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Purpose: To describe a clinical entity called “rectus muscle pseudo?adherence syndrome” following buckling surgery. Methods: A retrospective data review was undertaken to analyze the clinical profile of strabismus patients who had developed it following buckling surgery. Between 2017 and 2021, a total of 14 patients were identified. The demography, surgical details, and intraoperative challenges were reviewed. Results: The average age of the 14 patients was 21.71 ± 5.23 years. The mean pre?op deviation was 42.35 ± 14.35 prism diopters (PD) of exotropia, and the mean post?op deviation was 8.25 ± 4.88 PD of residual exotropia at 26.16 ± 19.53 months follow?up. Intraoperatively, in the absence of a buckle, the thinned?out rectus adhered to the underlying sclera with much denser adhesions along its margins. When there was a buckle, the rectus muscle adhered to the outer surface of the buckle again, but less densely, with marginal union into the surrounding tenons. In both scenarios, due to the absence of protective muscle coverings, the rectus muscles were naturally adsorbed onto the immediately available surface in the presence of active healing by the tenons. Conclusion: While correcting ocular deviations following buckling surgery, a false sense of an absent, slipped, or thinned?out rectus muscle is very much possible. This is due to active healing of the muscle with the surrounding sclera or the buckle in a single layer of tenons. This is the rectus muscle pseudo?adherence syndrome, where the culprit is the healing process and not the muscle
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Neurologic complications are common in patients hospitalisedwith COVID-19 infection. Most common complications are myalgias, headaches, encephalopathy and dizziness. Uncommon complications are stroke, motor and sensory deficits, seizures, ataxia and movement disorders. Multiple neuro-ophthalmological manifestations have also been reported in association with COVID-19. These complications may be the result of a range of pathophysiological mechanisms like hypoxic neuronal injury during active COVID-19 infection, RAS dysfunction, immune dysfunction and direct injury by the virus etc throughout the course of the disease. Here we reported a case of neuro-ophthalmic complication of Idiopathic intracranial hypertension (IIH) followed by bilateral optic atrophy in a middle-aged man with recent COVID-19 infection. He presented to the emergency with complaints of headache, dizziness and sudden painless bilateral diminution of vision for 3 days. His fundus examination was suggestive of bilateral papilledema, his MRI brain was normal and opening pressure of CSF was raised on lumbar puncture. His MRV was normal, there was no evidence of CSVT. He was started on steroids and acetazolamide. His headache improved but there was no improvement in visual acuity. Repeat fundus showed pale disc and MRI orbit was suggestive of bilateral optic atrophy.
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Background: Reproductive tract infection (RTI) is a public health problem, especially in developing country like India. The associated odium with this reproductive morbidity is often a stumbling block in seeking health care. The aim was to study the prevalence of RTI symptoms and its socio-demographic corelates.Methods: A cross-sectional study was undertaken in the rural field practice area of department of community medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from July 2018 to September 2018. Total sample size calculated was 410. Random sampling was used to select eligible couple to whom a predesigned, pretested, semi-structured and anonymous interview schedule was administered after taking consent.Results: The prevalence of self-reported reproductive tract infections was found to be 41.2%. The prevalence was more in lower socio-economic classes, and it was statistically significant. Other socio-demographic corelates (age, education, occupation) did not showed any significant association.Conclusions: The reproductive tract infections prevalence is found to be considerably high in the women of reproductive age group. The frequency was higher among multigravida women and those using cloth during menstrual periods. RTIs are usually spurned by women and even the health care providers, so there is a need to give due consideration to this aspect of reproductive health.
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The stress vulnerability model emphasizes the interplay of genetic vulnerability, personal characteristics and psychosocial factors in the causation of mental illness. The index case highlights the genesis of psychiatric illness in an adolescent female with a family history of bipolar disorder and substance dependence leading to impaired family interaction and family dynamics. Individual psychotherapy, family therapy and pharmacological management proved beneficial in the index case.
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Background: Himachal Pradesh is an endemic area for scrub typhus. If not treated early, it can lead to life threatening complications. Therefore, more emphasis needs to be laid on the diagnosis and prompt treatment, so that mortality due to severe scrub typhus can be prevented. So, this study was done with an objective to study the clinical profile of patients diagnosed with severe scrub typhus and assess their severity using APACHE II score in IGMC, Shimla.Methods: Authors conducted a descriptive cross-sectional study in Indira Gandhi Medical College, Shimla over one year (June 2016-May 2017). Out of 538 confirmed scrub typhus cases, 58 severe cases were reported, and their severity was assessed with predefined criteria of sepsis and APACHE II score.Results: Mean age of males (50.18±18.6 yrs) was found to be more than that of females (45.52±14.5 yrs), the difference being statistically insignificant t(56)= -1.01, (P=0.32). Fever (100%), headache (84.5%), vomiting (79.3%) were the major presenting symptoms and tachycardia (96.5%), hypotension (87.9%), tachypnoea (94.8%) were the main clinical signs. The mean APACHE II score on admission was 16.25±5.0 with a predicted mortality of 23.5%, that was found to be less than actual reported hospital mortality (25.8%).Conclusions: APACHE II score was found reliable tool for risk stratification. Case fatality in diagnosed cases of severe scrub typhus was found high. Early diagnosis and prompt treatment according to guidelines would help in decreasing the mortality, financial burden on patient, society and health system.
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Background: Tobacco smoking is a pandemic affecting populations and contributing to global morbidity and mortality. It is well known that the second hand smoke is equally hazardous like first hand smoke. Cigarette and other tobacco products act 2003 is an effort put forth by Government of India in order to curb this menace and protect people from ill effects of second hand smoke.Methods: The present study was conducted to assess the compliance to smoke free act in tertiary healthcare institutes in Shimla city, Himachal Pradesh. A total of 57 public places and 8 shops in five Tertiary healthcare institutes were evaluated for various provisions of the act. Compliance to different sections of the act was assessed using a structured observational checklist.Results: Signage indicating ban on smoking was seen at 71.9% places. Active smoking was absent at 77.2% places. About 25% shops around the institutes were found selling tobacco products. Signage displaying ban on sale within 100 m of educational institution and sale to minors was not observed at any shop. Tobacco product vendor was seen around 80% of educational buildings. Tobacco free institution signage was seen at 60% of educational premises.Conclusions: The study highlights that the level of compliance did not meet the standards laid down for a smoke free city. Timely and periodic assessment of the compliance must be conducted by the administrative authorities of the institutes for ensuring the adherence and strict implementation of the provisions of the act.
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Background: Bio-ethics i.e. health care ethics is a set of moral principles, beliefs and values that guide us in making choices about medical care. This novel study was carried out with an objective of assessment of knowledge regarding the medical ethics among the resident doctors of Indira Gandhi Medical College, Shimla Himachal Pradesh.Methods: This descriptive analytical cross-sectional study was conducted at Indira Gandhi Medical College (IGMC), Shimla, Himachal Pradesh among the resident doctors using predesigned, structured, self-administered anonymous close-ended questionnaire. We analyzed the data using Stata software version 12.Results: There were a total of 61 study participants, who consented to participate, of which more than half were females (52.5%). The mean age of the study participants was 28.6±0.63 years. Regarding the source of knowledge about medical ethics most of the study participants had acquired the information during their experience at their workplace (42.6%). A majority of the male participants disagreed that confidentiality while providing the health care services should be abandoned (54.3%). More than 90% of the study participants agreed that incorporation of medical ethics is necessary in undergraduate curriculum.Conclusions: Incorporation of a formal structured teaching on medical ethics in the undergraduate curriculum is the need of the hour. Besides research work, the medical ethics committee in the institution should also act as the guiding hands to address the grievances faced by the doctors during medical practice.
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Background & objectives: Reusable biostrip consisting enzymes immobilized onto alkylamine glass beads affixed on plasticized PVC strip for determination of triglyceride (TG) suffers from high cost of beads and their detachments during washings for reuse, leading to loss of activity. The purpose of this study was to develop a cheaper and stable biostrip for investigation of TG levels in serum. Methods: A reusable enzyme-strip was prepared for TG determination by co-immobilizing lipase, glycerol kinase (GK), glycerol-3-phosphate oxidase (GPO) and peroxidase (HRP) directly onto plasticized polyvinyl chloride (PVC) strip through glutaraldehyde coupling. The method was evaluated by studying its recovery, precision and reusability. Results: The enzyme-strip showed optimum activity at pH 7.0, 35oC and a linear relationship between its activity and triolein concentration in the range 0.1 to 15 mM. The strip was used for determination of serum TG. The detection limit of the method was 0.1 mM. Analytical recovery of added triolein was 96 per cent. Within and between batch coefficients of variation (CV) were 2.2 and 3.7 per cent, respectively. A good correlation (r=0.99) was found between TG values by standard enzymic colrimetric method employing free enzymes and the present method. The strip lost 50 per cent of its initial activity after its 200 uses during the span of 100 days, when stored at 4oC. Interpretation & conclusions: The nitrating acidic treatment of plasticized PVC strip led to glutaraldehyde coupling of four enzymes used for enzymic colourimetric determination of serum TG. The strip provided 200 reuses of enzymes with only 50 per cent loss of its initial activity. The method could be used for preparation of other enzyme strips also.
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Introduction: The intraoperative diagnostic accuracy of a tumor is an essential part in patients’ work-up. If the surgeon finds it malignant during surgery, widespread dissection including lymph nodes can be done simultaneously and thus preventing the need of second surgery. Objective: The aim of this study is to determine the accuracy of imprint cytology (IC) for the intraoperative diagnosis in patients with tumor and its usefulness in low facility set up. The diagnostic accuracy of IC has been compared with histopathological examination (HPE), the gold standard diagnostic. Material and methods: This study included 55 patients presenting as a tumor mass of different organs with clinically diagnosed as malignant. In the operation theater, smears for IC were made from cut surfaces of tumors. These ware stained with Papanicolaou stain and hematoxylin and eosin (H&E) stain. The results of IC were compared with HPE using H&E staining. Results: This study included tumor specimens of five from lymph nodes, three from cervix, 31 from breast, four from gastrointestinal tract (GIT), three from parotid gland, five from ovary, one from uterine corpus and three from skin. Table 3 shows categorization of benign and malignant tumors. Locally infiltrative tumors have been shown in benign tumor list. The result of my study is as follows: IC for benign and locally infiltrative tumors gave 100% accuracy and that for malignant tumor it was 34/35 (97%) accuracy. The only case which was misdiagnosed as reactive lymph node (LN), which was turned out to be as Hodgkin’s lymphoma. Conclusion: Intraoperative IC is a useful method for evaluating tumors. The simplicity of technique can be used at small centers with low facility set-up.
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Introduction: Myeloid sarcoma (MS) is a rare localized extramedullary tumor of myeloid precursor cells. Short clinical history: An 11-year-old male presented with nasal bleed, two days; breathlessness and loss of appetite, one month and bilateral nasal blockade for two months. There was no fever. On clinical examination, bilateral cervical lymphadenopathy and hepatosplenomegaly was found. On opening mouth, a pink mass hanging behind the soft palate was noted. Magnetic resonance imaging of head and neck revealed a nasopharyngeal mass in maxillo-ethmoidal sinus. Gross pathology: Excised mass was greenish pink, measuring 2 × 2 × 2 cm. Microscopic examination: Hemogram revealed total leukocyte count 1.2 lac/mm3, hemoglobin 10.1 g/dl, and platelet count 41,000/mm3. Differential count showed 24% blasts with marked left shift. Bone marrow aspirate revealed 27% blasts. No auer rod seen. Cytochemistry showed myeloperoxidase (MPO) positivity. Trephine biopsy showed myeloid hyperplasia with excess blasts. Histopathological examination of lymph nodes and soft tissues showed leukemic infiltration. Immunohistochemistry showed blasts positive for MPO and negative for CD3. On multicolor flow cytometry blasts were positive for MPO, CD34 and CD45, and negative for CD3 and CD79a. A diagnosis of MS with acute myeloid leukemia (AML) was made. Discussion: It is rare in children (1 month-89 years). Any site of body, most commonly skin, lymph node, bone, etc. are affected. Prediction of first appearance of MS or AML was difficult in this case. MS may progress to AML simultaneously or may remain localized, never progressing to AML. Conclusion: Any extramedullary tumor showing myeloid precursor cells, should be investigated for MS, easily misdiagnosed as solid tumors.
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Background & objectives: The use of epoxy resin membrane as a support for immobilization of enzyme has resulted into improved sensitivity and stability of biosensors for uric acid, ascorbic acid and polyphenols. The present work was aimed to prepare an improved amperometric biosensor for determination of serum cholesterol required in the diagnostics and management of certain pathological conditions. Methods: Epoxy resin membrane with immobilized cholesterol oxidase was mounted on the cleaned platinum (Pt) electrode with a parafilm to construct a working electrode. This working electrode along with Ag/AgCl as reference and Ag wire as an auxiliary electrode were connected through a three terminal electrometer to construct a cholesterol biosensor. Results: The sensor showed optimum response within 25 sec at pH 7.0 and 45°C. The linear working range of biosensor was 1.0 to 8.0 mM cholesterol. Km and Imax for cholesterol were 5.0 mM and 9.09 μA, respectively. The biosensor measured serum cholesterol. The minimum detection limit of the sensor was 1.0 mM. The mean analytical recoveries of added cholesterol in serum (2.84 and 4.13 mM) were 91.4±2.8 and 92.3±3.1 per cent (n=6), respectively. Within and between assay coefficient of variation (CV) were <2 and <4 per cent, respectively. Biosensor had a storage life of 6 months at 4°C. Interpretation & conclusions: The use of epoxy resin membrane as a support for immobilization of cholesterol oxidase has resulted into an improved amperometric cholesterol biosensor. The present biosensor had an advantage over the existing biosensors as it worked at comparatively lower potential.