Solitary orbital myofibroma in a child: A rare case report with literature review

Myofibroma is a rare benign mesenchymal tumor of uncertain histogenesis. A six-year-old boy presented with a unilateral lower eyelid mass of six weeks' duration. MRI revealed a circumscribed mass in the inferolateral orbit with bony erosion. A systemic examination was unremarkable. Excision with histopathology revealed a partially infiltrative spindle cell tumor with bland nuclear morphology expressing smooth muscle actin and muscle-specific actin, compatible with myofibroma. Solitary myofibroma is a rare childhood orbital tumor and may clinico-radiologically closely mimic a malignancy. Histopathology and immunohistochemistry can help reach a definitive diagnosis. Systemic evaluation and close follow up are crucial in such cases.

External dacryocystorhinostomy for isolated lacrimal sac rhinosporidiosis – A suitable alternative to dacryocystectomy

Purpose: To describe the outcome of external dacryocystorhinostomy (DCR) as a suitable alternative to dacryocystectomy (DCT) in cases of isolated lacrimal sac rhinosporidiosis. Methods: This was a retrospective, interventional case series. Institutional review board approval was obtained for the study. The chart review of 13 patients who underwent external DCR surgery for isolated lacrimal sac rhinosporidiosis between July 2012 and May 2018 was performed. Demographic details, clinical presentation, preoperative and intraoperative findings, surgical technique used, postoperative management, surgical outcome and duration of follow up were reviewed for each patient. Results: Thirteen patients were included in the study. Nine (69.2%) were male and four (30.8%) were female. The mean age was 22.1 years (range: 8–46 years). Involvement was unilateral in all cases. The commonest presenting complaint was epiphora with discharge seen in 10 cases (76.9%). An intrasac granuloma was grossly identified intraoperatively in 12 out of the 13 patients. Mean follow up was 26.9 months (range: 1.5–68 months). Till the last follow up, all cases were symptom free and did not have any evidence of recurrence of infection. Conclusion: From this series of cases reported by the authors, external DCR with appropriate precautions to prevent recurrence appears to be a suitable alternative to conventional DCT with excellent long-term outcomes without disease recurrence.

Prevalence and Correlates of Substance Use in rural Bhubaneswar – A Community based Cross sectional Study

Background: Substance use is an ever-increasing public health problem in the Indian society. Besides being a personal health risk, it is also a social and economic issue. The present study was undertaken to find out the prevalence and pattern of substance use in rural Bhubaneswar, Odisha. Material & Methods: A cross sectional community-based study was undertaken in rural Bhubaneswar in two phases, a pre survey qualitative assessment followed by the quantitative assessment. The prevalence, pattern and habit of use of different psychoactive substances were accessed using a predesigned pretested questionnaire among 574 study participants of greater than ten years of age. Results: The prevalence of use of at least one substance was 44.1%. Tobacco (smokeless) was the most commonly used substance followed by alcohol and smoked tobacco. Male gender, age greater than 40 years, joint family and being illiterate were the important predictors of substance use. Conclusions: A predominance of smokeless tobacco consumption was found in our study. Family members’ being the source of introduction in majority of users is a matter of serious concern. Community based intervention strategies can be helpful in targeting the rural population for deaddiction and delivering a social message for curbing the use of harmful substances.

Oral versus single intravenous bolus dose antibiotic prophylaxis against postoperative surgical site infection in external dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction – A randomized study

Purpose: To compare the efficacy of a single perioperative bolus dose of intravenous antibiotic versus postoperative oral antibiotic prophylaxis for prevention of surgical site infection (SSI) in external dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO). Methods: This was a prospective randomized controlled study with a noninferiority design. Patients undergoing external DCR surgery were randomized into two groups A and B. Patients in group A received a single bolus dose of intravenous cefazolin 1 g at surgery, whereas those in group B received oral cephalexin 500 mg postoperatively twice a day for 5 days. Allocation concealment was ensured by sequentially numbered opaque sealed envelopes (SNOSEs). Both groups were advised identical postoperative local wound care regimens. Any clinical evidence of SSI at 4 weeks of follow-up in either group was the main outcome measure. Results: In all, 338 patients randomized into two groups of 169 patients each participated in this study. At follow-up of 4 weeks, only one patient in group B developed postoperative SSI. None in group A developed postoperative SSI. Other potential risk factors for postoperative SSI were also analyzed by univariate and multivariate analyses but none achieved statistical significance in either group. Conclusion: Our results demonstrate that a single bolus dose of perioperative intravenous antibiotic offers adequate prophylaxis against postoperative SSI and compares favorably with the more commonly used oral antibiotic prophylaxis in external DCR for PANDO in our population and our practice scenario.

Patients with malnutrition related diabetes mellitus are as insulin sensitive as insulin dependent diabetics.

OBJECTIVES: High insulin requirement is considered as indicative of insulin resistance in malnutrition related diabetes mellitus (MRDM). Hyperinsulinemic euglycemic clamp technique (HECS) is the gold standard to assess insulin sensitivity in vivo. Hence we carried out HECS in a group of MRDM and compared it to subjects with insulin dependent diabetes mellitus (IDDM) to assess whether patients with malnutrition related diabetes mellitus have lower insulin mediated glucose disposal than IDDM. METHODS: In a case control design insulin mediated glucose disposal assessed by HECS at insulin infusion rate of 40 mU/m2 during steady state of 60-120 minutes. Mean coefficient of variation of plasma glucose during 60-120 minute steady state was 3.58 +/- 0.33 mg%. Whole body glucose disposal rate ("M" value) was expressed in mg/kg/min, which was equal to the glucose infused under steady state plasma glucose concentration during last one hour of HECS. RESULTS: Insulin mediated glucose disposal was measured in MRDM and compared with ketosis prone diabetes of young (IDDM) by HECS. Both groups were matched for age (23.4 +/- 1.8 vs. 19.8 +/- 2.5 years) and BMI (16.7 +/- 0.6 vs. 18.5 +/- 0.6 kg/m2). They were also comparable in duration of illness (4.4 +/- 1.0 vs. 4.5 +/- 1.0 years) and WHR (0.87 +/- 0.02 vs. 0.83 +/- 0.02). Patients in both groups had comparable glycemic control (HbAl 12.1 +/- 0.54 vs. 10.5 +/- 1.2), serum cholesterol (145 +/- 11 vs. 167 +/- 21 mg/dl) and serum triglyceride levels (147 +/- 13 vs. 110 +/- 9 mg/dl). Glucose disposal rate (M-value, mg/kg/min) during 60-120 minutes (7.06 +/- 0.80 vs. 7.50 +/- 0.87) and during 100-120 minutes (7.76 +/- 0.96 vs. 7.75 +/- 1.25) was not different in the two groups. CONCLUSIONS: High insulin requirement considered as indicative of insulin resistance in atypical ketosis resistant young diabetics is not due to insulin resistance.

Cholelithiasis in sickle cell disease in India.

Eighty cases (63 Males and 17 Females) of sickle cell disease were searched for gall stone by ultrasonography, 8 (10%) cases had gall stone. Gall stones were more common in males (11.1%) than females (5.8%). It was not found below 13 years of age. Three cases had single and five cases had multiple gall stones. Three of them had thickened gall bladder wall. Typical biliary colic was uncommon (1 case). There was no case of obstructive jaundice. HbF% level was significantly lower in cases with gall stone (12.31 +/- 3.95) than without gall stones (16.73 +/- 6.30). Episodes of aggravated anaemia and total serum bilirubin was significantly higher (1.27/pt and 4.12 +/- 1.34 mg%) in cases with gall stone than without gall stone (0.31/pt and 2.74 +/- 1.47 mg%). The above findings suggest association of greater degree of haemolysis with formation of gall stone in sickle cell disease cases.