Cross-sectional study to describe the severity, bio-chemical associations, and final outcomes of COVID-19-associated rhino-orbital-cerebral mucormycosis in a tertiary hospital of East India

Purpose: The second wave of coronavirus disease 2019 (COVID?19) pandemic triggered a mucormycosis epidemic in India. Diabetes mellitus and dysregulated immune response were contributors, and rhino?orbital?cerebral mucormycosis (ROCM) was the most common presentation. It is however not known whether bio?chemical parameters at presentation correlate with stage of ROCM or final outcome in terms of vision or mortality. Methods: This retrospective, hospital?based study included all in?patients of mucormycosis with ophthalmic manifestations at presentation admitted during June 1, 2021 to August 31, 2021. It aimed to evaluate the association between severity of infection, serum levels of HbA1c, ferritin, interleukin?6 (IL?6), C?reactive protein (CRP), and D?dimer levels at presentation and outcome. Results: There were altogether 47 eligible cases having a mean age of 48.8 ± 10.9 years with a male:female ratio of 2.6:1; forty?two (89.4%) had pre?existing diabetes, and five (10.6%) had steroid?induced hyperglycemia. The mean HbA1c among diabetics was 9.7 ± 2.1. HbA1c and serum CRP showed an increase over subsequent stages, which was not statistically significant (P = 0.31). IL?6 values for all stages were similar (P = 0.97). Only serum ferritin levels showed a statistically significant increase over stages (P = 0.04). IL?6 was significantly lower (P = 0.03) in patients who survived, whereas CRP levels were significantly lower in patients who had final visual acuity (VA) better than only perception of light (P = 0.03). Conclusion: Uncontrolled diabetes mellitus is a significant association of ROCM. Serum ferritin levels at presentation best correlate with extent of the disease. CRP levels are best to prognosticate cases that will have sufficient VA to carry on activities of daily living, whereas IL?6 levels are best associated with survival

The ligation of the intersphincteric fistula tract (LIFT) technique for simple and complex fistula-in-ano

Background: Fistula-in-ano is one of the most common clinical condition encountered in a surgical outpatient department. Many treatment modalities have been described with variable outcomes but gold standard surgical treatment is yet to be agreed upon. The aim of the present study is to evaluate the treatment outcomes of ligature of intersphincteric fistula tract (LIFT) technique in the treatment of simple and complex fistula-in-ano with the primary objective of recurrence rate and broad objective of other postoperative complications during the period of study and after long-term follow-up. Methods: It is a retrospective study of prospectively collected data from the patients who havebeen operated for fistula-in-ano using the LIFT technique at our institute from February 2018 to March 2020 and followed-up until September 2020. Results: A total of 56 patients with fistula-in-ano were treated with the LIFT procedure during the study period, of which 20 patients had simple fistula and 36 had complex fistula. A success rate of 83% was obtained with completely healed fistulas in 46 patients. No patient developed postoperative incontinence. Conclusion: Ligature of intersphincteric fistula tract is an effective treatmentmodality for fistula-in-ano with less procedure-related morbidity, but it is associated with a higher recurrence rate in simple fistula than in complex fistula. (AU)

Pattern of Ocular Morbidity in School Going Children

We wanted to determine the prevalence of ocular morbidity among school going children between ages of 6 and 16 yrs. in public schools of urban and rural areas of Kanpur city and study its pattern. METHODSA cross-sectional prospective study was done among a total of 2105 school going children (rural - 956 and urban -1149), 6-16 years of age in rural and urban areas of Kanpur city. A comprehensive ocular examination was done with the help of torch light, slit lamp and +90 D and direct ophthalmoscope to examine the anterior & posterior segment pathologies. RESULTSOcular morbidity in the rural population was 817 (no. of diagnosed cases) of which 43.30 % were in rural areas of which 63.52 % were males. 35.07 % were in urban areas of which 57.81 % were males. The most common type of ocular morbidity in rural population was refractive error (15.9 %), followed by vitamin A deficiency (12.86 %), blepharitis (5.43 %), squint (3.66 %), amblyopia (2.87 %), stye (2.40 %), ptosis (1.67%), colour blindness (1.15 %), and posterior segment pathologies (0.19 %).in urban areas, the most common cause was refractive error (26.19 %), followed by squint (2.78 %), amblyopia (1.91 %), vitamin A deficiency (1.91 %), blepharitis (1.83 %), colour blindness (1.21 %), stye (0.70 %), ptosis (0.35 %) and posterior segment pathologies (0.08 %). The difference was statistically extremely significant with p = 0.0001. CONCLUSIONSRefractive error was the most common ocular morbidity in both urban and rural areas, but Vitamin A deficiency and blepharitis were more common in rural areas. In rural areas malnutrition seems to be the major cause of ocular morbidity while more use of gadgets and less outdoor activity seems to play vital role in urban areas.

Effect of acute hypobaric hypoxia on blood pressure and heart rate and its restoration by chlorogenic acid

Increase in altitude is always accompanied with low pressure and lack ofoxygen. In order to replicate high altitude conditions in normal altitudes, hypobarichypoxia model is often studied. Chlorogenic acid is known to have a variety of effects onhealth and is most notably used to reduce blood pressure and weight loss. In the presentstudy, a simple hypobaric condition has been created using a hypobaric chamber in whichvarious pressure points (0.06, 0.05 and 0.04 MPa) has maintained for different timeperiods (1h, 2h and 4h). The study has been simulated in rat model and their physiologicalconditions including systolic blood pressure and heart rate was monitored after exposureof hypobaric pressure at different time periods with or without administration ofchlorogenic acid. Data reveals that a brief exposure to low pressure do not affect thephysiological conditions to a great extent but longer exposures lead to increased bloodpressure and heart rate. However, it was observed that pre-treatment with chlorogenicacid enabled the rats to combat the stress and the physiological parameters were revertednear to the normal conditions. It can be concluded from this study that, chlorogenic acidbeing an antioxidant can help to recover the altered physiological condition induced byhypobaric hypoxia. Further, biochemical studies are required to explore the amelioratingmechanism. The study also provides an idea regarding the physiological changes takingplace in rats due to low pressure.

Are NSAIDS Really Responsible For Increasing Incidence Of Duodenal Perforation – Our Experience

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed drugs for pain and inflammation all over the world by medical practitioners. Long-term overuse of these drugs leads to severe gastrointestinal complications such as peptic ulcers and erosions. Aim of study is to evaluate the incidence of NSAIDS related peptic ulcer perforation in our region and to know the role of NSAIDS in the causation of duodenal perforation. Methods: This was retrospective study conducted in the Department of General Surgery Rohilkhand Medical College and Hospital on 51 patients of duodenal perforations to know its causation with NSAIDS. The results obtained were compiled in a tabulated form. Mean ± Standard Deviation (SD) were analyzed using with Statistical Package for Social Sciences (SPSS 23.0). The level P < 0.05 was considered as the cutoff value for significance. Results: The Mean age of all patients was 43.86±11.05 years. In majority of 28 (54.90%) patients NSAIDS was responsible either alone or concomitantly associated with excessive smoking and alcohol in 20(71.42%) patients and NSAIDS alone in 8(28.57%) patients. Conclusion: Excessive high dose intake of these drugs and intake of the combination of two NSAIDS instead of single NSAIDS therapy has resulted in increased chances of peptic ulcer perforation. So indiscriminate use of NSAIDS should be avoided.

Postoperative Functional Results of Posterior Tibial Tendon Transfer for Foot Drop as a Consequence of Nerve Palsy in Leprosy.

Background: The aim of this study was to access the postoperative functional results of posterior tibial tendon transfer for foot drop as a consequence of nerve palsy in leprosy. Methods: sixteen patients (13 Male and 3 females) with ages ranging from 14 to 47 years (mean=27.56 ± 8.41 years) were submitted to posterior tibial tendon transfer by the circumtibial route to correct foot drop in leprosy cured patients. The operated patients were followed up on the end of 6th, 12th, 18th and 24th weeks. The Stanmore system was used as a method for evaluating the functional results of postoperative tibialis posterior tendon transfer. This system is made up of 7 different categories and the total score is 100. Results: According to the Stanmore system, the results of 62.5% of patients i.e., 10 patients out of 16 had very good result. More so 12.5% of them (two out of sixteen) had shown good results, whereas other patients i.e., 12.5% of them had fair results. Rest 12.5% of them had poor results. All the patients were satisfied with their near normal gait pattern. Conclusion: The posterior tibial tendon transfer for foot drop in leprosy cured patients is efficient in restoring normal function of the foot and achieving “heel to toe” gait pattern without changing foot posture. In the absence of a standardized method for assessing the results of posterior tibial tendon transfer, the Stanmore system seems to be a good tool for an objective evaluation.

Inadequate Nasogastric Drainage In Acute Intestinal Obstruction (A Rare Cause With Literature Review).

Abstracts: Background: Nasogastric aspiration is bedside procedure in surgical wards. Amount and type of nasogastic drainage is helpful in establishing conditions such as intestinal obstruction and its level. Knotted nasogastric tube is rarely reported in literature. In our case of intestinal obstruction this rare condition led to a diagnostic dilemma. Through this we want to highlight that in patients with intestinal obstruction and inadequate nasogastric tube drainage, possibility of this rare complication should be thought of.

A comparative evaluation of end-emic and non-endemic region of visceral leishmaniasis (Kala-azar) in India with ground survey and space technology

In visceral leishmaniasis, phlebotomine vectors are targets for control measures. Understanding the ecosystem of the vectors is a prerequisite for creating these control measures. This study endeavours to delineate the suitable locations of Phlebotomus argentipes with relation to environmental characteristics between endemic and non-endemic districts in India. A cross-sectional survey was conducted on 25 villages in each district. Environmental data were obtained through remote sensing images and vector density was measured using a CDC light trap. Simple linear regression analysis was used to measure the association between climatic parameters and vector density. Using factor analysis, the relationship between land cover classes and P. argentipes density among the villages in both districts was investigated. The results of the regression analysis indicated that indoor temperature and relative humidity are the best predictors for P. argentipes distribution. Factor analysis confirmed breeding preferences for P. argentipes by landscape element. Minimum Normalised Difference Vegetation Index, marshy land and orchard/settlement produced high loading in an endemic region, whereas water bodies and dense forest were preferred in non-endemic sites. Soil properties between the two districts were studied and indicated that soil pH and moisture content is higher in endemic sites compared to non-endemic sites. The present study should be utilised to make critical decisions for vector surveillance and controlling Kala-azar disease vectors.

Olfactory ensheathing cell tumor.

Olfactory ensheathing cells (OECs) are found in the olfactory bulb and olfactory nasal mucosa. They resemble Schwann cells on light and electron microscopy, however, immunohistochemical staining can distinguish between the two. There are less than 30 cases of olfactory groove schwannomas reported in the literature while there is only one reported case of OEC tumor. We report an OEC tumor in a 42-year-old male and discuss the pathology and origin of this rare tumor.

Desmoplastic fibroma of the frontal bone.

Desmoplastic fibroma is a benign but locally aggressive tumor arising usually from the mandible, pelvis and long bones with a potential for recurrence. We report a case of desmoplastic fibroma of the frontal bone in a young male.

Microendoscopic discectomy for prolapsed lumbar intervertebral disc.

BACKGROUND: Lumbar disc prolapse is a common problem and the current surgical standard for its treatment is a microsurgical discectomy. Microendoscopic discectomy (MED) is a minimally invasive spinal procedure being done successfully for prolapsed intervertebral disc disease. AIMS: We report the technique, outcome and complications seen in 107 cases of prolapsed lumbar intervertebral disc who underwent MED. SETTING AND DESIGN: The study was carried out at the Department of Neurosurgery, at a tertiary hospital in South India and the data was collected prospectively. MATERIALS AND METHODS: 107 patients with prolapsed lumbar intervertebral disc who were seen at our institution between November 2002 and January 2006 were included in the study. Data was collected prospectively. The METRx system (Medtronic Sofamor Danek, Memphis,TN) was used to perform MED. Outcome assessment was done by the modified Macnab criteria. RESULTS: 107 patients (67 males, 40 females) underwent MED for prolapsed lumbar intervertebral disc. Follow up ranged from 2 to 40 months with a mean follow up 12.9 months. Seventy six patients had an excellent outcome, 22 patients had a good outcome, 5 patients had a fair outcome and 3 patients had a poor outcome. One patient with a long dural tear required conversion to a standard microdiscectomy and was excluded from outcome assessment. Complications included dural puncture with K-wire (1), dural tear (2), superficial wound infection (1), discitis (1) and recurrent disc prolapse (2). CONCLUSIONS: Microendoscopic Discectomy (MED) is a safe and effective procedure for the treatment of prolapsed lumbar intervertebral disc.

Transradial primary angioplasty and stenting in Indian patients with acute myocardial infarction: acute results and 6-month follow-up.

BACKGROUND: Coronary angioplasty and stent implantation is effective as primary intervention in acute myocardial infarction. Because of fewer puncture site complications and improved patient comfort, transradial access has been increasingly used as an alternative to transfemoral access for percutaneous coronary interventions. METHODS AND RESULTS: We studied 103 patients (94 men, 9 women: mean age 52.5 +/- 11.96 years) with a diagnosis of acute myocardial infarction (<12 hours after onset), who underwent primary percutaneous coronary intervention. Transradial access was used in all patients with a normal Allen's test and transfemoral access was used additionally only if intra-aortic balloon counterpulsation was required. Follow-up duration was 6 months. Transradial access was successfully achieved in all patients. Radial artery cannulation took <2 min in more than 85% patients. During percutaneous coronary intervention, cannulation to balloon inflation times and total procedure times were 11.3 +/- 5.2 min and 19.9 +/- 10.8 min, respectively. Stents were implanted in 99 (96.1%) patients andplain balloon angioplastywas performed in 3.9%. The primary success rate was 98.1%, with no major bleeding complications. Total length of hospitalization averaged 2.4 +/- 0.8 days. In-hospital major adverse clinical events rate was 5.9%. Six-month clinical follow-up was achieved for 84 (86.6%) patients. Six (7.1%) patients died during follow-up. Follow-up coronary angiography was performed in 22 (26.2%) patients. After 6 months, 7 patients required revascularizationof the target lesion. The rate of survival without myocardial infarction, bypass surgery or repeat coronary angioplasty was 88.5% at 6 months. CONCLUSIONS: Transradial access may represent a safe and feasible technique for performing primary percutaneous coronary intervention with good acute results and without major bleeding complications.

The modified Inoue technique: a simple troubleshooting approach to a proximal segment tear of an Inoue balloon.

A tear in the proximal segment of an Inoue balloon was encountered during the dilatation of a calcific mitral stenosis. As a troubleshooting measure, we modified the steps of the standard Inoue technique. The mitral valve was successfully dilated using the same Inoue balloon.

Successful retrieval of transradially delivered unexpanded coronary stent from the left main coronary artery.

Stent dislodgment during percutaneous coronary intervention is a rare complication. We report a case of successful retrieval of a dislodged stent from the left main coronary artery. It was retrieved via the transradial route using a 6 F coronary guiding catheter supported by an inflated percutaneous transluminal coronary angioplasty balloon distal to the stent.

Direct coronary stenting through the radial approach in an anomalous coronary artery.

An anomalous origin of the coronary artery is an infrequent finding on coronary angiogram. Percutaneous coronary intervention may sometimes be difficult in such situations. We report two cases of anomalous coronary arteries in whom direct stenting was done via the radial approach.