Evaluation of liposomal amphotericin B for the treatment of fungal keratitis in a tertiary eye care hospital

Purpose: To evaluate the efficacy of liposomal amphotericin B (L?AMB) for the treatment of fungal keratitis. Methods: Patients with fungal keratitis confirmed by potassium hydroxide (KOH) smear and/ or confocal microscopy were administered topical L?AMB and randomized into three groups treated with three different formulations. The medication was administered two hourly till clinical improvement was achieved, followed by six hourly till complete resolution. The outcome measures were time to clinical improvement, resolution of epithelial defect, stromal infiltrate, hypopyon, extent and density of corneal opacity, neovascularization, and best corrected visual acuity (BCVA) at 3 months. Results: Mean age of the patients was 46.6 ± 14.8 years, and trauma with vegetative matter was the most common predisposing factor. Aspergillus flavus (36%) was the most common fungus cultured, followed by Fusarium (23%). Mean time to clinical improvement, time to resolution of epithelial defect, mean time to resolution of infiltrate, and time to resolution of hypopyon were 3.45 ± 1.38, 25.35 ± 8.46, 37.97 ± 9.94, and 13.33 ± 4.90 days, respectively, and they were comparable among the three groups. There was a significant difference between treatment failure and success cases in terms of days of presentation (P < 0.01), size of the epithelial defect (P?value 0.04), and infiltrate size at presentation (P?value 0.04). At 3 months follow?up, no statistically significant difference was noted in BCVA and mean scar size among groups. Conclusion: L?AMB in a gel form is an effective antifungal agent that promotes the healing of fungal ulcers with notably least vascularization and better tolerance.

An analytical review of contributory factors in intervertebral disc degeneration / Revisão analítica dos fatores contribuintes para degeneração de disco intervertebral / Revisión analítica de los factores que contribuyen a la degeneración del disco intervertebral

ABSTRACT Objective: To summarize current trends in the pathogenesis and management of disc degeneration and suggest areas where more research would be of benefit. Methods: The available literature relevant to Lumbar disc degeneration (LDD) was reviewed. PubMed, MEDLINE, OVID, EMBASE, Cochrane, and Google Scholar databases were used to review the literature. Institutional Review Board approval was not applicable for this study. Results: This article summarizes trends in the pathogenesis and factors associated with disc degeneration. Conclusions: The genetic contribution to lumbar disc degeneration is a newer concept, still being researched in different populations around the world. Investigators have demonstrated a familial predisposition in the etiology of lumbar disc degeneration. The effect sizes of most genetic variants are small and, thus, individual gene-environment studies must have very large sample sizes to provide compelling evidence of any interaction. Level of evidence; Narrative review of available literature.

RESUMO Objetivo: Resumir as tendências atuais da patogênese e do tratamento da degeneração do disco e sugerir quais áreas de pesquisa seriam benéficas. Métodos: A literatura disponível relevante para degeneração do disco lombar foi revisada. Os bancos de dados PubMed, MEDLINE, OVID, EMBASE, Cochrane e Google Scholar foram usados para revisar a literatura. A aprovação do Comitê de Ética em Pesquisa não se aplica a este estudo. Resultados: Este artigo resume as tendências da patogênese e os fatores associados à degeneração do disco. Conclusões: A contribuição genética para a degeneração do disco lombar é um conceito mais recente, que ainda é pesquisado em diferentes populações ao redor do mundo. Os investigadores demonstraram uma predisposição familiar na etiologia da degeneração de disco lombar. Os tamanhos de efeito da maioria das variantes genéticas são pequenos e, portanto, os estudos individuais de ambiente genético devem ter tamanhos de amostra suficientemente grandes para fornecer evidências convincentes de qualquer interação. Nível de evidência; Revisão narrativa da literatura.

RESUMEN Objetivo: Resumir las tendencias actuales de la patogénesis y del tratamiento de la degeneración discal y sugerir qué áreas de investigación serían beneficiosas. Métodos: Se revisó al literatura dispobible sobre degeneración discal. Se utilizaron las bases de datos PubMed, MEDLINE, OVID, EMBASE, Cochrane y Google Scholar para revisar la literatura. La aprobación del Comité de Ética en Investigación no se aplica a este estudio. Resultados: Este artículo resume las tendencias de la patogénesis y los factores asociados a la degeneración discal. Conclusiones: La contribución genética a la degeneración del disco lumbar es un concepto reciente, que todavía se encuentra en estudio en diferentes poblaciones de todo el mundo. Los investigadores han demostrado una predisposición familiar en la etiología de la degeneración del disco lumbar. Los tamaños de efectos de la mayoría de las variantes genéticas son pequeños y, por lo tanto, los estudios individuales del entorno genético deben disponer de tamaños de muestra lo suficientemente grandes como para proporcionar pruebas convincentes de cualquier interacción. Nivel de evidencia; Revisión narrativa de la literatura.

Cemental tear: An unusual cause for persisting endodontic periodontal lesion

Cemental tear represents a rare form of root surface fracture which makes teeth prone to periodontal breakdown. The diagnosis of cemental tear becomes a challenge as it is usually neglected or misdiagnosed and is also underreported in the literature. Correct diagnosis and early treatment of cemental tear can prevent further periodontal breakdown and may preserve the affected tooth for a longer duration. This case presents the diagnosis, treatment, and an analysis of a right maxillary lateral incisor with an improper endodontic treatment coupled with a cemental tear. Despite surgical removal, the cemental tear led to the development of an endodontic periodontal lesion. This article intends to help recognize early signs and symptoms of cemental tear and establish timely diagnosis. It determines that if the periodontal destruction caused by cemental tears is diagnosed and treated early, it may be possible to prevent further periodontal breakdown and preserve the tooth for a longer period.

Correlation of OPG and DEXA: A Case Control Study

Introduction: Osteoporosis is a common disorder affectingolder females. But it remains undetected in many cases. Theaim of the present study is to evaluate the correlation of lowerborder of mandible of OPG and bone mineral density changesas measured by dual energy x ray absorptiometry.Material and methods: 30 female patients were subjected toOPG and DEXA. The visual analysis of OPG was done andcompared with bone mineral density obtained by DEXA.Results: It was found that statistically no significant differencewas observed between OPG and DEXA technique.Conclusion: There is a significant correlation between lowerborder of mandible and bone mineral density. So visualestimation of panoramic radiograph can be used as a screeningtool for evaluation of osteoporosis.

Role of Physiotherapy in the Management of Oral Submucous Fibrosis: A Case Control Study

Introduction: Oral submucous fibrosis is a disorder with nodefinitive treatment. So a treatment that results in symptomaticimprovement in these patients is very important. The aim ofthe present study was to evaluate the use of physiotherapy inthe management of oral submucous fibrosis patients.Material and methods: 30 patients of OSMF were randomlydivided in two groups. Group I – received physiotherapy andwere on regular follow up. Group II- patients did not receivephysiotherapy but were recalled and were under follow up.Results: Significant improvement was observed in patientswith physiotherapy after a period of 4 weeks.Conclusion: Conservative management with physiotherapy iseffective for oral submucous fibrosis.

Synthesis and in vivo Anti-inflammatory and Analgesic activities of Oxadiazoles clubbed with Benzothiazole nucleus.

The aim of the present work is to synthesize and evaluate the anti-inflammatory and analgesic activity of 2-(5-substituted-1,3,4-oxadiazole-2-yl)-1,3-benzathiazole derivatives. In the present investigation, a series of 2-(5-substituted-1,3,4-oxadiazole-2-yl)-1,3-benzathiazole derivatives (3a1-3a9) were synthesized by condensing benzothiazolyl carboxyhydrazide and appropriate aryl acids in the presence of phosphorous oxychloride. Structures of synthesized compounds were established on the basis of IR, 1H NMR, and Mass spectroscopy. All the synthesized compounds were screened for their in-vivo anti-inflammatory and analgesic activities at the dose of 50 mg/kg and 10 mg/kg po. The biological result shows that some compounds were good in their anti-inflammatory and analgesic actions.

Attitude of First Year Indian Medical Students Towards Cadaver Dissection.

Introduction: Cadaveric dissection is routinely practiced for teaching anatomy for medical students. Anatomy is one of the most important subjects offered during the first year MBBS course. Dissection is very important in learning anatomy, so the first year students will encounter, most likely for the first time, a dead human body. This experience, even though emotionally stressful, provides essential knowledge and skills for their future studies. Methods: A total of 150 newly admitted first-year medical students emotional and physical reactions to cadaveric dissection were assessed by using a questionnaire. The questionnaires were given just before, after a week and 2 months after the initiation of dissection classes. Results: Most of the students experienced negative physical symptoms, such as eye irritation (63.33%), headache (10%), decrease in appetite (12%), nausea (3.3%), sweating (35.33%) giddiness (2.66%), shivering (4.66%) and desire to leave dissection hall (9.33%) in the first encounter with a cadaver in the dissection hall. They also experienced adverse emotional responses such as fear (61.33%), depression (14.66%). However, most of these reactions decreased significantly 2 months later, except for eye irritation and their interest has increased on subsequent visit to dissection classes. A majority (95.5%) considered the cadaver dissection to be the most helpful tool in learning anatomy and it increased their skills. Conclusion: The initial encounters with a cadaver caused emotional and physical stress to students, but most students adapted gradually to the stressful learning environment. The amount of stress can be greatly reduced if they are properly counselled before the dissection classes. Majority of students preferred dissection as the most useful tool to learn anatomy than any other method.

Synthesis and in vivo Anti-inflammatory and Analgesic activities of Oxadiazoles clubbed with Benzothiazole nucleus.

The aim of the present work is to synthesize and evaluate the anti-inflammatory and analgesic activity of 2-(5-substituted-1,3,4-oxadiazole-2-yl)-1,3-benzathiazole derivatives. In the present investigation, a series of 2-(5-substituted-1,3,4-oxadiazole-2-yl)-1,3-benzathiazole derivatives (3a1-3a9) were synthesized by condensing benzothiazolyl carboxyhydrazide and appropriate aryl acids in the presence of phosphorous oxychloride. Structures of synthesized compounds were established on the basis of IR, 1H NMR, and Mass spectroscopy. All the synthesized compounds were screened for their in-vivo anti-inflammatory and analgesic activities at the dose of 50 mg/kg and 10 mg/kg po. The biological result shows that some compounds were good in their anti-inflammatory and analgesic actions.

Iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus: A rare injury / 中华创伤杂志(英文版)

Complications following supracondylar fracture of humerus are well-known. Pre- and post-operative complications have been documented in the literature. Neurovascular injury due to fracture fragments following this type of fracture is described. Iatrogenic brachial artery during surgical treatment of this fracture is unknown to the literature. So we report a rare case of iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus and try to create awareness to the surgeons that such injuries can occur with improper operative techniques.

Variability in the Origin of Lateral and Medial Circumflex Femoral Arteries: An Anatomical Study in South Indians.

Aim: The objectives were to study the anatomical variations in the origin of lateral and medial circumflex femoral arteries in cadaveric lower limbs of South Indian population. Material and method: The present study included 48 embalmed cadaveric lower limbs from the southern part of India. The branching patterns of femoral artery and deep femoral artery were observed in all the specimens. The branching patternwas categorized into different types as per Vazquez et al. The type 1a, the lateral circumflex femoral artery branched distal to the medial circumflex femoral artery and type 1b, the medial circumflex femoral artery branched distal to the lateral circumflex femoral artery. They are grouped under the type 1c, if both the circumflex femoral arteries, were found branching at the same level. Subtype 2a, if the lateral circumflex femoral artery is branching fromthe deep femoral artery and themedial circumflex femoral artery is branching from the femoral artery. Type 2b, if the medial circumflex femoral artery is branching from the deep femoral artery and the lateral circumflex femoral artery is branching from the femoral artery. In type 3, both the lateral and medial circumflex femoral arteries were branching from the femoral artery. Results: In the present study, the type 1awas observed in 43.7% of specimens, type 1c in 12.5%of cases, type 2a was found in 33.3% specimens, type 2bwas observed in 6.2%cases and type 3 in 4.2%of cases. The type 1b was not observed in the present study. Conclusion: The present study has provided additional knowledge about the variability in the origins of lateral and medial circumflex femoral arteries in the cadaveric lower limbs of South Indian population. The morphological knowledge will enlighten the surgeons to avoid complications like catastrophic bleeding and diagnostic misinterpretations.

High origin of the deep femoral artery: a case report and literature review / Origem alta da artéria femoral profunda: relato de caso e revisão da literatura

Arterial variations of the femoral triangle are rarely reported in the literature. In the present article, we have reported a case of high origin of the deep femoral artery, which was originating just lower to the inguinal ligament. It was also observed that the lateral circumflex femoral artery arose directly from the femoral artery instead from the deep femoral artery. We have discussed the anatomy, embryological basis, and clinical implications of these variations along with relevant literature review. The importance of knowledge about these variations in therapeutic and diagnostic interventions is discussed.

Variações arteriais no triângulo femoral têm sido pouco relatadas na literatura. No presente artigo, relatou-se um caso de origem alta da artéria femoral profunda, que estava se originando pouco abaixo do ligamento inguinal. Também foi observado que a artéria femoral circunflexa originava-se diretamente da artéria femoral, ao invés de ser originada da artéria femoral profunda. Discutiu-se sobre anatomia, base embriológica e implicações clínicas dessas variações junto com uma revisão da literatura pertinente. A importância do conhecimento sobre essas variações no quadro das intervenções diagnósticas e terapêuticas é discutida.

Morphometric analysis of the menisci of the knee joint in South Indian human fetuses / Análisis morfométrico de los meniscos de la rodilla en fetos humanos del Sur de India

The morphometrical data related to the menisci of the adults have been reported by few authors and that of the fetuses have not been reported. The aims of the present study were to analyse the external circumference thickness, the width, peripheral and inner border lengths, and the distance between anterior and posterior horns of the fetal menisci and to compare the meniscal dimensions with that of the adult meniscal parameters which are available in the literature. The menisci from 106 knee joints of the formalin fixed South Indian fetuses which were obtained from the anatomy department were analysed. The fetuses which had musculoskeletal anomalies were excluded from the study. A vernier caliper of 0.02 mm accuracy and a non elastic cotton thread were used for the morphometry. After comparing the meniscal dimensions of the present study with the adult meniscus parameters, we established that the fetal parameters of the meniscus are entirely different from the adults. These differences are may be due to the mesenchymal differentiation or variability of the vasculature early in embryonic life. We believe that our study will provide support to the fetal anatomy, concerning surgical procedures and arthroscopy of the knee joint. Since the morphometric studies of the fetal menisci are not reported, this study may be considered new and needs to be studied further with different groups of fetuses from various stages of intrauterine development. This study is important not only for orthopedic surgeons, but also for morphologists and embryologists.

Los datos morfométricos relacionados con los meniscos de los adultos han sido reportados por algunos autores, mientras que en fetos éstos aún no han sido descritos. El objetivo del estudio fue analizar, en fetos, el grosor de la circunferencia externa, ancho, y longitud de los márgenes interno y externo, asi como la distancia entre los cuernos anteriores y posteriores. Además, comparar las dimensiones del menisco fetal con los parámetros de adultos disponibles en la literatura. Fueron analizados los meniscos de 106 articulaciones de rodillas fijadas en formalina, pertenecientes a fetos del sur de la India, obtenidos desde el Departamento de Anatomía. Los fetos con anomalías musculoesqueléticas fueron excluidos del estudio. Un pie de metro de 0,02 mm de precisión junto a hilo de algodón no elástico fueron utilizados para la morfometría. Después de comparar las dimensiones del menisco del presente estudio con los parámetros de meniscos adultos se estableció que los meniscos fetales son totalmente diferentes a los adultos. Estas diferencias pueden deberse a la diferenciación mesenquimal o la variabilidad de temprana vasculatura en la vida embrionaria. Creemos que nuestro estudio prestará apoyo a la anatomía fetal, en relación con los procedimientos quirúrgicos y la artroscopía de la rodilla. Los estudios morfométricos no han informado datos en meniscos fetales, por lo que esta investigación puede ser considerada novedosa y requiere seguir siendo estudiada con diferentes grupos de fetos en las diversas etapas del desarrollo intrauterino. Además el estudio de ser importante para los cirujanos ortopédicos, también lo es para morfólogos y embriólogos.

Iron deficiency and infection.

Iron deficiency is the most common micronutrient deficiency in the world. Children, particularly infants living in developing countries are highly vulnerable to infectious diseases. Therefore, understanding the relationship between iron deficiency and infection is of great importance. Iron deficiency is associated with impairment of innate (natural) immunity and cell mediated immunity, thereby contributing to increased risk of infections. The iron acquisition by the microbes and their virulence is determined by various host and microbial mechanisms. Altering these mechanisms might provide modes of future therapy for infectious diseases.

Noninvasive evaluation of endothelial function and arterial mechanics in overweight adolescents.

OBJECTIVE: To evaluate endothelial function and arterial mechanics in apparently healthy overweight adolescents. Design: Analytical observational study. SETTING: Tertiary hospital. METHODS: 40 asymptomatic, normotensive and non-smoking adolescents (11 to 18 years old) were evaluated. Of these 20 were overweight or obese as per International Obesity Task Force criteria while 20 were controls. High resolution ultrasonography was performed to measure flow mediated and Glyceryltrinitrate induced dilation in brachial artery, and arterial mechanics in common carotid artery. RESULTS: Overweight adolescents had significantly lower ratio of flow mediated dilation to Glyceryltrinitrate mediated dilation (0.40 plusminus 0.41 versus 0.61 plusminus 0.17; P = 0.039). On age and sex adjusted multiple regression analysis, the ratio of flow mediated to Glyceryltrinitrate mediated dilation had a significant negative association with body mass index (P = 0.012) and mean skin fold thickness (P = 0.011). However, for mean skin fold thickness, flow mediated dilation also had a significant negative association (P = 0.027). None of the measures of arterial mechanics were significantly different amongst overweights and controls, or significantly associated with either body mass index or mean skin fold thickness. CONCLUSION: Endothelial function can be mildly impaired in apparently healthy adolescents who are overweight (assessed by body mass index) or adipose (assessed by skin fold thickness). The use of overweight for screening adolescents likely to develop coronary artery disease is therefore justified. Skin fold thickness is a better indicator than Body Mass Index for predicting endothelial function.