Outcomes of 8 × 8 mm osteotomy in powered external dacryocystorhinostomy

Purpose: To study the endoscopic ostium characteristics and outcome of 8 × 8 mm osteotomy in external dacryocystorhinostomy (DCR) using the microdrill system. Methods: This prospective interventional pilot study was performed on 40 eyes of 40 patients with primary acquired nasolacrimal duct obstruction (NLDO) from June 2021 to September 2021 in patients undergoing external DCR. An 8 × 8 mm osteotomy was performed using round, cutting burr attached to a microdrill system. Success was defined as patent ostium on lacrimal syringing (anatomical) and a Munk score <3 (functional) at 12 months. Postoperative endoscopic ostium evaluation was done using a modified DCR ostium (DOS) scoring system at 12 months. Results: The mean age of the study participants was 42.41 ± 11.77 years and the male?to?female ratio was 1:4. The mean duration of surgery was 34.15 ± 1.66 minutes and that for osteotomy creation was 2.5 ± 0.69 minutes. The mean intraoperative blood loss was 83.37 ± 11.89 ml. Anatomical and functional success rates were 95% and 85%, respectively. The mean modified DOS score was “excellent” in 34 patients (85%), “good” in 1 patient (2.5%), “fair” in 4 patients (10%), and “poor” in 1 patient (2.5%). Complications included nasal mucosal injury in 10% (4/40) of patients, complete cicatricial closure of ostium in 2.5% (1/40), incomplete cicatricial closure in 10% (4/40), nasal synechiae in 5% (2/40), and canalicular stenosis in 2.5% (1/40). Conclusion: An 8 × 8 mm–sized osteotomy created by powered drill and covered by lacrimal sac–nasal mucosal flap anastomosis in external DCR is an effective technique that has minimal complications and shorter surgical time

Correction of pre-existing astigmatism by on-axis incision size modulation in manual small-incision cataract surgery

Purpose: To study the effect of wound size modulation on pre?existing astigmatism by on?axis placement of incision in manual small?incision cataract surgery (MSICS). Methods: In this prospective interventional study conducted at a tertiary care centre, 40 eyes of 40 consecutive senile cataract patients with 1.00�00 D corneal astigmatism were enrolled for the study. MSICS by modified Blumenthal抯 technique was performed through 6.0, 6.5, and 7.0 mm on?axis incision in 1.0�49 D (group A), 1.50�99 D (group B), and 2.00�00 D (group C) astigmatism, respectively. Surgically induced astigmatism (SIA) was calculated by vector analysis and double angle plots (DAP) at 12 weeks postoperatively. Results: There were 22 males and 18 females with mean age of 58.12 � 1.18 years. The mean SIA at 12 weeks was 0.85 � 0.28 D in group A (17 eyes), 1.32 � 0.65 D in group B (10 eyes), and 1.91 � 0.69 D in group C (13 eyes). The overall median uncorrected visual acuity was 0.18 (IQR = 0 to 0.2). The mean astigmatism decreased from 1.95 � 0.74 D to 1.04 + 0.57 D (P = 0.00) in superior incision and from 1.70 + 0.50 D to 0.92 � 0.45 D (P = 0.00) in temporal incision group with central shift of centroid in all cases. Conclusion: The customization of on?axis external incision size can be used to manage pre?existing corneal astigmatism of less than 3.00 D using both temporal and superior incisions effectively

Need for artificial intelligence in pharmaceutical industry and its limitations

Artificial intelligence (AI) is often being touted as the means to bring about the fourth industrial revolution and its role in almost all sectors of our society is almost certain. This brings about an urgent need for evaluating the benefits and limitations of AI and machine learning (ML) across various sectors. Pharmaceutical industry has pioneered in embracing the use of AI in all its core areas but the success as of now seems very limited. The major advantage of AI is that it reduces the time that is needed for drug development, and in turn, it reduces the costs that are associated with drug development, enhances the returns on investment, and may even cause a decrease in cost for the end user along with improved drug safety. Hence, in this article, we will review the scope and limitations of AI in the pharmaceutical industry along with the brief review of how AI/ML can impact geriatric health care.

In vitro evaluation of free flavonoids in Cassia fistula Linn. calli of different ages under varying concentrations of plant growth regulators (PGRs)

Cassia fistula Linn, a paramount medicinal plant consumed by huge population all over the world. Its bioactive metabolites include flavonoids, phenolics, and polyphenols. Major objective of current study is to find right media combination and age of callus for maximum accumulation of free flavonoids in Cassia fistula cultures. In this study, the calli were induced in MS + 1.0mg/L 2,4-D + 0.05 mg/L BAP with 50 mg/L ascorbic acid. These calli were then transferred to basic MS medium with 1.0 mg/L2,4,5-T and varied BAP concentrations. Four and 8 weeks old calli were used to find out the right concentration of BAP and age for upscaling of free flavonoids. The samples were extracted and HPTLC analyzed for free flavonoids at 260 nm along with the leaf explants. The study revealed that the amount and number of free flavonoids in 4 weeks old calli increased as the amount of cytokinin (0.5 to 1.0 mg/L BAP) increased but decline with further addition of BAP (2.0 mg/L BAP). In aged calli number and amount of free flavonoids exhibit a tremendous increase when compared to the calli in the same medium at 4 weeks. This is inferred that accruing age of callus, reduced quantities of plantgrowth regulators (optimized for callus growth) accumulate free flavonoids. The best medium for free flavonoid production is MS+ 1.0 mg/L 2,4,5-T with 1.0 mg/L BAP may be recommended for producing a high amount of free flavonoids in C. fistula in vitro.The results were justified with the results of quantification.

Anti-inflammatory and analgesic activities of imidazolyl triazolo hydroxamic acid derivatives

Hydroxamic acids are directly related with cancer and its progression. Long term exposure with inflammatory responses, dysplasia develops which leads to cancer. Metastasis of cancer and expression of transient potential receptor ankyrin-1 are known to cause severe pain. Here, we explored the possibility of developing newer hydroxamic acid derivatives as anti-inflammatory and analgesic agent. Animals were administered with 100 mg/kg dose of the synthesized imidazolyl triazolo hydroxamic acid derivatives (FP1-FP12) and 50 mg/kg dose of standard diclofenac sodium. Carrageenan induced rat paw edema and Eddy’s hot plate methods were considered for anti-inflammatory and analgesic activities. Among all the synthesized molecules, FP10 and FP4 were the most effective anti-inflammatory and analgesic agent, respectively. The activity profile of remaining molecules as anti-inflammatory agents was as follows: FP4>FP9> FP8> FP2 and as analgesic activity profile was FP10>FP3>FP8 >FP11 >FP2 > FP12. Presence of ethyl- benzyl and furan groups in linker portion of the structure minimized both the anti-inflammatory and analgesic activities. Results have shown that compounds with electron releasing groups considerably enhance both anti-inflammatory and analgesic activities.

Laparoscopic repair of post hysterectomy ureterovaginal fistula

The fistulas, following gynecologic, surgeries are not uncommon. Hysterectomy is one of the most common causes of lower urinary tract fistula in pelvic surgery. Higher incidences are associated with laparoscopic hysterectomy as compared to vaginal or abdominal hysterectomy. Early identification and management of ureterovaginal fistula (UVF) are of utmost importance. The laparoscopic approach in the management of UVF is preferred over open surgery as it reduces pain, hospital stay, and morbidity. However, the laparoscopic approach needs higher surgical dexterity, sound knowledge of pelvic anatomy, and has a higher learning curve. One such approach is discussed here.

Comparative Study between Timed Intercourse and Intrauterine Insemination in Ovulation Stimulated Cycles in Unexplained Infertile Couples

Background and Objectives: It cannot be stressed enough that infertility is a problem of the couple and not an individualalone. IUI as a mode of artificial insemination is widely used in treating couples with unexplained infertility. The present studywas done with the objective of comparing the effectiveness of TI and IUI with husband’s sperm in couples with unexplainedinfertility undergoing superovulation with clomiphene.Methodology: In this cross-over study, a total of 60 couples with unexplained infertility were subjected to controlled ovarianhyperstimulation with clomiphene and prospectively randomized to receive either TI (Group A) or IUI (Group B). The groupswere interchanged when pregnancy was not achieved in either group after three cycles of each intervention.Results: A positive pregnancy test was seen in both IUI and TI after cross-over. There were seven pregnancies (four in IUI andthree in TI), out of which 6 (85.71%) were viable pregnancies, while one was non-viable (14.29%). Both IUI and TI had threeviable pregnancies each. The one non-viable pregnancy was from the IUI group.Interpretation and Conclusions: The findings of the present study showed that both TI and IUI are effective treatment modalitiesfor women with unexplained infertility. Although the addition of IUI to ovulation induction does increase the cycle fecundability,it does not improve the fecundity.

Single-nucleotide polymorphisms in CLEC7A, CD209 and TLR4 gene and their association with susceptibility to paratuberculosis in Indian cattle

The aim of this study was to identify the single-nucleotide polymorphisms (SNPs) in bovine candidate genes CLEC7A, CD209 and TLR4, and explore the association between these SNPs with the occurrence of bovine paratuberculosis (PTB) disease. For this purpose, 549 animals were screened by a panel of four diagnostic tests, namely Johnin PPD test, ELISA test, faecal microscopy and IS900 blood PCR against Mycobacterium avium ssp. paratuberculosis (MAP) to develop case–control populations. SNPs were genotyped by polymerase chain reaction-restriction fragment length polymorphism method. Genotypic–phenotypic associations were assessed by the PROCLOGISTIC procedure of SAS 9.3. Of the seven SNPs; rs110353594 in CLEC7A gene and rs8193046 in TLR4 gene were found to be associated with PTB. For SNP rs110353594, odds of CC and CT genotypes vs TT genotype was 1.543 (0.420–5.667; 95% CI) and 0.284 (0.104–0.774; 95% CI), respectively which means that CT genotype was more resistant than TT and CC genotypes against bovine PTB. For SNP rs8193046, odds of AA and AG genotypes versus GG genotype was 0.947 (0.296–3.034; 95% CI) and 3.947 (1.555–10.022; 95% CI), respectively, i.e. probability for getting an infection in animals with AG genotype was 3.94 times more as compared to GG genotype. Hence, a selection programme favouring CT genotype for rs110353594 and against AG genotype for rs8193046 may be beneficial for conferring resistance against bovine PTB

Assessment of the learning curve: total laparoscopic hysterectomy versus total abdominal hysterectomy

Background: Abdominal hysterectomy is the most frequented way of hysterectomy in the world; today we have a lot of techniques for hysterectomy. Total Laparoscopic Hysterectomy (TLH) versus Total Abdominal Hysterectomy (TAH) needs experience an assessment of the learning curve. Objective of the study was to determine the feasibility and safety of TLH and TAH.Methods: Total 100 women were taken for study. Operating time, estimated blood loss, operating complication and length of stay in hospital were noted for each patient. The success rates of TLH were more compared to TAH. The operating time estimated blood loss, conversion to laparotomy was directly proportional to size of uterus.Results: There were no statistically significant differences between the two groups regarding age, body mass index (BMI), specimen weight, pre-operative hemoglobin (Hb) value and rates of the complications. The mean post-operative Hb value was significantly higher in group TLH than group TAH (11.3±0.7 gr/dl versus 10.6±1.6, p = 0.03). The mean time of operation was significantly longer in TLH than group TAH (105.4±22.9 minutes versus 74±18, p<0.001). The mean duration of hospital stay was statistically shorter in TLH compared to the TAH (2.47±0.5 days versus 4.86±1.1, p<0.001).Conclusions: Advantage of TLH over TAH are less blood loss, fewer wound infection and fever, smaller incisions, with less pain, shorter hospitalization time, speedier recovery.

Termination Of The Common Facial Vein Into The Anterior Jugular Vein: A Rare Case Report

The facial vein drains the facial region of our body. It unites with the anterior division of the retromandibularvein to form the common facial vein. In this case report, the retromandibular vein was seen dividing normallyinto the anterior and posterior divisions. The posterior division was seen uniting with the posterior auricularvein to form the external jugular vein. Formation and course of the external jugular vein was normal. The anteriordivision of the retromandibular vein was uniting with the facial vein to form the common facial vein, which wasdraining into the anterior jugular vein instead of the internal jugular vein.

Detection Of Esbl-Producing Escherichia Coli And Klebsiella Pneumoniae In Patient Suffering With Symptomatic Urinary Tract Infection In Tertiary Care Hospital.

Aim and objectives: This study is to determine the prevalence of Extended spectrum beta-lactamases (ESBLs) in urinary isolates. To compare different phenotypic methods for ESBL detection and to evaluate the antibiotic resistance patterns among ESBL producing urinary Escherichia coli. Methodology: rd Urinary isolates of E.coli that were resistant to at least one of 3 generation cephalosporins (cefotaxime, ceftazidime) were screened and tested for ESBLproduction using the Double disc diffusion test (DDDT), quantitative E-strip method and Automated Vitek-2. Result: A total of 341 Klebsiella pneumoniae and Escherichia coli isolates were screened from patients with symptomatic UTI. 207 (60.7%) Escherichia coli, 134 (39.2%) Klebsiella pneumonia. ESBL production was detected in 48.8% and for 161 screening test positive E. coli, ESBL production was detected in 40%

Supernumerary Heads Of Biceps Brachii With Median Nerve And Brachial Vessels Passing Through The Third Head

A rare case of four-headed biceps brachii was observed during routine dissection on 60-year -old female oldcadaver. The short head and long head had normal origin. The third head was originating from the humerusbelow the insertion of coracobrachialis, whereas fourth head was coming from the greater tubercle of thehumerus. The median nerve and brachial vessels were passing through the third head. These variations areimportant because they could compress median nerve and brachial vessels

Variation In The Histological Structure Of Round Ligament Of Uterus At Uterine Cornu With Age

Introduction: The aim of present study is to evaluate the microscopic structure of the round ligament of uterusat the uterine cornu to examine the changes in the structure in different age groups i.e.adult females inreproductive age group, pregnancy & menopause.Materials and Methods: Twenty two round ligaments of uterus (25-70 yrs) were taken for the study of themicroscopic structure at the uterine cornu. The specimens were collected from adult females of reproductive agegroup, pregnant females and menopausal females. Microscopic structure was studied under light microscopeusing haematoxylin and eosin and Van Gieson’s stain was used to differentiate muscle from fibrous tissue.Results: The round ligament showed changes at the two ends of age spectrum chosen for the study (25-70 yrs). Inadult females of reproductive age group (25-40 yr old) it was predominantly muscular and the smooth muscleof the ligament was found to be continuous with that of the myometrium. In pregnant females markedhypertrophied smooth muscle bundles with increased collagen bundles and vascularity were seen. In menopausalage group, tendency towards fibrosis was seen and blood vessels were reduced in number.Conclusion: Variations seen in the ligament in different age groups and continuation of the smooth muscle ofthe round ligament with the myometrium at the uterine cornu may explain the role played by it in keeping theuterus in anteverted position. Role of the ligament would become clearer through a further study of microscopicstructure of a larger sample size including different age groups.

Incidence Of The Third And Fourth Head Of The Biceps Brachii Muscle In Caucasian Race – A Study And Review Of Literature

Anatomic variations in the heads of biceps brachii are not uncommon. It varies from one head to seven heads buttwo heads (long and short) are considered normal. In this study, 56 arms from 28 cadavers were studied for thirdand fourth heads in the anatomy laboratory of Weill Cornell Medicine. We observed supernumerary heads in 5cadavers (8.92%), out of which three heads were seen in 4 cadavers (7.14%) and four heads in only one cadaver(1.78%). Clinically, these kinds of anomalies are important because supernumerary heads could compressneighboring blood vessels and nerves.

Uterine Transplantation: An Option beyond Surrogacy.

Over the years, a lot has developed in the field of infertility and artificial reproductive techniques worldwide, but the uterine factor infertility still remains an unresolved issue in reproductive medicine. Absolute uterine factor infertility is synonymous with congenital absence of uterus or a physiologically nonfunctioning uterus. Very few options including surrogacy and adoption are available for these patients. Both surrogacy and adoption are associated with legal, ethical, financial, religious, and psychological issues. For some of these patients, uterine transplant could be a viable option in future. However, the ability of uterus to carry the pregnancy to the period of viability and the effect of immunosuppressant on the fetus make the uterine transplant a more complex operation than any other transplants. From the earliest uterine transplant tried in 1931 in Germany to the first successful child birth following transplant in Sweden in 2014, uterine transplantation has come a long way. Among the countries that have tried this till now, Sweden has reported five cases of successful births posttransplant. Behind these successful cases, there is dedication and perseverance of few individuals who continued their efforts in spite of repeated failures. At the moment, the uterine transplant can be considered experimental at the best. However, considering the large number of hysterectomies done all over the world and uteruses available for transplantation, uterine transplant has potential to surpass, in numbers, the other transplant in near future.

High CA 125 in a Case of Abdominal Tuberculosis mimicking Ovarian Malignancy.

A 45-year-old patient was admitted with history of abdominal pain and distension. Clinically diagnosis was pointing toward a case of right-sided ovarian mass with ascites. Computed tomography (CT) scan of the abdomen was suggestive of mucinous cystadenoma of right ovary with moderate ascites. Ascitic fluid tap was exudative in nature and negative for malignant cells. Blood investigations were within normal limits except for raised CA 125 (more than 1000 mIU/L) and raised erythrocyte sedimentation rate (ESR) (112 mm/h). Our provisional diagnosis was serous cystadenocarcinoma right ovary or pelvic tuberculosis (TB) involving right adnexa and pelvic peritoneum. Ascitic fluid findings were more in favor of pelvic TB, therefore the patient was started on antitubercular treatment (ATT) on trial basis. The patient responded considerably well to ATT.

An Observational Study Showing Incidence of Heart Disease in the Male Population from North India.

Background: Structural Heart Disease (SHD) is a preventable cause of mortality. As age advances the morbidity rates due to SHD increases. SHD is more common in rural areas and lower socio-economic status because of poor hygiene and poor nutrition. The aim of this study was to find the incidence of heart disease in a male north Indian population. Method: A team consisting of three doctors examined all the candidates presenting over a period of one and a half years for enrollment at a particular Centre. The age group of this population was between 18 years to 22 years. All candidates underwent medical examination. Candidates having suspicion of SHD were referred to the physician/cardiologist. All those persons whose disability was within permissible limits were taken as fit and the others were taken as unfit. Results: Total 4223 candidates reported in the above period. 334 candidates who had disabilities were lost to follow-up and excluded, leaving a total of 3889 candidates. After specialist review, 1471 candidates were found unfit for various causes, out of which 283 were for cardiac murmurs. Many candidates were found to be suffering from multiples disabilities. Conclusion: Our study found an incidence rate of 72.7 per thousand which is much higher than that of other studies. The possible reasons for this could be that the persons are primarily from rural background and low socioeconomic strata which have a comparatively incidence of SHDs. Also contributing to the higher incidence may be the fact of stricter application of physical standards for enrollment in the army.

Rising Maternal Mortality in Mumbai Metropolitan Region: Need for Action.

Data from the past suggest that maternal deaths mostly occurred due to obstetric complications, like postpartum hemorrhage, sepsis or maternal morbidities, like eclampsia and cardiac diseases. This trend, however, has changed over a period of time in developing countries, like India where increasing number of maternal deaths have been attributed in recent years to preventable infectious causes, such as hepatitis, tuberculosis and malaria. Rising maternal mortality ratio (MMR) due to infections indicates there are several loop holes in the basic healthcare system at various levels in their prevention and control. Although maternal mortality worldwide is decreasing progressively, curbing maternal deaths in certain developing regions of the World including few parts of India and Mumbai Metropolitan Region at a faster rate is essential in order to achieve the United Nations Fifth Millennium Development Goal of 2015.