: In the present investigation, the micro architecture of the anu tailam is studiedvia column chromatography and high performance thin layer chromatography to prove the contents arepolar hydrophilic compounds followed by optical microscopy, photon correlation Spectroscopy (PCS) andenvironmental scanning electron microscope (ESEM) to study the particle/vesicle size of the formulation.Results: In this study, it was proved that the formulation contained only polar ingredients and can beextracted in polar solvents like methanol and ethanol. It was also found that the formulation taken forstudy contained nano particles of the active botanical ingredients embedded in a network of vesicularstructures of the lipid base.Conclusion: The selected Ayurvedic formulation ‘anutailam’ found to contain novel nano drug deliverysystem to deliver water soluble ingredients across barriers.

Absence of Glia Maturation Factor Protects from Axonal Injury and Motor Behavioral Impairments after Traumatic Brain Injury

Traumatic brain injury (TBI) causes disability and death, accelerating the progression towards Alzheimer’s disease and Parkinson’s disease (PD). TBI causes serious motor and cognitive impairments, as seen in PD that arise during the period of the initial insult. However, this has been understudied relative to TBI induced neuroinflammation, motor and cognitive decline that progress towards PD. Neuronal ubiquitin-C-terminal hydrolase- L1 (UCHL1) is a thiol protease that breaks down ubiquitinated proteins and its level represents the severity of TBI. Previously, we demonstrated the molecular action of glia maturation factor (GMF); a proinflammatory protein in mediating neuroinflammation and neuronal loss. Here, we show that the weight drop method induced TBI neuropathology using behavioral tests, western blotting, and immunofluorescence techniques on sections from wild type (WT) and GMF-deficient (GMF-KO) mice. Results reveal a significant improvement in substantia nigral tyrosine hydroxylase and dopamine transporter expression with motor behavioral performance in GMF-KO mice following TBI. In addition, a significant reduction in neuroinflammation was manifested, as shown by activation of nuclear factor-kB, reduced levels of inducible nitric oxide synthase, and cyclooxygenase- 2 expressions. Likewise, neurotrophins including brain-derived neurotrophic factor and glial-derived neurotrophic factor were significantly improved in GMF-KO mice than WT 72 h post-TBI. Consistently, we found that TBI enhances GFAP and UCHL-1 expression and reduces the number of dopaminergic TH-positive neurons in WT compared to GMF-KO mice 72 h post-TBI. Interestingly, we observed a reduction of THpositive tanycytes in the median eminence of WT than GMF-KO mice. Overall, we found that absence of GMF significantly reversed these neuropathological events and improved behavioral outcome. This study provides evidence that PD-associated pathology progression can be initiated upon induction of TBI.

Mainstreaming genetic counseling for BRCA testing into oncology clinics – Indian perspective

BReastCAncer (BRCA) susceptibility genes BRCA1 and BRCA2 are mainly associated with hereditary breast and ovarian cancer (HBOC) syndrome and present an estimated 45%–65% cumulative lifetime risk of developing breast cancer and an 11%–39% risk of ovarian cancer. HBOC is also linked to triple-negative breast cancer (TNBC). BRCA1 mutations in TNBC are observed in 36% of women age <40 years and 27% of women age <50 years. In India, the prevalence of BRCA1/2 mutation varies from 2.9% to 38% among families with genetic predisposition toward hereditary cancers. With HBOC being linked to early-onset breast cancer and increased susceptibility to other cancers, early screening for BRCA mutations has become a pressing need. Though genetic counseling (GC) for BRCA mutation testing is common in most of the developed countries, India still faces several challenges in mainstreaming the same. Many barriers to effective GC for BRCA testing are unique to India. There is a dearth of trained geneticists which puts the pressure on oncologists to give GC for which they neither have the time or training. Presence of multiethnic/linguistic population acts as a major hindrance along the way toward development of robust predictive and effective GC models for BRCA testing. The current review discusses the need and benefits of GC in breast cancer prevention, through BRCA testing, from an Indian perspective. The functional framework of GC and the role of genetic counselors are discussed in detail. In addition, importance of GC training and role of a multidisciplinary team approach for mainstreaming pre- and post-BRCA test GC is highlighted.

Study on spectrum of heart diseases in children aged 1 month to 12 years in a rural medical college in Southern India

Background: To study the pattern of heart diseases in children aged 1 month to 12 years of age and to assess the pattern, age and gender specific distribution of congenital heart diseases and acquired heart diseases in various age groups like infants, toddler, preschool and school children to prevent morbidity and mortality. To study the various complications associated with various types of heart diseases.Methods: This is a descriptive study of one-year duration in which children with suspicion of heart disease were subjected to ECG, Chest X ray and Echocardiogram. Patients with confirmed heart disease were included and the infants less than 1 month, CCF due to anaemia or without any structural abnormality were excluded.Results: The prevalence of heart disease was 0.9% in author study. VSD is the commonest acyanotic lesion in all age group observed and TOF is the commonest cyanotic lesion. Most of the cyanotic lesions were observed in less than one year. Most of the acyanotic lesions fall within 5 to 12 years. RHD and rheumatic carditis forms the major acquired lesion followed by dilated cardiomyopathy. VSD, ASD, PDA, TOF, Pulmonary stenosis, Rheumatic carditis and MR were predominant in females whereas Aortic stenosis (Bicuspid aortic valve), AV canal defect, TGA, TAPVC were predominant in males. Among the nutritional status 64.2% of patients from acyanotic group and 100% patients from cyanotic group were malnourished. 35% of acyanotic and 100% of cyanotic group were stunted.Conclusions: Acyanotic lesion is the commonest, among which VSD is most common. TOF is the common cyanotic CHD. More than half of the patients were asymptomatic in acyanotic group and presented in the 5- 12 years age group and diagnosed on the basis of clinical suspicion on routine health visits or for some other reason.

Nutritional and therapeutic benefits of medicinal plant Pithecellobium dulce (Fabaceae): A review

Pithecellobium dulce, an evergreen medium-sized, spiny tree, each part of the plant has vast nutritional values; stuffedwith essential vitamins, amino acids, and minerals. The fruits of P. dulce were widely used in Ayurvedic medicinesand home remedies. The plant has also been a rich source of biologically active compounds such as tannin, olein,and glycosides. Totally 38 active phytocompounds like quercetin, kaempferol, and dulcitol were identified from thevarious parts of the plant. Notably, this plant has catechol type of tannins in the bark. There are polyphenol classesof phytocompounds which have found to hold potent antivenom activity. Their fruits are a rich source of phenols,flavonoids, and saponins reported for their efficacy to treat diabetes, oxidative stress, and gastrointestinal disorders.The plant leaf and seed have an antibacterial, antifungal, and adulticidal activities. Thus, the present review describeson exploiting the medicinal properties of P. dulce and its biomedicinal applications in therapeutic development.

Prediction Of Successful Supraclavicular Brachial Plexus Block Using Pulse Oximeter Perfusion Index

Background and goals:Supraclavicular approach to brachial plexus block is a popular approach for anaesthesia for upper limb surgeries. Conventional methods for evaluation of block success are time consuming. The aim of this study is to evaluate whether the change in perfusion index (PI) can be used to predict the ultrasound-guided supraclavicular nerve block success.Methodology: The study was performed after written informed consent from 32 ASA PS I, II patients scheduled for elective hand, wrist and forearm surgery under ultrasound-guided supraclavicular nerve block. After local anaesthetic injection, sensory block success and motor block success was assessed every 5min.The PI was recorded at baseline and at 10, 20min after anaesthetic injection in both blocked and non-blocked limbs. The PI ratio was calculated as the PI after 20min divided by the PI at the baseline.Results:Baseline values of PI ranged from 0.2 to 3.42 in 32 patients for whom supraclavicular block was performed. At 10 min, percentage increase of PI was (mean ± standard deviation) 484.38 ± 295.80 % from baseline. At 20 min, percentage increase of PI was 557.31 ± 239.25 % from baseline. All changes from baseline were significant (p < 0.01) Conclusion: Perfusion index monitoring may provide a highly valuable tool to evaluate the success of regional anaesthesia of the upper extremity in clinical practice.

Bilateral optic neuropathy with central diabetes insipidus in a child

Central nervous system germ cell tumors are rare and they occur in the first two decades of life. Optic nerve germinomas can sometimes mimic optic nerve inflammation. In this case report, we discuss an 11-year-old girl who presented with features of presumed bilateral optic neuritis and developed polyuria and polydipsia, subsequently she was diagnosed to have infiltrative etiology. Her clinical and radiological presentations were initially consistent with inflammatory optic neuropathy. Poor visual recovery to steroid therapy and progressive visual loss warranted the need for optic nerve biopsy which revealed germinoma.

Antimicrobial susceptibility profiles of gram-negative bacteria causing infections collected across India during 2014–2016: Study for monitoring antimicrobial resistance trend report

Background: The emergence of antibiotic resistance among bacterial pathogens in the hospital and community has increased the concern to the health-care providers due to the limited treatment options. Surveillance of antimicrobial resistance (AMR) in frequently isolated bacterial pathogens causing severe infections is of great importance. The data generated will be useful for the clinicians to decide empiric therapy on the local epidemiological resistance profile of the antimicrobial agents. This study aims to monitor the distribution of bacterial pathogen and their susceptibility pattern to the commonly used antimicrobial agents. Materials and Methods: This study includes Gram-negative bacilli collected from intra-abdominal, urinary tract and respiratory tract infections during 2014–2016. Isolates were collected from seven hospitals across India. All the study isolates were characterised up to species level, and minimum inhibitory concentration was determined for a wide range of antimicrobials included in the study panel. The test results were interpreted as per standard Clinical Laboratory Standards Institute guidelines. Results: A total of 2731 isolates of gram-negative bacteria were tested during study period. The most frequently isolated pathogens were 44% of Escherichia coli (n = 1205) followed by 25% of Klebsiella pneumoniae (n = 676) and 11% of Pseudomonas aeruginosa (n = 308). Among the antimicrobials tested, carbapenems were the most active, followed by amikacin and piperacillin/tazobactam. The rate of extended-spectrum beta-lactamase (ESBL)-positive isolates were ranged from 66%–77% in E. coli to 61%–72% in K. pneumoniae, respectively. Overall, colistin retains its activity in > 90% of the isolates tested and appear promising. Conclusion: Increasing rates of ESBL producers have been noted, which is alarming. Further, carbapenem resistance was also gradually increasing, which needs much attention. Overall, this study data show that carbapenems, amikacin and colistin continue to be the best agents available to treat drug-resistant infections. Thus continuous monitoring of susceptibility profile of the clinically important Gram-negative pathogens is of great importance to guide effective antimicrobial therapy.

Liquid Fire In The Stomach A Minimally Invasive Approach

Corrosive injuries are common in developing countries. Acid ingestion is more common in developing countries when compared to alkali ingestion in developed countries. Ingestion may be accidental or suicidal. The nature of the corrosive ingested determines the extent of injury caused. Acidic injury commonly affects stomach than alkalis and it ranges from acute to chronic gastric injuries. In this article we discuss about the management of corrosive stricture of pylorus of stomach which was dealt by laparoscopy.

Idiopathic intracranial hypertension associated with anaemia, secondary to antiretroviral drug in a human immunodeficiency virus positive patient

Papilledema in a patient with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome is an alarming finding. Any condition giving rise to raised intracranial tension (ICT) can cause papilledema, and in these patients, it could be secondary to opportunistic infections like meningitis to neoplasm. We report a case of a 28-year old female with HIV on antiretroviral therapy, who presented to us, with papilledema. Her fundus examination revealed superficial hemorrhages and Roth's spots along with papilledema. Patient was diagnosed with idiopathic intracranial hypertension (IIH), and all other possible systemic associations were ruled out. Her blood tests showed severe anemia. The papilledema and retinal changes resolved with treatment of anemia. This is a rare presentation of IIH in HIV positive patient due to anemia, secondary to zidovudine adverse effect.