New Onset Facial Nerve Palsy : A Part of Post COVID Mucormycosis Disease Spectrum — A Descriptive Observational Study

Introduction : COVID Associated Mucor (CAM) is a well known entity with defined symptomatology. Cranial Nerve Palsy involving II, III, IV, V, VI th Nerve is common. Facial Nerve involvement is an out of tract presentation. The study was aimed to find the incidence of Facial Nerve involvement in CAM and document their route of involvement. Material and Method : Descriptive observational study was done in an Apex Centre for CAM in West Bengal between April, 2021 to January, 2022. CAM having Rhino-orbital-cerebral Mucormycosis (ROCM) and new onset Facial Palsy were considered. Participants were included following stipulated inclusion and exclusion criteria. Collected data was analysed. Observations : Total 11 patients of new onset Facial Palsy in COVID-19-Associated ROCM were included. 81.8% had coexisting other Cranial Nerve involvement. Facial Palsy was one of the primary presentations in the patients of ROCM. Discussion : CAM is angioinvasive and can cause concomitant hypoxic neural damage due to involvement of the vasa nervorum. Skull base involvement can be hypothesized to be the predominant route of Facial Nerve involvement. Facial palsy can be an important initial presentation of CAM. Conclusion : Facial Nerve Palsy may be a part of the spectrum of disease presentation in CAM.

Prospective Observational Study to Review the Contemporary Management of Amoebic Liver Abscess

Introduction: Amoebic liver abscess is an inflammatory space-occupying lesion of the liver caused by Entamoeba histolytica.Trophozoites after lodging in sufficient numbers in venules lead to thrombosis and infarction and microabscesses formationand thence amoebic abscess. Fever and pain right upper quadrant are very common.Aims and Objectives: The aim of the study was to review the contemporary management of amoebic liver abscess.Materials and Methods: This hospital based observational study for 100 patients was performed in the Surgery Departmentin SGT Medical College, Budhera, Gurugram, Haryana. A detailed history and focussed clinical examination and requiredinvestigations were done. Patients were divided into three categories according to sizes of abscesses, <5 cm, 5–8 cm, and>8 cm. In Category I, patients were treated with metronidazole 40 mg/kg body weight in three divided doses. If toxemia wasthere, then metronidazole 100 ml, IV 8 hourly was given for 3–4 days and switched onto oral metronidazole. In CategoryII, if a trial of conservative treatment for 3 days did not relieve the symptoms, and in Category III, ultrasound-guided pigtailcatheterization was done.Results: In our study, maximum patients were between 21 and 60 years of age. Male:female ratio was 4.55:1. Patients presentedwith fever, pain right hypochondrium, and hepatomegaly. Liver enzymes were elevated. Total lymphocyte counts were raisedand serum albumin was decreased in some patients.Conclusion: Due to our concrete planning and meticulous care at every step, there was lack of infection at the port site ordeep-seated, and there has been no failure of resolution, no hemorrhage, recurrence, pleural complications, and fever andthere has been no death in our series.

​Evaluation Of The Efficacy Of Tamsulosin And Deflazacort Versus Tamsulosin Alone In Expulsion Of Lower Ureteric Stones In A Tertiary Center

Introduction: Urolithiasis is a very common problem present. About 70% of all ureteric stones are found in the lower third ofureter. Many factors affect the modality of treatment such as setup available, type, size of stone and expertise of the surgeon.Extracorporeal shock wave lithotripsy and ureteroscopy and removal of stone are very effective, but they require the help ofanesthetist. Ureter is to be stented, and the stent has to be removed later on. They are very costly and not without complications.Many pharmacological agents have been used for the expulsion of ureteric stones, for example, diclofenac, alkalizers, ketorolac,nifedipine, deflazacort, prazosin, silodosin, and tamsulosin.Materials and Methods: This prospective observational study was conducted in the Surgery Department at SGT MedicalCollege. A total of 100 patients of distal ureteric stones of sizes 4–10 mm were taken in this study, divided into two groups of50 patients each. Group I patients were given tamsulosin 0.4 mg and deflazacort 30 mg once in a day, Group II patients weregiven tamsulosin 0.4 mg once in a day. Treatment was for 10 days.Results: In Group I, the stones were expelled in 38 (76%) patients, while in Group II, 26 (52%) patients passed stones. Thisis statistically significant with P = 0.038. The median time for stone expulsion was 3 days in Group I and 11 days in Group IIwith P = 0.032.Conclusion: We have evaluated that medical expulsive therapy using tamsulosin alone is also effective and can be used inpatients where steroids are contraindicated, but by adding deflazacort, it becomes very effective for management of distalureteral calculi.

Modulation of signal transduction pathways by natural compounds in cancer / 中国天然药物

Cancer is generally regarded as the result of abnormal growth of cells. According to World Health Organization, cancer is the leading cause of mortality worldwide. Mother nature provides a large source of bioactive compounds with excellent therapeutic efficacy. Numerous phytochemicals from nature have been investigated for anticancer properties. In this review article, we discuss several natural compounds, which have shown anti-cancer activity. Natural compounds induce cell cycle arrest, activate intrinsic and extrinsic apoptosis pathways, generate Reactive Oxygen Species (ROS), and down-regulate activated signaling pathways, resulting in inhibition of cell proliferation, progression and metastasis of cancer. Several preclinical studies have suggested that natural compounds can also increase the sensitivity of resistant cancers to available chemotherapy agents. Furthermore, combining FDA approved anti-cancer drugs with natural compounds results in improved efficacy. On the basis of these exciting outcomes of natural compounds against several cancer types, several agents have already advanced to clinical trials. In conclusion, preclinical results and clinical outcomes against cancer suggest promising anticancer efficacy of agents from natural sources.

Arteriovenous Fistula of the Filum Terminale Misdiagnosed and Previously Operated as Lower Lumbar Degenerative Disease

Filum terminale arteriovenous fistula (FTAVF) presenting as a cause of failed back surgery syndrome is a rare entity. We report a 48-year-old male patient who presented with clinical features of a conus medullaris/cauda equina lesion. He had upper and lower motor neuron signs in both the lower limbs with autonomic dysfunction. The patient was misdiagnosed and was operated twice earlier for lumbar canal stenosis and disc prolapse. After reviewing his clinical and radiological findings a diagnosis of FTAVF was made. He underwent surgery and there was a significant improvement in his neurological functions. We discuss the case and review the literature on FTAVF's.

Role of Ace Inhibitors & At-Ii Receptor Antagonists in Migraine Prophylaxis: An Overview.

Migraine is a chronic neurological disorder characterized by recurrent moderate to severe headaches, associated with a number of autonomic nervous system symptoms. Migraine constitutes 16% of primary headaches affecting 10-20% of general population according to International Headache Society. Typically the headache is unilateral (affecting one half of the head) and pulsating in nature, lasting from 2 to 72 hours. Associated symptoms may include nausea, vomiting, photophobia, phonophobia and the pain is generally aggravated by physical activity. Globally, approximately 15% of the population is affected by migraine at some point in life. Initial recommended management is with simple analgesics such as ibuprofen and acetaminophen for the headache, an antiemetic for the nausea, and the avoidance of triggers. Specific agents such as triptans or ergotamines may be used by those for whom simple analgesics are not effective. All the already available drugs have certain limitations. Either they are unable to produce complete relief or 30-40% patients are no responders or drugs produce adverse effects. A new class of drugs like angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor antagonists have recently been studied for their off label use in prophylaxis of migraine. Studies done so far, have shown results in favour of their clinical use because of the ability to reduce number of days with headache, number of days with migraine, hours with migraine, headache severity index, level of disability, improved Quality of life and decrease in consumption of specific or nonspecific analgesics. This article reviews the available evidence on the efficacy and safety of these drugs in prophylaxis of migraine. Relevent literatures were chosen, examining the efficacy of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for migraine prophylaxis.