Clinical Presentation and Management of Eyes with Globe Perforation during Peribulbar and Retrobulbar Anesthesia: A Retrospective Case Series

Purpose@#To evaluate the clinical presentation, management, and outcome of eyes with an inadvertent globe perforation during peribulbar or retrobulbar block. @*Methods@#This retrospective study evaluated the eyes which had an accidental globe perforation during local ocular anesthesia from 2012 to 2020. The patients were divided into three groups: group 1, Clear media with no rhegmatogenous retinal detachment (RRD); group 2, significant vitreous hemorrhage (VH) precluding the retinal view without RRD; and group 3, RRD with/without VH. @*Results@#Twenty-five patients were included in the study. The mean axial length (AL) was 24.7 ± 2.7 mm (range, 20.9–31.2 mm). The most common presenting feature was VH (n = 14). The treatment included retinal laser barrage (n = 7) and vitrectomy (n = 17). Retinal breaks were identified in all the eyes (total breaks = 37). The mean presenting best-corrected visual acuity in groups 1, 2, and 3 were logarithm of the minimum angle of resolution 0.79 ± 0.73, 1.82 ± 0.78, and 2.13 ± 0.59 respectively. All the treated patients had an attached retina at the last follow-up. The mean final best-corrected visual acuity for each group was logarithm of the minimum angle of resolution 0.59 ± 0.79, 0.48 ± 0.26, and 1.25 ± 0.64, respectively (p = 0.006). The development of RRD was associated with a larger AL (p = 0.015); while the development of significant VH associated with the superior location of the perforation (p = 0.015), late recognition of the perforation (p = 0.004), and multiple perforations (p = 0.015). @*Conclusions@#Early recognition and intervention in eyes with an inadvertent perforation can lead to a good outcome. Eyes with a longer AL, superior, and multiple perforations are at higher risk of developing complications like RRD and VH. Complications like RRD, macular injury, and vascular occlusion are risk factors for poor prognosis.

Comparison of Conventional and Combined APGAR score in Predicting Adverse Early Neurologic Outcomes in Term and Near Term Babies with Birth Asphyxia

Objective: To compare the Conventional and Combined Apgar scoring systems in predicting adverse early neurologic outcomes in term and near term babies with birth asphyxia. Methods: A retrospective cross sectional study was conducted over a period of 2 years. All the neonates with gestational age more than 35 weeks delivered in this hospital with birth asphyxia requiring admission in NICU were included in the study. Neonates with gestational age less than 35 weeks, those with major congenital anomalies and death in delivery room were excluded from the study. The APGAR and COMBINED APGAR scores were noted. Convulsion, use of anticonvulsant drugs, requirement of mechanical ventilation, and duration of hospital stay were also noted. The data was analysed using fisher exact test. Results: Statistically significant associations were observed between Apgar score less than 3 at 1 minute and occurrence of convulsion (p=0.003) and requirement of ventilation (p<0.001), Apgar score less that 6 at 5 minutes” occurrence of convulsion (p=0.001) and requirement of ventilation (p<0.001), Combined Apgar score less that 7 at 1 minute and occurrence of convulsion (p=0.003) and requirement of ventilation (p=0.002), Combined Apgar score less that 10 at 5 minutes and occurrence of convulsion (p<0.001) and requirement of ventilation (p<0.001), and early neonatal death (within 7 days)” and Combined Apgar score less than 7 at 1 minute (p=0.09) and Combined Apgar score less than 10 at 5 minutes (p=0.09). Conclusion: Though a low combined apgar score was superior to the traditional apgar score in predicting early neonatal mortality, no difference was seen in prognostication of convulsion and mechanical ventilation.

Bioactive potential of bacterial endosymbionts isolated from Lamellodysidea herbacea, marine sponge from the coast of South Andaman, India, against human bacterial pathogens

Sponge diversity along the coasts of Andaman and Nicobar Islands comprises about 126 species and sponges are knownto act as a host to endosymbionts, which is found to possess novel antimicrobial metabolites. In the present study,screening and characterization of antibiotic producing endosymbiotic bacteria from the marine sponge Lamellodysideaherbacea were investigated. Eight isolated bacterial strains from the sponge were screened for bioactivity againsthuman pathogens Escherichia coli (MTCC 443), Bacillus cereus (MTCC 430), Bacillus subtilis (MTCC 121), Listeriamonocytogenes (MTCC 839), Staphylococcus aureus (MTCC 3160) and Salmonella enterica typhimurium (MTCC1252) and only two strains CAB1 and CAB38 exhibited activity. Ethyl acetate extracted metabolites of strain CAB1showed significant activity against four pathogens B. cereus, B. subtilis, S. aureus and S. entrica typhimurium andCAB38 against three pathogens B. subtilis, E. coli and S. entrica typhimurium. The 16S rRNA gene sequence of thesetwo strains showed 99% sequence similarity with known sequences in the GenBank and their phylogenetic analysisconfirmed strain CAB1 as Bacillus amyloliquefaciens (MK135790) and CAB38 as Alcaligenes faecalis (MK135791).The study demonstrated that metabolites from sponge associated bacterial endosymbionts can be a major source ofunique compounds with potential bioactivity.

Bioactive potential of bacterial endosymbionts isolated from Lamellodysidea herbacea, marine sponge from the coast of South Andaman, India, against human bacterial pathogens

Sponge diversity along the coasts of Andaman and Nicobar Islands comprises about 126 species and sponges are knownto act as a host to endosymbionts, which is found to possess novel antimicrobial metabolites. In the present study,screening and characterization of antibiotic producing endosymbiotic bacteria from the marine sponge Lamellodysideaherbacea were investigated. Eight isolated bacterial strains from the sponge were screened for bioactivity againsthuman pathogens Escherichia coli (MTCC 443), Bacillus cereus (MTCC 430), Bacillus subtilis (MTCC 121), Listeriamonocytogenes (MTCC 839), Staphylococcus aureus (MTCC 3160) and Salmonella enterica typhimurium (MTCC1252) and only two strains CAB1 and CAB38 exhibited activity. Ethyl acetate extracted metabolites of strain CAB1showed significant activity against four pathogens B. cereus, B. subtilis, S. aureus and S. entrica typhimurium andCAB38 against three pathogens B. subtilis, E. coli and S. entrica typhimurium. The 16S rRNA gene sequence of thesetwo strains showed 99% sequence similarity with known sequences in the GenBank and their phylogenetic analysisconfirmed strain CAB1 as Bacillus amyloliquefaciens (MK135790) and CAB38 as Alcaligenes faecalis (MK135791).The study demonstrated that metabolites from sponge associated bacterial endosymbionts can be a major source ofunique compounds with potential bioactivity

Quest for good quality medicines in hospitals: a structured approach

Patients use medicines to gain speedy recovery from illness or to maintain wellbeing under the care of their physicians. For chronic illnesses, the pharmacotherapy may continue for the entire lifetime. Significant expenditure is incurred in sustaining this pharmacotherapy. Quite expectedly, the patients are concerned about the quality of medicines that they receive and consume. In recent times, the quality concerns have increased phenomenally due to media hype and overexposure all around. Ensuring quality of medicines in developing countries is not easy. Multi-pronged approaches are needed to ensure procurement of good quality medicines by institutional buyers. However, ensuring the procurement of good quality medicines is not enough. The quality of medicines has to be maintained till their consumption by patients and a rational, scientific method has to be adopted to ensure this goal. A structured approach in ensuring good quality medicines for optimum pharmacotherapy is being presented in this review.

The Prevalence of Os Acromiale in Korean Patients Visiting Shoulder Clinic

BACKGROUND: The prevalence of os acromiale has been documented to be between 1% and 15% and is known to be clinically associated with subacromial impingement or rotator cuff tear. However, the prevalence of os acromiale in Korea has not yet been determined. The purpose of this study is to evaluate the prevalence of os acromiale in Korean patients who visited shoulder clinics and to investigate the correlations with rotator cuff tear. METHODS: We retrospectively reviewed the X-rays of patients visiting a shoulder clinic at a tertiary hospital in Korea from January 2011 to January 2012 to determine the frequency of os acromiale. X-ray findings were confirmed with magnetic resonance imaging (MRI) for patients who had these images available. MRI was also used to assess the status of the rotator cuff. The correlation between the presence of os acromiale either with gender, hand dominance or rotator cuff tear was analyzed statistically. RESULTS: A total of 2,946 shoulders from 1,568 patients were analyzed with X-rays. Thirteen cases out of 1,568 patients had an os acromiale; and there were five and eight cases of pre-acromiale and meso-acromiale, respectively. Thus, the prevalence of os acromiale in this study population was found to be 0.7 (7 cases per 1,000 patients). Bilaterality was found in two cases. Os acromiale was not more frequent according to gender (five males versus eight females, p = 0.525) and hand dominance was not associated with frequency of os acromiale (seven dominant arms versus six non-dominant arms, p = 0.631). A sub-analysis of shoulders with available MRIs (1,074 shoulders) revealed that there were two rotator cuff tears (40%) out of five cases of os acromiale, whereas 607 rotator cuff tears were observed (57%) among 1069 cases without os acromiale. This difference was not statistically significant (p = 0.656). CONCLUSIONS: The identified prevalence of os acromiale in Korean patients who visited shoulder clinics is 0.7%, which is much lower as compared with the prevalence of general population from other ethnic groups. No correlation was observed between rotator cuff tears and os acromiale in this study population.

ECG pattern in paediatric population of western Rajasthan

The ECG pattern in paediatric population varies with age and sex. The majority of changes occur during the first year of life due to changes in cardiac anatomy and haemodynamics soon after birth, as a result of the cessation of placental circulation and establishing cardiopulmonary circulation. Therefore the majority of normal adult values cannot be used in the newborn. This study was carried out in 200 children, with equal males and females, divided into 5 age groups from 0-14 years. Single chest lead ECG machine with standard setting [10 mm/mV. with a standard paper speed of 25 mm/sec.] was used in the study for recording of ECG. The electrocardiogram was recorded in all 12 leads and carefully interpreted for heart rate, rhythm, intervals and duration for evaluation of developmental, age and sex related changes. The heart rate was increased in first 1-2 month of age and then in the following 6 months it remained stable and then slowly declined after 1 year of age. Heart rate attained adult value at the 12-14 years of age. The PR interval correlated with heart rate and with age. PR interval progressively and significantly increased with age and decreased with heart rate up to 4 year of age. Duration of QRS increased with age; in new born infants ranging from [37-80 ms] and 75 ms at the age of 6-14 years. Mean QRS duration was greater for boys than for girls in most age groups, but the difference in upper limits of normal was small, ranging from 2 to 7 ms. Mean value of QTc interval was not significantly changed with age as compared to heart rate. We found an upper limit of the normal QTc interval as 523 ms which is higher than the commonly used criterion of 440 ms. Significant gender differences were demonstrated for amplitude and QRS duration. Normal limits of many ECG measurements in our study were different from those reported earlier. These findings are clinically significant and suggest that diagnostic criteria for the paediatric ECG should be adjusted. These gender specific ECG parameters are useful for the interpretation of paediatrics ECG

Basal ganglia involvement in herpes simplex encephalitis.

Herpes simplex encephalitis (HSE) is a leading cause of sporadic, nonepidemic viral encephalitis in children and adults. We report a very rare case of HSE with involvement of bilateral thalamus, putamen, upper pons and midbrain, with development of extrapyramidal symptoms which responded to corticosteroid therapy. A 15-mth-old female baby admitted with complaint of fever for 5 days and generalised tonic clonic seizure 10 hours before admission. On clinical examination patient was drowsy, temperature was 39.4 oC and vitals were stable with signs of increased intracranial tension. There were no signs of meningeal irritation. Patient gradually become unconscious in the next few hours and pupils were constricted bilaterally with development of atonia in all four limbs and neck muscles. Doll’s eye phenomenon was absent.

Anti-La negative cutaneous lupus erythematosus in a newborn.

A newborn presented with erythematous lesion over face, which appeared soon after birth. Diagnosis of neonatal lupus erythematosus (NLE) was confirmed by positive anti-Ro SSA antibody and skin biopsy. But anti-La SSB antibody was negative. Her hepatic transaminases were high. But no cardiac manifestations were noted.

Conscious off-pump coronary artery bypass surgery.

BACKGROUND: Cardiothoracic surgery has been previously performed successfully under thoracic epidural anesthesia alone. Between October 2001 and December 2003, we performed 123 conscious off-pump coronary artery bypass surgeries using epidural anesthesia as the sole anesthetic. This technique is an alternative to cardiothoracic surgery performed under general anesthesia. Certain modifications in the technique facilitate the process. METHODS AND RESULTS: There were 24 female patients and 99 male patients with mean age of 58.6 +/- 6.2 years; 12 patients underwent repeat coronary artery bypass surgery. All the patients underwent epidural catheterization on the evening before surgery. Out of the 123 patients scheduled for coronary artery bypass graft surgery, 120 underwent off-pump coronary artery bypass graft surgery successfully; 4 patients underwent off-pump surgery via left thoracotomy and the rest through mid sternotomy. These patients received 295 grafts in all (single graft in 26 patients, double in 42 patients, triple in 35 patients, and quadruple in 20 patients). Three patients required conversion to general anesthesia and one to cardiopulmonary bypass. There was no mortality in the group. CONCLUSIONS: Our experience suggests that by modifying the surgical techniques, we can accomplish conscious coronary artery bypass surgery.