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We present a case of post-trabeculectomy encapsulated dysesthetic bleb with scleral fistula, managed successfully with autograft. The child was operated on twice before for trabeculectomy, and intraocular pressure (IOP) recorded was in the normal range for the initial few years. This time child presented with a large encapsulated dysesthetic bleb with borderline IOP. As the IOP was on the lower side, an underlying scleral fistula was suspected and planned for bleb revision with a donor patch graft. We describe the novel technique of bleb revision along with the repair of the scleral fistula with an autologous free fibrotic Tenon’s tissue graft instead of a donor patch graft with a successful outcome.
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Background & objectives: Postpartum intrauterine contraceptive device (PPIUCD) is well accepted and recommended for contraception. However, anxiety at the time of delivery may restrict the acceptance of a PPIUCD for its immediate insertion. So far there is limited evidence to conclude anything concrete on the association between the expulsion rates and the timing of insertion following a vaginal delivery. Thus, this study was undertaken to compare the expulsion rates in immediate and early insertions and their safety and complications. Methods: This prospective comparative study was carried out over 17 months on women delivering vaginally in a tertiary care teaching hospital in South India. A copper device (CuT380A) was inserted using Kelly’s placental forceps either within 10 min of placental delivery (immediate group, n=160) or between 10 min upto 48 h postpartum (early group, n=160). Ultrasound was done before discharge from the hospital. The expulsion rates and any other complications at six-week and three-month follow up were studied. Chi-square test was used to compare the difference in expulsion rates. Results: The expulsion rate was five per cent in the immediate compared to 3.7 per cent in the early group (no significant difference). In ten cases, the device was found to be in the lower uterus upon ultrasound before discharge. These were repositioned. There was no case with perforation, irregular bleeding or infection up to the three-month follow up. Higher age, higher parity, lack of satisfaction and motivation to continue were predictors of expulsion. Interpretation & conclusions: In the present study PPIUCD was found to be safe with overall expulsion in 4.3 per cent. It was marginally, though not significantly, higher in the immediate group.
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Background: Hepatitis B infection is common in Dialysis population. Hemodialysis patients have high risk of hepatitis B virus transmission not only due to frequent blood or blood product transmission, decreased response to Hepatitis B vaccine and length on hemodialysis but also due to their immunosuppressed state. Hepatitis B vaccination has the potential to reduce the risk of HBsAg infection in dialysis units. Effective vaccination, blood donor screening, the use of erythropoietin and the isolation of HBV carriers have successfully regulated HBV infection in hemodialysis units (1). This study aims to assess the immunity to HBV & the seroconversion of HBsAg infection in hemodialysis unit. This retrospective observational study evaluated serological markers, hepatitis B vaccination status and co morbidities which can affect the immunity levels of patients undergoing hemodialysis. The patient’s data were collected from laboratory investigations and patient record for analysis. Out of 153 CKD-5D patients on maintenance hemodialysis, 39 patients had anti HBs titer <10U/ml, 30 patients had anti HBs titer between 10-100U/ml, 38 patients had anti HBs titer between100-1000 U/ml, 21 patients had anti HBs titer >1000U/ml and 24 patients didn’t check their titer value. Hypertension was the common co morbidity followed by anaemia and diabetes mellitus.
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Hemodialysis is the most commonly used treatment modality for end stage renal disease. A 6 months observational study was conducted in the Dialysis unit of Kasturba Hospital, Manipal to study the clinical profile, quality of life with the help of KDQoL SF 36 questionnaire and factors affecting quality of life of hemodialysis patients. A total of 45 participants were included who initiated dialysis in the year 2018 and 2019 and were receiving dialysis in our hospital. Out of 45 participant 77.8% were males and 22.2% were females, the mean age was 55.29 (11.29) years. 23 patient-initiated dialysis in the year 2018 22 patients-initiated dialysis in the year 2019. The prevalence of hypertension, diabetes mellitus and cardiovascular diseases in this population were found to be 95.2%, 35.6% and 8.9% respectively. The mean scores of the sub scales were analyzed with the help of scoring manual and descriptive statistics. In the result it was found the hemoglobin, intradialytic weight gain were found to be positively correlated with the Physical component summary (PCS) and Mental component summary (MCS). Effects of kidney disease was found to be very strongly and positively correlated with dialysis vintage. In the result of the study due to its smaller population we cannot determine more factors which were affecting the Quality of life scores.
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Kerala is rich in its culture for the traditional Ayurveda practices in children from the time of birth onwards. These traditional practices are mainly immune boosters and also enhance overall nourishment and development in children. Commonly used traditional Ayurveda practices are Uramarunnu Prayoga, Prakara Yoga, Abhyanga, Rasanadi churna lepana, Snana etc. for enhancing immunity and providing overall development to children. Uramarunnu is a baby care practice comprising of a group of drugs administered to the child in the form of paste in breast milk, after 28 days till 2 years of age. Prakara Yogas are immunomodulatory recipes and procedures to be adopted right from the day after delivery. Abhyanga provides nourishment, health, protection, emotional well-being and improves skin tone. All these can be used for enhancing immunity and preventing recurrent infections thereby helps in the maintenance of health and prevention of diseases. This mentions the importance of Kerala traditional Ayurvedic practices in the field of primary child health care. So, the present study aims to compile Kerala’s traditional Ayurvedic practices in children, by reviewing regional textbooks like Arogyakalpadruma, Vaidya Tarakam, Parambarya Balachikitsa etc., and also interviewing Ayurveda pediatrician through telephone.
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Natural antioxidants have an important role in the prevention of many age-related diseases and promotion of health. Among natural antioxidants from plants, flavonoids and other phenolic compounds are potent antioxidants and chelating agents. Panchavalkala the barks of five trees i.e. Nyagrodha (Ficus benghalensis L.), Udumbara (Ficus racemosa L.), Ashwatha (Ficus religiosa L.), Plaksha (Ficus virens Aiton) and Parisha (Thespesia populnea (L.)Sol.ex Correa) are also known as Pancha Ksheeri Vrikshas in use since Vedic period. Barks of these trees are dried in shade and are used for different formulations (Pancha Kashaya Kalpanas), in different pathological conditions, especially as wound healing, gynecological disorders and etc. The plant samples were extracted using ethanol and water, and subjected for the phytochemical analysis. It was confirmed that samples contain many biologically active compounds like flavonoids, polyphenols, tannins, alkaloids, glycosides and terpinoids etc. The marker compound of each trial drug and the quantitative analysis has been carried out by high performance liquid chromatography. The antioxidant study was done by using in vitro method 1, 1-diphenyl-2-picryl-hydrazyl (DPPH) radical scavenging assay. The marker compounds caffeic acid and gallic acid were quantified in each extract for their quality and efficacy. PVK barks showed high free radical scavenging activity as evidenced by the low IC50 values in DPPH (EE PVK- 20.46µg/ml, AE PVK-37.79µg/ml, EE T.poulenea-22µg/ml, AE T. poulenia- 23.31µg/ml AE F. benghalensis- 25.53µg/ml, EE F. benghalensis- 26.23µg/ml, EE F. religiosa - 34µg/ml). Quercetin- IC50 value 4.026µg/ml is used as standard. The results of the study demonstrated that PVK barks possess phyto-constituent’s viz. tannins, flavonoids, polyphenols etc. and has potential antioxidant activity. Thus these barks have good therapeutic potential as natural antioxidant and might be used in life style related conditions like hyperlipidemia, diabetes, obesity, cardiovascular disorders and etc.
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Learning about human eye movements broadens our comprehension of the visuomotor system and aids in the effective management of strabismus. One’s clinical practice is improved by a dynamic simulation of human eye movements using physical models of the extraocular muscles (EOMs). We use our eyeball model to teach the basics of strabismus to undergraduate students and ophthalmology residents. In Listing’s plane, extraocular movements of each muscle and the angle demonstration are being used to familiarize students with their knowledge. The degree of the residents’ understanding of strabismus is significantly influenced by the eyeball strabismus simulator. This model is an inexpensive, Do It Yourself (DIY) model that is simple to build.
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Purpose: The study intends to evaluate the demographic and clinical profile of pediatric patients (0–18 years) attending six vision centers (VCs) of a tertiary eye care facility in south India. Methods: This is a cross?sectional observation study conducted at six major peripheral VCs of a tertiary eye care facility in South India from June 20 to Dec 20. All children presenting at the VCs under a base hospital (BH) in Pondicherry, whose parents gave consent were included. Data were entered by the ophthalmic assistants in the VC and cross checked by the principal investigator at the BH. Results: A total of 250 pediatric patients were brought to the VCs during the study period, predominantly males (60.8%), with a mean age of 8.2 ± 4.5 years (0– 18 years). Half of them were staying within 5 km from the VCs. Most children were escorted by their parents (88%), and the expenditure of travel to the VC was affordable for most of the parents (75%). Also, 53.6% of patients were in their primary school, while schooling had not started for 28% of children. Visual acuity (VA) could be assessed only for school?going children and older children due to lack of age?matched VA assessment tools. Most children (91.3%) had uncorrected VA better than or equal to 6/18 in the better eye, and approximately 3% had VA worse than 6/60. All patients had best corrected VA of 6/6–6/18 after cycloplegic refraction. Most children reported to the VC for allergic conjunctivitis (25%), followed by refractive error (13%) and squint (10.4%). Urgent referral to the BH was made for 47 children. Conclusion: Primary eye care in pediatric population?I (PREPP?I) showed that most children can be treated at the VCs and only one?fifth of the children require active intervention at higher referral centers. Further study on satisfaction of services provided for pediatric patients in these VCs and barriers of not reporting to the BH when referred are considered for the PREPP?II study
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Purpose: Diabetes?related retinopathy is the leading cause of blindness in India. The study was carried out with the purpose of studying the association of sight?threatening diabetic retinopathy (STDR) with socioeconomic factors and demonstrating the impact of STDR on the affected individual. Methods: A mixed methods (quantitative and qualitative) research design was used. The study participants were divided into two groups for quantitative analysis. The control group consisted of non–sight?threatening diabetic retinopathy, whereas the study group consisted of sight?threatening diabetic retinopathy. Apart from demographics, data on comorbidities, type and duration of diabetes mellitus (DM), health insurance status, and socioeconomic data were collected from each individual. A statistical test (Chi?square) was performed to study the association between socioeconomic (SE) classes and STDR. For the qualitative part, a few people were chosen. Face?to?face interviews were conducted in depth. Results: A total of 207 individuals, were recruited, of which 69 had STDR and the remaining 138 had non?STDR. The incidence of STDR was high among patients with lower socioeconomic class (SEC) (upper lower and lower), and univariate analysis revealed a strong association between STDR and SEC, the presence of comorbidities, presence of health insurance, type and duration of DM, and P value <0.05. SEC, in contrast, emerged as an independent risk factor for STDR in multivariate analysis. STDR had a devastating effect on all patients interviewed. The financial impact was most likely the most severe. Conclusion: People with lower SEC are more likely to suffer from STDR?related vision loss. The impact of such vision loss on individuals is multifaceted, including a negative impact on social and work life, psychological well?being, and, most importantly, a significant financial impact.
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 in Wuhan city, Hubei province, China. The patients with comorbid conditions like diabetes mellitus, lung disease are prone to a wide range of viral, bacterial and fungal infections. Aims And Objectives 1. To know the frequency of mucormycosis in Covid-19 patients. 2. To describe histomorphological pattern of mucormycosis and other fungal infections in Covid-19 patients. Materials And Methods: A prospective study was conducted from May 2021 to August 2021 for four month period with a sample size of 57 at a tertiary care hospital in south India. All the patients who were diagnosed with and or recovered from COVID-19 infection and came back with the fungal infection symptoms were subjected to surgical debridement were included in the study. All the demographic and clinical data were obtained from requests. In the presentResults: study we got 57 cases of covid-19 patient with suspected fungal infections.We examined the biopsy taken from different sites of rhinoorbital area with H&E and GMS stain. Out of 57 cases 36 cases were found to be having mucormycosis. Conclusion: Since Covid-19 is a risk for many opportunistic infections, its association with invasive fungal infection is dangerous and must be given serious consideration
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For beginner surgeons, it is difficult to recognize the posterior capsule during cataract surgery. In the case of brown cataracts with a thin posterior capsule and in cataracts with asteroid hyalosis, it is difficult to identify the capsule before intraocular lens (IOL) implantation even for expert surgeons. Here we illustrate five important signs, which can be practiced in routine cases to make sure the posterior capsule is intact, before IOL implantation.
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Background: There is a substantial increase in the coincidence of diabetes mellitus and cardiomyopathy. The cardiomyopathy may occur in patients who have no evidence of large vessel disease or abnormalities. The early and commonest hemodynamic derangement of diabetic cardiomyopathy is left ventricular diastolic dysfunction. So, the present study was undertaken to assess the prevalence of diastolic dysfunction in patients with type 2 diabetes and to assess the correlation of diastolic dysfunction and HbA1c% levels. Materials and methods: A total of 100 diabetic patients with minimum 5 years duration of diabetes were selected from Malla Reddy Hospital, Suraram from August 2020 to June 2022. Patients with minimum history of 5 years of type 2 diabetes were scrutinized for Doppler echo cardiography and HbA1c levels. Results: Diastolic dysfunction of left ventricle was observed in 58 patients out of 100, of which 54 (93.1%) patients had HbA1c% of > 6.4. 2 (3.4%) patients belong to HbA1c% group of 5.7-6.4. and 2(3.4%) patients belong to HbA1c% of < 5. Conclusion: Our findings indicate that myocardial damage in patients with diabetes affects diastolic function before systolic function. Diabetic cardiomyopathy is characterized by an early diastolic dysfunction and a later systolic dysfunction. Impaired diastolic function was not affected by sex or type of diabetes. Even young patients with diabetics with normal systolic ventricular function have diastolic dysfunction, which serves as a marker of a diabetic cardiomyopathy. Diastolic seems not to correlate with disease duration. HbA1c% can be a very good indicator of long term prognosis. Strong corelation exists between diastolic dysfunction and HbA1c.
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Abstract Leishmaniasis is transmitted by sandfly which carries the intracellular protozoa in their midgut. Among visceral, cutaneous and mucocutaneous leishmaniasis, visceral type that is caused by Leishmania donovani is the most lethal one. Findings of leishmanial structure and species took place in 19th century and was initiated by Donovan. Leishmaniasis is still a major concern of health issues in many endemic countries in Asia, Africa, the Americas, and the Mediterranean region. Worldwide1.5-2 million new cases of cutaneous leishmaniasis and 500,000 cases of visceral leishmaniasis are reported each year. Leishmaniasis is endemic in nearly 90 countries worldwide and close to 12 million new cases of leishmaniasis are reported worldwide annually. Studies on antileishmanial drug development is of major concern as leishmaniasis are the second largest parasitic killer in the world and the available drugs are either toxic or costly. The major surface GP63 protease, also known as Zinc- metalloproteases present on the surface of leishmanial promastigotes, can be targeted for drug development. Protease inhibitors targeting such surface proteases show promising results. Different protease inhibitors have been isolated from marine actinobacteria against many infectious diseases. Metabolites produced by these actinobacteria may have greater importance for the discovery and development of new antileishmanial drugs. Hence, this review discusses the background, current situation, treatment, and protease inhibitors from marine actinobacteria for drug development against GP63 molecules.
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Abstract The antimicrobial activity of metallic nanoparticles (NPs) has been confirmed to fight a broad spectrum of microorganisms, through antimicrobial effects that are amplified when these particles are irradiated with light of the proper wavelength. This is the first study to use phytoconjugated Zinc oxide (ZnO) NPs containing traces of active biomolecules derived from Emblica officinalis (E. officinalis) plant extract in antimicrobial photocatalysis (PCT) during non-surgical periodontal therapy. Objectives This study aimed to evaluate the effects of repeated PCT application in the treatment of periodontitis, using a gel containing bio-hydrothermally synthesized ZnO NPs and visible light as an adjunct to scaling and root planing (SRP). Methodology In total, 16 systemically healthy volunteers with stage 3 grade B generalized periodontitis were recruited for this prospective double blind, randomized placebo-controlled trial. After receiving SRP, the subjects received the following interventions in a split-mouth design at baseline, 1 week and 1 month: Group 1 - Placebo gel + Sham PCT; Group 2 - Nano ZnO gel + Sham PCT; Group 3 - Placebo gel + PCT; and Group 4 - Nano ZnO gel + PCT. The site-specific profile of Porphyromonas gingivalis in the subgingival plaque and clinical parameters (Plaque Index, Gingival Index, Gingival Bleeding Index, Probing pocket Depth and Clinical Attachment Level) were assessed at baseline, 1 month and 3 months. Results All interventions tested caused participants' clinical and microbiological parameters to generally improve after 3 months. Subjects who received the Nano ZnO gel + PCT combination showed a sustained and progressive improvement in their treatment outcomes, a result that presented statistically significant differences from the outcomes obtained through the remaining interventions, at all time points during the study period. Conclusions The repeated application of PCT using bio-hydrothermally synthesized ZnO NPs can effectively complement SRP in the non-surgical treatment of Periodontitis.
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Background. Patient safety research is scarce in developing countries. Estimates of patient harm due to healthcare processes in resource-poor settings are thought to be greater than those in developed countries. Ideally, errors in healthcare should be seen as opportunities to improve the future quality of care. Objective. This study aimed to investigate patient safety culture within high-risk units of a tertiary hospital in South Africa. Methods. A quantitative, descriptive, cross-sectional methodology, using a survey questionnaire that measured 10 safety dimensions and one outcome measure among clinical and nursing staff, was employed. Results. Two hundred participants completed the survey questionnaire. Areas of strength identified by the participants included organizational learning (91.09%), staff attitudes (88.83%), and perceptions of patient safety (76.65%). Dimensions that have potential for improvement included awareness and training (74.04%), litigation (73.53%), feedback and communication about errors (70.77%), non-punitive response to error reporting (51.01%), size and tertiary level of the hospital (53.76%), and infrastructure and resources (58.07%). The only dimension identified as weak was teamwork and staffing (43.72%). In terms of the patient safety grade, respondents graded their own units highly but graded the hospital as a whole as having a poor patient safety grade. Conclusion. There are still significant gaps in the quality of care provided at this tertiary hospital. The current patient safety culture is perceived as punitive in nature with regard to reporting adverse events. It is advised that targeted patient safety improvements be made, followed by further investigation
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Humanos , Masculino , Femenino , Atención a la Salud , Seguridad del Paciente , Centros de Atención Terciaria , Calidad de la Atención de Salud , Errores DiagnósticosRESUMEN
Context: The proliferation and differentiation of human periodontal ligament stem cells (hPDLSC) into other cell types are also mediated by mechanical stresses; they might offer therapeutic benefits in tissue regeneration and angiogenesis. Objectives: The study was planned to assess the proliferation, clonogenic potential, and osteogenic differentiation of human periodontal ligament stem cells (PDLSC) following the application of light and heavy orthodontic forces. Materials and Methods: A couple forces of 50 gm (light force) were applied on the 1st premolar on the one side and 250 gm (heavy force) on the contralateral side in the upper arch of patients requiring orthodontic treatment with extraction of all 1st premolars. After 30 days, periodontal tissues were scrapped from extracted teeth for the establishment of PDLSC in vitro. PDLC from the lower premolar teeth where no orthodontic force was applied acted as the control group. Morphology, viability, proliferating rate and population doubling time, clonogenicity, and alkaline phosphatase activity were analysed. Result: The osteogenic potential was confirmed by Alizarin red staining and the expression of the osteogenic markers by qRT?PCR. The morphology, growth kinetics, potency, and osteogenic lineage characteristics inferred the application of high force reduced the proliferative ability and osteogenesis of PDLSC, though the difference was not significant. Conclusion: The established PDLSCs demonstrated their MSC?like properties based on morphology, growth kinetics, colony forming ability, and AP activity. The culture?expanded PDLSCs showed their differentiation potential into osteocytes. The application of high force reduced the proliferative ability and osteogenesis of PDLSCs, variations were not significant.differentiation
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Scrub typhus is a vector-borne disease caused by Orientia tsutsugamushi. Clinical manifestations generally occur due to vasculitis and infammation and can have variable degrees of systemic involvement. Meningoencephalitis and cerebellitis are well-known neurological manifestations of scrub typhus, but the occurrence of Guillain–Barré syndrome is extremely rare. The authors report a 7-y-old boy who developed fever followed by rapidly progressive ascending quadriparesis with arefexia and whose etiological workup revealed positive IgM scrub typhus antibody, as well as, a high OXK titer (1:80). Nerve-conduction studies in all four limbs were suggestive of demyelinating neuropathy. He showed complete recovery after treatment with intravenous immunoglobulin (2 g/kg) and azithromycin.
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Multisystem infammatory syndrome in children (MIS-C) occurs secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A retrospective study, involving 6 tertiary-care centers in Haryana, was conducted to evaluate the clinical features, severity, laboratory fndings, and outcomes of patients with MIS-C. Disease severity was graded (mild/ moderate/severe) and presence of cardiac abnormalities noted. Patients with and without cardiac abnormalities and with and without severe disease were compared. Forty-eight children with MIS-C were included (median age - 9.5 y). Fever (100%), gastrointestinal (83.3%) and mucocutaneous (50%) symptoms were common. Only 16.7% patients had previous history of documented SARS-CoV-2 infection/contact. Severe disease and cardiac abnormalities were seen in 47.9% and 54.2% patients, respectively. NT-proBNP>1286.5 pg/mL and thrombocytopenia (?119500/µL) were signifcant risk factors for severe MIS-C. Forty-fve patients (93.8%) recovered and 3 died. Median hospitalization duration was 7 d (5–9.5). MIS-C must be considered as a possibility in any febrile child, even if a positive epidemiological history is absent. High NT-proBNP and thrombocytopenia are signifcant risk factors for severe MIS-C.
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Background: In India, most individuals with an intellectual disability live with their families. The present study examines the perceived burden of family members, treatment expectations, and awareness of disability benefits for adult individuals with Intellectual Disability (ID). Methodology: A sample of 50 individuals registered in an Adult Psychiatry Unit was referred for intelligence assessment. The assessment was done using standardized psychological tests. Data was gathered using a semi-structured interview schedule during counselling the participants’ family members. Data obtained was examined using descriptive statistics. Results: Average age of participants was 27.5 years, and the majority 64%, were male patients. Comorbid conditions such as seizure disorder, psychosis and obsessive-compulsive disorder (OCD) were present in 46 % of the sample. Caregivers were primarily parents, and a higher level of family burden was due to behavioural problems. Half (50 %) of the sample was unaware of disability benefits. Conclusion: Findings indicate the need to address caregiver burden and plan psychosocial rehabilitation and improve awareness about disability benefits and its implications more consistently across India.
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‘Phyllodes’ is a Greek word which means leaf- like. Phyllodes tumour, though appears well circumscribed, is characterized by irregular surface surface projections. These projections may be cut during surgical excision and predispose to recurrence. Phyllodes tumour shows a wide spectrum of activity varying from an almost benign condition to a locally aggressive, and sometime metastatic tumour. We report a 61 year old female patient presented with a lump on the left breast. Excision was done and histo pathology report revealed phyllode tumour.