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Purpose: Aim of this study was to compare the efficacy of sodium hyaluronate (SH) and carboxymethyl cellulose (CMC) eye drops in treating mild to moderate dry eye disease in terms of relief of symptoms, mean change in tear film breakup time, Schirmer’s test, and impression cytology of conjunctiva from baseline. Methods: An observational study was carried out during a 2?year period in our tertiary referral hospital. The study consisted of 60 patients randomly allotted to two groups to receive SH and CMC eye drops for an 8?week period. Ocular surface disease index, tear film breakup time, and Schirmer’s test were performed at baseline visit and 4 and 8 weeks of treatment, and impression cytology of conjunctiva was performed at baseline and 8 weeks. Results: Significant improvement in patient symptoms, tear film breakup time, and Schirmer’s test from baseline was seen in both SH and CMC groups at 8 weeks posttreatment, whereas impression cytology of conjunctiva in both groups did not show significant improvement at 8 weeks of treatment. Data analysis using unpaired t?test showed comparable results. Conclusion: Both CMC and SH demonstrated equal efficacy in treating mild to moderate dry eye disease.
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Purpose: Increased screen time has been a major concern among the students who have adopted the online curriculum amid the pandemic. The study was conducted to shed light on the changing trends of symptoms pertaining to dry eye disease and digital eyestrain due to the online curriculum and its negative implications on the ocular health of students. Methods: A cross?sectional study was conducted among students of Manipal Academy of Higher Education who are currently following the E?learning curriculum amid the COVID?19 pandemic the participants were surveyed using a pre?validated structured questionnaire. Results: The mean age of study participants was 23.33 ± 4.604 years. In total, 97.9% (321/352) of the respondents experienced at least three symptoms associated with the usage of digital devices. 88.1% of the participants were exposed to an average screen time of more than 4 hours per day. An increased number of hours of digital device usage was found to be associated with higher total symptom scores (P = 0.04). The total symptom scores were found to be considerably higher for those with continuous contact with the screen (P = 0.02). Headache (69.9%, n = 246) is the most commonly reported symptom followed by neck pain (65.3%, n = 230), tearing (44.6%, n = 157), eye pain (40.9%, n = 144), and burning sensation (40.1%, n = 141). Conclusion: This study highlights a tremendous increase in the prevalence of symptoms related to dry eye and digital eyestrain among students attending online classes during the COVID?19 pandemic. Eye care professionals need to be aware of this emerging public health threat and the appropriate measures for its prevention
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Purpose: Dry eye disease (DED) is because of a decrease in the tear film’s volume or a change in the composition of tears. Evaporative dry eye is the most common type, which is due to meibomian gland dysfunction (MGD). In this study, the morphology of meibomian glands was evaluated in all kinds of dry eyes to look for any loss of meibomian glands, assess the function of remaining glands, and investigate the relationship between anatomy, function, and severity of DED. Methods: A total of 300 patients were included in the study, with 150 eyes in the study group and 150 in the control group. Meibomian gland morphology was assessed by examining the tarsal plate after everting the eyelids. Tear film function was evaluated using tear film break?up time (TBUT) and Schirmer’s test (SCH I and II). Meibomian gland morphology was examined with a slit?lamp under magnification, a transilluminator using a small light emitting diode (LED) bulb, and non?contact meibography using an auto refracto?keratometer (ARK). Results: Females had a higher prevalence of dry eyes in our study. In all, 103 eyes (68.6%) in the study group had evaporative dry eye, making it the most prevalent type. Among the 150 controls, 104 controls with 69.3% had no dry eye symptoms, and in those with symptoms, the evaporative type was the most common, with a 28% prevalence. Conclusion: TBUT should be performed in all patients with detectable MG abnormality. Meibography has high specificity and sensitivity to diagnose MGD and in turn dry eyes and should be considered a routine screening modality.
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Wilms tumor or nephroblastoma is the second most common renal tumor occurring in the neonatal age group next to congenital mesoblastic nephroma. The most common age group of presentation of Wilms tumor is between 3 and 4 years of age. Here, we report a case of right-sided Wilms tumor in a 2-day-old neonate. A term-born female baby presented on day 2 of birth with abdominal distension and physical examination revealed a large palpable mass in the right lumbar region crossing the midline. Imaging features were suggestive of a retroperitoneal mass of probable right renal origin. The patient was taken up for right radical nephroureterectomy and Per-operatively, there was anticipated tumor spillage. Post-operative histopathological examination was suggestive of a triphasic Wilms tumor with no anaplasia and favorable histology. The patient was diagnosed with Wilms tumor of the right kidney, COG stage III, SIOP (“International Society of Pediatric Oncology”) intermediate risk. Loss of heterozygosity testing for 1p and 16q was negative. She was started on chemotherapy with a DDA4 regimen. She completed whole abdominal radiotherapy and tolerated treatment well. The child is disease free and is under regular follow-up. This case of neonatal Wilms tumor was indeed a challenge to the pediatric surgeons and the oncologists but the final results were worth the challenge that was faced
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Objective@#COVID-19 has gravely affected patients with psychiatric conditions. Potential interactions may occur between psychotropic medications and medications used in treatment of COVID-19. This study aimed to compare the online databases in terms of the quality of drug-drug interaction related information available on them. @*Methods@#216 drug interactions which included fifty-four psychotropic medication interactions with four COVID-19 drugs across six databases were analyzed by four authors independently. The overall grading of the databases was done on Likert scale independently by the authors using the parameters of ease of understanding for consumers and professionals, level of completeness, discussion on level of evidence and the number of available drugs, congruity with other databases and the mean score was tabulated. @*Results@#Drugbank and Lexicomp had maximum discrepancy. The safety profile of Hydroxychloroquine was the best (eighteen moderate/severe psychotropic medication reactions) while Ritonavir has worst profile with thirty-nine medications. Drugbank had the highest SCOPE score (1.00) for completeness and covid19druginteractions.com had least (0.81). Overall, Liverpool© Drug Interaction Group and Lexicomp scored the highest (23/30 each) and were the best interaction checker software closely followed by Drugs.com (22/30). Medscape and WebMD were the poorest interaction checker databases. @*Conclusion@#There is significant variability in the available online databases. Liverpool © Drug Interaction Group and Lexicomp were the most reliable sources for healthcare workers whereas for patients, Drugs.com was the easiest to understand (as it segregates the needs of general consumers and professionals distinctly to explain the interaction).
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Objective@#Traumatic brain injury (TBI) is characterized by damage to the blood-brain barrier, inflammation, and edema formation. In this pilot study, we aimed to investigate the effects of a complement inhibitor, C1-esterase inhibitor (C1 INH), on brain edema and inflammation in a rat model of mild TBI. @*Methods@#Thirty-six male Sprague Dawley rats were randomly assigned to control, TBI, or TBI plus C1 INH groups. TBI and TBI plus C1 INH rats received an injection of saline or 25 IU/kg C1 INH, respectively, with TBI using a weight drop model. Control rats received saline only. Rats were subsequently euthanized and their brain tissue harvested for analysis. The primary outcome was the extent of edema as assessed by the brain’s water content. Secondary outcomes included enzyme-linked immunosorbent assays to determine levels of pro-inflammatory mediators. @*Results@#Tumor necrosis factor-α levels were significantly greater in TBI rats than control rats, indicating that inflammation was generated by the weight drop impact. Brain water content following TBI was significantly different between TBI rats treated with C1-INH (78.7%±0.12), untreated TBI rats (79.3%±0.12), and control rats (78.6%±0.15, P=0.001). There was a significant decrease in C3a and interleukin 2 levels among C1 INH–treated rats compared with untreated TBI rats, but no change in levels of tumor necrosis factor-α and S100β. @*Conclusion@#C1-INH inhibited the complement pathway, suggesting that C1-INH may have a therapeutic benefit in TBI. Further studies are needed to investigate the effect of C1-INH on clinical outcomes.
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Background: Influenza A (H1N1) is a novel strain of the Influenza virus and is widely known as Swine Flu. It causes a respiratory illness and is very contagious. Symptoms of Influenza A (H1N1) are similar to those of the seasonal flu. First laboratory confirmed Influenza A (H1N1) case of India was reported from Hyderabad on 16th May 2009.Methods: The study was retrospective descriptive, record-based study and carried in deceased of Influenza A (H1N1) who were admitted in Jawaharlal Nehru Medical College and Hospital, Ajmer, Rajasthan, India from 01 January 2016 to 31 December 2018.Results: A total 1524 suspected cases were screened for Influenza A (H1N1) at JLN Medical College and Hospital, Ajmer during the period from 1st January 2016 to 31st December 2018. 294 cases were diagnosed as Influenza A (H1N1) positive and 44 died. Majority 25 (56.81%) were belonged to rural area and 30 (68.18%) females died as compare to 14 (31.18%) male.Conclusions: Incidence and mortality is common throughout the year but it more in winter months. Mortality is high in age group of 50 years and above, females and rural area. IEC activities should be throughout year.
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Background: AIDS, the acquired immune-deficiency syndrome (slim disease) is a fatal illness caused by a retro virus known as the human immunodeficiency virus (HIV) which breaks down the body’s immune system. Transmission of HIV is mainly by unprotected sexual contacts, mother to child (antenatal, perinatal and postnatal), and transfer of infected blood.Methods: The present cross-sectional study was conducted from January 2018 to June 2018 in randomly selected government and private schools from rural field practice area. A total of 300 students randomly selected from 10th to 12th class were included in the study, of whom 150 were boys and 150 were girls. The data collected were presented in percentage and figure.Results: Majority of students (61.35%) belonged to age group of 15-18 years and most of them were females. Most of the students (85.2%) had heard about HIV/AIDS but only 53.5% knew that HIV/AIDS caused by a virus. The knowledge regarding mode of transmission of HIV/AIDS was unprotected sex, as expressed by 86.1% students. 70.66% students believe that condoms is the best method of protection against HIV followed by safe blood 43.6%, Disposable syringes 40.29%.Conclusions: Majority of students (61.35%) belonged to age group of 15-18 years and most of them were females. Most of the students (85.2%) had heard about HIV/AIDS but only 53.5% knew that HIV/AIDS caused by a virus. The knowledge regarding mode of transmission of HIV/AIDS was unprotected sex, as expressed by 86.1% students. 70.66% students believe that condoms is the best method of protection against HIV followed by safe blood 43.6%, Disposable syringes 40.29%.
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Background: Hepatitis B virus is transmitted by body fluids, such as blood and serum. Sexual transmission, vertical transmission, and unsafe injections, including intravenous drug use, are the most common routes of infection for Hepatitis B infection. Medical students have a very important role in preventing the disease by improving the disease knowledge among themselves and the patients they will eventually treat.Methods: A cross sectional study was conducted to assess the KAP among medical students of the first three academic years regarding hepatitis B virus infection. The sample size was 222 students. Data were collected from 230 students using a semi structured questionnaire and analyzed using SPSS v20.Results: Among 230 medical students, 79.1% students had good knowledge about hepatitis B whereas 84.3% of the respondents had the right attitude towards hepatitis B. The practice component was low with only 44.8% of the respondents having correct practice regarding hepatitis B infection.Conclusions: Although the knowledge and attitude regarding hepatitis B infection is high, the practice levels are low indicating the need to encourage proper practices among the medical students.
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Background: Pre-eclampsia is an important cause of maternal and neonatal complication and death. If hypertension in pregnancy is diagnosed at an early age, we can provide an efficient care to mother for good outcome of pregnancy. The aim of this study to evaluated the role of B-HCG and AFP as predictors of HDP. Methods: This prospective Investigation study was conducted on 100 pregnant women attending the antenatal clinic in Department of Obstetrics and Gynaecology, Jaipur. Estimation of serum β-HCG and AFP was done by ELISA technique. Then there finding were correlated with the value of serum β-HCG and AFP in second trimester to see whether there is any relation between levels of serum β- HCG and AFP in second trimester and development of HDP. Results: ‘Out of 100 women, 5 i.e. 5% were <20 years of age, maximum i.e. 62 (62%) were in 21-25 years of age group, 25 (25%) were in 26-30 years of age group and 8 (8%) were in 31-35 years age of group. Significantly higher mean S. β-HCG (mIU/ml) was observed in HDP group i.e. 13450.5±3420.8 as compared to 7732±2024 in normotensive group and a test of full model was statistically significant indicating that the predictors reliably distinguish between HDP group and normotensive group (Chi square 55.328, df 4, p<.001). Conclusion: We conclude from this study the measurement of serum β-HCG and AFP should be routinely done in second trimester of pregnancy, to predict the occurrence of HDP for better fetomaternal outcome.
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Background: To sustain the standards of quality medical education, the faculty needs to be well trained in the medical education technologies, both traditional and innovative. Students are the real beneficiaries of all training programmes conducted for faculty development and they appreciate good teaching. Their involvement in all possible aspects of teaching and learning will go a long way in achieving the best outcomes. The objective of the study was to assess the effectiveness of an ‘Abridged course in Medical Education Technology’ for entry level teachers based on the students’ evaluation of the (teaching) performance of the teachers.Methods: An interventional study was carried out amongst 447 students, in which an educational intervention was done and the effectiveness of the ‘Abridged course’ was assessed. Teaching by the teacher trained through the ‘Abridged course’ formed the ‘intervention’ in the study. ‘Evaluation of the teaching performance’ by the students was the outcome studied.Results: The performance of teacher as assessed by the students had a higher mean score (61.28, SD 9.8) for residents who underwent training in medical education technology, as compared to other residents (56.81, SD 9.2) with a p-value of <0.001.Conclusions: This study highlights that an abridged course in teaching methodology for entry level medical teachers improves the quality of their teaching
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Background: A common response to stress is anxiety which is present in patients undergoing surgery. As compared to general surgical population, a higher level of preoperative anxiety has been reported in obstetric patients. The present study was conducted to assess and compare preoperative anxiety in obstetric patients undergoing elective or emergency cesarean section
Methodology: A total of 200 obstetric patients, having physical status II according to the American Society of Anesthesiologists, undergoing elective [n=100] or emergency [Grade 2] [n=100] cesarean section were included in the study. State version of state trait anxiety inventory scale [S-STAI] and Visual analogue scale for anxiety [VAS-A] were used as study tools
Results: A high level of anxiety in patients undergoing emergency cesarean section as compared to elective patients [S- STAI [67.29 +/- 8.51 vs 48.35 +/- 10.29] and VAS -A [73-61 +/- 5.31 vs 52.43 +/- 4.16]] was observed in present study, the difference found to be statistically highly significant [p < 0.001]. Overall 110 [55%] patients had anxiety. Out of these 40 patients [40%] belonged to elective group and 70 patients [70%] were of emergency group. Anxious patients had higher education level. The difference in hemodynamic parameters was highly statistically significant between the two groups
Conclusion: Every patient requiring surgery whether elective or emergency should be assessed for the presence of anxiety in their routine preoperative anesthesia assessment and the patients found to have a high level of anxiety should be scheduled for an additional counselling session
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Adult , Humans , Female , Young Adult , Anxiety , Elective Surgical Procedures , Emergencies , Preoperative Period , Cross-Sectional StudiesABSTRACT
Coloprep is a bowel preparatory solution given before endoscopic procedures to get a unobscured internal vision. It has among its constituent's sodium sulphate, potassium sulphate and magnesium sulphate which produce an osmotic effect in the bowel. However, the use of such agents in hyponatremic and patients predisposed to seizures can have adverse ramifications. The current case outlines manifestation of absence seizure in a 52-year-old male patient who was administered Coloprep for colonoscopy. There was absence of other predisposing factors and the symptoms were ameliorated using timely identification and rectification of the underlying derangements.
Coloprep é uma solução preparatória intestinal administrada antes de procedimentos endoscópicos, com o objetivo de se ter uma visão interna não obscurecida. Entre os constituintes de Coloprep, observa-se sulfato de sódio, sulfato de potássio e sulfato de magnésio, que provocam efeito osmótico no intestino. Mas o uso de tais agentes em pacientes hiponatrêmicos e com predisposição para convulsões pode ter ramificações adversas. O caso em tela delineia uma manifestação de convulsão de ausência em paciente do gênero masculino com 52 anos e que recebeu Coloprep para colonoscopia. Não havia outros fatores predisponentes e os sintomas melhoraram graças à oportuna identificação e correção dos transtornos subjacentes.
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Humans , Male , Middle Aged , Seizures/complications , Sulfates/administration & dosage , Cathartics/adverse effects , Colonoscopy/adverse effects , Sodium Compounds/administration & dosage , Potassium Compounds/administration & dosage , Magnesium Sulfate/administration & dosage , Seizures , Sulfates/analysis , Sulfates/adverse effects , Sulfates/therapeutic use , Cathartics/administration & dosage , Cathartics/therapeutic use , Sodium Compounds/analysis , Sodium Compounds/adverse effects , Sodium Compounds/therapeutic use , Potassium Compounds/analysis , Potassium Compounds/adverse effects , Potassium Compounds/therapeutic use , Hyponatremia , Magnesium Sulfate/analysis , Magnesium Sulfate/adverse effects , Magnesium Sulfate/therapeutic useABSTRACT
Hemophilia A is a congenital bleeding disorder with low factor VIII levels in the blood. We report the anesthetic management of a hemophilic patient presenting with trauma in the left forearm. Patient received Factor VIII perioperatively with no excessive blood loss intraoperatively. We stress that adequate preoperative preparation and a planned anesthesia leads to a successful management of hemophilic patients
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Bleeding, a major cause of morbidity and mortality, is one of the most difficult challenges for obstetricians and anesthesiologists. The management of major obstetric hemorrhage is challenging resulting in surgical and medical interventions, sometimes requiring hysterectomy. Use of Recombinant activated factor VII r[FVIIa] is a recent advancement in the control of PPH. In situations of intractable PPH, where primary measures to control hemorrhage fail, administration of rFVIIa should be considered before decision to perform a hysterectomy is undertaken. We hereby present a case report of a 21 year female presenting with post caesarean PPH refractory to standard therapy, managed successfully by r[FVIIa]
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Aims: Heterotaxy syndrome is a rare, complex, and confusing presentation in the realm of situs anomalies. The concurrence of heterotaxy syndrome with dextrocardia and Eisenmenger syndrome has never been reported in an adult. We described, for the first time, an adult patient who had heterotaxy syndrome with dextrocardia, complicated by Eisenmenger syndrome with large ventricular septal defect (VSD). Presentation of Case: A 43 year-old female presented to the emergency room with worsening exertional dyspnea. She carried past medical history of cyanotic congenital heart disease since birth. Her physical examination findings were significant for hypoxia and clubbing with cyanotic fingers and toes, dextrocardia, and a 3/6-holosystolic murmur over the right lower sternal border. Laboratory investigation showed polycythemia andher chest x-ray showed dextrocardia. Echocardiography showed dextrocardia with a dilated left ventricle and a large VSD with left-to-right shunting. Computed tomography (CT) angiogram of the chest showed bilateral bi-lobed lungs with both main stem hyparterial bronchi, right-sided polysplenia, right-sided stomach with left-sided dominant liver. Discussion and Conclusion: Heterotaxy syndrome has a complex variation in clinic presentation. We illustrate the occurrence of heterotaxy syndrome, polysplenia type with Eisenmenger syndrome and dextrocardia. Recognition of this rare anomaly is important for establishing a diagnosis in a patient with multiple organ displacement.
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Patients with peripheral vascular disease continue to challenge the anesthesiologist as these patients often have associated coronary artery disease. There is always a danger of myocardial ischemia and cardiac morbidity both intraoperatively and postoperatively in this group of patients. We here report a patient presenting with aorto occlusive disease posted for emergency laparotomy for intestinal obstruction.