ABSTRACT
Background: Bacterial meningitis is a medical emergency and late diagnosis and treatment can lead to neurological damage and death. For definitive diagnosis of meningitis, laboratory based CSF analysis is required which is based on microscopy, protein and sugar estimation. This requires laboratory set up with experienced pathologist and long turn around time. Hence urinary reagent strips as a semiquantitative method can be applied for CSF analysis. This method can be used where laboratory set up is not available as well as bedside test for early diagnosis of bacterial meningitis. The present prospective study was undertaken to evaluate the utility of urine reagent strips in rapid diagnosis of bacterial meningitis. The aim of the present was to evaluate the role of urine reagent strips in the analysis of cerebrospinal fluid in suspected cases of meningitis.Methods: The prospective study was carried out in the department of pathology in a tertiary care centre for a period of 6 months from September 2018 to February 2019. CSF analysis of suspected cases of meningitis was done with urine reagent strip as well as with standard laboratory method. The results of both were compared.Results: Out of 79 cases of meningitis, 68.35% cases were of bacterial meningitis. The specificity and sensitivity of CSF analysis with reagent strip was 93.33% and 82.35% respectively, for cell count, 94.4% and 88.2% respectively for proteins and 91.3% and 60.2% respectively for glucose.Conclusions: Semiquantitative analysis of CSF sample with urine reagent strips helps in rapid diagnosis of bacterial meningitis and can be useful to facilitate therapeutic decisions in resource constrained settings.
ABSTRACT
Background: Idiopathic orbital inflammatory disease has myriad clinical presentations. It is a common presentation to our oculoplasty clinics. The management is with anti inflammatory agents. The relapsing nature and the occasionally encountered refractory cases make it a clinical challenge. Aim: The aim of the study is to document the clinical presentation and management of fifteen consecutive cases of idiopathic orbital inflammatory disease seen at a regional institute of ophthalmology. Methods:The clinical presentation of fifteen consecutive cases of idiopathic orbital inflammatory disease were documented. Serology was carried out to rule out specific causes of orbital inflammation. A Computed tomography scan was carried out to document the findings and confirm the diagnosis. Results: Five cases presented to us with dacryoadenitis. Seven patients presented with proptosis with accompanying ophthalmoplegia.Three cases presented to us with orbital apex syndrome.Five cases presented to us with myositis with ocular motility restriction with good vision. Discussion: Idiopathic orbital inflammatory disease has been reported by many research workers acroos the globe. Our study presents a unique perspective on this entity from our part of the world. Conclusion: The clinical presentation and management of idiopathic orbital inflammatory disease at our western regional institute of ophthalmology is documented.
ABSTRACT
Background & Objective: NMDA is a receptor for the excitatory neurotransmitter glutamate, which is released with noxious peripheral stimuli. The activation of NMDA receptors has been associated with hyperalgesia, neuropathic pain, and reduced functionality of opioid receptors. Hyperalgesia and neuropathic pain are a result of increased spinal neuron sensitization, leading to a heightened level of pain. The reduced function of opioid receptors is caused by a decrease in the opioid receptor's sensitivity. Therefore, NMDA antagonists have a role in these areas of pain management. Ketamine is a strong NMDA antagonist. To study the role of NMDA receptors in pain and modulation by blocking the receptors through antagonist ketamine given pre-emptively and postoperatively via epidural route in patients of lower limb amputation. Methodology: This study was conducted at Civil Hospital Ahmedabad during the year 2012-2015 with the permission of ethical committee of hospital and after written informed consent of 60 adult patients of age group 18- 60 years of either sex and ASA grade 1 or 2 posted for lower limb amputation. Patients were divided into three groups where one was administered epidural opioid and ketamine, the second group was administered epidural opioid only and in the third group epidural saline was administered. Pain scores of all the groups were compared. Results: Requirement of first dose of analgesia in group 1 is after 12.5±1.03hrs, in group 2 after7.6± 0.98 hrs and in group3 after 3.4± 0.8hrs and average duration between consecutive analgesic doses were 11.5hrs in group 1, 7.6hrs in group 2 and 4.5hrs in group 3 respectively. Conclusion: NMDA receptor antagonist is effective in management of acute post-operative pain compared to opioid analgesics alone as the time to first dose of analgesia is much larger in group 1 than 2 and 3. Ketamine has definitive role in opioid sparing effect as supplemental analgesic requirement is decreased.
ABSTRACT
Myofibroblasts have been implicated in most fibro-contractive diseases and even in developing and specialized normal body tissues. Myofibroma denotes benign neoplasms composed of contractile myoid cells arranged around thin-walled blood vessels affecting the soft tissue, bone, or internal organs at all ages with the intraosseous variant being an uncommon entity. Histologically, these tumors are characterized by being circumscribed masses of spindle cells, which may lead to confusion in diagnosis with more aggressive soft tissue spindle cell tumors. A case is reported of a 7-year-old female patient who presented with a solitary intraosseous myofibroma in the inferolateral aspect of the left orbit. This article describes the clinical, radiographic, histopathologic, and immunohistochemical features of an intraosseous myofibroma in a female child.