ABSTRACT
Background: Urethroplasty for hypospadias is a difficult surgery in the best of hands. One stage surgery is usually preferred for its multiple benefits. Many techniques exist each with its own merits and demerits. Aim of the study was to compare different techniques in hypospadias surgery with special emphasis on transverse prepucial onlay island flap urethroplasty.Methods: All children operated for hypospadias from the period of 2016-2019 in Department of Surgery at Geetanjali Medical College and Hospital, Udaipur were included in the group after obtained approval from institutional ethical clearance commitee. The technique to be used was decided on a case to case basis depending mainly on the position of the meatus, size of the urethral plate and chordee (ventral curvature). All patients were analyzed for various complications and overall success rate.Results: 77 patients were operated and analyzed. Overall the study could not establish the superiority of one technique above another. At the same time it establishes the versatility, satisfactory results and low complication rate of transverse prepucial onlay island flap (TPOIF) in different types of hypospadias.Conclusions: Success in urethroplasty depends on proper case selection, meticulous technique, a buttressing layer wherever possible and that TPOIF is a versatile technique for single stage hypospadias repair in distal, mid and proximal penile hypospadias.
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Background: The cornea is the transparent frontal part of the eye that covers the iris, pupil and anterior chamber. Together with the lens, the cornea refracts light accounting for approximately two-thirds of the eye’s total optical power. The cornea has unmyelinated nerve endings that are sensitive to touch, temperature and chemicals. The cornea is devoid of blood vessels as transparency is of prime importance. The cornea receives its nutrients by diffusion from the tear fluid at the outside and from the aqueous humor at the inside. In humans the cornea has a diameter of about 11.5 mm and a thickness of 500-600μm at the centre and 600-800μm at the periphery. Transparency, avascularity, presence of immature resident immune cells and immunologic privilege makes the cornea a very special tissue. Corneal opacity is a disorder of the cornea and it occurs when the cornea becomes scarred. This condition causes disruption of light waves passing through the cornea to the retina thus giving a cloudy or hazy appearance of the cornea. The aim of the study is to evaluate the prevalence and causes of corneal opacity in a rural area in Bihar. Design of the study – A population based retrospective and observational study. Methods: Among all the cases that presented with ocular morbidity between September 2014 and February 2016 to the outdoor clinic of Department of Ophthalmology or any of the primary health centres of Katihar Medical College, those with corneal opacity were enrolled for this study. Participants belonged to rural areas that were medically catered to by the primary health centres under the Department of Community Medicine of Katihar Medical College. Those participants who attended either the primary health centres or the outdoor clinic of the Department of Ophthalmology with corneal disease were included in this study. Results: During the study period a total of 519 cases presented with ocular morbidity and were diagnosed for corneal opacity. Prevalence of corneal opacity was 2.35% among the study population. Corneal opacity was reported to be much higher in the elderly probably due to a weakened immune system and among cases with poor personal hygiene. Common causes of corneal opacity in the study population was corneal degeneration, infective keratitis, ocular trauma and pterygium. Conclusion: Corneal morbidity in rural Bihar is attributed to keratitis, keratopathy, corneal degenerations, lack of hygiene and generalized immunodeficiency. Efforts must be made by health workers for health promotion and health awareness for promotion of corneal blindness.
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Background: Ocular trauma especially in children is an unpleasant occurrence. A protocol for timely presenting the patient before the nearest available physician or ophthalmologist and rapid evaluation of severity along with indispensible clinical management must be followed at all levels of healthcare. The aim of the study is to evaluate the causes and management of blunt ocular trauma in children and prevention of monocular blindness in a rural area in Bihar. Design of the study – A tertiary centre based retrospective and observational study. Methods: Children up to the age of fifteen years who presented with ocular trauma between September 2014 and February 2016 to the outdoor clinic of Department of Ophthalmology or any of the primary health centres of Katihar Medical College were undertaken for this study. Results: A total number of 212 children presented with ocular trauma. The minimum age at presentation was 1 year while the maximum was at 14 years and 9 months. Out of 212 cases, 159 (75%) were males and 53 (25%) were females. Blunt mode of ocular trauma was observed in 180 (85%) cases and was more common than penetrating mode of ocular trauma which was observed in 32 (15%) cases. Among the cases with blunt trauma, 132 (63%) received conservative treatment with weekly follow up for visual acuity. The remaining 80 (27%) underwent surgery. Post trauma the two most common complaints of visual impairment were compression of the globe in 30 (14%) cases followed by of corneal opacity in 19 (9%) cases. Conclusion: Ocular trauma in general particularly in children of is alarming. Majority of presenting cases are boys. There is a need for creating awareness among family members and school teachers. Emphasis must be laid on seeking quality treatment within shortest possible time. improved health care facilities should be provided at the primary health care levels.
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Background: Data comparing tapentadol with an antidepressant is limited. A comparison of tapentadol with mirtazapine at different dose has not been performed, the other antidepressant in the same therapeutic class with a significant market share, has been undertaken. In the absence of relevant data to assess the place that tapentadol should occupy in the therapeutic arsenal, indirect comparisons are the most rigorous way to go. We conducted a study evaluate antidepressant and analgesic activity of tapentadol with mirtazapine at different doses in Swiss albino mice. Methods: Tapentadol was administered at 10, 20 and 40 mg/kg (i.p) once daily for 14 days to swiss albino mice of either sex. The immobility period for antidepressant activity of mice were recorded in forced swim test and reaction time for analgesic activity of mice were recorded in tail flick test of the control and drug treated group. The antidepressant and analgesic activity of tapentadol (10, 20, 40 mg/kg i.p) was compared with that of mirtazapine (3, 5, 7 mg/kg i.p), administered for 14 days. Results: Tapentadol produced better antidepressant at (20, 40 mg/kg), but less at 10 mg/kg and significant analgesic activity at all the three doses, as indicated by reduction in immobility times and increase in reaction time as compared to control. Mirtazapine produced no antinociceptive activity at 3 mg/kg, but significant at 5, 7 mg/kg and showed better antidepressant activity at all the three doses in mice. The result of this study indicates the better analgesic activity of tapentadol at all the doses and least antidepressant activity at 10 mg/kg, as compared to mirtazapine which has shown better antidepressant activity at all the three doses but no analgesic activity at 3 mg/kg. Conclusion: It can be concluded that tapentadol is a better drug in case of depression associated with pain compared to mirtazapine in mice.
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Cefuroxime axetil is a semi synthetic cephalosporin antibiotic, which is prescribed for different types of infections such as lung, ear, throat, urinary tract, and skin. This is the drug of choice in the treatment and prevention of streptococcal infections. In this case, the patient was prescribed cefuroxime axetil, diclofenac, and paracetamol for pharyngitis. The patient developed glossitis 3 hrs after ingestion of above drugs which improved after withdrawing the offending drug. Glossitis is an uncommon, but serious adverse drug effect of cefuroxime axetil. It is important to recognize and manage it to prevent fatality. The case has been reported to the Pharmacovigilance Center Uttar Pradesh Rural Institute of Medical Sciences and Research Saifai, Etawah.
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OBJECTIVE: To study the clinical presentation, management and results of treatment of 41 consecutive cases of choledochal cyst (CC) managed from 1999 to 2006. METHODS: The age of the patients ranged from 20 days to 11 years. Eleven cases were 1 year or less in age (infantile group) and 30 patients were more than 1 year old (classical pediatric group). Children less than 1 year old presented with jaundice (72%), hepatomegaly (54%) and clay-colored stools (63%); whereas those above one year in age presented with pain (83.3%) and jaundice (47.6%). Three cases had biliary perforation with localized or generalized biliary peritonitis. Ultrasonography (US) diagnosed/suggested CC in all 41 patients, however, contrast-enhanced computed tomographic (CECT) scan (n=12), radionuclide DISIDA scan (n=5) and magnetic resonance cholangiopancreatogram (MRCP) (n=3) also contributed to the diagnosis. 19 patients, including 4 from the 'infantile' group, had significant dilatation of intrahepatic biliary ducts. RESULTS: Nine patients from the 'infantile' group had cystic type I CC (type Ic), while 2 patients had fusiform dilatation of the common bile duct (type If disease). In contrast, 21 of the older patients had type If disease while 9 had type Ic disease. Operative management included primary complete excision of the cyst with a Roux-en-Y hepaticodochojejunostomy (HDJ) (n=32), Lilly's modification of submucosal resection with a HDJ (n=8) and cyst excision with a hepaticodochoduodenostomy (HDD) (n=1). All 3 patients with biliary perforation had primary excision of the CC with a HDJ. Unusual operative findings included accessory hepatic ducts (n=2), anteriorly placed common or right hepatic arteries (n=3) and partially or completely blocked proximal extrahepatic bile ducts (n=3). There were 2 postoperative deaths, one had cirrhotic liver disease with portal hypertension, the other had deep icterus with poor general condition. Both patients succumbed to overwhelming sepsis. One patient required reexploration and refashioning of the HDJ for biliary leak. Short-term follow-up was satisfactory in all 39 patients. CONCLUSION: Infants with CC constitute a distinct group with regard to clinical presentation and the pathological should be kept in mind while evaluating neonates and infants with cholestatic jaundice and older children with recurrent abdominal pain. Primary excision of the cyst with a HDJ provides satisfactory results in the management of the vast majority of cases of CC including those in infants, massive CC and in the presence of biliary perforation and peritonitis.