Social-emotional issues among children with strabismus higher than among non-strabismus children in Western India

Purpose: Data on social?emotional aspects among children with strabismus in India are scanty. We compared the emotional symptoms (ES), loneliness and social dissatisfaction (LSD), and self?esteem (SE) and their associated risk factors among children with and without strabismus in India. Methods: A cross?sectional case–control study design was used to recruit 101 children with strabismus aged 8 to 18 years and a control group of 101 children that were age? and gender?matched. Interviews were performed using standardized scales to assess ES, LSD, and SE. Variations in the intensity of ES, LSD, and SE were assessed using multiple classification analysis (MCA). Results: A total of 202 children participated in the study. The mean ES, LSD, and SE scores were 3.4 (standard deviation [SD] 1.9), 48.4 (SD 3.2), and 22.1 (SD 3.8) for the strabismus group and 1.8 (SD 1.5), 33.3 (SD 3), and 31.3 (SD 2) for the non?strabismus group, respectively. Among the strabismus group, the highest levels of mean ES, LSD, and SE scores were observed among children facing problems in performing daily tasks. Amongst the non?strabismus group, children studying at the primary level and those facing neglect had the highest mean scores. In MCA, being affected with strabismus had the highest effect on the intensity of ES, LSD, and SE with a beta (?) value of 0.223 (P = 0.016), 0.922 (P < 0.001), and 0.853 (P < 0.001). Conclusion: A significantly high proportion of children with strabismus deal with elevated levels of ES, LSD problems, and low SE as compared with non?strabismus children, highlighting the need to address the poor social?emotional health of children

Results of fusional vergence therapy in managing consecutive esotropia: A case series

Purpose: To analyze the efficacy of fusional vergence therapy (FVT) in management of consecutive esotropia with diplopia after intermittent exotropia (IXT) surgery. The current study is carried on how FVT affects the duration of treatment, sensory fusion, and exotropic drift. Methods: This was a retrospective study for the medical record of 11 patients with consecutive esotropia after IXT surgery of 543 patients over the period of 5 year, with mean surgery age of 9.5 (range: 4–33 y). FVT was planned after minimum 6 weeks of surgery and was considered for maximum 24 weeks. Patients underwent a combination of office-based and home-based FVT. Successful outcome of therapy was considered where diplopia resolves in free space and achieves sensory fusion, stereopsis with no manifest deviation. Results: Record of 543 patients who had horizontal muscle surgery for IXT were identified and reviewed. Records of 11 patients who showed consecutive esotropia of 10 prism diopter (PD) or more with normal retinal correspondence, with or without diplopia complaint, after 6 week of surgery and had undergone vision therapy management were reviewed. A successful outcome of binocular single vision with good sensory and motor fusion with no manifest deviation or prism requirement was achieved with in the mean duration of 4.8 month of therapy. With a mean duration of 4 weeks of therapy, the mean angle of deviation reduced by 53% for distance (17 PD to 8 PD) and 27% for near (11 PD to 8 PD) and mean stereopsis improvement by 80% with 94% patients demonstrating sensory fusion on Bagolini test and 94% of patients having no symptoms of diplopia or squint. Conclusion: With nonsurgical management involving refractive error correction, FVT, and prism, consecutive esotropia was resolved in 74% cases. Management of consecutive esotropia with FVT can result in satisfactory sensory fusion and successful motor alignment.

Spontaneous intracranial hypotension associated with posterior reversible encephalopathy syndrome

Spontaneous intracranial hypotension (SIH) is usually due to cerebrospinal fluid (CSF) leak, resulting in loss of CSF volume. Posterior reversible encephalopathy syndrome (PRES) is the inability of the posterior circulation of the brain to autoregulate in response to significant variation in blood pressure.Altered perfusion with associated blood-brain barrier disruption may lead to vasogenic edema, usually without infarction, commonly in the parieto-occipital regions. Magnetic resonance (MR) imaging of the brain and spine and cerebral MR venography are essential tools for diagnosing clinically suspected SIH and PRES. We present 18-year-young gentleman with clinical and radiological signs of SIH, which later evolved toward PRES.

Screening and evaluation of PGPR strains having multiple PGP traits from hilly terrain

Plant growth-promoting rhizobacteria (PGPR) with multiple beneficial traits serve as potentially, ecofriendly,and cost-effective alternatives to chemical fertilizers and pesticides. They have both direct and indirectaffirmative impacts on overall plant growth and health. PGPRs are well known to directly improve the plantgrowth by phytohormone production and availability of minerals in soil. A total of nine soil samples were takenfrom near the rhizospheric zone of different crops and 56 rhizobacterial strains were isolated. Only 16 out of56 rhizobacterial strains were found positive for more than one beneficial trait that included solubilization ofphosphate, indole acetic acid (IAA), siderophore, ammonia and H2S production. Among all PGPR strains,RKM15 was observed having the highest phosphate solubilizing index (3.4), solubilized phosphorus (339mg L−1) and also siderophore unit (70.54 %). The maximum IAA production was observed by RKM25 strain(35.56 µg ml−1). The most promising RKM15 isolate was identified as Pantoea dispersa (MN629239) through16S rRNA gene sequencing technique. This characterized PGPR strain may be used for the development ofbiofertilizers to enhance crop productivity and improvement in soil fertility

An assessment of the factors affecting surgical decision making: a multi institutional study

Background: Decision making is a complex process, especially when guidelines are lacking. Surgeons then turn to other factors to help guide them make these decisions. This study is an attempt to understand these factors which play a role in the decision making process of surgeons.Methods: A prospective qualitative study was conducted amongst consultant surgeons and surgical residents from various institutes across Bangalore. The questionnaire was sent out to these surgeons and responses were recorded using Google Forms. A total of 158 responses were received and analyzed.Results: 69.2% of surgeons felt that patient preferences influence their decision making process. Age of the patient and medical comorbidities played a role in the decision making process of 95.5% and 94.2% of the surgeons respectively. 91% of the surgeons agreed that their age and experience has a strong influence on the decisions made by them. The institution of work and availability of tools mattered to 61.7% and 80.1% of the surgeons respectively.Conclusions: Factors such as patients’ age, comorbidities, preferences, surgeon’s institution of study, institution of work, experience, and institutional factors influence the decisions made by surgeons. Further study is needed on the larger scale to fully understand the various factors playing a role in the final decision making process.

Therapeutic and medicinal uses of lycopene: a systematic review

Lycopene is a carotenoid present in fruits and vegetables. The richest sources of lycopene are tomatoes and tomato products. The beneficial effects of lycopene in human health and disease are mainly associated with its antioxidant properties. Lycopene is a carotenoid with strongest antioxidant property because of its capability of quenching the singlet oxygen. Eleven conjugated double bonds of lycopene give it a deep red color and are responsible for its antioxidant activity which is major functional feature of lycopene. Dietary intakes of tomatoes and tomato products containing lycopene have been shown to be associated with decreased risk of chronic diseases such as cancer and cardiovascular diseases in numerous studies. Although there are evidences from many epidemiological and cell culture and animal studies explaining the inverse relationship between lycopene and cancer or cardiovascular disease risk, more clinical trial data is needed to support this hypothesis. In this article we outline the possible mechanisms of action of lycopene and review the current understanding of its role in human health and disease prevention.

Indigenous Knowledge and Practices on Medicinal Plants Used by Local Communities of Gambella Region, South West Ethiopia

Indigenous knowledge and practices on medicinal plants used by local communities of Gambella region, south west Ethiopia was conducted to investigate those potential and popular medicinal plantsused for the treatment of various diseases in Gambella region.A total of 100purposivelyselected inhabitants were employed in the study of which 84 were male and 16 werefemales. A traditional use of plants information was obtained by semi structured oral interviews from experienced rural elders, Focus group discussion and through questionnaire administered to traditional herbal medicine practitioners of the study area. 81 medicinal plants were identified for the traditional treatment of both human (25) and animal (16) disease. The highest numbers of medicinal plants for traditional uses utilized by this community were belonging to shrubs 30(37.03%) followed by trees (32.10%). The result reviled that 15.2% of the remedies are prepared from root part and Original ResearchArticle squeezing accounts 17(20.99%) followed by chewing 14(17.28%). The major routs of administration of traditional medicines were reported oral 50(61.73%). Urine, placental retention and milk let down accounts higher informants’ consensus factor value (0.96). Thefindings showed that sheferaw and leele have higher fidelity level which is 100 and 92 respectively. Various factors were recorded as the main threats of medicinal plants in the study area. In conclusion,the community carries a vast knowledge of medicinal plants but this knowledge is also rapidly disappearing in this community. Such type of ethno-botanical studies will help in systematic documentation of ethno-botanical knowledge and availing to the scientific world plant therapies used as antivenin by the Gambella community and further research on plant species identification and chemical extraction is recommended

Effect of Withania somnifera on gentamicin induced renal lesions in rats

ABSTRACT Gentamicin induced renal complications are well known in humans and animals. Medicinal properties of Withania somnifera (L.) Dunal, Solanaceae, are recognized to improve renal functions. However, the pharmacological function of W. somnifera is not completely understood. We sought to unravel medicinal therapeutic function of W. somnifera on gentamicin-induced nephrotoxicity in wistar rats. Twenty-four adult male wistar rats evenly divided into four groups to evaluate in vivo nephroprotective and nephrocurative function of W. somnifera in gentamicin induced nephrotoxic rats. Experimental design as follows: Group I, saline control for 21 days; Group II, gentamicin nephrotoxic control for eight days; Group III, alcoholic extract of W. somnifera for 13 days + simultaneous administration of gentamicin and W. somnifera, from day 14 to 21 (nephroprotective) and Group IV, gentamicin for 8 days + alcoholic extract of W. somnifera from day 9 to 21 (nephrocurative). End of experiment, respective serum and kidney tissue samples used to analyze renal function. Withania somnifera as a nephroprotective and nephrocurative molecule significantly restore the renal function on gentamicin-induced nephrotoxicity. This phenomenon is accompanied with significantly reduced blood urea nitrogen, creatine, alkaline phosphatase, gamma-glutamyl transferase, albumin, total protein, calcium, potassium and kidney malondialdehyde concentrations. Additionally, W. somnifera significantly increased antioxidant activities of glutathione and superoxide dismutase to protect renal tissue damage from gentamicin in wistar rats. Over all, W. somnifera treated nephroprotective animal shows improved recovery compared to nephrocuartive. The nephroprotective or nephrocurative effect of W. somnifera could be due to inherent antioxidant and free-radical-scavenging principle(s). In the near future, biologically active compounds of W. somnifera (withanolides) could appear as a novel therapeutic molecule for renal disorders.

A comparison of Streptococcus agalactiae septic arthritis and non-Streptococcus agalactiae septic arthritis

<p><b>INTRODUCTION</b>Streptococcus agalactiae (Group B Streptococcus, GBS) is an uncommon cause of septic arthritis in the adult population. In recent years, there has been an increase in the incidence of GBS septic arthritis. This study aims to compare the clinical presentation, investigations, microbiology and outcome of management in patients with GBS and non-GBS septic arthritis.</p><p><b>METHODS</b>Retrospective review of hospital surgical records was done to identify all patients treated surgically at our institution from January 2011 to January 2016 for primary septic arthritis. Patients were categorised into two groups: those with culture-proven GBS septic arthritis and those with causative pathogens that were not GBS. Patients who were medically unfit for surgical intervention as well as those who declined interventional procedures were excluded from the study.</p><p><b>RESULTS</b>A total of 83 patients were included in the study: 62 (74.7%) had non-GBS septic arthritis and 21 (25.3%) had GBS septic arthritis. Patients with GBS septic arthritis were more likely to have polyarticular involvement (p < 0.001) and involvement of less common sites such as the elbow joint. They were also more likely to have elevated inflammatory markers (C-reactive protein > 150 mg/L; p = 0.017) and positive blood cultures (p = 0.02), and were typically healthy adults with no medical comorbidities (p = 0.012).</p><p><b>CONCLUSION</b>Patients with GBS septic arthritis were more likely to present with polyarticular involvement, positive blood cultures and higher levels of C-reactive protein on admission, and tended to be healthier individuals with no medical comorbidities.</p>

A study of symptomatic choledochal cyst in South India

Introduction: Choledochal cyst is a type congenital anomaly in which there is dilatation of the intra or extrahepatic biliary tree. Choledochal cysts are classified into five types based on location or shape of the cysts. Materials and methods: A prospective analytical study was conducted from January 2015 to June 2017 at Madras Medical College, Chennai, India. All patients who underwent ERCP and had finding of choledochal cyst on cholangiogram were included in the study. Patients were assessed on their demographic data, clinical findings, presentation, and complications. Results: The incidence of symptomatic choledochal cyst was 2.5%. Type 1C was the most common type of choledochal cyst with obstructive jaundice due to large CBD stones as the most common presentation in this study. None had 30 day post-operative mortality. Conclusion: Type IC is the most common type among symptomatic choledochal cyst in south India. As it is a premalignant condition management includes endoscopic retrograde cholangiography followed by surgery with good clinical outcome.

Is the Apprehension Test Sufficient for the Diagnosis of Anterior Shoulder Instability in Young Patients without Magnetic Resonance Imaging (MRI)?

<p><b>INTRODUCTION</b>The purpose of this study is to compare the sensitivities and positive predictive values (PPV) of the anterior apprehension test and magnetic resonance imaging (MRI) in the diagnosis of anterior labral tears in young patients with shoulder instability and to determine if surgery could be carried out without this investigation in selected patients.</p><p><b>MATERIALS AND METHODS</b>We undertook a retrospective study of 168 patients aged between 15 and 30 years with a history of shoulder dislocation and compared the sensitivities and the PPV of the apprehension test with both MRI and magnetic resonance arthrograms (MRA) in the diagnosis of a Bankart lesion. The radiological investigations were interpreted by general practice radiologists and specialised musculoskeletal radiologists. All patients had their diagnosis confirmed by shoulder arthroscopy.</p><p><b>RESULTS</b>Our results showed that the apprehension test was highly reliable when it was positive with a PPV of 96%. It was more sensitive than MRI in the diagnosis of a Bankart lesion. The clinical test was significantly better when a musculoskeletal radiologist interpreted the MRI. The MRA interpreted by a musculoskeletal radiologist had the highest rates of sensitivity in detecting Bankart lesions. The figure was similar to that for the apprehension test. There was no difference in the PPVs among the clinical test, the MRI and the MRA read by the 2 categories of radiologists.</p><p><b>CONCLUSION</b>We conclude that a routine MRI may be unnecessary in evaluating a young patient with clinically evident anterior shoulder instability if the apprehension test is positive. A MRA that can be interpreted by a musculoskeletal radiologist will be the next best investigation if the clinical test is negative or equivocal.</p>

Frequency of cardiorenal syndrome type-I in hospitalized children with acute heart failure in a tertiary-care hospital

To determine the frequency of cardiorenal syndrome in hospitalized children with acute heart failure. Descriptive study. Paediatric Intensive Care Unit, The Aga Khan University Hospital, Karachi, from December 2010 to December 2011. Sixty eight [68] children with acute heart failure fulfilling the selection criteria were evaluated for worsening of renal function [WRF]. Serum creatinine was done at baseline and repeated at 72 hours to see the worsening of renal function. Estimated serum creatinine clearance was calculated by Schwartz formula. Mean age of patients was 43.6 +/- 55.2 months. There were 43 [63%] males, 70% were under 57 months of age. Mean weight on admission was 14.7 +/- 19.13 kg and mean height was 83 cm [ +/- 31.08 SD]. Mean serum creatinine on admission was 0.77 mg/dl [ +/- 1.18 SD]. Worsening renal function was noted in 55 [81%] of children, out of those, majority 36 [70.5%] were under 5 years of age. Worsening renal function was found in 81% of children admitted with the diagnosis of acute heart failure. Majority [70.5%] were under 5 years of age indicating a closer observation of renal status in younger age group to reduce, morbidity and mortality

Readmission to paediatric intensive care unit: frequency, causes and outcome

Readmission to intensive care units is considered to be an important quality indicator in ICU settings. This study was carried out at the paediatric intensive unit [PICU] and step down units of paediatric ward at the Aga Khan University Hospital, Karachi, Pakistan, to assess the frequency, common causes and outcome of patients readmitted in PICU within 48 hours after discharge from unit. During the study period, 1022 patients were admitted in PICU, out of which 24 [2.34%] patients required readmission. Male to female ratio was 1.2:1. The mean length of stay on paediatric floor before readmission was 24 hours. Fifteen [62%] patients were readmitted due to worsening of primary condition while 9 [38%] developed new problems. Respiratory problems accounted for 15 [62.5%] of readmissions, followed by cardiovascular 4 [16.5%] and sepsis related causes 3 [12.5%]. The mortality rate of readmitted patients was 21% [5/24] in this study as compared to overall PICU mortality of 122 [11.93%]

Thrombotic Microangiopathic Syndrome: A Novel Complication of Diabetic Ketoacidosis.

Thrombotic microangiopathic syndrome secondary to diabetic ketoacidosis is an under reported entity in children. We describe 2 girls who developed thrombotic thrombocytopenic purpura (TTP) and thrombocytopenia associated multi organ failure (TAMOF) in new onset diabetes. Both patients presented with classical findings of DKA and were intubated due to low GCS, admitted in PICU and managed according to DKA guidelines. Later on, both patients developed thrombocytopenia, acute kidney injury, and low hemoglobin along with evidence of microangiopathy on peripheral smear. One patient developed paraparesis while other patient had high LDH levels. The clinical diagnosis of TTP and TAMOF was made respectively. Both patients were treated with plasmapharesis and renal replacement therapy. Both gradually improved and were discharged.

Botulism in children: a diagnostic dilemma in developing countries

Botulism is a well-known disease of the neuromuscular junction. It is a rare but curable cause of paralysis in paediatric population. In addition to classical clinical signs and symptoms, the diagnosis of botulism requires laboratory confirmation of intoxication by various biological tests. These include demonstration of botulinum toxin in serum or isolation of the Clostridium botulinum from stool/gastric aspirates. However, it is not always possible to confirm intoxication due to unavailability of technical facilities, especially in resource limited countries like Pakistan. Under these circumstances, electrophysiological studies serve as an excellent diagnostic tool. These studies can provide quick diagnosis of botulism so that early administration of botulism immunoglobulin, if available, can reduce morbidity, mortality and length of stay in hospital. We report a case of botulism from Pakistan diagnosed on the basis of electrophysiological studies

Pediatric gliosarcoma with fibrosarcomatous differentiation: Report of a rare case.

Gliosarcoma is a rare variant of glioblastoma with a biphasic pattern showing glial and mesenchymal differentiation. It is seen in adults during their fifth to sixth decades of life and is extremely rare in children. We report a case of primary gliosarcoma with fibrosarcomatous differentiation in an 11-year-old boy presenting with headache and vomiting. Imaging showed a contrast-enhancing isodense space-occupying lesion with areas of calcification in the right temporoparietal cortex. A total excision was done and, on histopathologic examination, a differential diagnostic consideration of gliosarcoma and teratoma with malignant transformation was made. After immunohistochemical analysis, a final diagnosis of gliosarcoma with fibrosarcomatous differentiation was then made. Primary gliosarcoma is a very rare tumor in children with a poor prognosis.

Evaluation of antidepressant action of various fractions of methanolic extract of Terminalia bellirica roxb in rats

The present study was aimed to investigate the effect of various fractions of methanolic extract of Terminalia bellirica on depression in rat using forced swim test [FST]. Antidepressant activity was evaluated by Forced swim test. Gallic acid [10, 30, 50, 100mg/kg], Fluoxetine, and Imipramine were administered in separate group of male Sprague rats one hour before the test. Gallic acid equivalent doses of various fractions of methanolic extract of Terminalia bellirica has been administered to a particular group of animals. The interference of antidepressant activity with gross motor activity of rats was determined by Open field test. Gallic acid shows a significant decrease in immobility time in dose dependent manner in FST. The efficacy of Gallic acid [50mg/kg] was found to be similar to that of Imipramine [10.5 mg/kg, p.o.] and Fluoxetine [14.5 mg/kg, p.o.]. Gallic acid equivalent dose of various fractions [200mg/kg] of methanolic extract of Terminalia bellirica showed a significant reduction in immobility time when compared to normal control and was not interfered with gross motor activity. Antidepressant property of various fractions of methanolic extract of Terminalia bellirica is due to the presence of Gallic acid. The antidepressant effect of Gallic acid may be through maintaining the level of nor adrenaline, 5-HT, and dopamine because TB extracts reversed reserpine induced depression suggested that antidepressant like effect of TB extracts may be through the restoration of brain monoamines, like nor epinephrine, 5-hydroxy tyrptamine [5-HT] and dopamine levels

Elective tracheostomy in mechanically ventilated children

Tracheostomy is an important procedure in children requiring prolonged mechanical ventilation. We conducted a retrospective study to assess the frequency, indications, postoperative course and short-term outcome of elective tracheostomy in a Paediatric Intensive Care Unit [PICU] of Pakistan. Twenty-five patients underwent tracheostomy in last 5 years [2.2% of all PICU admissions]. Mean age of patients was 6 years and 60% were male. The most common indication for tracheostomy was prolonged mechanical ventilation secondary to neurological disease [60%], followed by upper airway obstruction [40%]. Major complications included accidental decannulation [20%] and tube obstruction [20%]. Three patients [12%] developed ventilator-associated pneumonia after tracheostomy change while persistent bacterial colonization of trachea was observed in 8 patients [32%]. Decannulation was achieved in 40% [10/25]. There was no mortality related to tracheostomy in this series

Evaluation of antioxidant activity of various fractions of methanolic extract of Terminalia bellirica roxb on diabetic neuropathic rat

The present study was aimed to investigate the antioxidant activity of various fractions of methanolic extract of Terminalia bellirica roxb in Diabetic Neuropathic rats. Diabetes was induced by Streptozotocin [50mg/kg, i.p]. Diabetic neuropathy was assessed by thermal and chemical stimuli. Antioxidant status has been evaluated. In this preventive therapy treatment has started with various fractions and gallic acid one day before the induction of diabetes and continued till 5th week of diabetes. Blood glucose level has been checked for each group and sciatic nerve histopathological studies have also done. Animals treated with Gallic acid, n-butanol and ethyl acetate fractions of methanolic extract of Terminalia bellirica showed an extremely significant increase in the level of SOD, Catalase, reduced glutathione and decrease in the level of TEARS when compared to diabetic control and also significantly [p<0.001] increased the reaction time in Hot plate test, Hot water Tail immersion and significantly reduced the number of flinches in each phase in Formalin test when compared to diabetic control. Moreover animals treated with all these fractions except water fraction was not showed any significant effect in reaction time when compared to normal rat indicated the prevention of neuropathic pain. Diabetic animals treated with all fractions showed a gradual decrease in blood sugar in each week. Gallic acid and N-butanol shown preserved fiber density and vascular thickening was not observed when compared to diabetic control. Gallic acid present in the methanolic extract of Terminalia bellirica is the better option for diabetic neuropathy, that will act through two mechanisms i] by reducing the blood glucose level ii] due to the antioxidant activity they may retain the antioxidant status in animals to prevent the development of diabetic neuropathy