ABSTRACT
Purpose: Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40–80. The best way to manage primary open?angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. Methods: An open?label, real?world, multicentric, observation?based 3?month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first?line therapy. Diurnal IOP measurements, best?corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day?1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Results: Four hundred and sixty?nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once?daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. Conclusion: We found that netarsudil 0.02% w/v solution monotherapy when used as the first?line treatment in primary open?angle glaucoma and ocular hypertension was both safe and effective.
ABSTRACT
Recent advances in lymphatic imaging have provided novel insights into the lymphatic system. Interventional radiology has played a significant role in the development of lymphatic imaging techniques and modalities. Radiologists should be familiar with the basic physiology and anatomy of the lymphatic system to understand the imaging features of lymphatic disorders, which reflect their pathophysiology. This study comprehensively reviews the physiological and anatomical aspects of the human lymphatic system as well as the latest lymphatic imaging techniques.
ABSTRACT
Lymphatic disorders encompass a broad spectrum of diseases involving the lymphatic system, ranging from traumatic lymphatic leaks to lymphatic malformations. Lymphatic disorders can be categorized into traumatic and non-traumatic disorders according to their etiology. These two categories may be further divided into subgroups depending on the anatomical location of the lymphatic pathology and their association with clinical syndromes. Thoracic duct embolization was a milestone in the field of lymphatic intervention that encouraged the application of percutaneous embolization techniques to treat leaks and reflux disorders in the lymphatic system. Additional access routes for embolization, including retrograde thoracic duct and transhepatic lymphatic access, have also been developed. This article comprehensively reviews a variety of options for the treatment of lymphatic disorders, from conservative management to the most recent embolization techniques.
ABSTRACT
Background: Early inflammatory lesions of lichen sclerosus are histopathologically difficult to diagnose until the hallmark of the disease i.e., papillary sclerosis becomes visible in histological sections. Pre-sclerotic and late or resolved phases of the disease have not been extensively studied. Methods: We retrospectively reviewed all cases diagnosed as genital lichen sclerosus over a ten-year period from 2006 to 2016, correlating the clinical findings with the histological features. Results: A total of 133 cases of genital lichen sclerosus (90 males and 43 females) were identified. Both genders demonstrated a similar histological spectrum. Fifty eight (44%) cases were identified as having pre-sclerotic lichen sclerosus, 64 (48%) as having progressive disease and 11 (8%) cases were classified as fully resolved with atrophy. Asymptomatic vitiligoid lesions were identified in 19 (14%) cases of which 12 were male. Low-grade squamous cell carcinoma was seen within the areas affected by long-standing lichen sclerosus, in four patients (3%, 2 male). Limitations: We studied only haematoxylin and eosin stained sections. The presence of basement membrane thickening could have been better illustrated with the periodic acid–Schiff stain. Conclusion: The pathogenesis of lichen sclerosus probably involves an immune reaction to the basement membrane at the epidermal interface and around the adnexa. The initial band of inflammation shifts gradually downwards from the epidermal interface into the dermis destroying the vascular channels and appendages, resulting in excessive deposition of altered extracellular matrix. Basilar infiltration of lymphocytes along with a grossly vacuolated or thickened basement membrane is proposed as the characteristic diagnostic feature of the pre-sclerotic stage. Greater awareness of the clinicopathological spectrum of lichen sclerosus should enable early diagnosis and treatment, thereby preventing structural damage and possible malignant transformation in chronic cases
ABSTRACT
BACKGROUND India is the second most crowded nation in the world. India will become the most populous country in the world in near future if it follows the current growth rate. Family planning is one of the best methods to tackle this problem. The aim of the study is to assess the knowledge of family planning among married women in reproductive age group in an urban area of northern Kerala. METHODS A community based cross sectional study was conducted in Kandangali, the field practice area coming under Urban Health Training Centre of a tertiary care Centre from June, 2016 - July, 2017.A total of 491 married females in reproductive age group were studied. A semi-structured pre-tested self-administered questionnaire was used to collect information. . Data was analysed using SPSS software. RESULTS: Out of 491 married females, 98.4%, 0.8% and 0.8% were Hindus, Muslims and Christians respectively. Majority (57%) of them belongs to a family size of less than or equal to 4 members. Majority (97.4%) of women had an educational qualification more than high school and most of the study participants (35.2%) were graduates. Majority (71.5%) of the women were housewives. Most of the study participants have average knowledge (62.3%) about family planning methods. Still there are misconceptions regarding condom and male sterilization. The main source of information about family planning was from health workers. Majority (95.7%) of them had heard of condom (95.7 percent) and the least heard method was injectable (10.6%). CONCLUSION: Majority of women had average knowledge towards family planning; still there are misconceptions especially about male sterilization and condom. Continuous health education program have to be conducted about family planning methods.
ABSTRACT
Background: COPD can affect the heart as secondary effects of the disease. The electrocardiography has been seen as a very best tool for early diagnosis of any cardiac changes that may occur as a result of secondary effects of the chronic obstructive pulmonary disease. Objective of the study was to study the P wave axis and its correlation with severity of COPD.Methods: Here, 30 Patients of COPD confirmed by clinical history, examination and Pulmonary function tests were included in the study. These patients were clinically examined, and they underwent routine investigations like hemogram, urine examination, blood urea, serum creatinine, chest x-ray, random blood sugar, sputum examination and ABG analysis. These patients underwent pulmonary function test, ECG and ECHO.Results: In this study 36.66% of patients had RVH. Incomplete RBBB was seen in 20%. 13.33% had normal ECG. Most common finding in patients with less than one year of exposure was RVH. Low voltage complexes and R/S ratio in V1>1 were the only ECG changes with significant correlation with severity of the disease (p<0.05). Maximum no. of patients had a P wave axis of 71-800. the correlation between P wave axis and the duration of the disease was found to be statistically significant. the correlation between P wave axis and the severity of the disease was found to be statistically significant, 8/27 patients (29.63%) with less than one year of disease had features of corpulmonale.Conclusions: P-axis verticalization can serve as a very effective electrocardiographic screening tool for emphysema in the general population.
ABSTRACT
Background: Chronic obstructive pulmonary disease progresses if the exposure to aggravating factors continues. As lung function is declined, even after exposure is reduced or totally stopped, the COPD continues to progress though may be at a slower pace and as an effect of increasing age. Objective of the study was to study the clinical profile of patients with chronic obstructive pulmonary disease at a tertiary care hospital.Methods: A hospital based cross sectional study was carried out among 30 patients as decided by inclusion and exclusion criteria at MediCiti Institute of Medical Sciences, Medchal from November 2012 to June 2014. Detailed history, detailed clinical examination, Systemic examination and Forced expiratory volume (FEV1) was done for all patients included. Pack years of smoking was calculated. Data was entered in Excel worksheet and analyzed using proportions.Results: Maximum number of patients was in age group of 60-69 years (36.67%). Majority were males i.e. 83.34%. Smoking was major risk factor. Maximum number of patients (90%) had symptoms of less than one year of duration. Maximum number of patients (80%) had moderate to severe airflow obstruction at time of presentation and only 13.34% had mild disease. Four patients had mild form of the disease. Majority of patients with severe to very severe disease had more than 20 pack years. All patients in the study had breathlessness at the time of presentation. Wheeze and Crepitations were present in 96.66% of patients.Conclusions: Smoking has been found to be the major risk factor and it was positively correlated with the severity of COPD.
ABSTRACT
Introduction: In present medical scenario relating to therenal failure patients in order to enhance the quality of lifeof such individuals the best modality is the dialysis. Thisprocedure itself involves lot of risk & can complicate themedical condition. The patients experiencing renal collapseare at more risk for increased metabolic & heart related issuesthough they are on treatment of dialysis. Dialysis itself canlead to the condition where other systems are compromised.Study aimed to find out the haemodialysis-to-generalanaesthesia time interval and post-operative complications inhaemodialysis patients in order to better define a more optimalpre-anaesthetic waiting period.Material and Methods: A retrospective study was carriedon patients with end-stage renal disease managed by chronichaemodialysis. The time gap between the haemodialysis end& the introduction of general anaesthesia was calibrated fromthe records available from the inpatient & outpatient files. Theside effect after the end of anaesthesia post operatively wasrecorded in our databank. based on the available informationfrom the records document between the haemodialysis &general anaesthesia, the subjects were divided into threegroups: Group 1 interval >24 hours; Group 2 interval from7-23.9 hours; or Group 3 interval < 7 hours.Results: Demographic and illness scores were not differentbetween groups. The only difference in complications waspostoperative hypotension, which was more common inGroup 3 than either Group 1 or 2.Conclusion: The present study results suggest that it is prudentto put a time lag the elective & urgent induction of generalanaesthesia for major surgeries for about 7 hours subsequentto haemodialysis in order to minimize hypotension.
ABSTRACT
Urinary bladder tumors were one of the most common entities of urological pathology. Neoplastic & nonneoplastic lesions of urinary bladder were the common reasons for morbidity and mortality throughout world. Among neoplastic lesions, urothelial carcinoma is a common primary tumor of urinary bladder. The aim of this retrospective study was to determine the spectrum of various urothelial lesions from cystoscopic bladder biopsies received over a period of 3 years. All the urinary bladder biopsies received with two inadequate biopsies were included in this study. Out of 54 biopsies received, 12 were non neoplastic & 40 were neoplastic cases and two were inadequate biopsies. Majority of the cases were in 60-79 years age group. Males were affected more than females ( 2.85:1 ratio). Majority of the neoplastic lesions were urothelial carcinomas. Conclusion : Among the bladder tumors ,urothelial carcinoma was the most common type, among these, high grade urothelial carcinoma was common in our study. Non invasive were more common than invasive carcinoma.Identification of grade &invasion into muscle layer has an impact on prognosis as well as on therapeutic approach.
ABSTRACT
Background: Examining the knowledge, attitude and practices (KAP) of the medical students regarding antibiotic resistance (ABR) and use can help us in devising suitable educational interventions for them, tailored according to their earlier held knowledge, beliefs, capabilities and experience.Methods: A cross sectional, questionnaire based survey was conducted among medical students of a teaching hospital, whereby their KAP regarding antibiotic use and resistance was assessed by using a questionnaire, whose responses ranged from ‘agree’ to ‘disagree,’ ‘always to never’ and true / false. The data was analysed by using simple descriptive statistics. Wherever it was relevant, the Chi-square test was used to determine any significant difference.Results: The number of medical students who agreed that ABR was an important and a serious public health issue in this teaching hospital was 76 percent (n = 325). But, only 54.3% (n = 233) of the students were aware that bacteria were not responsible for causing cold and flu, while the remaining 37.2 percent (n = 22) were not knowledgeable about this fact. More than 80% rated the adverse effect profile of the antibiotic and the risk of a super infection as the important factors which deserved consideration. Cost of the antibiotic was considered to be an important factor deserving consideration by only 65.5% (n=277) of the participants.Conclusions: Our survey revealed that most of the students were aware of the antimicrobial resistance and its consequences. The only concern was their casual attitude regarding the antibiotic use. Further educational interventions are necessary to improve their understanding and perceptions on antibiotic resistance, as well as their attitude towards antibiotic use.
ABSTRACT
Edema is a recognized complication of ongoing heavy opioid use, regardless of the means of delivery or the specifics of the drug in question. The mechanism responsible remains incompletely understood. Hypotheses currently offered include increased Anti-Diuretic Hormone (ADH) secretion, histamine-mediated permeability changes, independent opioid-receptor mediated fluid retention and an exacerbation of pre-existing vascular compromise. Authors report a case of a 39yr old lady in whom edema emerged 7 months after cessation of opioid abuse. All secondary causes of edema were excluded by an exhaustive battery of investigations. The edema failed to recede with loop diuretics, and resolved only on institution of spironolactone, on which she maintained improvement. This case study reinforces hypotheses of ADH likely mediating opioid associated edema and suggests that aldosterone receptor antagonists are probably a superior class of drugs in opioid-associated edema. It also suggests that the physiological changes caused by opioid use that are responsible for edema are likely stable and persist well beyond the period of actual use. Reformed opioid abusers who never received OST are a huge population whose unique physiological status is likely to yield valuable insights into not just the pathology of opioid-abuse related edema, but the pathology of opioid use as a whole.
ABSTRACT
Rheumatic fever is a rare but potentially life-threatening disease that may occur as complication of untreated infection caused by bacteria called group Astreptococcus. The main clinical features are -fever, myalgia, swollen and painful joints, and in some cases, a red, grille like rash typically manifest two to four weeks after a bout of streptococcal infection. In some cases, though, the infection might be too mild to recognize clinically. A 27year old male case was admitted in SSANH on 27/5/2015 with following chief complaints - severe pain and stiffness over multiple joints symmetrically since 2years, swelling of larger joints of both upper and lower limbs symmetrically since 2 years and recurrent episodes of fever accompanied with dyspnoea and body pain. The case was diagnosed as Rheumatic fever and treated with Rasnasapthakamkashayam, Rasasindhooram, Yogarajaguggulu as main internal medications and treatments like choornakizhi, Choornavasthi and Lavana Kizhi. The Ayurvedic management provided better relief in subjective and as well as objective parameters.
ABSTRACT
Background: We have reported segmented lesions in acral vitiligo as well as in generalized vitiligo and thereby proposed somatic mosaicism as a predisposing feature in all forms of vitiligo. This study is a further attempt to characterize and understand such segmented lesions by screening a large series of patients. Methods: We searched our electronic archives (from 2002 to 2014) and identifi ed/reviewed the photos of 615 vitiligo patients inclusive of all clinical types. Over 3500 photographs were screened for patterns that were repeatedly seen in two or more patients and a composite picture of these were marked on a body map. Results: Similar unilateral/bilateral segmented lesions were identifi ed among all forms of vitiligo during relatively stable phases of the disease. These appeared to be related to small and large anatomical divisions of the body. In rapidly evolving disease on the trunk, the lesions conformed to Blaschkoid patterns. Several instances of stable mirror image lesions, symmetric incremental progressions and regressions were also recorded. Limitations: These are observations of a retrospective, single-center review which need to be substantiated further in larger prospective studies. Conclusion: Similar unilateral/bilateral segmented patterns delineating major/minor anatomical divisions of the body may indicate a preexisting developmental defect (such as mosaicism).
ABSTRACT
Background: The aim and objective of the study was to calculate intraocular lens power with IOL master in 100 eyes of 100 patients with long axial lengths between 25mm to 32mm.To analyse and compare the results of various formulae by postoperative auto refractometry and corrected distance visual acuity and to know the most accurate formula for highly myopic eyes (Axial length more than 25.00 mm). Methods: Patients coming to Sarojini Devi Eye Hospital from December 2012-September 2014 for cataract surgery were considered in this study. All patients with visually significant cataract having fundus findings within normal limits were included in this study and patients of complicated cataract due to trauma, uveitis, Glaucoma and any corneal pathology were excluded from the study. Results: The Mean AL was 27.25 ± 1.25 mm, the Mean keratometric value was 43.62 ± 1.45 D, and the Mean Absolute Error (MAE) calculated by the Haigis was 0.07 DD. Compared to the MAEs generated by the other formulae, the MAE generated by the Haigis was comparable to that by the SRK/T (0.231 D), and significantly lower than those by the Hoffer Q (0.481 D) and Holladay (0.864 D). Conclusions: The Mean post-operative refractive error (spherical equivalent) was found to be the least with Haigis formula followed by SRK/T for eyes with long axial length. The HAIGIS formula has a better predictability and accuracy. The postoperative hyperopic shift was comparable between HAIGIS and SRK-T formulae the least postoperative hyperopic shift with Haigis formula compared to other formulae.
ABSTRACT
Background: Outbreaks of dengue infection occur in several parts of India with clockwork precision closely related to changing seasons. Most recent outbreak in Puducherry occurred between October 2012 and January 2013, affected a sizable pediatric population. A prospective study was done to characterize the demographic, diagnostic and clinical profi le of pediatric patients in a tertiary care center in Puducherry. Materials and Methods: Data of patients serologically positive for either dengue NS1 antigen or anti-dengue IgM antibodies were analyzed. Duration of fever, platelet count, complications, risk factors, morbidity and mortality were analyzed. Results: Among pediatric cases with fever who were screened for NS1/ IgM antibody during the recent outbreak, 161 (37.5%) tested positive. NS1 was detected in 85% while 5.5% tested positive for IgM and 3% for IgG. Few (4.9%) tested positive for both NS1 and IgM and 1.2% were positive for both NS1 and IgG. The mean age was 6 years of which 9% were <1-year, the youngest being 1-month old infant. Mean duration of fever was 4 days. Vomiting was associated in 42% of cases. Thrombocytopenia (51%) and hepatomegaly (41%) were two major observations. Among the NS1 positive cases, 49% had thrombocytopenia. IgM alone and NS1 with IgM were associated with thrombocytopenia in 67% and 78% respectively. 14 children had complications of dengue shock syndrome, and four had dengue hemorrhagic fever. Totally, 22 of the children had platelet transfusion. There was no mortality reported among any of these children. Conclusion: Combination of clinical fi ndings and rapid NS1, IgM detection helped in confi rming the diagnosis for appropriate management of dengue in children.
ABSTRACT
Water quality assessment and timely intervention are essential for health. Microbiology, total dissolved solids (TDS) and free residual chlorine were measured for water quality maintenance in an oncology center in India. Impact of these interventions over a period of 22 months has been demonstrated with four cardinal events. Pseudomonas in hospital water was controlled by adequate chlorination, whereas high TDS in the central sterile supply department water was corrected by the installation of electro-deionization plant. Contaminated bottled water was replaced using quality controlled hospital supply. Timely detection and correction of water-related issues, including reverse osmosis plant was possible through multi-faceted approach to water quality.
ABSTRACT
A SPECT (single photon emission computed tomography using Tc-99m HMPAO) study of brain with segmental quantitative analysis was conducted to access the cerebral perfusion in cases of Down’s syndrome (DS). Varying level of brain hypo-perfusion was documented, probably explaining the neurophysiologic basis of cognitive and neuropsychological deficits, which are not well understood in DS.
ABSTRACT
We report a 61-year-old male patient who presented with one month history of exertional dyspnea, persistent dry cough, abdominal pain with distension, poor appetite, and weight loss. This case illustrates a rare presentation of hepatocellular carcinoma with mobile right atrial thrombus and pulmonary embolism along with disseminated tumor thrombosis at multiple sites. Furthermore, this case reiterates that an early detection and diagnosis may have increasing importance in the advent of new therapies for treating advanced hepatocellular carcinoma
ABSTRACT
The main goal of this study was to evaluate the prevalence of leptospirosis among field rodents of Tiruchirappalli district, Tamil Nadu, India. In total 35 field rats were trapped and tested for seroprevalence by the microscopic agglutination test (MAT). Isolation of leptospires was performed from blood and kidney tissues and characterized to serovar level. Genomospecies identification was carried out using 16S rRNA and lipL32 gene sequencing. The molecular phylogeny was constructed to find out species segregation. Seroprevalence was about 51.4 percent, and the predominant serovars were Autumnalis, Javanica, Icterohaemorrhagiae and Pomona. Two isolates from the kidneys were identified as serovar Javanica of Serogroup Javanica, and sequence based molecular phylogeny indicated these two isolates were Leptospira borgpetersenii.