To compare intralesional and oral propranolol for treating periorbital and eyelid capillary hemangiomas

Purpose: A pilot randomized control trial to compare the efficacy and side effects of intralesional and oral propranolol in periorbital and eyelid capillary hemangiomas. Methods: Twenty patients were prospectively randomized to two groups of ten each. Group 1 was initiated on oral propranolol 1 mg/kg/day titrated to final dose of 3 mg/kg/day over 1 week which was continued for 6 months and then tapered over 1 week; Group 2 received 3 doses of direct intralesional propranolol hydrochloride 1 mg/ml; 0.2 ml/cm 4�6 weeks apart. Hemangioma area and corneal astigmatism were measured. Results: Within each group at 6 months there was a significant reduction in area (group 1: 83.48 � 11.67%,P= 0.0019; group 2: 67.78 � 21.71%,P= 0.0019) and improvement in astigmatism (pre, post: group 1: 2.98D @ 179.8�, 1.13D @ 179.8�,P= 0.0045; group 2: 1.62D @ 90.16�, 0.75D @ 179.9�,P= 0.0001). There was no difference in area reduction (P = 0.056), change in appearance (P = 0.085), ptosis (P = 0.23) and side effects (lethargy, poor feeding;P= 0.171) between the two groups. Conclusion: Efficacy and side effects with intralesional propranolol are comparable to oral propranolol for periorbital and eyelid lesions.

Determination of Antimicrobial Efficacy of Calcium hydroxide, Ozonated sesame oil and their combination as intra canal medicament against Enterococcus faecalis A Study in Fathima Institute of Medical Sciences, Kadapa

Background: Among all the microbial organisms Enterococcus faecalis and Candida albicans were the most commonly seen and most resistant organisms in persistent or failing root canals. Even after chemomechanical preparations and treatment 40 to 70% of the microorganisms survive. Aim: This in vitro study was done to evaluate the antimicrobial efficacy of intra canal medicament in root canals charged with Enterococcus faecalis. Materials and methods: Forty eight extracted human single rooted teeth were taken. Biomechanical preparations and access preparations were done. Specimens were sterilized by autoclaving and later contaminated with Enterococcus faecalis and incubated for 24 hours. Confirmation of Enterococcus faecalis was done and then divided into 3 experimental and 2 control groups. Groups (n=12) A) Animireddy Kishore, G. Obulesu, Madhu Babu. Determination of Antimicrobial Efficacy of Calcium hydroxide, Ozonated sesame oil and their combination as intra canal medicament against Enterococcus faecalis – A Study in Fathima Institute of Medical Sciences, Kadapa. IAIM, 2016; 3(8): 219-227. Page 220 Ozonized Sesame Oil, B) Calcium Hydroxide, C) Calcium Hydroxide + Ozonised Sesame Oil. Control groups Group 1:- (n=6) Negative Control, Group 2:- (n=6) Positive Control. Intra canal medicament was placed in each root canal corresponding to the groups and incubated at 370C. First sampling was done after 24 hours and second or final sampling was done after 72 hours of placement of intra canal medicament. Microbial growth was checked by counting CFU (Colony Forming Units). Results: In the first sampling ozononised sesame oil was 100% efficient, next efficient was Calcium Hydroxide group, and combination of Ozonised sesame oil and Calcium Hydroxide also showed almost similar results. But in the second and final sampling after 72 hours Ozonised sesame oil was highly efficient when compared to other two groups. Calcium Hydroxide was moderately efficient whereas combination of both the drugs was least effective as it showed highest CFU/ml. Conclusion: Ozonised sesame oil was most effective for longer duration when compared to other groups and can be used as an alternative intra canal medicament.

Characterisation of Susceptibility of Candida Spp to Three Essential Oils A Study done in FIMS, Kadapa

In the present investigation, anti-Candida activity of three essential oils that is Betel leaf (Piper betel), Black cumin (Nigella sativa) and Curry leaf (Murraya koienigii) were screened against three human pathogenic species of Candida namely Candida albicans, Candida glabrata and Candida tropicalis. The minimum inhibitory concentration (MIC) values of the oils ranged between 14.80 and 236 µl/ml while studied through the dilution method. The oils retained their anti-Candida activities even after heat treatment (at 450C, 600C, 1000C for 1 hour) and also on autoclaving. Black cumin leaf oil showed better anti-Candida activity against Candida albicans, resulting in an irreversible damage to the cells. The anti-Candida activity of these essential oils could be attributable to the membrane inhibition mechanism. The activity of the cells is reported to be microbicidal.

Significance of MRSA strains in community associated skin and soft tissue infections.

The study was conducted to determine the antibiotic susceptibility profile of community-associated methicillin resistant Staphylococcus aureus (CAMRSA) strains isolated from infections. S. aureus strains were isolated from clinical specimens using the standard procedures. CDC definition was used to classify CAMRSA. Antibiotic susceptibility test was done using Kirby-Bauer disk diffusion method. Double disk diffusion method (D-test) was used to detect inducible macrolide, lincosamide and streptogramin B resistance (inducible MLS B resistance ) . A total of 83 CAMRSA were isolated from abscesses and other skin infections in persons without known risk factors for MRSA infection. All CAMRSA were susceptible to vancomycin. Out of 83 CAMRSA, 13 (15.65%) were D-test positive (inducible MLS B positive) and 6 (7.23%) were positive for constitutive MLS B resistance. Eight strains (9.63%) were resistant to tetracycline and 26 (31.32%) strains were resistant to erythromycin. Increased rate of inducible clindamycin resistance among CAMRSA indicates the importance of identification of such strains by D test to avoid treatment failure when clindamycin is used.

Blindness, ophthalmoplegia and extensive radiculopathy: an unusual clinical syndrome in intracranial sino-venous thrombosis.

Isolated intracranial hypertension is a common manifestation of intracranial sino-venous thrombosis (ISVT). Markedly elevated intracranial tension presents with unusual features including cranial neuropathies and radiculopathy. We report two cases with ISVT, which presented with headache, papilledema, progressive visual loss, complete ophthalmoplegia and flaccid areflexic quadriparesis along with a normal sensorium. Magnetic resonance imaging (MRI) of the brain and cervical spinal cord showed no lesions that could account for the neurological deficits. Markedly elevated lumbar CSF pressure was noted in both cases. Nerve conduction study favored radiculopathy in one case and was normal in the other. Raised intracranial pressure was found to be the sole cause for the clinical manifestations. Visual impairment persisted in one patient despite lumbo-peritoneal shunting while the other died of septicemia. To our knowledge there are no previous reports of a syndrome comprising blindness, ophthalmoplegia and flaccid quadriplegia due to intracranial hypertension in ISVT.

Satoyoshi syndrome.

Satoyoshi syndrome (Komuragaeri disease) is a rare disorder of presumed autoimmune etiology, characterized by painful muscle spasms, alopecia, diarrhea, endocrinopathy with amenorrhoea and secondary skeletal abnormalities. Most of the previous reports are of the Japanese people. We report the first case from India.

Two siblings with Allgrove's syndrome and extrapyramidal features.

We report two siblings with Allgrove's syndrome and extrapyramidal features. Though various neurological abnormalities have been described in this disorder, we report the first patient of Allgrove's syndrome associated with dystonia and chorea.

Deep brain stimulation for Parkinson's disease.

Dopaminergic replacement therapy with levodopa/carbidopa is still the cornerstone for the treatment of Parkinson's disease (PD). However, the medical management of PD is complicated by the appearance of disabling motor response fluctuations, levodopa-induced dyskinesias and psychosis. Since the early 1990s, surgical therapies have made a rapid reentry into the therapeutic armamentarium for PD and deep brain stimulation (DBS) of the globus pallidus interna or subthalamic nuclei is currently the most promising of such interventions. Recognition of the physiological changes in basal ganglia circuits in animal models of PD has provided the much-needed theoretic basis for targeting these areas. DBS of these areas has proven to be a safe procedure and effective against all the major motor symptoms of PD. Though not curative it can substantially reduce motor response fluctuations, levodopa-induced dyskinesias, and improve the quality of life of these patients. DBS is an expensive treatment and hardware-related complications are not rare. The results of the procedure are dependent on careful patient selection and the experience of the performing team. An update on the principles, methods and results of such procedures is essential to raise the awareness of this new therapeutic modality and to provide guidelines to the referring physicians.

Acute dysautonomia following mumps.

Pure acute or subacute dysautonomia is a rare entity. Its etiology is as yet unknown. However, majority of these cases have a preceding viral infection such as herpes simplex, infectious mononucleosis, rubella or coxsackie B. A unique patient in whom acute dysautonomia followed mumps is reported.

Inappropriate shocks in patients receiving internal cardioverter-defibrillators for malignant ventricular arrhythmias.

Implantation of internal cardioverter defibrillators (ICDs) for treatment of malignant ventricular arrhythmias is complicated by failure of therapy or inappropriate shocks. We studied 81 patients (age range 16-72 years; mean 48 +/- 13 years) who underwent ICD implantation for device therapy. The underlying aetiology was ischaemic heart disease (39%), cardiomyopathies (32%) and others (28%). Information regarding shocks was collected using Holter monitoring, telemetry or device memory (stored electrograms) and lastly by clinical follow-up. Fifty-eight patients completed 36 months of follow-up. Thirty-five patients experienced 337 spontaneous shocks, appropriate in 21, inappropriate in 12, and both in two patients. Of the 74 episodes of inappropriate discharges for rhythms other that ventricular tachycardia (VT) or ventricular fibrillation(VF), 55 percent were due to supraventricular arrhythmias (atrial flutter or fibrillation). Lead malfunction occurred in four and the device was replaced in two. Additional drugs controlled AF in one. There was no mortality in any of the 81 patients. The frequency of shocks was highest in the first six months after implantation and atrial fibrillation remains the main cause. In conclusion, inappropriate shocks are frequent in patients undergoing ICD implantation.

Correlation of 12 lead ECG QRS score with severity of aortic stenosis.

The hemodynamic data and electrocardiograms of thirty-three patients of moderate to severe aortic stenosis were analysed retrospectively to find out if there was any correlation between 12 lead ECG-QRS score and left ventricular peak systolic pressure (LVPSP) and/or peak systolic gradient (PSG) across the aortic valve. The mean age of the study population was 33.33 (+/- 15.02SD) years, with the male to female ratio being 9:2. The mean 12 lead ECG-QRS score in these 33 patients was 281 mm (+/- 46.02SD), the mean LVPSP 203.52 mmHg (+/- 46.62SD) and the mean PSG across the aortic valve was 81.0 mmHg (+/- 41.62SD). There was good correlation of 12 lead ECG-QRS score with LVPSP (r = 0.47, P less than 0.001) and with PSG across the aortic valve (r = 0.58, P less than 0.001), latter being more significant. The best correlation was however found between 12 lead ECG-QRS score and PSG across the aortic valve in patients over 35 years of age (r = 0.88). In conclusion there is a direct relationship between 12 lead ECG-QRS score and peak systolic gradient across the aortic valve and the latter can be approximately calculated non-invasively with the help of regression equation- Peak systolic gradient (in mmHg) = 12 lead ECG-QRS score/3 - 10.6