Assessment of intraocular pressure measurement between Goldman applanation tonometer, rebound tonometer, non-contact tonometer, and its correlation with central corneal thickness

Purpose: To compare readings of intraocular pressure (IOP) taken with the Goldmann applanation tonometer (GAT), the non?contact tonometer (NCT), and the rebound tonometer (RBT), and to compare their correlation with central corneal thickness (CCT). Methods: This was a prospective, cross?sectional, observational study to which patients above 18 years of age were enrolled. A total of 400 eyes of 200 non?glaucomatous patients underwent IOP recordings using the GAT, NCT, and RBT, and CCT was also noted. Informed consent of the patients was taken. The IOP readings taken via the three methods were compared and correlated with CCT. Paired t test was used to compare the two devices. Simple and multivariate linear regression analyses were used to study the relationship between factors. A P value less than 0.05 was considered significant. Correlation was determined using the Pearson correlation coefficient, and a Bland–Altman graph was plotted. Results: Mean IOP measured by the NCT was 15.65 ± 2.80 mmHg, by the RBT was 14.23 ± 3.05 mmHg, and by the GAT was 14.69 ± 2.97 mmHg. The mean CCT was 510.61 ± 33.83 microns. The difference between mean IOP recorded by the NCT and that by the RBT was 1.41 ± 2.39 mmHg, between the NCT and GAT was 0.95 ± 2.03 mmHg, and between the GAT and RBT was 0.45 ± 2.22 mmHg. The difference between the IOP values was statistically significant (P < 0.005). All tonometers showed a statistically significant correlation with CCT, but it was observed that the NCT had a stronger correlation (0.4037). Conclusion: The IOP readings taken by all the three methods were comparable; however, RBT values were closer to GAT values. CCT did influence the IOP values, and this should be kept in mind while evaluating.

Idiopathic-abdominal-cocoon—a-rare-cause-of-small-bowel-obstruction

The idiopathic form of sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare entity of unknown cause that leads to intestinal obstruction due to complete or partial encapsulation of the small intestine by a fibro- collagenous membrane. As the initial clinical features are non-specific, they often remain unrecognized making it difficult to make a definite pre-operative diagnosis. Recurrent episodes of small intestinal obstruction along with relevant imaging findings and lack of other causative mechanisms, gives rise to a clinical suspicion. We report a young lady who presented to us with features suggestive of acute intestinal obstruction. Thorough enquiry revealed similar episodes on multiple occasions in the past which was temporarily relieved with conservative management. The need to keep an open mind regarding the uncommon causes of commonly encountered problems is the point of interest in our case.

Current understanding of frictional dermatoses: A review

Human skin is continually exposed to internal and external forces, dynamic as well as static. The skin is normally flexible and can resist mechanical trauma due to friction, pressure, vibration, suction and laceration to a considerable degree. However, an excess of these forces can abnormally affect the structure and function of the skin, setting the stage for the development of a skin disorder. Repetitive trauma can cause lichenification, hyperpigmentation, erythema, scaling, fissuring, blisters, ulceration and chronic alterations. Frictional dermatoses is an under-recognised entity with no clear-cut definition and encompasses a variety of terms such as frictional dermatitis, frictional melanosis, frictional pigmentary dermatoses and certain other named entities, many of which are confusing. The authors propose to define frictional dermatoses as ‘a group of disorders caused by repetitive trauma to the skin as a result of friction of varied aetiology which can have a wide range of cutaneous manifestations depending on the type of insult.’ The exact prevalence of frictional dermatoses as a separate entity is unknown. Authors who conducted this review include a group of dermatologists and post graduate students from various institutions. Literature was reviewed through PubMed, Medscape, Medline, ResearchGate and Google Scholar using the terms ‘frictional dermatitis,’ ‘friction and skin,’ ‘dermatoses and culture,’ ‘clothing dermatitis,’ ‘friction melanosis,’ ‘PPE induced dermatoses in COVID-19 era,’ etc. A total of 122 articles were reviewed and 100 articles among them were shortlisted and included in the study, after removing duplications. The review was followed up with further deliberation which resulted in the formulation of a new definition and classification of frictional dermatoses taking into account the morphology, histopathological characteristics, anatomical region affected and the major predisposing factors. The rising incidence of mechanical dermatoses in the COVID-19 era was also emphasised.

A RETROSPECTIVE STUDY OF PREVALENCE AND MAJOR INDICATIONS OF CESAREAN SECTION IN A TERTIARY CARE HOSPITAL IN INDIA

According to the World Health Organisation (WHO), a caesarean section is a surgical procedure that can save the life of a woman and her baby when undertaken for medical reasons. Thus, the procedure should only be used in complicated pregnancies.However, C-sections have gradually become common in developing countries, and it is already quite common in the developed countries for a long time. A number of obstetric complications such as dystocia, foetal distress, breech births, post-term pregnancy, multiple pregnancy, and pregnancy-induced hypertension are recognized as reasonable motives behind caesarean section deliveries. Approximately 18.5 million caesarean births have been recorded each year globally, accounting for 19.1% of total births, which is beyond the cut-off recommended by the World Health Organization (WHO). In India, the rate of caesarean section delivery is dramatically increased from 3% in 1992–93 to 17% in 2015–16. In terms of regional variations, south Indian states have recorded substantially higher levels of caesarean deliveries in comparison to north India.Despite several studies that have investigated the factors contributing to caesarean section delivery, systematic evidence is still lacking towards understanding the determining factors and formulating effective policies to address the increasing rate of caesarean section deliveries in India. With this backdrop, this study attempts to observe the major indications and prevalence of caesarean section among pregnant women in a tertiary care hospital in India.

DIAGNOSTIC DILEMMA IN TYPHOID ENCEPHALOPATHY

Using the immune system to its advantage, Salmonella Typhi initially invades the gut followed by the reticuloendothelial system and finally the nervous system, involvement of which usually occurs around the second week of fever. In developing countries, delayed diagnosis is predominantly due to hesitation in seeking treatment. Our subject presented with fever since one week, altered mentation, headache and neck pain; she was diagnosed with enteric fever. Although her neurological abnormality could be a complication of the infection, it appeared when she became afebrile- hence we evaluated her for autoimmune conditions. Positive results hinted at autoimmune encephalitis triggered by the infection; further studies were inconclusive. Association of enteric fever with autoimmune encephalitis has not been reported. Three months later, presence of antinuclear antibodies (ANA) was rechecked- a negative report led to a retrospective diagnosis of transient ANA positivity in a nonautoimmune inflammatory disease, the case in point being enteric fever.

Influence of N95 Mask-related Hypoxemia on Headache, Stress, Anxiety, and Quality of Sleep during COVID-19 Patient Care among Frontline Health Care Professionals

Background: Prolonged use of N95 masks by healthcare workers might affect physical health due to mask-related hypoxia in addition to the psychological effects of N95 masks. We tried to explore the association of N95 mask-related hypoxia and headache with stress, quality of sleep, and anxiety in the current study. Materials and methods: The sample (N = 78) consisted of 41 doctors and 37 nurses involved in COVID-19 patient care and using N95 masks with or without PPE for at least 4 hours. Perceived stress scale (PSS), Coronavirus anxiety scale (CAS), and Pittsburgh sleep quality index (PSQI) were administered, and physical parameters like heart rate and oxygen saturation (SpO2) were measured. Results: Around 42% of the study participants experienced headaches after wearing an N95 mask and had a higher increase in heart rate (mean percent:10.5% vs 6.3%) and decline in SpO2 (mean percent: 2.6% vs 1.5%) compared to those who didn’t develop a headache after N95 mask use. Independent samples t-test showed a mean difference for PSS and CAS between those who experienced headaches and those who didn’t. The mean PSQI scores among the study participants were 8.91 ± 5.78; the score among those participants with and without headache was 10.57 ± 3.11 and 7.68 ± 2.53, respectively. Conclusion: Perceived corona anxiety, poor sleep quality, and corona anxiety are associated with N95-related headaches and SpO2 drop among health professionals who wear N95 masks for at least 4 hours.

Factors predicting mortality in elderly patients hospitalized for congestive heart failure

Background: Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. There are range of factors that predict the mortality, morbidity, and outcome in congestive HF (CHF) patients. Objectives: The objective was to study the clinico‑epidemiological characteristics and predictors of inhospital mortality of elderly patients ≥60 years hospitalized for HF. Subjects and Methods: A complete medical history of enrolled patients and physical examination inclusive of etiology, New York Heart Association (NYHA) grade, heart rate (HR), and systolic blood pressure (SBP) were noted. Complete blood count, blood urea, serum creatinine, serum sodium, serum potassium, 12-lead electrocardiogram, X-ray of the chest, and echo were obtained in all patients. Outcomes were analyzed till the study endpoints. Results: Compared to normal comparators, a higher mortality was observed in patients with age >75 years (33.3%), HR >100 beats per min (27.14%), SBP <80 mmHg (60%), NYHA IV HF (37.1%), hemoglobin (Hb) <12 mg/dl (31.25%), blood urea ≥40 mg/dl (26.39%), serum creatinine >1.30 mg/dl (29.17%), serum sodium <135 meq/L (26.69%), and ejection fraction (EF) <50% (26.39%). Conclusion: Increasing age, prior history of CHF on admission, higher NYHA grade on admission, higher HR, lower SBP, lower EF, low Hb, higher blood urea, serum creatinine, and low serum sodium levels are statistically significant predictors of inhospital mortality of elderly CHF patients

Exploring the performance of Escherichia coli outer membrane vesicles as a tool for vaccine development against Chagas disease

BACKGROUND Vaccine development is a laborious craftwork in which at least two main components must be defined: a highly immunogenic antigen and a suitable delivery method. Hence, the interplay of these elements could elicit the required immune response to cope with the targeted pathogen with a long-lasting protective capacity. OBJECTIVES Here we evaluate the properties of Escherichia coli spherical proteoliposomes - known as outer membrane vesicles (OMVs) - as particles with natural adjuvant capacities and as antigen-carrier structures to assemble an innovative prophylactic vaccine for Chagas disease. METHODS To achieve this, genetic manipulation was carried out on E. coli using an engineered plasmid containing the Tc24 Trypanosoma cruzi antigen. The goal was to induce the release of OMVs displaying the parasite protein on their surface. FINDINGS As a proof of principle, we observed that native OMVs - as well as those carrying the T. cruzi antigen - were able to trigger a slight, but functional humoral response at low immunization doses. Of note, compared to the non-immunized group, native OMVs-vaccinated animals survived the lethal challenge and showed minor parasitemia values, suggesting a possible involvement of innate trained immunity mechanism. MAIN CONCLUSION These results open the range for further research on the design of new carrier strategies focused on innate immunity activation as an additional immunization target and venture to seek for alternative forms in which OMVs could be used for optimizing vaccine development.

Seroprevalence of acute leptospirosis in a tertiary care hospital of western India

Background: Leptospirosis is a widespread re-emerging zoonotic disease, especially in developing countries. According to World Health Organization, despite being severe, the disease is neglected in most endemic countries because of a lack of information and awareness about the extent of the problem. Objective: The objective was to study the seroprevalence and epidemiology of leptospirosis with its biochemical correlation in the general population in Pune, Maharashtra. Materials and Methods: It is a retrospective observational laboratory-based study over 1 year from January to December 2020 in a tertiary care hospital in western India. A total of 561 blood specimens received during 1 year for the diagnosis of fever were processed for Leptospira IgM antibodies using enzyme-linked immunosorbent assay (ELISA). Results: A total of 111 of 561 blood specimens that were received during the study period tested positive for IgM antibody against Leptospira. The seroprevalence of Leptospira spp. was found to be 19.78%. In seropositive patients, the age ranged from 4 to 77 years. The highest seropositivity was observed in the age group of 21–30 years (42%). There were 34% (n = 38) males and 66% (n = 73) females, among those who tested positive. Seroprevalence in Pune was highest in the months of June–August. Renal function tests were deranged in 44 (39.63%) patients (serum creatinine > 1.5 mL). Hyponatremia and hypokalemia were observed in 37.84% and 21.62% of patients, respectively. In liver function tests, serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) both were deranged (SGOT > 40 U/L; SGPT > 56 U/L) in 36 (32.43%) patients, whereas SGOT alone was deranged in additional 18 patients (48.64%). Serum bilirubin was deranged in 65.45%. Coinfection was observed with chikungunya, dengue, and malaria in 7.2%, 6.3%, and 0.90% of patients, respectively. Conclusion: Because morbidity is high in this infection, early diagnosis of leptospirosis is essential because antibiotic therapy provides the greatest benefit when initiated early in the course of illness.

The Impact of Framing on Attitudes Towards Vaccination in an Indian Sample

Introduction: Vaccines have emerged as a ray of hope in our battle against Covid-19. That as the backdrop, this research was aimed at studying how the framing of messages impacts attitudes of Indians towards Covid- 19 vaccines. The hypothesis was that the perceived norms about taking the vaccine will influence participants’ reported intentions to take the Covid vaccine. That is, exposure to a message indicating how willing or unwilling other Indians are to get vaccinated for the Covid-19 disease, will bring about a change in the beliefs and behavioural intention of the participants which will be in line with the message. Methodology: A between-subjects design was used. Participants (N=125. M=56, F=69) were randomly assigned to either of the two levels - positive or negative. Participants were pro-vaccines in general and between 18 to 30 years. A seven-point Likert scale was used to measure participants' willingness to take the vaccine, once it is commercially available. Results: Data was found to be not normally distributed. Wilcoxon Rank Sum Test was used. The Median score was 6 and 5 for level 1 and level 2, respectively. The obtained difference between the two groups was insignificant. Descriptive data was found to be in line with the hypothesis. Conclusion: Statistical significance was not found in the impact of framing on the participants in this study. In qualitative responses, groups expressed concerns over vaccines. Respondents from the negative framing group, agreeing to take the vaccine, could have been due to the social desirability bias

Dual pathogen valvular endocarditis in a case of severe aortic aneurysm

ABSTRACT Infective endocarditis (IE) is the heart valve or endocardium infection. We report a rare case of polymicrobial endocarditis, namely invasive Aspergillus spp and Acinetobacter baumannii, in a 36-year-old male with a medical history of degenerative disease of the aorta with abdominal aortic and ascending aortic aneurysms with a fulminant clinical course and fatal outcome. The treatment was challenging due to multiple comorbidities. The autopsy revealed dual pathogen endocarditis due to Acinetobacter baumannii sepsis and invasive Aspergillus spp mycosis. This report emphasizes that polymicrobial endocarditis (PE) is an infrequent finding with a poor prognosis requiring high clinical suspicion.

Article 15: truth or fiction?

Article 15 of the Indian Constitution states that, “The State shall not discriminate against any citizen on grounds only of religion, race, caste, sex, place of birth or any of them; No citizen shall, on grounds only of religion, race, caste, sex, place of birth or any of them, be subject to any disability, liability, restriction or condition with regard to (a) access to shops, public restaurants, hotels, and places of public entertainment or (b) the use of wells, tanks, bathing ghats, roads, and places of public resort maintained wholly or partly out of State funds or dedicated to the use of the general public”

Ayurvedic Management Of Plaque Psoriasis- A Case Study

Psoriasis is a chronic, multisystem inflammatory disease with predominantly skin and joint involvement. In Ayurveda all skin diseases are described under the umbrella of Kushtha. Ayurvedic system of medicine is giving good results in management of Psoriasis. Repeated Samshodhana (purificatory therapies) along with Samshamana (palliative therapies) is the main line of treatment if skin diseases in Ayurveda. Three assessments were taken before and after treatment on scoring of Dermatology Life Quality Index (DLQI), Psoriasis Disability Index (PDI) and PASI score. Score of the patient was 63.3% before treatment and 13.3% after treatment and 3.3% after follow up on Dermatology Life Quality Index (DLQI), 44.4% before treatment and 15.5% after treatment and 5.3% after follow up on Psoriasis Disability Index (PDI) and 24.5% before treatment, 5.1% after treatment and 1.2% after follow up in PASI (Psoriasis Area and Severity Index). This case study wants to substantiate the effectiveness of Ayurvedic treatment in the management of Plaque psoriasis.

Carbon Monoxide Poisoning Secondary To Gas Geyser

Carbon monoxide (CO) is a non-irritating, colorless and odorless gas produced by the incomplete burning of carbon-containing fossil fuels. CO poisoning remains a leading cause of unintentional poisoning worldwide. During winters, accidental CO poisoning has been reported mostly due to incomplete burning of coal. Here, we report the case of a young female patient who presented with hypoxic brain injury due to CO poisoning while using gas geyser in bathroom. The diagnosis of CO poisoning was made on the basis of history, vital signs, blood gas, and MRI scan. The patient recovered well after high-flow normobaric oxygen therapy and showed significant resolution on follow up MRI. A high index of suspicion, early recognition of symptoms by emergency physicians followed by careful history taking can help in making a clinical diagnosis of CO toxicity.

Deodorant Cap Lodged In The Rectum: A Case Report

Anorectal foreign bodies are rare but have shown a rising trend in recent times. Various kinds of a foreign object may be observed in the rectum, including sharp instruments which may pierce rectum, colon, or create visceral organ injuries. Most common presenting symptoms include abdominal, rectal pains and bleeding per rectum. Without proper history and examination, these foreign objects can easily be missed in the emergency department as these are still a matter of taboo especially in countries like India. We report a case of an elderly gentleman who presented to the emergency with bleeding per rectum and did not initially give a history of foreign body insertion

Study of inter pedicular distance of lumbar spinal canal in perspective of lumbar canal stenosis using plain antero-posterior radiographs in western population of Rajasthan, India

Background: Various causes have been attributed to low backache, but lumbar canal stenosis is turned out to be a major causative factor. It has been suggested that reduced IPD is one among the major cause of narrowing of the spinal canal. The objective of this study was to evaluate the inter pedicular distances in lumbar vertebral column in both sexes of western Rajasthan, India.Methods: The present descriptive type study was conducted in Department of Anatomy and Neurosurgery Sawai Man Singh Medical College, Jaipur, Rajasthan, India. Antero-posterior plain radiographs of lumbar spine in 1000 subjects aged between 20 to 60 years and those who were born and brought up in Rajasthan state were used for the study. All measurements were made by using electronic digital Vernier caliper. Student t-test was used for analysis.                           Results: Mean transverse diameter of lumbar vertebral canal (I.P.D) is minimum at L1 vertebra in both sexes. The maximum values of I.P.D were recorded for vertebra L5 for both sexes.Conclusions: The values of IPD are higher in male population in comparison to female counterparts.

MRI Spectrum of Symptomatic and Non –Symptomatic Tarlov Cyst: Series of Seven Cases in Orthopaedic Management Point of View

Tarlov cysts are perineural cysts and are usually found in sacral region. The dorsal nerve root is encased in this type of the cyst. These may or may not be with any of the symptomatology. The entity is infrequently found as an incidental finding. These are cerebrospinal fluid (CSF) filled sacs which are diagnosed on cross sectional imaging modalities especially in magnetic resonance imaging (MRI). Tarlov cysts can cause different type of myelopathies as per their location and size. Methods: We present a series of seven cases where these perineural cysts were found during the routine imaging of lumbosacral spine. All these patients had undergone Magnetic Resonance Imaging (MRI) of lumbosacral spine for backache or some other pelvic complaints. In one case Computerized Tomography (CT) Myelography also helped in diagnosis and related bone remodeling.MR myelography adds to the delineation of CSF wrapping around the spinal cord. Results: Three patients were found to be symptomatic and the intensity of complaints corresponded to the size and location of the cysts. In our three cases, the etiopathogenesis also corresponded to the underlying development of these entities. Four patients were asymptomatic as the size of these cysts were small and not contributing to the complaints of the patient. Conclusion: MRI is the best modality to diagnose these perineural cysts which are responsible for different types of myelopathies .T2WI sequences in non contrast MRI studies are the best in delineating the size, shape, outline and location of these cysts. This also further elaborates their extension to the surrounding regions.MR myelography is adjuvant to more morphological features of these cysts.

A Critical Review On The Application Of Yukti Pramana For The Logical Inclusion Or Rejection Of A Drug Mentioned In Oushadha Yoga (medicinal Formulations) According To Clinical Condition

An Ayurvedic physician usually depends on classical compound medicinal formulations for treating patients. Sometimes, patients themselves demand us that they will prepare the medicines themselves, especially Kwatha (decoctions). One reason is the superior efficacy of the self prepared medicines than the bottled decoctions due to the presence of chemical preservatives. While preparing formulations, we may need to add or delete drug/drugs depending on the clinical condition of the patient. Scarcity of herbal drugs is also another reason which compels us for substitution. In Bhavaprakasha, there is a reference stating that any drug which is inappropriate and unsuitable to a disease, even though found included in the drug group or medicinal formulae may be rejected and any drug which is found suitable or appropriate may be included though not mentioned in it. There are so many references in Ayurvedic classics where we can see deletion or inclusion of drugs in a formulation according to the condition of the patient or disease. This is an attempt to analyse the logic (the application of Yukti pramana) behind it. This article also want to depict the relevance of logically changing the contents of a medicinal formulation by analyzing its Rasapanchaka (five Ayurvedic principles of drug action), depending on the condition of disease or patient.

Preliminary Phytochemical Analysis Of Leaves Of Guchakaranja (quassia Indica Gaertn)

The drug Guchakaranja is mentioned as one of Karanja variety by Raj Nighantu and Nighantu Ratnakara. The references of the drug are not seen in other classical textbooks of Ayurveda and the only references seen in these two Nighantus. The drug had been correlated to Karinjotta, a locally available plant in Kerala. The drug Guchakaranja is botanically correlated as Quassia indica Gaertn (Samadera indica Gaertn) belonging to the family Simaroubaceae commonly known as Niepa bark tree. The drug had been extensively used in folklore practices and usage of the plant in main stream clinical practices is less. So giving a standardization and to justify its traditional usages preliminary phyochemical analysis had been done. The preliminary phytochemical analysis aims at analyzing the physico chemical property of drugs, their qualitative analysis, ash values, extractive values, moisture and volatile contents, estimation of Tannins and Phenols and HPTLC. Previous studies are available regarding the Qualitative Analysis of phytochemicals, tannin and total phenolic estimation. References regarding ash values, quantitative estimation of fiber, reducing sugar and total sugar, pH, cold and hot alcohol and water soluble extractives, moisture content were not available from previous research works On analyzing the phytochemical constituents present in the crude drug, the drug revealed the presence of alkaloids, flavonoids, saponins, carbohydrates, proteins, phenols, steroids, and tannins. This phytoconstituents present in the drug may be responsible for specific action of the drug. This preliminary phytochemical evaluation may be helpful to identify the potential of Guchakaranja and should be helpful in developing new formulations with additional therapeutic effect.