Glauco-Claw: A novice implant for chronic angle-closure glaucoma

This article describes 1-year outcomes of a new intra-ocular implant, “Glauco-Claw,” in refractory chronic angle-closure glaucoma (ACG). Glauco-Claw is a novice polymethylmethacrylate implant with a central ring and five claws placed circumferentially. It was placed in the anterior chamber and the peripheral iris was tucked into the claws, thus causing goniosynechialysis and preventing the reformation of goniosynechiae. It was implanted in five eyes of five patients, and they were followed up for 1 year. Target intra-ocular pressure was achieved and maintained in all the patients till the last follow-up. Two patients did not require any anti-glaucoma medication. No significant complications were observed in any patient. Glauco-Claw could be another armamentarium in the management of refractory chronic ACG.

The Commonly Encountered Rheumatological Manifestations amongst Patients with Type 2 Diabetes.

Introduction: Type 1 DM is the result of complete or neartotal insulin deficiency. Type 2 DM is a heterogeneous groupof disorders characterized by variable degrees of insulinresistance, impaired insulin secretion, and increased glucoseproduction. Several studies have reported an associationof early osteoarthritis and DM. The present study wasconducted with the aim to analyze the commonly encounteredrheumatological manifestations amongst patients with type 2diabetes.Material and methods: The study was conducted among100 patients of already diagnosed type 2 diabetes mellitus,attending outpatient/inpatient department of Department ofMedicine, Rajindra Hospital/ Government Medical College,Patiala. The selected patients were subjected to furtherevaluation using Baseline diabetic questionnaire: Name, age,sex, occupation especially manual labor, height, weight, BMI(We considered overweight subjects with a BMI between25 and 29.9 and obesity with BMI >30 kg/m2)3, durationand onset of type 2 diabetes, smoking habits, any historyof systemic diseases, medications: oral hypoglycemic orinsulin injection, blood sugar level: fasting, post prandialand glycosylated hemoglobin. Musculoskeletal system wassystematically examined. Student t test was used for statisticalanalysis. Probability value of less than 0.05 was consideredas significant.Results: The age ranges from 41 years to 80 years. Most ofthe patients were between 61-70 years of age and were 40%of the total patients. In our study out of 100 diabetic patients27 had rheumatological manifestations. The most commonmanifestation was Osteoarthritis (Osteoarthritis knee in ourstudy) which was found to be present in 14% cases. Out of 100patients 27 had rheumatological manifestations out of which11 were males and 16 were females. 35 males and 38 femaleswere without rheumatological manifestations.Conclusion: Rheumatological manifestations are commonamongst subjects with Type 2 diabetes mellitus. The overallprevalence of rheumatological manifestations was 27%. Thiscould be helpful in preventing chronic disability in patientsand improving their quality of life. Good glycemic control isa key to prevent rheumatological manifestations in patientswith T2DM.

Wilson’s Disease - A Case Report

Introduction: Wilson's disease (WD) is a disorder of coppermetabolism leading to the accumulation of this metal indifferent organs. Hepatic manifestations tend to occur in thefirst decade and neurological symptoms in the third decade.Neurological manifestations are said to worsen with chelationtherapy.Case report: In our patient however the initial manifestationwas head tremor at the age of 43 years which improved withtreatment. The patient for some reason stopped the therapy for8 years after which he decided to resume it only to precipitatethe liver cirrhosis clinically –something that has not beenreported earlier. The diagnosis was missed initially. Howevertreatment produced good results.Conclusion: The case also serves as a reminder not to dismissthis disease as a rare theoretical possibility but to suspect itin a case of liver cirrhosis of unknown etiology or when thepatient presents with an obscure isolated neurological signsuch as tremor. Delayed recognition of the disease or stoppingtherapy can lead to a progression of the disease. The patienthad many unusual features which are being reported for futurereference by researchers and practioners

Comparative study of azathioprine and cyclosporin in rheumatoid arthritis – a sixteen weeks follow-up study.

Rheumatoid Arthritis (RA) is a chronic progressive deforming polyarthritic disease involving multisystems and associated with considerable morbidity. Immunosuppressive drugs have been used to reduce/arrest the progression of the disease. The present study was undertaken to compare the efficacy of Azathioprine and cyclosporin in Rheumatoid Arthritis patients. Study consisted of 100 patients of Rheumatoid Arthritis (as per criteria of American Rheumatism Association, 1987) divided into two groups : group I received Azathioprine 1 mg/kg/d and group II received cyclosporin 2.5-3.0 mg/kg/d for 16 weeks. Assessment of efficacy was based on clinical, biochemical and radiological parameters. All patients showed marked improvemen (p value < 0.001) in all clinical parameters i.e. relief in pain, reduction in morning stiffness, painful/swollen joint along with walking time for 50 feet and increase in grip strength. All patients showed reduction (p < 0.001) in ESR without any change in rheumatoid factor titres. Both drugs showed equal efficacy (p value = NS) in improvement of clinical and biochemical parameters. But cyclosporin showed more reduction in bony erosions and juxtaarticular osteoporosis. Ten patients showed nephrotoxicity with cyclosporin. Cyclosporin has an edge over azathioprine in reducing the rate of progression of joint change in Rheumatoid Arthritis but is associated with increased incidence of side effects that are generally manageable.