Prevalence of ocular manifestations and related morbidity in severely malnourished children in a tertiary eye care center

Background: Ocular involvement is relatively common in malnourished children, and the consequences of malnutrition on the eye are frequently more severe during the formative years of life. This is a significant cause of avoidable blindness that has to be addressed with affordable methods. This study aims to determine the nature, extent, and seriousness of ocular manifestations in malnourished children and to evaluate the current prevalence given improving nutritional parameters through increased public awareness, education, and knowledge of vaccination and nutrition. Materials and Methods: This study was carried out in the department of ophthalmology of a tertiary eye care center for 1 year. Eye camps were held close by in urban shantytowns. We considered 518 kids between the ages of 6 months and 5 years who lived in those slums. The patient was subjected to a general, systemic, and ocular examination, including a vision and fundus examination. Results: A total of 100 children aged 6 months and 5 years (60 months) who were severely critically malnourished were enrolled and given an eye examination. In this study, 72% of very acutely malnourished children had ocular involvement. Conjunctival pallor was the most general observation in the anterior segment in 179 of the eyes (71.5% of the eyes). Retinal hemorrhage was the most pervasive posterior segment findings in 19 eyes (36.8%). Conclusion: This study is aimed to determine how frequently ocular symptoms occurred in malnourished children who visited tertiary eye care facilities. A vital target population that requires comprehensive screening to avoid vitamin A deficiency (VAD) and detect eye problems early is preschoolers. Every child should also receive an immunization and vitamin A prophylaxis. Low socioeconomic position, illiterate parents, and inadequate sanitation were determined to be the key risk factors for VAD.

A Comparison of Glasgow Coma Scale Score with “Full Outline of Unresponsiveness Scale” to Predict Outcome of the Patients with Traumatic Brain Injury Presenting to Emergency Medicine Department

Introduction: In patients presenting to Emergency Department(ED) with traumatic brain injury, it is important to evaluate the neurological status to determine the present clinical status and to predict outcome of the patient. GCS is the most widely used score,but it has some drawbacks which led to the development of other scores such as the Full Outline of Unresponsiveness (FOUR) score. In our study, we compared the GCS and the FOUR scores in patients presenting with traumatic brain injury. Aims: 1) To compare the FOUR score with the GCS score in traumatic brain injury (TBI) patients. 2) To understand the effectiveness of FOUR score as an assessment tool. 3) To assess whether FOUR score is an alternative tool in TBI patients or could be complimentary. Methods: We conducted a prospective observational study at a trauma centre of a tertiary care hospital during January 2019 to March 2019 after taking institutional ethical committee approval. All patients presenting with clinical diagnosis of TBI were evaluated and given a GCS and FOUR score by the emergency physician. Relevant investigations were done and findings were noted. We tabulated all information in Microsoft Excel 2019 and statistical analysis was done with SPSS software. Results: The mean age of study population was 38.295+/- 15.33 years. Male patients were 79% and 21% were female patients. Road traffic accidents contributed highest percentages of causes of TBI (60%). By comparing the median value of FOUR score with mortality and the median value of GCS score with the mortality by using the Mann-Whitney test showed a p-value of ?1, which is statistically non-significant. Conclusions: FOUR score is equally reliable with GCS score. Both have their own significance

Clinical Profile, Electrodiagnostic Variations, Treatment and Outcome in Guillain-Barré Syndrome: Prospective Study of 78 Patients

Introduction: Guillain–Barre syndrome (GBS) is an acutepolyradiculoneuropathy with varied severity of presentation.Objectives: To study clinical presentation, electrodiagnosticvariations, hospital care and outcome of patients of GuillainBarre Syndrome (GBS). Current research aimed to studyefficacy of Plasmapharesis and Intravenous Immunoglobulin(IVIG) in patients of GBS.Material and Methods: 78 patients of GBS were studiedin detail including history, clinical examination andinvestigations. Patients were treated with Plasmapharesis andIVIG; and outcome was observed.Results: Commonest age group affected was 13-40 yrs.The male:female ratio was 1.2:1. Antecedent infection werepresent in 42 out of 78 patients. Quadriparesis was presentin 74 patients and paraparesis in four patients. Cranial nerveinvolvement was seen in 47 out of 78 patients. Areflexia wasfound in all 78 patients. Albuminocytologic dissociation waspresent in 44 out of 61 patients underwent CSF examination.NCV findings show conduction velocity slowing, delayedf latencies in 92% patients. Out of 72 patients, 33[43%]required mechanical ventilation. Out of 78 patients, 71 weretreated with Plasmapharesis and seven patients were treatedwith IVIG. Out of 78 patients 56 [72%] patients recoveredcompletely, 19 [24%] patients died and three [four%] patientsdeveloped severe neurologic deficit.Conclusion: GBS is more common in male as compare tofemale. Commonest presentation is paresthesia in legs andascending paralysis. Patients who received treatment early inthe course of disease had faster recovery. Plasmapheresis andIVIG both showed similar efficacy in treating GBS.

Significance of Abnormal T Waves in Acute Coronary Syndrome without ST Changes in ECG

T-wave abnormalities are common electrocardiographic occurrences in patients with acute coronary syndromes. The clinical and electrocardiographic course and angiographic findings in patients with evolving inverted or biphasic T waves have not been fully elucidated. Patients with abnormal T waves associated with unstable angina represent a subgroup with a high probability of near total obstruction of coronary artery and myocardial dysfunction. In the present study we describe a subgroup of patients with myocardial ischemia who during the acute Ischemic phase did not develop elevation but only biphasic or inverted T waves in the ECG and had >90% stenosis of 1 or more coronary arteries. Methods: The study comprised 125 patients presented with unstable angina pectoris. Patients’ characteristics, Electrocardiographic Data, Cardiac enzymes and Coronary angiography findings were obtained. Collected data was analyzed and sensitivity, specificity, positive predictive value, significance of test (p value) were calculated using appropriate statistical method. Results: Of the 125 patients deep symmetrical and sustained T-wave inversions were present in 72 patients & biphasic T-waves in 28 patients. 125 patients underwent coronary angiography, 92(74%) patients had >90% stenosis of 1 or more coronary arteries; sensitivity of abnormal T waves for significant stenosis was 90%, specificity 92%, positive predictive value 97.83 % and p value <0.001. Conclusion: We have identified a subgroup of patients with critical obstruction of coronary artery in patients with unstable angina and non diagnostic ECG T-wave abnormalities are significant electrocardiographic occurrences in patients with acute coronary syndromes and frequently associated with coronary artery obstruction

Role of NT-Pro BNP Estimation In Patients with Acute Dyspnoea presenting to Emergency Department

Dyspnoea can be defined as an unpleasant or uncomfortable sensation of difficult breathing experienced by an individual. The differential diagnosis includes acute heart failure (AHF), acute coronary syndrome (ACS) and pulmonary embolism (PE) as the main diseases to be excluded for their potential acute severity and mortality. NT-pro BNP is a sensitive and specific marker of ventricular dysfunction. Materials & Methods : Observational cross sectional study was done from October 2016 to October 2017 with 70 patients of acute dyspnoea presenting to emergency department. An automated immuno-analytical test for NT-pro BNP was carried out. Data was analyzed using appropriate statistical tests. Observation : Out of 70 cases of breathlessness, 48 patients were diagnosed with cardiovascular disease, 17 had Respiratory disease and 5 were of other causes (non respiratory, non cardiac). In Cardiovascular causes of breathlessness (n=48) the mean NT-pro BNP level was 2234 pg/ml, and in Non cardiovascular causes of breathlessness (n=22) the mean NT-pro BNP level was 677 pg/ml. Thus, there was a significant difference in the levels of mean NT-pro BNP. Conclusion : The statistically significant difference was observed when plasma NT-pro BNP levels of cardiovascular disease were compared to non cardiovascular disease (in respiratory causes levels were significantly lower) .Thus it supports the ability of NT pro BNP to provide specific information about the cardiac involvement in acute dyspnoea

Sonographic Measurement of Inferior Vena Cava Diameters and Its Usefulness during Resuscitation of Patients with Trauma

Introduction: Hemorrhagic shock is the leading etiology in most cases of trauma and can be rapidly fatal. Thus adequate fluid resuscitation is required to improve the outcome of patients. CVP is usually used to guide resuscitation. Point-of-care sonography in emergency medicine provides non-invasive assessment of intravascular volume status. Measurement of inferior vena cava does not require special preparation as it can be done along with FAST examination. Materials & Methods : This observational study was conducted on patients with history of trauma presenting to Emergency Department. The patients were divided into two groups: a hypotension group with hypotension on presentation and a normotensive group with normal blood pressure. The diameters of IVC both during inspiration (IVCi) and expiration (IVCe) were measured by M-mode ultrasound using a 3-5 MHz Phased Array Transducer. Results: Both IVCe and IVCi were significantly smaller in hypotension group as compared to normotension group of patients, while collapsibility index was increased in hypotensive group. The mean IVCe diameter was 7.8 mm in hypotension group. There was positive correlation of IVC parameters to blood pressure, and shock index. Post-resuscitation there was increase in diameters of IVC, decrease in collapsibility of IVC, and significant improvement in the vital parameters. Conclusion: The study showed that the measurement of IVC diameter can be used as a reliable tool to guide resuscitation in trauma patients and can help to predict significant hypovolemia, in patients having normal blood pressure

Split hand/split-foot malformations: a report of four cases in a family with variable presentations.

Split hand/split-foot malformation is a congenital anomaly with failure of development of the central digital rays of hand or foot to a variable extent. It is characterized by hypoplasia/aplasia of the phalanges, toes, metacarpals and metatarsals. The presentation may be an isolated anomaly or may be associated with syndrome and thus have variable pattern of inheritance. We report a family of 10 members; four of which are affected with autosomal recessive pattern of inheritance. We discuss here the clinical presentation, genetic inheritance, prenatal diagnosis and treatment for the malformation.

Unusual presentation: fracture neck femur in 18 months old child.

An 18 months old child was brought to the emergency department with alleged history of trauma due to hit by two wheeler and sustained injury over right hip. Child was not able to move the right lower limb. Physical examination of child revealed contusion over right hip region and injury over perineal region. There was no active vaginal bleeding. Rest of the systemic examination was normal. Routine blood was normal. On X-ray of pelvis with both hip showed fracture of neck femur on right side without any pelvic injury. Patient was treated with hip spica cast and complete bed rest for 1 month. After 1 month of the treatment, on follow-up the patient was able to weight bear and fractured was united on X-ray.

Orthopaedic aspect of anatomy and radiology of proximal femur.

Femoral pathology is common in relation to the orthopedic. There is complex anatomy of the proximal femur and hip joint. So, its knowledge regarding anatomy and radiological correlation is necessary to the well-known fact for the orthopedics for the routine day to day practice. This review article briefly illustrates important anatomical and radiological aspect of the proximal femur.

Magnets in Orthodontics: An Overview.

Magnetic force is an essential ingredient of nature. The electron and the atom are the smallest magnets. The magnetic moment of the atom is caused by its own spin or by orbital motion of its electrons. Magnets have been used in the dentistry for many years, most commonly to aid in the retention of dentures and over dentures as well as obturators. In orthodontics, they have been used for treatment of unerupted teeth, for tooth movement along arch wire, for expansion, fixed retention, in correction of anterior open bite and in functional appliances.

Study to assess the psychosocial aspects of refractive errors and effectiveness of health education in correcting stigmas related to spectacle use in high-school students of rural India.

Background: Refractive error is the most common cause of blindness which can be corrected easily using simple modality like spectacles but because of ignorance, stigmas and cost related issues it is underutilized. Aims & Objective: Study to assess the psychosocial aspects of refractive error and effectiveness of health education in correcting stigmas related to spectacle use in high-school students of rural India. Material and Methods: This was a cross sectional study in which total of 255 high school students from a school near Bhopal were included. The responses were recorded on a pre-designed and pre-tested questionnaire. The health education was provided to all the participants and they were reassessed after one month using same questionnaire. The researcher used the STATA version 12.1 for data entry and analysis. Results: Amongst total of 255 students, 165 were males and 90 were females. During initial phase most of the respondents believed that common reasons for low vision were nutritional deficiency (68%) and bad eye care (56%). The respondents refused to use spectacles at all if needed as spectacles are cosmetically unacceptable (62%) , fear of rejection from opposite sex (54%) and likely teasing from colleagues (36%).Following health education there were statistically significant changes in the knowledge, attitude and care seeking behaviour of spectacle use. Only two parameters i.e. cosmetic acceptance of spectacles and that traditional methods were more than spectacles did not changed significantly. Conclusion: Prevalent stigmas regarding spectacle use among students of rural India were effectively corrected with health education.

Drug carrier transfersomes: A novel tool for transdermal drug delivery system.

Transport of the drug through skin is best route of drug delivery because of the skin is largest organ human organ with total weight 3 kg and a surface of 1.5 -2.0 m2. Drug carries used in transdermal drug delivery such as liposomes, noisomes, or microemulsions has problem that they remains mostly confined to the skin surface and therefore do not transport drugs efficiently through the skin. By using the concept of rational membrane design we have recently devised special composite bodies, so-called Transfersomes. Transfersomes penetrate through the pores of stratum corneum which are smaller than its size and get into the underlying viable skin in intact form. This is because of its deformable nature. The system can be characterized by in vitro for vesicle shape and size, entrapment efficiency, degree of deformability, number of vesicles per cubic mm. They can act as a carrier for low as well as high molecular weight drugs e.g. analgesic, anesthetic, corticosteroids, sex hormone, anticancer, insulin, gap junction protein, and albumin.

Ethosomes: A recent vesicle of transdermal drug delivery system.

Transdermal drug delivery system was first introduced more than 30 years ago. The technology generated tremendous excitement and interest amongst major pharmaceutical companies in the 1980s and 90s. By the mid to late 1990s, the trend of transdermal drug delivery system merged into larger organizations. Ethosomes are the ethanolic phospholipid vesicles which are used mainly for transdermal delivery of drugs. Ethosomes have higher penetration rate through the skin as compared to liposomes hence these can be used widely in place of liposomes. Ethosomes have become an area of research interest, because of its enhanced skin permeation, improved drug delivery, increased drug entrapment efficiency etc. The purpose of writing this review on ethosomes drug delivery was to compile the focus on the various aspects of ethosomes including their mechanism of penetration, preparation, advantages, composition, characterization, application and marketed product of ethosomes. Characterizations of ethosomes include Particle size, Zeta potential, Differential Scanning Calorimertry, Entrapment efficiency, Surface tension activity measurement, Vesicle stability and Penetration Studies etc.

Novel oral sustained release technology: A concise review.

The advantage of administering a single dose of a drug that is released over an extended period of time instead of numerous doses is now a day’s area of interest for formulation scientists in Pharmaceutical industry. There are several advantages of sustained release drug delivery over conventional dosage forms like improved patient compliance due to less frequent drug administration, maximum utilization of the drug, increased safety margin of potent drug, reduction of fluctuation in steady-state drug levels, reduction in healthcare costs through improved therapy and shorter treatment period. Wide varieties of polymers like Hydroxy Propyl Methyl Cellulose (HPMC), Carboxy Methyl Cellulose (CMC), Ethyl Cellulose (EC), Cellulose Acetate Phthalate, HPMC K100M, Xanthan gum, Carrageenan gum, Karaya gum, HPMC K15, Carbopol 971P and Carbopol 974P etc. are available for retarding the release rate of drugs hence sustains the action of drugs. This review article describes the basic information regarding sustained-release formulation, its advantages, disadvantages, selection of drug for sustain release, mechanism of release, different types, and factor involved in oral sustained-release dosage form design.