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Abstract Introduction Low-frequency noise (LFN) is hazardous to hearing. Long-term exposure to LFN may lead to vibroacoustic disease (VAD), which not only affects a specific organ but the physiological function of entire systems, such as the auditory, phonatory, respiratory, and cardiac systems. Moreover, VAD may lead to many psychological problems and hence affect the quality of life. Objective To investigate the adverse effects of LFN on hearing, acoustic and perceptual correlates of the voice, blood pressure, cardiac rate, and anxiety level. Method A total of 20 subjects exposed to LFN and 20 not exposed to LFN were included, and a detailed case history was recorded. The patients were submitted to pure tone audiometry, otoscopic examination, acoustic and perceptual analyses of the voice, maximum phonation time, and an assessment of the s/z ratio. We also assessed blood pressure, and the results of a voice-related quality of life questionnaire and of the Hamilton anxiety rating scale. Results The results indicate that LFN had an adverse impact on the high-frequency threshold. The present study found a significant difference in shimmer and harmonics-to-noise ratio (HNR) values. Few subjects had high blood pressure and showed the sign of anxiety on the Hamilton anxiety rating scale. Conclusion Low-frequency noise has adverse effects on entire systems of the body and causes many psychological issues, which, in turn negatively affect quality of life.
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Purpose: To find the association between reduced best?corrected visual acuity and non?pathologic components after optical correction in individuals with low to high myopia. Methods: Myopic children under 16 years of age were reviewed using electronic medical records and the following data were extracted and recorded: participant’s age, gender, uncorrected visual acuity (UCVA), manifest refraction, and best corrected visual acuity (BCVA). Spherical equivalent and cylinder were classified into low, moderate, and high categories based on the magnitude range. Similarly, astigmatism was defined into with?the?rule, against?the?rule, and oblique based on the location of the steepest meridian. Reduced BCVA was defined when the decimal visual acuity was less than 0.66 (equivalent to Snellen’s acuity of 6/9 or 20/30). Logistic regression was performed to test the factors associated with reduced visual acuity after optical correction in the absence of myopic pathologic changes. Statistical significance was considered if P < 0.05. Results: Overall 44.9% (N = 242/538) of myopes had reduced best?corrected visual acuity (BCVA) and none of the patients had pathologic myopic lesions. Using logistic regression, we found that high spherical refraction (OR 27.98, 95% CI 14.43–54.25, P < 0.001) and moderate spherical refraction (OR 5.52, 95% CI 2.56–11.91, P < 0.001) were significantly associated with reduced best corrected visual acuity despite any pathological lesions. Additionally, oblique and ATR astigmatism were associated with reduced visual acuity in myopic children with (OR 2.05, 95% CI 0.77–5.42) and (OR 1.59, 95% CI 0.82–3.08). Conclusion: Higher magnitude of refractive error components causes reduced visual acuity in the absence of pathologic changes.
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Purpose: During the coronavirus disease 2019 (COVID?19) pandemic, private practice, inpatient consult services, and academic residency programs in ophthalmology saw a decrease in patient encounters. This study elucidates how community hospital ophthalmology consult (OC) services were affected during the pandemic. We aim to determine whether there was a change in resident OC volume in a community?based ophthalmology program consult service during the COVID?19 pandemic. Secondary objectives included analyzing the change in the types of diagnoses and the number of patients seen for diabetic retinopathy over the same time. Methods: A retrospective cross?sectional study was conducted reviewing the electronic health record (EHR) charts from OCs for the period 2017–2021. Records were categorized by referral source and the nature of OCs (trauma, acute, or chronic); OCs were further grouped by year and weak of referral. An intermonth analysis of weekly OC counts in each category was performed for the average number of consults in February–April 2017–2019 and for February–April 2020. A one?tailed t?test was performed. All t?tests assumed equal variances. Results: Weekly OCs in 2020 revealed no statistically significant differences in overall cases or in acute or chronic cases when the volume before the COVID?19 pandemic was compared to the volume after the onset of the pandemic. However, a statistically significant increase in the average weekly trauma cases was noted when 2020 (an average of 2.7 cases per week) was compared to the weekly average for the same weeks of years 2017– 2019 (0.4; P = 0.016). This statistically significant increase in trauma in 2020 disappeared when comparing weeks 11–17 in 2020 (2.2 cases per week) and the average of 2017–2019 (1.1).Conclusion: This report outlines no significant change in OCs before and after the onset of the pandemic compared to three previous years. There was, however, an increase in trauma consults during the pandemic and an increase in the number (though not the proportion) of diabetic retinopathy (DR+) patients seen by residents. This report uniquely describes no significant changes in the resident volume of patients seen during the COVID?19 global pandemic
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Purpose: To elucidate distance and near vision changes after intravitreal injections in center?involving diabetic macular edema (CIDME) in phakic and pseudophakic groups. Methods: A retrospective study was done on 148 eyes (72 phakic and 76 pseudophakic) with center?involving DME. All eyes were treated with intravitreal anti?vascular endothelial growth factor (VEGF) injection. All patients underwent distance best?corrected visual acuity (BCVA) testing, near BCVA testing, dilated fundus examination, and optical coherence tomography (OCT) at baseline and follow?up visits. Eyes that could not improve after the first injection were given 2nd, 3rd, and more injections in the subsequent visits. Results: On follow?up, post injections in the phakic group (n = 72), there were 65 eyes (90.3%) with stable/improved near vision and 59 eyes (81.9%) with stable/improved distance vision, whereas in the pseudophakic group (n = 76), 63 eyes (82.9%) and 60 eyes (78.9%), respectively. Both in phakic and pseudophakic eyes, 7.7%–13% of the cohort showed only near vision improvement. Conclusion: In DME, besides the changes in distance vision, there are also changes in near vision. These changes should be taken into account while determining the response to anti?VEGF in DME treatment.
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Background: Scleral fistulas are known to develop following blunt trauma in patients with retinochoroidal coloboma. These cases can be managed by surgical options such as silicone buckles, or with glue and scleral patch graft. Some cases have been shown to close spontaneously. We report the first?ever case managed by vitrectomy, endophotocoagulation, and gas tamponade. Purpose: We present a rare and interesting case of an atypical choroidal coloboma with traumatic scleral fistula due to blunt trauma manifesting with hypotony?related disc edema, maculopathy, and chorioretinal folds, which was managed surgically with vitrectomy, endophotocoagulation, and gas tamponade with a good anatomical and visual outcome. Synopsis: The video contains the case description and surgical management of a traumatic scleral fistula in a patient with atypical superotemporal choroidal coloboma. The patient developed hypotonic maculopathy and disc edema after 3 months following a blunt trauma sustained in a road traffic accident. A scleral fistula was suspected at the temporal edge of the coloboma but could not be accurately localized. In addition, due to the edge effect of the coloboma, the external repair was difficult. Hence, vitrectomy with internal tamponade was attempted. Highlights: The video highlights a different surgical approach to managing a traumatic scleral fistula at the edge of a retinochoroidal coloboma. There was a risk of leakage of intravitreal fluid into the orbit through the fistula; however, the gas bubble gave a better tamponade due to higher surface tension. It sealed the fistula presumably by creating a trap?door?like effect. The endophotocoagulation helped create adhesion between the tissues at the edge of the coloboma effectively sealing it. This was followed by a rapid recovery of the hypotony?related problems with good vision. Traumatic scleral fistula, at a difficult place such as the edge of a coloboma, can be successfully closed from an internal approach with vitrectomy, endolaser, and gas tamponade.
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Introduction: Diabetes mellitus is the most common endocrine disorder of humans characterized by metabolic abnormalities leading to long term complications. Neuropathy is one of the common complications of diabetes. Despite being a well-known consequence, autonomic neuropathy has received less attention than other microvascular sequelae. The involvement of both parasympathetic and sympathetic chains in autonomic neuropathy results in a variety of manifestations affecting various body organs. Gallbladder involvement in diabetic autonomic neuropathy is in the form of high incidence of gallstones and a significant increase in gallbladder volume with lack of symptoms of gallbladder disease. The study was conducted on 150 Materials & Methods: known diabetic patients and 150 age and sex matched controls. After detailed history, cardiac autonomic function is assessed by simple bedside tests and CAN score was assigned as per Ewing and Clarke's criteria. Ultrasound is used to assess the fasting gallbladder volume after 8 hours of fasting and postprandial gallbladder volume after fixed standard fatty meal. The results are analysed using MS-EXCEL, SPSS and MedCalc software. p value<0.05 was taken as statistically significant. The fasting gallbladder volume in s Results: tudy group was 33.96 ± 15.19 as compared to 24.79 ± 9.96 in controls. Postprandial volume in study group was 24.01 ± 14.41 as compared to 16.28 ± 9.01 in controls. The difference was statistically significant. 120 patients in cases show some degree of autonomic neuropathy as compared to 65 patients in control group. Correlation of GBV with different parameters like HbA1c had Pearson's correlational coefficient (r) = 0.430, correlation with duration of diabetes had r = 0.391, correlation with CAN scoring had r = 0.757, correlation with microalbuminuria had r = 0.299. All results were statistically significant with pvalue<0.05. However, correlation of GBV with age had (r) =0.0033, Correlation with BMI shows r=0.152 both results were statistically insignificant. Autonomic neuropathy was more prevalent in hypertensive subjects but result was statistically insignificant. The Conclusion: fasting and PP-gallbladder volume was higher in study subjects due to autonomic neuropathy. Correlation of GBV with glycemic control, duration of diabetes, Cardiac autonomic neuropathy shows a positive correlation, whereas correlation of autonomic neuropathy with Age, BMI and hypertension was statistically insignificant.
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Abstract Introduction Acoustic change complex (ACC) is a type of event-related potential evoked in response to subtle change(s) in the continuing stimuli. In the presence of a growing number of investigations on ACC, there is a need to review the various methodologies, findings, clinical utilities, and conclusions of different studies by authors who have studied ACC. Objectives The present review article is focused on the literature related to the utility of ACC as a tool to assess the auditory discrimination skill in different populations. Data Synthesis Various database providers, such as Medline, Pubmed, Google, and Google Scholar, were searched for any ACC-related reference. A total of 102 research papers were initially obtained using descriptors such as acoustic change complex, clinical utility of ACC, ACC in children, ACC in cochlear implant users, and ACC in hearing loss. The titles, authors, and year of publication were examined, and the duplicates were eliminated. A total of 31 research papers were found on ACC and were incorporated in the present review. The findings of these 31 articles were reviewed and have been reported in the present article. Conclusions The present review showed the utility of ACC as an objective tool to support various subjective tests in audiology.
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Introduction: Collection of medicinal herbs having similar effect are collectively known as Gana (group) in Samhita and Vargas (category) in Nighantu. Surasadi Gana is included in 37 of such groups mentioned in Sushruta Samhita, with 21 Herbs completing the group. This article is made in a view to review the importance and utility of few herbs included in Surasadi Gana indicated for the management of respiratory disorders. Material and Methods: The literature regarding the drugs mentioned in the group, collected from different Ayurveda classics. Research papers are compiled from published sources and discussed in light of therapeutic effects. Observation and Result: Maximum of the herbs in this group are having properties as Katu rasa (pungent) and Ushna veerya (hot potency). Such herbs are predominantly advised in Kapha (phlegm humour) dominant diseases, viz. Kasa (cough), Shwasa (asthma), Pratishyaya (common cold), Kushtha (skin disorders), Krimi (worm infestation) and Vrana (wound). Conclusion: The herbs, despite having several Ayurvedic indications, the respiratory tract is the focus of the specific activity.
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The pandemic-starting SARS-CoV-2 novel coronavirus was found in Wuhan, China. WHO declared this pandemic, which began in late 2019, in March 2020. Experts say this was the first SARS-CoV-2 outbreak. It was the first of many. This virus constantly mutates in response to its replication environment, causing waves, the deadliest of which was the delta variant-caused second wave, which killed millions worldwide. This review examines viral genome alterations and their global effects. We used references from previous research articles on this or similar issues to make our review more data-driven. We found that the virus’ mutation has caused major health problems in humans, including deaths. The viruses changed genome, proteins, local food, sanitation, immunity, and milieu may be involved. We also found that while some of the impacted variations are milder and less contagious, some have had record-breaking peaks and significant death rates in a short time. This analysis examines COVID-19’s impact on diabetes, cardiovascular disease, asthma, aging, and community hygiene. SARS-CoV-2 increases stress and blood glucose in diabetics. Clinical investigations have linked COVID-19 to cardiovascular disease, although the mechanism is uncertain. Asthmatics are more vulnerable to respiratory infections. Its effects change as one age. Cleanliness campaigns are needed to put an end to the epidemic.
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Introduction: The aim of this study was to compare the fracture resistance of simulated immature teeth using four different apical plug materials, i.e. Pro? Root MTA, Neo? MTA Plus, Biodentine, and Bioactive Glass. Materials and Methods: 80 extracted human maxillary anterior teeth were divided into 4 groups for this study. They were prepared using Peeso reamers to simulate immature teeth and to mimic Cvek’s stage 3 of root development. A 5 mm apical barrier was placed using different materials. The remaining canal was obturated using gutta?percha and AH plus sealer. The final samples were stored at 37°C and 100% humidity for 4 weeks. Fracture resistance of the teeth was measured in Newtons using a universal testing machine. The comparison of fracture resistance between the four groups was done using Kruskal Walis ANOVA followed by post hoc Mann Whitney U test for pairwise comparison. Results: Biodentine group showed the highest fracture resistance as compared to the other three groups and the difference was highly significant (P < 0.001). Conclusions: Biodentine can be advocated over MTA as an effective material for the management of teeth with wide open apex. Bioactive glass also has shown promising results in increasing the fracture resistance of simulated immature teeth.
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Since the declaration of COVID-19 infection as Pandemic in March, 2020, There has been rise in Multisystem Complications apart from regular Acute Respiratory Syndrome which is hallmark of COVID-19 infection. As the second wave surge of COVID-19 has occurred, most of the patients already suffered from dyspnoea but also rare complications like CVA (Infarct and Haemorrhage) , Seizure and altered sensorium related to Hypoxic Brain Injury. COVID-19 frequently presents with a state of altered coagulability which increases the risk of pulmonary embolism and other Thrombotic events such as Cerebrovascular events. This case report is limited to Neurological complications seen in COVID-19 Infected patients
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Medicinal plants have been used in all cultures as a source of medicine since ages. When parts of plants such as rhizomes, leaves or barks and other natural materials are used as drugs to treat illnesses, they are called crude drugs and the study of crude drugs is called pharmacognosy. Proximate analysis in plants gives valuable information and help to assess the quality of a crude drug. Beneficial effects of crude drugs are believed to be attributed to plant phytochemicals. Hedychium coronarium J. Koenig, a medicinal and aromatic plant of high value is an endangered and red-listed plant. The rhizome of this plant is used for the treatment of various diseases. Crude extracts prepared from the rhizomes show antibacterial and antifungal properties. Essential oils obtained from Hedychium coronarium are found to be rich in terpenes and used for bactericidal, fungicidal, medicinal and cosmetic applications. The present study assesses the quality of crude drugs prepared from this highly medicinal plant. Proximate analysis and phytochemical screening of rhizomes of Hedychium coronarium, which is frequently consumed as food and as medicine were carried out. Ash content was found to be low) when compared to the moisture content. The water extractive value was more than alcohol extractive. Preliminary tests carried out on phytochemicals revealed the presence of terpenoids and oils. High Resolution Liquid Chromatography Mass Spectrophotometry was carried to ascertain the different components of essential oils and revealed the presence of eucalyptol (1,8-cineole), caryophyllene oxide, camphor, linoleic acid, ricinin, phloroglucinol, 6-gingerol, carvone and arjungenin.
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Cardiovascular disease (CVD) is the major cause of death in chronic kidney disease (CKD). Of the various risk factors, vascular calcification has only recently come into prominence. CKD is associated with an increased risk of vascular calcification. In routine practice, clinicians usually overlook this finding. Screening for vascular calcification is often missed during first contact with nephrologists. With this article, we would like to reiterate the importance of preventing vascular calcification in early stages of CKD and once it starts appearing, its progression needs to be halted early with individualized treatment. The prevalence, sites of involvement, detection, quantification, pathogenesis, risk factors, clinical manifestations and management options have been discussed.
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Free flap procedure provides an overall success rate of 97%, which decreases to 85% in hypercoagulable states. COVID-19, as a pro-thrombotic disorder, therefore seems detrimental to free flap survival. We encountered a case of unique pattern of free flap partial failure in a young male who underwent extremity reconstruction. The patient was diagnosed as COVID-19 positive on the 3rd day post-reconstruction. The flap survived well for the first 7 days post-operatively, but gradually the skin got necrosed and the subcutaneous fat layer was preserved when debriding. To our knowledge, this is the only case in which the skin of the free flap of a COVID-19 positive patient was necrosed almost entirely subsequently, while the subcutaneous fat was relatively preserved.
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Humanos , Masculino , Muslo/cirugía , Colgajos Tisulares Libres/cirugía , Procedimientos de Cirugía Plástica , COVID-19 , Extremidad Inferior/cirugía , Enfermedades Vasculares , Complicaciones Posoperatorias/cirugíaRESUMEN
The purpose of this study is to compare short term outcome of rotablation in ACS versus non-ACS patients. 60 Consecutive patients who underwent rotational atherectomy were followed prospectively. The mean duration of follow up was 13.05 ± 5.2 months. The mean ejection fraction was 52.41% ± 9.4%. 45% patients had diagnosis of CSA and 55% were ACS. The mean syntax score was 29.23 ± 7.99. LAD was the most common vessel treated by RA in 76.6%. Rotablation of LM was done in 30%. IVUS guided procedure was done in 66.7%. RA can be done with comparable safety and success in both non-ACS and ACS patients
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Dibrugarh Health and Demographic Surveillance System (Dibrugarh-HDSS), was started in the year 2019 with the objective to create the health and demographic database of a population from a defined geographical area and a surveillance system for providing technical assistance for the implementation of programmes and formulating intervention strategies for reducing disease morbidities and mortalities in the population. Dibrugarh-HDSS adopted a panel design and covered 60 contiguous villages and 20 tea gardens. Line listing of all the households was conducted and a unique identification number detailing State, district, village/tea garden and serial number was provided along with geotagging. Detailed sociodemographic variables, anthropometric measurements (subjects ?five years) and blood pressure data (subjects ?18 yr), disease morbidity and mortality were collected. All data were collected in pre-designed and pre-tested questionnaires using a mobile application package developed for this purpose. Dibrugarh-HDSS included a total of 106,769 individuals (rural: 46,762, tea garden: 60,007) with 52,934 males (49.6%) and 53,835 females (50.4%). The number of females per thousand males were significantly higher (1042 in tea garden vs. 985 in rural populations) in the tea-garden community as compared to the village population. More than one-third (35.1%) of tea populations were illiterate compared to the rural population (17.1%). Villagers had significantly higher body mass index than the tea-garden community. The overall prevalence of hypertension (adjusted for age) was 29.4 vs. 28.2 per cent, respectively, for the village and tea-garden population. For both these communities, males (village=30.8%, tea garden=31.1%) showed a higher prevalence of hypertension (adjusted for age) than females (village=28.2%, tea garden=25.8%). The findings of the present study give an insight into the profile of the native rural and tea-garden populations that will help to identify risk factors of different health problems, review the effectiveness of different ongoing programmes, implement intervention strategies for reducing morbidity and mortality and assist the State health authorities in prioritizing their resource allocation and implementation strategies.
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Background & objectives: Scrub typhus is a neglected tropical disease common in Asia and Africa. It usually presents with non-specific symptoms like fever, rashes, and lymphadenopathy. It has a varying range of clinical picture that often leads to misdiagnosis and initiation of non-specific treatment. This disease is thus associated with high morbidity and mortality. We aim to highlight the uncommon presentations of this common disease to create awareness regarding the unusual presentations of scrub typhus. Methods: This prospective study was performed over a period of two months enrolling eleven adult patients with serological evidence of anti-scrub typhus IgM antibodies. Results: All enrolled 11 cases [5 males (45.5%) and 6 females (54.5%)] were positive for anti-ST IgM antibodies and negative for other tested microbial agents. 7/11 (63.6%) patients were admitted with a clinical diagnosis of acute encephalitis syndrome (AES as per standard WHO definition), 3/11 (27.3%) patients presented with jaundice and 1/11 (9.1%) patients presented with rashes. Two out of 7 (28.6%) AES cases had developed peripheral gangrene of extremities. Interpretation & conclusion: Scrub typhus is a common tropical disease that can have various unusual clinical presentations like meningoencephalitis, vasculitis, acute kidney injury, jaundice, MODS. It closely mimics other infective etiologies making its diagnosis difficult. A high index of suspicion and clinical awareness is required in clinical practice to identify the different presentations of this disease so that early treatment can be initiated to reduce morbidity and mortality associated with this disease.
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Purpose: Myopia is the most common type of refractive error and the leading cause of functional visual loss. Increased risk of myopic maculopathy, retinal detachment, glaucoma and cataract has been seen with a myopia of as low as ?1D. This study was done to determine the effect of atropine 0.01% eye drops on the progression of myopia in children >5 years. Methods: This was a single?blind, prospective, randomized case–control study which included children of 5–15 years with myopia of >2D and were divided into treatment group (group 1) and placebo group (group 2). Children under treatment group were treated with application of 0.01% atropine at night. Children with history of any ocular surgery, chronic ophthalmic illness, squint and amblyopia were excluded from the study. The follow?up for myopia progression was done for two years. Results: This study showed a significant difference in increase of spherical equivalent and axial length among treatment and placebo groups after a duration of two years. Total duration of follow up was twenty?four months. Mean increase in axial length of group 1 and 2 was 0.115 mm and 0.32 mm, respectively. Mean increase in refraction of groups 1 and 2 was ?0.30 D and ?0.88 D, respectively, showing significant change in axial length and refraction (P < 0.0001). Conclusion: This study supports the use of atropine 0.01% eye drops in reducing the progression of myopia.
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Objectives: Various types of minimally invasive techniques have been developed for the treatment of lumbar disc herniation. The original laminectomy was refined into microdiscectomy and now into tubular discectomy and endoscopic discectomy. This study aimed to evaluate the immediate postoperative to 6 months outcomes of patients undergoing tubular discectomy using a simple tubular dilator system and 2.5x binocular loupe. 60 patients were operated Materials and Methods: with tubular discectomy at PDU Hospital, Rajkot which is a tertiary level center between June 2021 to December 2021. They were studied for the following data: Baseline characteristics, Visual analog scale (VAS) for leg pain and post operative back pain, Modified Oswestry Disability Index (ODI) scores, length of hospital stay, time taken to return to work, duration of surgery, intra- and post-operative complications, and reoperation rates. The VAS Results: score for leg pain, post-operative back pain, and Modified ODI scores showed improvement during the 6 Months after Surgery. Mean ODI score improved from 64.18 to 24.04 at 1 month and 19.38 at 6 months follow-up and Mean VAS score improved from 8 to 3.23 at 1 month and 2.72 at 6 months follow up .Time taken to return to work and mean hospital stay was shorter. The mean duration of surgery was shorter with less blood loss. This study revealed that the rate of recovery is significantly faster Conclusion: for tubular discectomy , Shorter hospital stay, less blood loss with fewer complications