Comparative evaluation of outcomes of novel approach of subconjunctival Mitomycin C (MMC) injection at the end of trabeculectomy versus intraTenon injection of MMC prior to the initial conjunctival incision – A pilot study

Purpose: To describe a novel approach of subconjunctival injection of mitomycin C (MMC) at the end of trabeculectomy and compare it with intraTenon MMC injection. Methods: This pilot study included 40 eyes of 40 patients with uncontrolled primary and secondary glaucoma. Patients below18 years and failed trabeculectomy were excluded. Patients were randomly allocated into groups A and B (20 patients each). Group A patients received subconjunctival MMC injection in the superonasal quadrant at the end of standard trabeculectomy. Group B received an intraTenon MMC injection before the initial conjunctival incision. Outcome measures included intra?ocular pressure (IOP) reduction, bleb morphology, and complication rates. The complete success was defined as an IOP of ?21 mmHg without antiglaucoma drugs. Results: The mean preoperative IOP of 46.00 ± 11.2 mmHg in group A and 43.05 ± 10.3 mmHg in group B reduced to 12.00 ± 2.41 mmHg (P ? 0.001) in group A and 13.65 ± 2.76 mmHg in group B (P ? 0.001) at last follow?up. Complete success was 95% and 75% in groups A and B, respectively, 19 months after surgery. Avascular microcystic blebs (70% of group A and 45% of group B) were more common than avascular white blebs (15% in group A and 35% in group B). No intraoperative complications were seen. Postoperative wound leak, hypotony, choroidal detachment, or endophthalmitis were not encountered in any group. Conclusion: A novel approach of subconjunctival MMC application during trabeculectomy is reported. Both approaches appear to be highly effective in reducing IOP in primary and secondary glaucoma with similar safety profiles and bleb morphology. Subconjunctival MMC yielded a greater success rate (95%) compared to the intraTenon MMC group (75%)

STUDY OF FREQUENCY OF NEWLY DIAGNOSED DIABESTES IN PATIENTS RECOVERING FROM SARS CoV-2 INFECTION ATTENDING FOLLOW UP OPD IN A TERTIARY CARE CENTRE

SARS-CoV-2, the virus that causes the COVID-19 infection, has been linked to all sorts of long-term health issues.Diabetes mellitus has a bidirectional relationship with COVID-19. Poorly controlled diabetes increases the severity of COVID-19 and is associated with increased morbidity and mortality. COVID-19 pandemic has also resulted in poor control of diabetes, progression of prediabetes to diabetes, increase in number of new onset diabetes.

Covid-19 presenting as isolated severe thrombocytopenia in an HIV-lymphoma survivor

Coronavirus disease has myriad manifestations and can present with predominantly extrapulmonary manifestations. We describe a 50-year-old man, a person living with HIV (PLHA), a non-Hodgkin lymphoma survivor, who presented with isolated severe thrombocytopenia. He was found to have immune-mediated thrombocytopenia, and showed excellent response to intravenous immunoglobulins.

Detection of oral spirochete (Treponema denticola) by modified Fontana staining technique from sub-gingival plaques of patients suffering from periodontal disease and to analyse the morphology of spirochetes with respect to the disease’s status

Background:A large proportion of fixed dose combinations (FDCs) are manufactured and used widely in Nepal. This study aimed to evaluate the FDCs and its utilization in medicine department of tertiary care hospital. Methods:A cross-sectional study was conducted for 50 days among admitted patients in the medicine department of tertiary care hospital, Nepal. A predesigned form was used to collect the data at the time of patient discharge. Only the oral FDCs were selected for study.Microsoft Excel 2007 was used for statistical analysis and data were presented as number and percentage in tabulated and figure forms.Results:Oral FDCs were used in 27.08% of admitted patients. A total of 295 FDCs were prescribed in 208 patients with 44 FDC items in 58 different brand names. Categorically, the most commonly used FDCs were of analgesics (34.24%) followed by antibiotics (25.76%) and vitamin supplements (22.71%). The 27.27% of FDCs prescribed contain more than two active pharmaceutical ingredients (APIs) up to nine and the highest number of APIs were found in vitamin supplements. All FDCs were prescribed in the brand names. The very few 2.27% and 4.55% of FDCs were prescribed from the essential medicine list of Nepal and world health organization, respectively.Conclusions:The use of FDCs listed in essential medicine list was very poor. Similarly, generic prescribing was also zero. The regulatory body must study the rationality of FDC before production, marketing, importing, and utilization in hospital.

Impact Analysis of the National Faculty Development Program for Medical Teachers: A Way Forward

Background: Medical Council of India, New Delhilaunched a National Faculty Development Program(NFDP) across India in 2009. NFDP was neverevaluated in the context of its operational utility,efficiency and effectivity. Aim and Objectives: Presentstudy was undertaken to evaluate the NFDPat one of theMedical Council of India (MCI) Nodal Centre foridentifying the gap with regards to its impact,operational utility and effectivity as envisioned by theregulatory body and to invocate interventionaloperations arising thereof and to calibrate it and tocreate evidences for the same. Material and Methods:The study has been carried out at Jawaharlal NehruMedical College (JNMC), Sawangi (Meghe), Wardha, aNodal Centre recognized by MCI New Delhi for theNFDP. A validated questionnaire was sent to 667stparticipants of the NFDP at JNMC from 1 July 2009 tost31 July 2017 and responses were obtained aboutgenerating evidences in education technology, transferof knowledge at the workplace and contribution in theinstitutional growth. The impact analysis was studied interms of individualization, internalization andinstitutionalization of the participants. Results: 220(52%) of the participants confirmed their involvementin educational research activities in the form of eitheradvance course or a conference or an educationalresearch project. 250 (59%) of the participants couldtransfer their learning to the workplace and broughtchanges in the teaching learning Practices and 28.3% inassessment methods. 255 - 338 (60.32% to 79.90%)participants opined positive impact of NFDP onpersonal/ professional/ Institutional growth.Conclusions: In terms of the observations and findingsthereto, it was proposed that certain modifications(structural, operational and conceptual) are warranted inthe said program. Operational utility of the NFDP isdiscussed under two headings. Its link with CompetencyBased Medical Education and its relation toAccreditation Status of Medical schools in India.

Prevalence of Non-albicans Candida and its Antifungal Susceptibility at a Tertiary Care Hospital, Jaipur

Introduction: Acute appendicitis is one of the most commonsurgical emergencies. Accurate diagnosis of acute appendicitisneeds careful history, and physical evaluation, as the diagnosisis primarily clinical.Material and methods: A cross sectional study was done in50 patients who underwent emergency appendicectomy foracute appendicitis in a medical college hospital in Shimla.The aim was to study the clinical profile of patients with acuteappendicitis and compare it with the existing literature.Results: Mean age of patients was 26.48 (± 12.28) years.Out of 50 patients, 29 (58%) were males and 21 (42%) werefemales, so male predominance was seen in the present study.Most common complaints were pain in the right iliac fossa(100%), nausea and vomiting (82%), anorexia (80%), andmigration of pain (70%). Tenderness in right iliac fossa waspresent in all patients in our study (100%), while reboundtenderness (70%), guarding (64%), rigidity (6%), Rovsingsign (36%), Psoas sign (46%), Obturator sign (22%), andDunphy sign (60%), respectively.Conclusions: Acute appendicitis is more common amongmales than females, and between 10- 30 yrs of age. Themost common presenting features were pain abdomen,anorexia, nausea, and vomiting. The most common signs weretenderness, rebound tenderness and guarding. The rate ofaccuracy of clinical examination was 86%

Bird flu in Nepal

Avian flu also known as bird flu is caused by deadly virus H5N1 which initially was found in birds and wild animals, however, later it was found in human beings causing severe respiratory related problems. This review article was performed to understand the epidemiology of outbreaks of H5N1 in different districts of Nepal. First outbreak of strain H5N1 was reported in 2009. Consequently, highest number of outbreaks i.e. 201 was noted in the year 2013. Till date only one human case was identified by NPHL which was later confirmed by genetic laboratory in Japan in collaborating with WHO.

Myroides: An Emerging Pathogen Causing Urinary Tract Infections in Hospitalized Patients

Introduction: The genus Myroides comprises of Gramnegative, non-motile, and non- fermenting bacteria. It is arare opportunistic pathogen but many recent case reports,however, underscore the pathogenic potential that Myroidesspp. possesses for humans. Immunocompromised patients areat higher risk for Myroides infection. Diabetes, catheterizationand ICU stay may increase the chances of acquiring Myroidesinfection.Material and Methods: Urine specimens collected frominpatients were cultured as per standards. Myroides spp.were identified and sensitivity was performed on VITEK® 2Compact™.Results: A total of 16 Myroides spp. isolates were obtainedin the study period. All the isolates were from catheterizedpatients residing in intensive care units. Eleven (69%) patientswere suffering from diabetes mellitus. Extensive resistancewas seen in antibiotic sensitivity results. Minocycline was100% sensitive.Conclusion: Myroides spp. should be considered amongpathogens in hospitalized, catheterized patients. They couldbe extremely drug resistant. Minocycline is a useful antibioticwhile treating UTI caused by Myroides spp.

Global outbreak of deadly measles in 2019

Measles is an infection of the respiratory system caused by a virus, especially a Paramyxovirus of the genus Morbillivirus, a single stranded negative sense RNA virus. Infants younger than 12 months, school-aged children or young adults depending upon local immunization practice are highly susceptible for the disease.

Correntional study of the health-related quality of life, chronic obstructive airway disease in Northern India, New Delhi

Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines chronic obstructive pulmonary disease (COPD) as “a disease state characterized by airflow limitation that is not fully reversible. Due to progressive airflow limitation, the patients become increasingly symptomatic leading to worsening in their health-related quality of life (HRQOL). Objective of present study was to examine that correlation of health related quality of life with the chronic obstructive pulmonary disease.Methods: One hundred twenty consecutive stable COPD patients (diagnosed as per GOLD guidelines), without any co-morbid conditions (diabetes, congestive heart failure, coronary artery disease, hypertension) were recruited in this study after intuitional ethical clearance and informed consents. The health-related quality of life (HRQOL) was assessed using Hindi SGRQ-C. Forced expiratory volume in first one second (FEV1), forced vital capacity (FVC) and FEV1/FVC% and reversibility were measured using Spirolab III (Medical International Research USA, Inc.). The descriptive and the Pearson’s correlation coefficient were done in data treatment with SPSS version 20.Results: The component of SGRQ scores were as follows: Symptom score: 31.27±14.6 (range 2.3-64); Activity score: 59.01±23.08) (range 0-100); Impact score 42.19±22.25 (range 0-88.8) and the total score was = 45.34±17.96 (range 1.1.-88.6). There were significant negative correlations between all the parameters of SGRQ and FEV1% predicted (i.e. with lower FEV1% parameters of SGRQ will be high).Conclusions: Indian patients with COPD show significantly reduced HRQOL as measured by disease specific questionnaire SGRQ, similar to COPD patients in other countries. In our study, only FEV1 % predicted was significantly correlated with HRQOL, all other measures including GOLD staging were not significantly associated with HRQOL.

Expression of toll-like receptor 2 and 4 in peripheral blood neutrophil cells from patients with chronic obstructive pulmonary disease

Objectives: Chronic obstructive pulmonary disease [COPD] is one of the leading causes of morbidity and mortality around the world. Preliminary studies have evaluated the association between innate immunity including Toll-like receptors [TLRs] and airway samples of patients with COPD. The role of TLRs in peripheral blood neutrophils is poorly understood. Hence, this study aimed to investigate the role of TLR2 and TLR4 in peripheral blood neutrophils of COPD patients

Methods: A total of 101 COPD cases and an equal number of healthy controls participated in this case-control study. Peripheral blood neutrophils were isolated from all participants and cultured for 24 hours through lipopolysaccharide [LPS] stimulation. The gene expressions of TLR2 and TLR4 were assessed by real-time polymerase chain reaction. The protein levels of interleukin [IL]-8 and matrix metalloproteinase [MMP]-9 were measured in neutrophils cell culture supernatants using enzyme-linked immunosorbent assay [ELISA]

Results: The levels of IL-8 and MMP-9 were significantly higher in patients with COPD compared to healthy controls. Similarly, the gene expression of TLR2 and TLR4 were increased in LPS stimulated peripheral blood neutrophils of patients with COPD. Smoke pack years was positively correlated with IL-8 levels and negatively correlated with forced expiratory volume in the first second % [r = -0.33; p = 0.023] and FEV1/forced vital capacity [FVC] [r = -0.27; p = 0.011]

Conclusions: The increased expression of TLR2 and TLR4 suggests its role in disease pathogenesis of COPD. Smoke pack years was negatively associated with spirometric parameters in COPD patients. This may help to predict the smokers without COPD who risk developing the condition in the future

A Prospective Study On Prevalence Of Aerobic Bacteria In Intensive Care Units And Their Antibiotic Susceptibility Pattern In A Tertiary Care Hospital In Jaipur , Rajasthan.

Introducation: Multi-drug resistant nosocomial infections are one of the leading causes of mortality and morbidity amongst hospitalized patients throughout the world, accounting a major burden on the patients and public health system of any country Method :To determine the prevalence of aerobic bacterial in different clinical specimens received from various Intensive Care Units (MICU, SICU, CCU, PICU, and NICU) and their antibiotic susceptibility pattern in the isolated organisms in a tertiary care hospital in Jaipur, Rajasthan. Result : Out of 500 samples, 213 (43%) samples showed growth while 287 (57%) did not show any growth. In the 213 positive samples 183 (85.92%) were Gram Negative bacilli while 25(1.74%) were Gram Positive Cocci and 5 (2.34%) were candida spp.Out of Gram Negative Isolates Acinetobacter Spp. was found to be maximum 35.2% followed by E.coli 19.7% , Klebsiella spp.19.2%, Pseudomonas 12.2%, Citrobacter 0.93% and Proteus Spp. 0.93%. Among Gram Positive Isolates Staphylococcus aureus was maximum 6.5% followed by Enterococcus 3.75%, CONS 0.93% and streptococcus spp.0. 46%. Candida spp. contributes 2.34% of all positive culture. Conclusion: Isolates are sensitive to combination drugs while more resistant to single drug. Among gram negative bacteria most common isolate was Acinetobacter spp. 75 (35.2%) which were resistant to most of the antibiotics like amoxycillin- clavulanic acid (83%) , cefotaxime (76%), imipenem (71%), piperacillin- tazobactam (53%),cefepime (57%) while sensitive to aztreonam (64%) and cotrimoxazole (64%).

Prognostic Factors in Patients Hospitalized with Diabetic Ketoacidosis

BACKGROUND: Diabetic ketoacidosis (DKA) is characterized by a biochemical triad of hyperglycemia, acidosis, and ketonemia. This condition is life-threatening despite improvements in diabetic care. The purpose of this study was to evaluate the clinical and biochemical prognostic markers of DKA. We assessed correlations in prognostic markers with DKA-associated morbidity and mortality. METHODS: Two hundred and seventy patients that were hospitalized with DKA over a period of 2 years were evaluated clinically and by laboratory tests. Serial assays of serum electrolytes, glucose, and blood pH were performed, and clinical outcome was noted as either discharged to home or death. RESULTS: The analysis indicated that significant predictors included sex, history of type 1 diabetes mellitus or type 2 diabetes mellitus, systolic blood pressure, diastolic blood pressure, total leukocyte count, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, blood urea nitrogen, serum creatinine, serum magnesium, serum phosphate, serum osmolality, serum glutamic oxaloacetic transaminases, serum glutamic pyruvic transaminases, serum albumin, which were further regressed and subjected to multivariate logistic regression (MLR) analysis. The MLR analysis indicated that males were 7.93 times more likely to have favorable outcome compared with female patients (odds ratio, 7.93; 95% confidence interval, 3.99 to 13.51), while decreases in mean APACHE II score (14.83) and serum phosphate (4.38) at presentation may lead to 2.86- and 2.71-fold better outcomes, respectively, compared with higher levels (APACHE II score, 25.00; serum phosphate, 6.04). CONCLUSION: Sex, baseline biochemical parameters such as APACHE II score, and phosphate level were important predictors of the DKA-associated mortality.

Bilateral Communicating Branch Between Musculocutaneous and Median Nerve.

Connections between the musculocutaneous and median nerve are not uncommon. But knowledge of such variations is important for surgeons to perform surgical procedures. Here a female cadaver of 34 years age was found during dissection classes of undergraduate MBBS students, with communicating branch connecting musculocutaneous nerve with median nerve bilaterally.

Girls' Collectives Address Adolescents' Anemia and Social Norms in Socially-excluded Tea Estates in India: A Public-private Partnership in Assam.

Objectives: To generate evidence on engaging girls' collectives to address anemia and social norms in self-contained, privately-managed tea plantations in India. Methods: In 2006, UNICEF India partnered with a federation of tea companies in Assam's Dibrugarh district, and Twinning Corporate Social Responsibility to establish 158 girls' collectives across 117 of 273 tea gardens. These collectives meet weekly to discuss and address social issues such as child marriage, child labor, school dropout, and life skills. In 2012, supervised weekly iron folic acid (IFA) supplementation, biannual deworming and nutrition education were weaved in these peer interactions and implemented in 15 tea estates through 45 girls' collectives comprising 7097 adolescent girls, with the objective to address anemia. Visual aids, recipe demonstrations, and home gardening were used to make sessions interesting. Government positioned adequate supplies at tea estate hospitals/outposts. Two peer monitors per tea estate supervised the activities of the collectives. The follow up of this cohort included a baseline (2011) and an end line (2013) survey. Results: Compliance with weekly IFA supplementation (4 tablets per month) increased from 25% (2012) to 82% (2013). Home gardens were introduced in 1,002 homes and 55 community patches. Provisional end line data shows a 1.25 g/dl improvement in mean hemoglobin levels (9.77 to 11.2 g/dl). There is also evidence of increased girls' re-enrollment in high school and a reduction in the proportion of child marriages. Conclusions: Lessons from this public-private partnership can be adapted to similar programming environments that aim at reaching out to adolescent girls with anemia control interventions.

Guidelines for screening, diagnosis and management of hemoglobinopathies.

The b‑thalassemias and sickle cell disorders are a major health burden in India. Diagnosis and management of these disorders both in adults and in newborns using appropriate approaches and uniform technology are important in different regions of a vast and diverse country as India. In view of a National Thalassemia Control Program to be launched soon, a need was felt for guidelines on whom to screen, cost‑effective technologies that are to be used as well as for establishing prenatal diagnosis programs in regional centers. Newborn screening for sickle cell disorders is in its infancy in India and uniform approaches need to be followed. Also, included are guidelines for monitoring and managing patients who are now growing older and need comprehensive care as well as management of complications of the disease.

Prevalence of parasitic infestations amongst the food handlers in a city of North Eastern Region of India.

Background & objectives: The objective of this study was to determine the prevalence of intestinal parasitic infections among food handlers in the city of North eastern region of India. Materials and Methods: Three hundred food-handlers were included to in this study. The stool samples were collected from the subjects and examined for intestinal parasites following direct microscopic examination and Formol Ether concentration (Ritchie) technique. Results: The majority (88.63%) of the food-handlers (cases) were young adults and middle aged from 20 to 49 years. Eighty eight (29.33%) stool specimens were positive showing 99 different diagnostic stages of parasites. Some specimens were infected by more than 1 parasite. Ascaris lumbricoides 37(37.37%) was most frequent among the different detected intestinal parasites followed by Entamoeba histolytica 21(21.21%). Other parasites were Trichuris trichiura 10(10.10%), Giardia lamblia 9(9.09%) and Taenia species 5(5.05%). Most of the food handlers were having poor hygiene residing in rural area and slums. Conclusion: Routine screening of food handlers is a valuable tool for prevention of food-borne infections among the public. In addition we should provide health education emphasizing the importance of food handlers as potential sources of infections and suggested health institutions for appropriate hygienic and sanitary control measures.

A bearded indian female: A rare presentation of Cushing's Syndrome / Journal of the ASEAN Federation of Endocrine Societies

@#A 16-year-old Indian girl presented with increased facial hair growth, weight gain, amenorrhea and generalized weakness for the last 3 months. On examination she was found to have severe hirsutism, her modified Ferriman-Gallwey score was 24/36, she had broad purple striae on abdomen, hypertension and proximal myopathy. On investigations, the patient was found to have ACTH dependent Cushing's syndrome

Typical Striae in a case of Cushing’s Syndrome / Journal of the ASEAN Federation of Endocrine Societies

@#An 18-year-old Indian boy presented with increasing weight, generalised weakness, proximal myopathy and some rashes over his abdomen for the last 6 months. On examination, he was found to have broad purple striae on his abdomen, hypertension and proximal myopathy. He gave history of exogenous oral steroid use for his bronchial asthma which had been more frequent for the last year.