Intra-arterial chemotherapy in refractory and advanced intraocular retinoblastoma

Purpose: To evaluate the efficacy of secondary and salvage intra?arterial chemotherapy (IAC) as a globe salvage treatment modality in advanced and refractory intraocular retinoblastoma. Methods: A retrospective chart review of advanced intraocular retinoblastoma (groups D and E International Classification of Retinoblastoma [ICRB] classification) patients refractory to intravenous chemotherapy (IVC) and undergoing IAC as the secondary and salvage treatment modality between December 2018 and June 2021 was carried out. All patients underwent the IAC procedure by super?selective ophthalmic artery catheterization and with triple?drug chemotherapeutic agents of melphalan, topotecan, and carboplatin. Data were collected about tumor regression, eye salvage, metastasis, and survival outcome at follow?up. Results: Out of 13 patients, 12 patients received secondary IAC after being primarily treated with IVC and focal therapies and one patient received rescue IAC after recurrence following primary IAC. Mean number of IAC cycles administered was 2. Overall, globe salvage rate was 53.84%, with a mean follow?up of 17.53 months (range 6–37 months), three patients had enucleation for residual tumor or tumor recurrence. One patient developed metastasis post enucleation and two patients who were lost to follow?up after enucleation advice for residual tumor developed orbital tumor extension and eventually died of metastasis. Conclusion: Secondary triple?drug IAC following failure of IVC, along with other adjunct treatment modalities might a be a cost?effective option for eye salvage in advanced intraocular retinoblastoma patients who refuse enucleation, with a globe salvage rate of 53.84%. It can also be an effective approach to improve treatment compliance and can help in addressing the barrier of treatment refusal when enucleation is advised.

Sodium-glucose cotransporter-2 inhibitors: updated evidence on their efficacy and safety in patients with type-2 diabetes

Management of type-2 diabetes mellitus (T2DM) is challenging. The scope of existing therapies toward T2DM has transformed remarkably. These large assortments of therapies have produced evidence-based data. Sodium-glucose cotransporter-2 inhibitor (SGLT-2i) is the most recent class of oral anti-hyperglycemic agents. They are approved by Food and Drug Administration for the treatment of diabetes mellitus. SGLT-2i has a unique mechanism of action and that lower glucose independent of insulin. They reduce renal tubular glucose reabsorption, thereby lowering blood glucose without stimulating the release of insulin. Additional advantages involve suitable effects on blood pressure and weight. According to guidelines of the American Association of Clinical Endocrinologists/ the American College of Endocrinology 2016, SGLT-2i (in the form of canagliflozin, dapagliflozin, and empagliflozin) is one of the acceptable alternatives to metformin as initial therapy towards T2DM. Canagliflozin, dapagliflozin, and empagliflozin reduce the cardiovascular risk in comparison to placebo as the part of standard care. This review article focuses on the clinical trials published over the past year and specifically the metabolic aspect of SGLT-2i and the adverse effects related to SGLT-2 inhibitors.

Cervical ossification of the posterior longitudinal ligament and its post surgical outcome analysis

Background: Ossification of the posterior longitudinal ligament (OPLL) is a complex multi-factorial disease process having both metabolic and biomechanical factors. The objective of this study was to assess the surgical out come and post operative functional improvement in patients with cervical OPLL at a tertiary care centre.Methods: This prospective observational study included 35 patients undergoing surgery for cervical OPLL in the department of neurosurgery, Care hospitals Hyderabad from October 2015 to October 2016 with follow up at 3months and 6 months.Results: Total 35 patients who underwent surgery, majority (77.15%) were males and (22.85%) were female. The age of the patients was between 30 to 70 years. The most common type of OPLL was found to be segmental and mixed type. Nurick grade improved by 1.12 in anterior approach vs 0.66 in posterior approach. Recovery rates observed in anterior approach is 57.72% while in posterior surgical approach it is 48.87%. No complication was observed in this study.Conclusions: OPLL is more common in males as compared to females. The average age of presentation is sixth decade. Younger patients have better outcomes. The most common variant of OPLL is segmental.  The recovery rate achieved from anterior approach are better than those from the posterior approach. Improvement in NURICKS score is more in anterior surgical group than in posterior surgical group. No complications seen in this study. No mortality seen in this study.

Assessment of two‑way relationship between periodontal disease and gestational diabetes mellitus: A case–control study.

Background: Gestational diabetes mellitus (GDM) is glucose intolerance which begins during pregnancy. Few studies have examined the association between periodontal disease and GDM. Aim: The aim of this study was to assess the association between periodontal disease and GDM. Materials and Methods: The study population comprised ninety patients, out of which thirty were cases and sixty were controls. All cases underwent a laboratory screening test for GDM between 24 and 30 weeks of gestation based on the recommendation of the obstetricians and gynecologists. To assess the periodontal status, a full‑mouth periodontal examination assessing the probing depth, periodontal depth, bleeding on probing, clinical attachment level, and gingival recession was performed on all study participants by a single trained examiner. Tests for associations were performed using Chi‑square statistics and multivariate logistic regression analysis. Results: None of the periodontitis conditions was found to be a significant predictor of GDM. In GDM patients, 70% of females were having periodontal disease whereas non‑GDM patients 77% of patient had periodontal disease. Conclusion: The present study did not show any positive association between periodontal disease and GDM.

Septic Shock Due to Tuberculosis in Down Syndrome.

Thyroid nodules are uncommon in childhood and recurrent thyroid nodules even rarer. Spindle epithelial tumor with thymus-like differentiation (SETTLE), a rare and distinctive lowgrade neoplasm is amongst the differential diagnosis of solitary thyroid nodule in children. We describe a boy who underwent completion thyroidectomy for SETTLE in the thyroid remnant four years after initial lobectomy was performed for the same diagnosis. Patients with SETTLE are to be closely followed as multifocality may manifest and be detected later.

Ectrodactyly/split hand feet malformation.

Split-hand/split-foot malformation is a rare limb malformation with median clefts of the hands and feet and aplasia/hypoplasia of the phalanges, metacarpals and metatarsals. When present as an isolated anomaly, it is usually inherited as an autosomal dominant form. We report a case of autosomal recessive inheritance and discuss the antenatal diagnosis, genetic counseling and treatment for the malformation.

Segmental testicular infarction.

Segmental testicular infarction is described in 11-years-old-child presented with acute left hemiscrotal pain and swelling. Clinical examination suggested left testicular tenderness with no evidence of intratesticular mass and the rest of the scrotal contents were normal. Color doppler study suggested a well circumscribed avascular lesion in the upper pole of left testis and provided a clue to diagnosis. Partial orchidectomy resulted in a satisfactory recovery and provided histopathological confirmation of diagnosis. Authors review their experience with this rare entity and the pertinent literature.

Congenital muscular dystrophy with characteristic radiological findings similar to those with Fukuyama congenital muscular dystrophy.

Fukuyama congenital muscular dystrophy (FCMD) is the most common congenital muscular dystrophy in Japan and there are isolated reports of non-Japanese patients with FCMD. We report an Indian patient with congenital muscular dystrophy and characteristic radiological findings similar to those with FCMD.

Sewing needle appendicitis in a child.

A six-year-old boy presented with abdominal pain and vomiting five days after accidental ingestion of a sewing needle. The presence of the needle in the right iliac fossa on plain roentgenogram along with signs of appendicular inflammation on clinical and laboratory evaluation provided a clue to the diagnosis. Surgical exploration revealed inflamed appendix with the ingested needle in its lumen. The child recovered after appendectomy, and is well six months later.

Ectopic pancreas as a cause of gastric outlet obstruction in an infant.

We report a one-month-old male child who presented with clinical and radiological features of gastric outlet obstruction. Surgical exploration showed presence of a prepyloric mass; histological examination of the resected specimen confirmed presence of ectopic pancreatic tissue. The child is well 8 months later.

Congenital scaphoid megalourethera: A surgical experience with augmented Nesbitt's urethroplasty.

Congenital scaphoid megalourethera is described in two infants presented with abnormal large, flabby phallus and postvoiding dribbling of urine. MCU showed crescentric dilatation of penile urethra without any proximal or distal obstruction. A thorough evaluation suggested absence of any associated anomalies. Nesbitt's urethroplasty reinforced with dartos pedicle flap resulted in a satisfactory recovery. Authors review their experience with this modified surgical repair and the pertinent literature.

Pararectal duplication.

An unusual case of pararectal duplication is described in a 2 months old female infant presented with abdominal lump and constipation. The unusual clinical presentation and the management protocol of this rare entity are discussed. Authors review their experience with the present case and the pertinent literature.

Primary biliary tuberculosis in a child.

A case of primary biliary tuberculosis is described in an eight year old female child. The clinical and radiological features suggested presence of chronic cholecystitis. Surgical exploration revealed thick walled gall bladder distended with caseous material with adherent caseating portal lymph nodes. Cholecystostomy along with antitubercular therapy resulted in satisfactory recovery. Histopathological examination of lymph node biopsy and microbial examination of pus confirmed diagnosis of tuberculosis. Authors review their experience with this rare entity and the pertinent literature.

Post-traumatic retroperitoneal colonic injury presenting as gluteal abscess.

We report an 8-year-old boy who sustained blunt retroperitoneal right colonic injury in a vehicular accident and presented with gluteal abscess. Surgical exploration revealed perforated posterior wall of ascending colon with surrounding retroperitoneal abscess communicating with the gluteal region. Right hemicolectomy with drainage of retroperitoneal and gluteal collections resulted in satisfactory recovery.

Acute appendicitis presenting as acute hemiscrotum in a boy.

A 6-year-old boy presented with diffuse abdominal pain, nausea and vomiting followed by features of acute scrotum. Laboratory and radiological evaluation suggested presence of infective pathology in the inguinoscrotal region. Surgical exploration revealed patent right processus vaginalis with purulent collection resulting from the presence of perforated tip of appendix in the hernial sac. Appendectomy with drainage of scrotal collection and ligation of hernial sac resulted in satisfactory recovery.

Giant intraparenchymal neurocysticercosis: unusual MRI findings.

We report a case of surgically proven giant neurocysticercosis (NCC). MR imaging revealed an unusually large solitary parenchymal cystic lesion showing signal intensity similar to CSF on all pulse sequences, with internal septations and a small nodule in the anterior aspect of this lesion compatible with this diagnosis. Identification of a scolex in a cystic lesion with CSF intensity plays a key role in the diagnosis of NCC. The presence of internal septations is an atypical feature.