Lagophthalmos: An etiological lookout to frame the decision for management

Purpose: To describe the etiology, clinical profile, duration of lagophthalmos cases and thereby, framing a decision for the management based on the severity of Exposure keratitis (EK), Facial palsy (FP) with each etiology and to describe the outcome of the management options. Methods: The method was a prospective review of 120 lagophthalmos cases treated at a single tertiary center from January 2018 to January 2019. The main outcome measures were analysing the association between age, etiology, duration and management of lagophthalmos. Results: Of the 120 patients studied, paralytic etiology was noted in 86 and eyelid etiology in 34 patients. The percentage of various lagophthalmos etiology documented were Bell’s palsy (35.83%), lagophthalmos in ICU patients (15%), traumatic facial palsy(FP) (10.80%), stroke associated FP (6.67%), infection associated FP (6.67%), iatrogenic FP, cicatricial lagophthalmos (5%), lagophthalmos post eyelid surgeries (5%), neoplastic FP(3.33%), congenital FP (1.67%), proptosis induced lagophthalmos (1.67%), floppy eyelid syndrome induced lagophthalmos (0.83%) and lid coloboma associated lagophthalmos (0.83%). A statistically significant correlation was noted between exposure keratitis and age, with an increased prevalence age advances. The management showed significant variation with individual etiology, with some etiologies unquestionably requiring surgical management. Surgical management is crucial as the duration of lagophthalmos increases more than 6 weeks, EK involving pupillary axis and poor FP recovery. Conclusion: This study concludes that the conservative management was sufficient in all cases when the duration is less than 1 week, Exposure keratitis not involving the pupillary axis (EK< Grade II) and FP with good functional recovery ( FP < Grade III). The predominant causes being Bell’s palsy, lagophthalmos in ICU patients and vascular FP. Whereas, cases with poor functional recovery of facial palsy(FP) and permanent eyelid deformation require definitive surgical management like Traumatic FP & cicatricial lagophthalmos

Niemann-Pick disease type C-presenting as persistent neonatal jaundice: a rare case report

Neimann-Pick disease (NPD) is an autosomal recessive lysosomal storage disorder caused by inherited deficiency of acid sphingomyelinase enzyme or its transport which leads to deposition of sphingomylin and cholesterol in the lysosomes of reticuloendothelial system. It is characterized by failure to thrive, hepatospleenomeagaly and neurodegenerative changes. There are four subgroups of neimann pick disease, type A, B, C and D. Here authors are reporting a case of 5 months old female child presenting with persistent jaundice since neonatal period, progressive abdominal distention and failure to thrive. On examination patient had significant abdominal distension with moderate hepatosplenomegaly. On laboratory evaluation child diagnosed to have NPD type C. This case emphasizes the need to keep NPD in differential diagnosis of children presenting with persistent neonatal jaundice, hepatosplenomegaly, failure to thrive.

Cephalometric evaluation of condyle‑fossa position in dentulous and edentulous subjects.

Context: Whenever there is loss of teeth and occlusion, it triggers a change in the functional and structural relationship of the mandible. Various physiologic factor such as age and changes in occlusion lead to specific remodeling changes in the temporomandibular joint (TMJ). Aims: The aim of this study was to evaluate and compare the influence of dentition on condyle‑fossa position by comparing this variable in dentulous and edentulous subjects using lateral cephalogram. Settings and Design: The study was conducted on 25 dentulous and 25 edentulous subjects, comprising of males and females, visiting Yenepoya University, Mangalore. Subjects and Methods: The age ranges of dentulous subjects were 25–30 years and edentulous subjects of 45–65 years with 1–5 years of edentulousness were chosen. Lateral cephalograms were taken, and various reference lines and planes were used to determine the center of condyle and center of the glenoid fossa. Statistical Analysis Used: The results were analyzed by SPSS version 7.0 (SPSS Inc., Chicago) and statistical analysis used was t‑test. Results: Condyle was placed upward and forward, and glenoid fossa was situated more anteriorly in edentulous subjects compared to dentulous subjects. Conclusions: This study supports the concept that TMJ is an articular triad with two points of contact provided by TMJ and third contact by the dentition. Alteration in any one of these contact points will produce secondary morphological changes in other two points.

To evaluate the prevalence of female genital tuberculosis in Hyderabad.

Background: Tuberculosis (TB) is an increasing public health concern worldwide. It is one of the most important causes of infectious morbidity and mortality. Genital TB is one form of extra pulmonary TB and is not uncommon, particularly in communities where pulmonary TB is prevalent. The objective of the study was to evaluate the prevalence of female genital tuberculosis in Hyderabad and its presentational symptoms and methods of diagnosis. Methods: A total of 1102 cases of suspected genital TB who had been registered and treated in the AIMSR and few selected government urban health post and private hospitals and clinics in different zones of Hyderabad, from 2012 January to 2013 March were retrospectively and prospectively studied. From this group, 23 women were diagnosed as having genital TB based on the standard pathological and microbiological criteria of tissue specimens. Results: Out of 23 cases diagnosed as having genital tuberculosis, 3 patients (13.04 %) presented with abdominal or pelvic pain. In 17cases (73.91%) tuberculosis was diagnosed during studies performed to evaluate the cause of their infertility, and the most common diagnostic procedure was endometrial curettage. Remaining 3 cases (13.05 %) have past, present or contact history of tuberculosis. Female genital TB accounted for 2.08 % of all tuberculosis patients in this study. Conclusions: This study indicates the presence of a strong relationship between genital TB and infertility; therefore genital TB would be more frequently diagnosed if this possibility was considered in the evaluation of every infertile patient in areas where tuberculosis is endemic.

Effect of Deworming vs Iron-Folic Acid Supplementation Plus Deworming on Growth, Hemoglobin level, and Physical Work Capacity of Schoolchildren.

The effect of deworming vs deworming and weekly Iron-Folic acid (IFA) on growth, hemoglobin level, and physical work capacity of children was studied. Children from three rural schools studying from 4th to 7th standard were selected. One set of school children were given deworming tablet (400 mg albendezole) once in six months while the second school children received deworming tablet along with weekly dose of Iron Folic acid Tablet (60 mg of elemental iron and 0.5 mg folic acid). Anthropometric measurements, hemoglobin, and physical work capacity was estimated. No significant change was noticed in the prevalence of malnutrition or physical work capacity of the children. As compared to only deworming, IFA + Deworming showed 17.3 % increase in the hemoglobin levels (P<0.001). Thus weekly IFA along with deworming has shown beneficial effect on the hemoglobin levels of the children.

An exploratory study on the nutritional status and determinants of malnutrition of urban and rural adolescent children (12-16) years of Vadodara city.

Approximately 21.4 % of Indian population comprises of adolescents. In India, large number of adolescents suffers from chronic malnutrition which adversely affects their health. The study assessed the nutritional status of urban and rural adolescents of Vadodara district and found the determinants of malnutrition. Anthropometric measurements, dietary history, activity pattern were collected on a sample of 376 children. Location specific factors that influence adolescence nutritional status and lifestyle were studied. There were 120 urban and 256 rural students. The overall prevalence of obesity ranged from 0.4-0.8 % in rural setup and 0.8-3.3 % in urban setup. Thus dual burden of malnutrition was seen in both the settings. With regard to dietary assessment, it was seen that nutrient intake of the adolescent children was grossly inadequate in relation to energy, protein, iron and fiber, which was more pronounced in the rural children than urban. The determinants for undrenutrition were mother’s education, Per Capita Income (PCI) and energy intake of the children. Dual burden of malnutrition scenario calls for health promotion approaches to tackle the problem in adolescent children.

Subtypes of Ischemic Stroke in a Metropolitan City of South India (One year data from a hospital based stroke registry).

Limited data exists on the subtypes of ischemic stroke from the Indian subcontinent. The present study was aimed to investigate the frequency, spectrum and risk factors of various subtypes of ischemic stroke in a south Indian referral center. The study was conducted on consecutive patients of ischemic stroke, fully investigated to determine the underlying mechanism and enrolled in the stroke registry of Nizam's Institute of Medical Sciences between Ist February 2000 to 31st January 2001. There were 282 men and 110 women (mean age 54 years; range 2-97 years). Of all ischemic stroke patients, 41%, 18%, 10%, 4%, and 27% were classified as large-artery atherosclerosis, lacunae, cardioembolism, other determined etiology and undetermined etiology respectively. The most notable difference of this registry from western registries was the predominance of intracranial rather than extracranial location of the large artery atherosclerosis. Hypertension, diabetes and smoking were the common risk factors among all the subtypes. Coronary artery disease and rheumatic heart disease were responsible for most of the cardioembolic strokes.

Prevalence of cigarette smoking among Peshawar university students

The aim of this study was to determine the prevalence of smoking among University students in Peshawar. A simple random sample of 511 students was invited to participate in this study. A structured questionnaire was used to elicit information on demographics, smoking habits, media influences and health histories from the participants of the study. The smokers in the sample population were 77 [15%] among them 99% were male and 1% were female with a mean age of 21 years. Seven% of the smokers started smoking before the age of 10, 26% at ages 11-16 and 57% at ages 17-21 and 10% after age 21. The influencing factor of smokers in the family was evident with 10% of fathers, 14.3% brothers and 13% cousins being cigarette smokers. The brand of cigarette favored by 42% of the smokers was Gold Leaf and 91% of the smokers claimed that they were influenced by cigarette advertisements. The social smokers were 14%, and 25% smoked due to peer pressure and another 25% smoked only in College. Less than 40% of the smokers had a hobby or did regular exercise to keep fit and 26% complained of illnesses related to ear, nose and throat. However it was encouraging to note that 56% of the smokers wanted to quit the habit. The information gathered in this study facilitates the understanding of various influencing factors that revolve around young smokers. It also highlights the need to help young smokers quit the habit, by providing them healthy choices that may include counseling, and nicotine replacement therapy, among many others

Patient satisfaction survey at emergency satellite hospital, Nahaqi in rural Peshawar

A survey was conducted to assess the current status of Emergency Satellite Hospital [ESH] as compared to its function before July 2001. The management of this hospital has been taken over by Abaseen Foundation on the basis of public/private partnership with the health Ministry of the Government of N.W.F.P. A structured questionnaire was developed to elicit information on patient's satisfaction on the quality of health care services, hospital staff interactions, hospital environment and also to determine areas for improvement at ESH, through patient opinion on OPD fee structure, staff appraisals and hospital infrastructure. The survey revealed that almost every department of the hospital has shown improvement, in particular, the improved X-Ray facility and Laboratory facility enhances the diagnosis and treatment procedures at the hospital. The participants suggested that the hospital needs an Eye specialist and a Surgeon to be added to its clinical specialties so that the rural patients need not travel to the city for these services. This rural population dwell below the poverty line and their urgent demand is for free medicines. In this article the authors have attempted to acknowledge the patients experiences, values and preferences and document this information to effectively use it for improving services in the hospital and establish good governance for clinical practice through shared decision making between patients and health care providers