Ultrasonic fragmentation for removing thick organized clots during diabetic vitrectomy – A novel technique

A 65?year?old male with proliferative diabetic retinopathy (PDR) and non?clearing vitreous hemorrhage underwent 25G pars plana vitrectomy (PPV). A large disk of thick organized blood of 5 disk diameter (DD) size was encountered in subhyaloid space. All attempts including lower cut rates to remove this disk using a 25G cutter turned futile. We used a 20G fragmatome to safely remove this hard clot from vitreous cavity in 50 s. Surgical time for removal of similar clot of 3 DD by 25G cutter in another eye was 5 min. Removal of thick clotted subhyaloid blood by ultrasonic fragmentation during diabetic vitrectomy is a safe, faster, and useful maneuver.

Assessment of core capacities for antimicrobial stewardship practices in indian hospitals: Report from a multicentric initiative of global health security agenda

Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.

To Compare the Effect of Vertical Ground Reaction force in Conventional below Knee Prosthesis Versus Modular below Knee Prosthesis on Unilateral Transtibial Amputee Patients

Proper prescription of prosthetic device and potential rehabilitation increases the quality of life for subjects with amputations

A unique case of pulmonary artery catheter bleeding from the oximetry connection port / Caso único de sangramento pela porta de conexão do cateter de artéria pulmonar ao módulo de oximetria / Caso único de sangrado por el puerto de conexión del catéter de arteria pulmonar al módulo de oximetría

Pulmonary artery catheter is an invasive monitor usually placed in high-risk cardiac surgical patients to optimize the cardiac functions. We present this case of blood oozing from the oximetry connection port of the pulmonary artery catheter that resulted in the inability to monitor continuous cardiac output requiring replacement of the catheter. The cause of this abnormal bleeding was later confirmed to be due to a manufacturing defect.

O cateter de artéria pulmonar é um monitor invasivo geralmente usado durante cirurgias cardíacas em pacientes de alto risco para aprimorar as funções cardíacas. Apresen-tamos o caso de escoamento de sangue pela porta de conexão do cateter de artéria pulmonar para oximetria que resultou na impossibilidade de monitorar o débito cardíaco contínuo e na substituição do cateter. A causa do sangramento anormal foi posteriormente confirmada como um defeito de fabricação.

El catéter de arteria pulmonar es un monitor invasivo generalmente usado durante cirugías cardíacas en pacientes de alto riesgo para optimizar las funciones cardíacas. Presen-tamos el caso de entrada de sangre por el puerto de conexión del catéter de arteria pulmonar para oximetría, trayendo como resultado la imposibilidad de monitorizar el gasto cardíaco continuo y, por ende, la sustitución del catéter. La causa del sangrado anormal fue posteriormente confirmada como un defecto de fabricación.

Mechanism of action of probiotics

The modern diet doesn't provide the required amount of beneficial bacteria. Maintenance of a proper microbial ecology in the host is the main criteria to be met for a healthy growth. Probiotics are one such alternative that are supplemented to the host where by and large species of Lactobacillus, Bifidobacterium and Saccharomyces are considered as main probiotics. The field of probiotics has made stupendous strides though there is no major break through in the identification of their mechanism of action. They exert their activity primarily by strengthening the intestinal barrier and immunomodulation. The main objective of the study was to provide a deep insight into the effect of probiotics against the diseases, their applications and proposed mechanism of action.

Diabetic retinopathy is a poor predictor of type of nephropathy in proteinuric type 2 diabetic patients.

BACKGROUND: Both diabetic nephropathy (DN) and nondiabetic nephropathy (NDN) are reported to occur in patients with type 2 diabetes mellitus (DM). The precise diagnosis of the type of nephropathy has obvious clinical and prognostic implication. The aim of the study was to evaluate the histologic spectrum of nephropathy in proteinuric type 2 diabetic patients and to find the correlation between type of nephropathy and diabetic retinopathy (DR). METHODS: Twenty eight proteinuric type 2 diabetic patients were included in the study. Five patients (ADPKD 3 and chronic pyelonephritis 2) were excluded from biopsy. Percutaneous renal biopsy was carried in remaining 23 patients. RESULTS: There was a preponderance of male (75%) and majority of the patients were in the age group of 30-78 years. Duration of diabetes ranged between 4 months to 25 years with mean +/- SD of 10.53 +/- 7.62 years. The presenting features were nephrotic syndrome 14 (60.9%), non-nephrotic proteinuria 9 (39.1%) and impaired renal function in 19 (82.6%) patients. Renal biopsy in 23 cases revealed; isolated diabetic nephropathy 13 (56.2%), NDN7 (13.43%) and 3 (13%) patients had NDN superimposed on diabetic nephropathy. Membranous nephropathy (2), focal segmental glomerulosclerosis (2), mesangiocapillary glomerulonephritis (1) were the nondiabetic glomerular disease in our type 2 diabetic patients. Chronic pyelonephritis and ischemic interstial nephropathy was the predominant tubulointerstial lesion in this study. Diabetic retinopathy (DR) observed in 12 (75%) patients with biopsy proven DN and absent in 4 (25%) patients with DN. The distribution of renal lesions in patients with DR (n = 15) showed DN in 9 (60%), NDN 3 (20%) and remaining 3 patients had combined lesions. Renal biopsy in 8 patients without DR showed typical DN in 4 (50%) and NDN in 4 (50%) patients. CONCLUSION: This study demonstrates presence of both glomerular and tubulointerstitial lesions unrelated to diabetes (NDN) in proteinuric type 2 diabetic patients. Further presence or absence of DR was a poor predictor of diabetic nephropathy because DN was noted in 50% of patients without DR and 40% of patients with DR had non-diabetic nephropathy either alone or in combination with DN.

A new strategy of drug treatment in NSAID-unresponsive ankylosing spondylitis: combination of pamidronate and methylprednisolone monthly intravenous infusions on the background of a combination of disease modifying drugs sulfasalazine and methotrexate.

OBJECTIVES: To assess short term efficacy and tolerability of a therapeutic strategy in patients with ankylosing spondylitis (AS) unresponsive to nonsteroidal anti-inflammatory drugs (NSAIDs) or coxibs and unable to take anti-tumour necrosis factor-alpha (anti-TNFalpha) biological treatment. METHODS: Established AS patients were given a background treatment consisting of subcutaneous injections of methotrexate weekly (MTX, dose stepped up to a maximum of 20 to 25 mg), weekly 12-16 mg of methylprednisolone orally 30 mts before methotrexate dose (for nausea prevention), sulfasalazine (SSZ, 1 gm orally twice per day) with folic acid supplementation (5 mg daily except on the day of MTX). Additionally, they were given monthly cycles of intravenous (IV) methylprednisolone 'pulse' (MPP) and pamidronate infusions (MPP 500 mg 3 consecutive days + pamidronate 60 mg in a slow IV infusion on day 2 of the MPP infusion). A minimum of six treatment cycles at monthly intervals were given. Adjunct treatment consisted of 1 gm elemental calcium supplementation, paracetamol 650 mg 'as-and-when-required' for symptomatic pain relief, amitriptyline 10 mg 2 hours before bed time daily. RESULTS: Of a total of 46 intent-to-treat patients, 39 patients achieved ASAS-20 and BASDAI-50 response (85%, 95% CI, range 71% to 94%); 7 (15 %) patients failed to improve. The expense involved in 6 months of treatment was approximately 10-fold less than anti-TNFalpha treatment over the same period of time. CONCLUSION: For AS patients unresponsive to standard NSAIDs/coxibs and unable to take anti-TNF biological agents a combination therapeutic strategy showed efficacy and good tolerability in a majority of patients evaluated over a short-term.