Augmented loop myopexy with concurrent intraocular lens implantation for myopic strabismus fixus

Purpose: To evaluate safety profile and surgical outcomes of loop myopexy with concurrent intra? ocular lens implantation in cases of myopic strabismus fixus (MSF). Methods: A retrospective chart review of patients who underwent loop myopexy with concurrent small incision cataract surgery with intra?ocular lens implantation between January 2017 and July 2021 for MSF at a tertiary eye care centre was undertaken. A minimum of 6 months of follow?up after surgery was required for inclusion. The main outcome measures were improvement in alignment postoperatively, improvement in extra?ocular motility postoperatively, intraoperative and postoperative complications and post?operative visual acuity. Results: 12 eyes of 7 patients (male (6): female (1)) underwent modified loop myopexy at a mean age of 46.86 years (range 32?65 years). 5 patients underwent bilateral loop myopexy with intra?ocular lens implantation whereas 2 patients underwent unilateral loop with intra?ocular lens implantation. All eyes underwent additional medial rectus (MR) recession with lateral rectus (LR) plication. At the last follow?up, mean esotropia improved to 16 prism dioptres (PD) (Range: 10?20 PD) from 80 PD (Range:60?90PD), P = 0.016; and success (deviation ?20PD) was achieved in 73% (95% CI 48 to 89%). Mean hypotropia at presentation was 10 PD (range 6?14 PD), which improved to 0 PD (range 0?9 PD), P = 0.063. Mean BCVA improved from 1.08 LogMar to 0.3 LogMar units. Conclusion: Loop myopexy combined with intra?ocular lens implantation is a safe and effective procedure in the management of patients who have Myopic Strabismus Fixus with visually significant cataract and improves both visual acuity and ocular alignment significantly.

Professional indemnity/medical malpractice insurance—Awareness among medical students and consultants of India: An online survey study

Introduction: Professional indemnity (PI) or medical malpractice insurance (MMI) has been a hot topic considering the increasing number of medical negligence cases rising worldwide. However, there is a palpable difference in understanding and usage of this tool in developed countries and regions such as India. Aim: This study aimed to analyze the general understanding of resident doctors and consultants about MMI and knowledge about its technical jargon. Materials and Methods: We distributed short Google Form questionnaires about various aspects of MMI. We recorded the data from 141 resident doctors and 42 consultants in the Navi Mumbai area of India. As it was a survey, we required no ethical review. Results: As consultants’ experience grew, so did their understanding of medical indemnity. Approximately 90%, 64%, and 22% of consultants with 10 years, 5–10 years, and 5 years of experience had acquired PI. The AOY:AOT (any one year:anyone time) ratio was known to just 35% of these specialists. About half of the resident doctors were aware of PI and the effects of medical specialization on PI. Around a fifth of the individuals had only acquired the PI. Conclusion: There needs to be more clarity between the need and knowledge of MMI in India. This needs to be addressed by teaching medical postgraduates about it during training. “There should be special emphasis on medical indemnity in terms of its need, clauses, and cost during postgraduate medical training.”

Rare case of multiple primary malignant neoplasms

Multiple Primary Malignant Neoplasms (MPMNs) are rarely reported and are defined as the diagnosis of ?2 independent, primary malignancies of different histologies/ origins in a single individual. In this study, we report a patient with Male Breast Cancer (MBC) and coexisting Small Lymphocytic Lymphoma (SLL) and Chronic Lymphocytic Leukemia (CLL). A 65-year-old male with complaints of a lump in his left breast since 2 years. CT scan findings were a non-homogeneous mass in the left breast along with bilateral axillary lymphadenopathy. Modified radical mastectomy was done. Microscopic examination showed the features of infiltrating duct carcinoma NOS: Modified Nottingham Bloom Richardson抯 Grade II in breast specimen. A peripheral smear of the patient showed features of chronic lymphocytic leukemia (absolute lymphocyte count was 16400 cells/mm3). IHC of breast tumor showed ER/PR positivity with H scores of 350 and 240 respectively and HER- 2/Neu protein expression was negative with a score of (1+). Lymph nodes were immunoreactive for CD 19, CD 23 and CD 5. Cells were non-reactive for Cyclin D1a and CD3. This is probably the first case of MBC with SLL and CLL. The diagnosis is consistent with synchronous MPMNs, which are increasingly reported nowadays.

Consensus Statement : The Need for Tobacco Harm Reduction in India

Cigarette smoking is a major public health issue in India and leads to significant morbidity and mortality. Addressing the issue of smoking is a major challenge to public health, as the addiction is hard to break. Counseling smokers regarding smoking cessation is the first step to achieving cessation, but the quit rates remain low. Several pharmacological interventions have been developed over the years. Nicotine replacement therapy is available in a variety of formulations, each with different advantages, drawbacks, acceptability among smokers and quit rates. In addition, a range of novel nicotine and tobacco products, including Heated Tobacco Products (HTPs), have been developed which leverage nicotine to aid in smoking cessation. A group of medical experts convened to review the evidence on the burden of smoking, the concept of Tobacco Harm Reduction (THR), novel nicotine and tobacco products for THR, and the potential of HTPs to aid in smoking cessation. This paper outlines the findings and recommendations regarding THR in the Indian context. The panel opined that tobacco cessation centers and counseling remain the foundation of tobacco cessation in India. At the same time, there appears to be potential for the application of THR products in India. The relevant authorities must review the potential of THR products, and make these available, to provide the best possible cessation strategy for the Indian population that is currently at risk of mortality and severe morbidity.

Voluntary blood donations in Navi Mumbai, India: Experience in coronavirus disease pandemic

Introduction: In India, voluntary blood donation camps (VBDCs) are a key supply of blood and its products. Conducting blood donation drives was challenging in Navi Mumbai due to the widespread lockdown during the coronavirus disease (COVID) outbreak. Study Type: This was a retrospective study. Materials and Methods: To relieve the anxieties and apprehensions of the blood donor population, extensive confidence-building efforts were required. Various safety measures and standard operating procedures were also included, as well as training for VBDC organizers and medical personnel. We studied the blood donations done at our institute on a retrospective basis from blood bank records. Results: Our study showed a 7% increase in outdoor VBDC donations in 2021 over the previous year 2020. However, according to the advice of the local transfusion council, promoting in-house donations raised their number by a stunning 33% in 2021. Conclusion: Even during the COVID pandemic, confidence-building methods and precautions helped restore VBDC’s legitimacy and increase donation numbers by a marginal extent.

Comparison of measurements between manual and automated eyetracking systems in patients with strabismus – A preliminary study

Purpose: The main objective is to test the measurements made by an automated eye?tracking system in the presence of strabismus and to compare the data with manual measurements of deviation. Methods: A prospective observational cross?sectional masked double?blinded study was conducted in a tertiary eye care center with 39 participants included in our study, aged 3–41 years. Initial screening of all participants was performed by an ophthalmologist. Ocular deviations were evaluated and compared between manual measurements and an automated eye?tracking system. The device is based on eye?tracking technology. The participants had either a congenital or acquired type of manifest or latent strabismus. Children less than 3 years of age, visual acuity <6/36, and abnormal configuration of the anterior segment were excluded from the study. Results: The prism alternate cover test (PACT) manual measurements and the automated alternate cover test for measuring horizontal deviation, the manual measurement, and the automated eye track system showed a highly positive correlation (r = 0.932, P < 0.001). The Bland Altman plot analysis shows good agreement between the two measurements, with the mean difference between the two measurements being 1.55 PD, and the 95% limit of agreement was ± 10 PD. Conclusion: The results obtained with an automated eye?tracking system correlate well with manual strabismus measurements with PACT in terms of diagnosis, precision, and accuracy, with an added benefit of lesser time consumption in performing the test in cooperative/motivated patients. Considering these aspects, patients above the age of 3 years could be assessed with the equipment.

The art of tackling strabismus skillfully by sparing vessels

Background: Detaching a rectus muscle irreparably destroys its ciliary artery circulation which also supplies the anterior segment of the eye. Purpose: To educate strabismus surgeons about a method of detaching a muscle without compromising anterior segment circulation. Synopsis: A limbal based conjunctival incision is made. The muscle is identified, separated from its attachments and secured with 6-0 Vicryl. The anterior ciliary vessel supplying it is isolated by making a small snip incision in the muscle capsule with delicate blunt dissection parallel to the anterior ciliary artery The muscle is detached from its original insertion. The muscle is tied to sclera at the intended point of recession. The intact anterior ciliary artery, thus will continue to function, untouched. Highlights: We recommend pre-placing the sutures in the muscle and also in the sclera at the point of reattachment to avoid possible stretching and breaking of anterior ciliary vessels at the time of muscle detachment and also to dissect the artery free from muscle several millimeters more than the intended recession in order to spare the anterior ciliary circulation in strabismus surgery.

Unusual case of isolated post-styloid parapharyngeal space metastasis in a treated case of carcinoma supraglottis: A case report and review of literature

Squamous cell carcinoma of supraglottis is a common head and neck malignancy, comprising 30% of laryngeal carcinoma. Supraglottic carcinoma commonly metastasizes to the Levels II, III, and IV cervical nodes, and distant metastases are uncommon. Delayed local and regional recurrences are known, local recurrence being more common. We report a case of carcinoma supraglottis with the advanced locoregional disease at initial presentation and treated with neoadjuvant chemotherapy followed by chemoradiotherapy with a complete response on post-treatment positron emission tomography-computed tomography (PET-CT) scan. Surveillance PET-CT showed an isolated lesion in the left post-styloid parapharyngeal space, where neurogenic tumors are more common and isolated nodal metastasis is unusual. We did ultrasound-guided FNAC and cytology confirmed the presence of metastatic poorly differentiated carcinoma.

Management of COVID-19 patients, with emphasis on limited resource setting:is less optimum?

Background:There is scarcity of essential medications, medical talent and health care facilities to treat covid-19, at remote places. This studyexplores various modalities in resource-limited settings for the management of COVID-19 patients.Methods: We retrospectively analysed data of 266 consecutive discharged and death Covid-19 patients from 26December 2020 to 29May 2021. All patients were admitted and received appropriate supportive care, regular clinical and laboratory monitoring.Results: Of total 266 patients the mean age of patients was 49.19 (SD 14.1) years and 185(69.54%) of them were males. 99(37%)cases were moderate, 83(31%)were severe cases remaining 84(32%)were mild cases. 16 (6.01%) patients expired and remaining 250 patients were subsequently discharged.Median duration of stay in the hospital was 9 (37) days. Of total 266 admitted patients� mortality rate was only 6.01%.Conclusions: We emphasize that even in healthcare facilities with limited resource, poor infrastructure and lack of ICU facilities, clinical observation-based managementt can help to reduce mortality considerably. Unique features of our study include; use of progesterone as an immunomodulator, use of dual antiviral agents, use of age-related lower limit of oxygen saturation.

Importance of Ultrasonography in Inspissated Bile Syndrome in a Neonate - A Case Report

Neonatal cholestasis is the diagnostic dilemma in clinical practice.1 It is a serious condition with the varied aetiological factors. Biliary atresia, hepatitis, choledochal cyst are common causes in neonates. Intrahepatic and extrahepatic causes can be easily differentiated by radiological investigations.2 Inspissated bile syndrome is a rare cause of neonatal jaundice.3,4 Predisposing factors for the development of inspissated bile in neonates include haemolysis, prematurity, parenteral nutrition, sepsis, and diuretic therapy.5 Ultrasonography is valuable in diagnosing the causes of obstructive jaundice especially in neonates where computed tomography scan cannot be done due to radiation exposure and MRI cannot be done due to the motion artefacts. Hepatobiliary scintigraphy single-photon emission computer tomography (HBS SPECT) is the most reliable diagnostic method. Generally, inspissated bile resolves spontaneously, but sometimes patient needs ursodeoxycholic acid. Rarely surgical drainage is also needed.Inspissated bile syndrome is a rare cause of neonatal jaundice. It is extrahepatic obstruction due to sludge of inspissated bile. We present a case of 8 days old child who presented with jaundice. Total bilirubin was raised mainly due to high levels of unconjugated bilirubin.

A study on WHO Frax score to predict fracture risk in predialysis patients of chronic kidney disease

Background: Disturbances in mineral and bone metabolism are prevalent in chronic kidney disease (CKD) and are an important cause of morbidity and decreased quality of life. These disturbances include renal osteodystrophy and CKD-Mineral and Bone Disorder (CKD-MBD). The Frax tool developed by WHO is an attempt to better estimate the fracture risk. It calculates a 10 year probability of osteoporotic fractures of spine, forearm, hip or shoulder based on clinical risk factors with or without BMD measurements.Methods: It is a Cross sectional observational study which was done from 01 November 2013 to 31 March 2015. The study group included 60 cases of pre dialysis Chronic Kidney Disease attending OPD, Emergency or admitted in medicine wards of Dr. RML Hospital, New Delhi. Bone mineral density measured by dual-energy X-ray absorptiometry and all patients were classified according to World Health Organization criteria. DEXA SCAN (manufacturer-Hologic INC.) was done of the lumbar spine, radius bone and neck of the femur. Frax score was calculated as per WHO guidelines.Results: On using the Indian Frax calculator the average 10 year probability for major osteoporotic fractures in stage 4 (9.47±2.62%) was found to be significantly higher (p<0.0001) than that in stage 3 (1.92±0.8%).Similarly, the average 10 year probability for hip fracture in stage 4 (4.61±1.45%) was also found to be significantly higher (p< 0.0001) than that in the stage 3 (0.75±0.49%).Conclusions: The study confirmed the high incidence of low BMD in patients of CKD. The 10 year fracture risk in these patients as predicted by Frax score was significantly higher in CKD patients irrespective of whether the Chinese or the Indian calculator was used.

Comparison of Efficacy of Oral and Intravenous Anti-Hypertensive Drugs in Eclampsia- A Randomized Trial.

Eclampsia increases the risk for both mother and foetus. The treatment aims to quickly bring about smooth reduction in blood pressure to levels that are safe for both, but avoiding any sudden drops, that may in themselves cause dizziness or foetal distress. Hence, this study was conducted to compare the efficacy of anti-hypertensive drugs in eclampsia.METHODS80 eclampsia patients were randomized into two groups: one received oral nifedipine and other intra-venous labetalol. Nifedipine group orally received 10 mg initially with repeated doses of 20 mg every 20 minutes up to maximum of 5 doses or until the therapeutic goal was reached. The other group received intravenous labetalol 20 mg initially followed by escalating doses of 40, 80, 80, and then 80 mg every 20 minutes until therapeutic goal was achieved or for a maximum of 5 doses. Once the therapeutic goal was reached, blood pressure was measured every 20 minutes till delivery.RESULTSMean time required to reach therapeutic blood pressure goal in nifedipine, and labetalol group was 45 ± 22.98 and 59.5 ± 25.41 minutes respectively. Total dose requirement was 1.65 ± 0.57 and 2.17 ± 0.74 mg respectively. The differences between two groups were significant. There was difference in urine output between the two groups as well. In the initial two hours, there was increased urine output in nifedipine group though it was statistically not significant. After two hours till 48 hours, this increased urine output in the nifedipine group was significant (p value 0.001).CONCLUSIONSnifedipine achieved the therapeutic blood pressure goal more rapidly than labetalol.

Parametrial hydatid cyst with cystovesical fistula: a rare presentation

Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. Theoretically, echinococcosis can involve any organ. The liver is the most common organ involved, followed by the lungs. However, uterus and and adnexa have an incidence of 0.5-1%. Till date, three cases have been reported in which a parametrial hydatid cyst formed a bladder fistula. A 57 year old female was admitted with complaint of burning micturition along with white coloured urine for the last 15-20 days with no other significant history. On examination and evaluation, it was suspected to a neoplastic pelvic mass causing gross right sided hydronephrosis. All biochemical markers were within normal limits. The patient was explored surgically on which a thick-walled lesion was found in right parametrium. The cavity of the lesion was filled with daughter hydatid cyst, along with communication into the bladder via a fistula. Open cystectomy was done after evacuation of daughter cysts and irrigation with scolicidal agents. The fistula was repaired. The patient recovered uneventfully and was doing well on follow-up. The incidence of hydatid cysts in the female reproductive system is very low and constitutes less than 0.5% of all hydatid cysts. However, rare cases have been reported, thus the clinician must be aware of this rare disease and should take precautions while operating, as any spillage may lead to anaphylactic shock.

Treatment of Unstable Diaphyseal Fracture Femur with Femur Intramedullary Interlocking Nailing

Introduction: Fractures of shaft of femur are among themost common fractures encountered in orthopaedic practice.The femur is the largest and strongest bone in the bodyarticulating with hip joint proximally forming knee joint withtibia at its distal end. As industrialization and urbanizationare progressing year to year with rapid increase in traffic,incidence of high energy trauma increasing with samespeed. Hence, the aim of the present study was to assess thetreatment of unstable diaphyseal fracture femur with femurintramedullary interlocking nailing.Material and methods: The present study was done among40 patients where skin traction or upper tibial traction forskeletal traction was given with the link supported in a BohlerBraun splint. All routine investigation and surgical fitnesswere asked for intramedullary nailing was chosen for fracturebelow the lesser trochanter and distally fracture within 8 cmfrom the femoral articular surface were chosen.Results: About 60% fractures involved upper 3rd as the site offracture. The pattern of fracture was found to be comminutedwhich was around 35%. The oblique pattern was around32.5% and transverse pattern of fracture was observed to be22.5%.The complications included were implant bending andbreaking, infection,delayed and nonunion,rotational deformityand shortening.Conclusion: Unstable diaphyseal fractures with femurintramedullary interlocking nailing gives excellent result withthis system there are minimal complications which help earlyreturn of patients to activity and work.

Preparation of Coronavirus nosodes sourced from a clinical sample of SARS-Cov-2 positive patient, inactivated strain, and spike glycoprotein

IntroductionNosodes, the homeopathicpreparationssourcedfrom biological materials including clinical samples, cultures of organisms, and diseased tissues have been in use against the source-specific infections as well as other diseases. The nosodes have demonstrated some efficacy in managing epidemics, such as influenza, dengue, and leptospirosis.This article presents the need and process of development ofnosodes from the SARS-CoV-2 to explore its prophylactic and therapeutic potentials against certain related viral diseases.Materials and methodsA clinical sample of SARS-Cov-2 positive patient,based on the cycle threshold (CT) value of the qRT-PCR, heat-inactivated SARS-CoV-2, and spike glycoprotein all were processed for making nosodesas per the method described in Homoeopathy Pharmacopoeia of India.Molecular tests, such as qRT-PCR and sterility tests were performed to establish the live organisms, RNA material, and the absence of contamination.ResultsThree variants of CoronavirusNosodewere developed using a clinical sample,heat-inactivatedSARS-CoV-2, and spike glycoprotein.In potencies 3c and above, no detectableSARS-CoV-2 RNA material was found by PCR.The analytical results for nosodes were reported as compliant for sterility testing as per the IP.ConclusionThree variants of Coronavirus nosodes were preparedwhich need to be evaluated further through pre-clinical and clinical studies.(AU)

Lipid-based floating multiparticulate delivery system for bioavailability enhancement of berberine hydrochloride

The objective of the present investigation was to design and optimize lipid-based floating multiparticulate of Berberinehydrochloride (BERH), so as to increase its solubility and to reduce P-Glycoprotein mediated efflux in the intestine,hence to improve oral bioavailability. Solid dispersions were prepared using hydrophilic carriers gelucire 44/14and gelucire 50/13 in different ratio. The prepared solid dispersion of BERH was further formulated into sustainrelease gastroretentive floating pellets using hydrophobic lipid carrier gelucire 43/01 as release retardant, sodiumbicarbonate (NaHCO3) and hydroxylpropyl methyl cellulose K4M (HPMC K4M) as gas former and matrix polymer,respectively. The effect of amount of gelucire 43/01 and NaHCO3: HPMC K4M were studied and optimized using a3-level, 2-factor, factorial design. Solid dispersion of BERH compared to pure drug showed 4-fold enhancement inaqueous solubility. The optimum system could float for more than 8 hours and showed 88.46% drug release in 8 hours.The pharmacokinetic study conducted in male Wistar rats indicated 2.32-fold increase in relative bioavailability ofoptimized formulation compare to the marketed tablet. The lipid-based floating pellets of BERH were obtained andcould be an applicable choice to deliver BERH with improved bioavailability in effective use for various clinicalapplications.

Hemophagocytic Lymphohistiocytosis (HLH) Associated With Scrub Typhus: Report Of 2 Cases

Hemophagocytic Lymphohistiocytosis (HLH) is a fatal hyperinflammatory syndrome characterized by histiocytic proliferation along with hemophagocytosis. HLH can be primary (inherited) or secondary, to any severe infection, malignancy or rheumatological disease. HLH, though rare, has also been noted in association with scrub typhus which is an acute febrile illness resulting from the bite of infected larval form of mite (also known as chigger). We hereby describe two cases of HLH associated with rickettsial infection (Oriental tsutsugamushi) in a 36-year-old male and in a 10-year-old male child. The former presented with high-grade fever and pruritic macular rash over abdomen. While the latter was presented with fever and decreased urinary output at the time of admission

Nutraceutical Potential and Antipsychotic Activity of Local Dry Fruit Waste – Juglans regia

Aim: To identify the biologically active components in shells of Juglans regia and study its nutraceutical potential and antipsychotic activity for effective waste management. Study Design: Biochemical and in vivo analyses of plant extract using established protocols. Place and Duration of Study: Sample extraction at Department of Food Science and technology, School of Biotechnology and Bioinformatics, DY Patil deemed to be University, Navi Mumbai, India; sample components identification at Sophisticated Analytical Instrument facility (SAIF), Indian Institute of Technology (IIT), Mumbai, India; and in vivo studies for antipsychotic activity using Caenorhabditis elegans at Department of Life Science and Biochemistry, St. Xavier’s College, Mumbai, India between November 2018 and May 2019. Methodology: The shells of Juglans regia were milled and the extract was prepared using Soxhlet extraction at 60oC using methanol as solvent. The GCMS analysis of the extract was carried out using a GC JEOL – The Accu TOF. Antipsychotic activity was studied using pharyngeal pumping assay in Caenorhabditis elegans. Results: GC-MS analysis of methanolic extract of shells of Juglans regia revealed the presence of Tridecanoic acid, Acetoxyacetic acid, nonyl ester, 2-hexenal, 2-ethyl, Eicosanoic acid, phenylmethyl ester, Undecane, Benzeneacetic acid decyl ester, (1-pentyl-allyoxymethoxy-methyl)-benzene), 9,12-octadecadienoic acid(Z,Z), phenylmethyl ester, Benzyl oxytridecanoic acid, 6,9,12- octadecatrienoic acid, phenylmethyl ester (Z,Z), 9- octadecanoic acid (Z), phenylmethyl ester, 9,12,15- octadecatrienoic acid, Z [(trimethyl (sil)oxy, 1 – trimethyl (sily)oxy] ethyl ester (Z,Z,Z). Furthermore, behavioural assay done using Caenorhabditis elegans as a model organism showed that the sample exerted antipsychotic activity at lowest concentration. Conclusion: The shells of Juglans regia being a natural source, can be used as an alternative to the synthetic antipsychotic drugs that have side effects. Our current work suggests that the walnut shells that end up into trash bins are an excellent source of effective natural biologically active compounds.

General Treatment Protocol Of Poisoning And Twenty Four Treatment Modalities By Acharya Charak - A Review

Ayurveda has its own way of approach towards the management of Visha (Poison), Agadtantra is a special branch of Ashtang Ayurveda having its own importance in Visha Chikitsa. A general principle of treatment of poisoning is explained in Ayurvedic Samhitas (Treatises) like Charaka, Sushruta and Vagbhata. Acharya Charak has explained Twenty four modalities in the treatment of poisoning irrespective of animate or inanimate poisoning. Other scholars have stated specific treatment in the poisoning cases but still 24 modalities retains its importance. Toxicology also explains general treatment protocol for management of poisoning. The Protocol consists of vital establishment, removal of poison, use of antidote, general and psychiatric care of patient. But due to complexity of poisoning cases; General Treatment protocol becomes the guideline for the further management. When we compare both Ayurveda and modern medicine with respect to this aspect, we find that all these principles which are suggested by modern medicine are already described in Ayurvedic Samhitas before thousands of years. Chaturvimshati Upakrama (24 modalities) are like the treatment principle which directs the actual treatment regime in individual cases. General treatment protocol of poisoning is the modern replica of Acharya Charak’s Chaturvimshati Upakarama. A comparison of twenty four modalities with the general treatment protocol of poisoning is attempted in this review article.