A long-term clinical outcome of Hoffmann pocket four-point scleral fixated intraocular lens implantation combined with penetrating keratoplasty – A single corneal surgeon’s report

Purpose: To analyze retrospectively the outcomes of Hoffmann pocket scleral fixated intraocular lens implantation combined with penetrating keratoplasty at a tertiary institute by a single corneal surgeon. Methods: Forty?two eyes of 42 patients, aged between 11 and 84 years, had a mean follow?up of 2 ± 2.216 years. Overall, five (11.9%) had congenital and 37 had acquired pathology, 15 were pseudophakic, 23 were aphakic, and four were phakic. The commonest indication was trauma in 19 (45.2%), and 21 had previous multiple surgeries including five retinal procedures. Results: The grafts were clear in 20 (47.6%), they failed in 20, three had acute rejection, three were ectatic, two had infection, one had persistent edema, and one had endophthalmitis. The mean log of minimum angle of resolution (logMAR) best corrected visual acuity was 1.902 pre?op, 1.802 at the final follow?up, and 0.52 after excluding preexisting retinal pathologies. At the last follow?up, the vision improved in 18 (42.9%), maintained in 6, and worsened in 18, and three needed more than ?5.00 D and seven needed more than ?3.00 D cylinder correction. Five had glaucoma preoperatively, 10 developed the condition postoperatively, six needed cyclodestructive procedure, and three had valve surgery. Conclusion: Advantages of this surgery are avoidance of additional sections to insert the lens, direct positioning of the lens in the posterior chamber, rotational stability of the lens from four?point fixation, and untouched conjunctiva over the scleral pockets. The fact that 20 had clear grafts and 18 visually improved, though two needed lens removal and one developed retinal detachment postsurgery is encouraging. More cases with longer follow?ups will help understand the technique better

Challenges of managing HIV cytomegalovirus co-infection in the presence of pancytopenia

A 60-year-old male patient who presented with generalized weakness and low-grade fever was diagnosed to be human immunodeficiency virus (HIV) positive with a CD4 count of 17. Routine laboratory investigations revealed pancytopenia. Serum cytomegalovirus (CMV) DNA polymerase chain reaction (PCR) was positive and fundoscopy showed CMV retinitis in the right eye. The patient was started on tablet valganciclovir. After 2 weeks, the patient was brought back in an altered sensorium. He was found to have hyponatremia which was corrected. He was started on antiretroviral therapy and tablet valganciclovir was continued. The patient came back again after one and a half months with a urinary tract infection and fissure-in-ano. He was found to have severe neutropenia. Valganciclovir was stopped. He was started on injection granulocyte colony-stimulating factor. The patient clinically improved and his hematological parameters became normal. Patients having HIV and CMV co-infection with pre-existing pancytopenia have to be closely monitored as the medicines used for treatment can exacerbate the existing conditions.

The Role of Oxidative Stress and Cytokine Storm in the Pathogenesis, Oral Manifestation, Progression and Adverse Effects Related to SARS-Cov2 Infection- A Review

Introduction: COVID-19 pandemic has been the most challenging global health concern that the world has ever seen and is the focus of active research around the world. The interaction of the SARS CoV2 virus with the target cells, their action on the immune system and the subsequent reaction has all been linked to the inflammatory processes that are taking place in the human body mainly the oxidative stress. Objective: Through this article we aim to analyse the effect of oxidative stress in the pathogenesis of COVID-19, highlighting the role of the same in the oral manifestations that are being reported in literature and its subsequent impact in the transmission and propagation of SARS-CoV2. The role of antioxidants in the control of the SARS-CoV2 infection has also been explored. Materials and Methods: Four reviewers independently collected the data pertaining to the topic from case reports and review articles published in electronic databases like PubMed, Scopus, Science Direct and Research gate. Conclusion: Increased release of cytokines known as cytokine storm has been associated with disease progression, oral manifestation as well as adverse effects in patients with COVID 19. However, as this is an ongoing pandemic with new mu- tations occurring frequently, further clinical trials are required to evaluate the exact mechanisms that may be at play in the pathogenesis of SARS-CoV2 infection.

Comparative study to evaluate retinal changes using spectral-domain optical coherence tomography in diabetics without diabetic retinopathy

Purpose: To elucidate changes in the neuro?sensory retina at the macula, using spectral?domain optical coherence tomography (SD?OCT) in type 2 diabetics without clinical signs of diabetic retinopathy, and compare with healthy subjects. Methods: This was a cross?sectional observational study, conducted at a tertiary eye institute from November 2018 to March 2020. Type 2 diabetics visiting the outpatient department with normal fundus (without any clinical signs of diabetic retinopathy) were taken as Group 1, and healthy subjects as Group 2. Both underwent recording of visual acuity, intraocular pressure (non?contact tonometry), slit?lamp anterior segment examination, fundus examination using an indirect ophthalmoscope, and macular SD?OCT. SPSS (Statistical Package for Social Sciences) version 20 [IBM SPSS statistics (IBM corp. Armonk, NY, USA released 2011)] was used to perform the statistical analysis of the data entered in the excel sheet. Results: Our study included 440 eyes of 220 subjects, divided equally into two groups. The mean age of patients with diabetes was 58.09 ± 9.42 years, and of controls 57.25 ± 8.91 years. The mean BCVA in group 1 and group 2 was 0.36 ± 0.37 and 0.21 ± 0.24 logMAR, respectively. SD?OCT showed thinning in all areas in group 1 compared to group 2, but statistically significant thinning was seen only in the central subfield (P = 0.0001), temporal parafoveal (P = 0.0001), temporal perifoveal (P = 0.0005), and nasal perifoveal areas (P = 0.023) in group 1. There was a significant inter?eye difference noted between the right and left eyes in nasal and inferior parafovea only in group 1 (P = 0.03). No significant difference was noted between males and females. Conclusion: There was significant macular thinning in diabetics compared with controls, which denotes the occurrence of neuronal damage in these eyes before clinical evidence of diabetic retinopathy.

Reverse graft suturing to avoid Descemet’s membrane detachment of glycerol-preserved donor cornea used for therapeutic penetrating keratoplasty during COVID-19 to overcome the tissue shortage – A novel surgical technique

To overcome tissue shortage during pandemic, we switched to 100% glycerol preservation of the donor cornea, which is economical and provides longer duration of storage than the short and intermediate storage mediums we normally use like McCAREY Kaufman (MK) or cornisol. During our initial few cases of therapeutic penetrating keratoplasty using glycerol preserved donor cornea, we faced spontaneous Descemet’s detachments resistant to air tamponade. We tried reverse graft suturing and successfully reinforced Descemet’s attachment along with air tamponade, in one of the cases after multiple failed air injections. In the subsequent two cases of infective keratitis needing therapeutic penetrating Keratoplasty, we took eight reverse sutures in between the eight cardinals, to anchor the Descemet’s membrane of the graft. Both the grafts showed attached Descemet’s and maintained good graft clarity. The reverse corneal suturing technique has not been described to the best of our knowledge and hope this helps our corneal fraternity.

Resource maximization during COVID-19 crunch – A novel graft marking technique to use one cornea for two recipients for either Descemet membrane endothelial keratoplasty or deep anterior lamellar keratoplasty

During pandemic, eye banks worldwide faced drastic reduction of corneal retrieval. Since precut tissues are uncommon in India, the onus is on corneal surgeons to maximize the donor corneal usage. The stumbling block making the stromal part unusable in the graft preparation of the Descemet membrane endothelial Keratoplasty is the stromal window creation to place the orientation mark on the stromal side of the folded graft. To overcome this, we simply marked directly on the folded Descemet graft, after partly stripping it from the donor cornea. Then, we unfolded, punched, and created two grafts after completely stripping it, retaining the Descemet part for the endothelial Keratoplasty and the stromal part for lamellar Keratoplasty. Initially, we used a special F marker, and later we marked an L using just a spatula. This simple technique needing no extra donor tissue or instrumentation maximizes the tissue utility with proper patient selection.

Imaging Findings of Knee Trauma on Magnetic Resonance Imaging

Background: Knee is one of the major joints involved in kinesis. With increasing involvement in sports related activities especially in young people, Trauma related knee pathologies have increased. An accurate diagnosis regarding the type and extent of injuries is essential for early operative as well as non-operative treatment. Methods:This prospective study included total of 82 cases. The patients were referred to the department of Radiodiagnosis from indoor and outdoor departments of Guru Nanak Dev Hospital, Amritsar with suspicion of internal derangement of the knee and with history of knee trauma.Results:The most common age group involved was young males between 15-34 years. In all age groups most of the patients were males. Most common ligament to be injured was Anterior Cruciate Ligament (ACL). Partial tears were more common than complete tears. Posterior Cruciate Ligament (PCL) tears were less common. Medial Collateral Ligament (MCL) tears outnumbered Lateral Collateral Ligament (LCL) tears and grade 2 tears were more common in both. Among the meniscal injuries Medial Meniscus (MM) tears were more common than LM and grade 3 signal was more common in both. Most of the patellar retinaculum injuries were associated with Anterior Cruciate Ligament ACL tears.Conclusions:Post-traumatic pre-arthroscopic MR imaging evaluation has proved to be cost-effective. MRI is an accurate imaging modality complementing the clinical evaluation and providing a global intra-articular and extra-articular assessment of the knee.

The outcome of 70/30 taco insertion through a 2.8 mm clear corneal incision in Descemet’s stripping automated endothelial keratoplasty - A retrospective analysis

Purpose: To assess the long?term outcome of graft insertion by taco technique through a 2.8?mm clear corneal incision in patients undergoing Descemet’s stripping automated endothelial keratoplasty (DSAEK). Methods: This is a retrospective interventional case series of 77 eyes of 75 patients who underwent DSAEK in a tertiary eye hospital. The DSAEK donor grafts were folded to an uneven 70/30 taco and held at a single point using Utrata forceps. All insertions were through a 2.8?mm clear corneal incision except the two aphakic patients requiring combined SFIOL implantation. All patients underwent a comprehensive eye examination preoperatively and were followed up to 6 years postoperatively. Visual outcomes, graft clarity, and complications of all and endothelial cell loss in 22 patients with available postop specular microscopy were analyzed. Results: Overall, 59 (76.6%) had clear grafts until the final follow?up. Visual acuity improved in 48 (62.3%) from an average of 1.3 to 0.8 logMAR (P = 0.0001). Vision was maintained in seven and worsened in four eyes. Grafts failed in 18 (23.3%) eyes: seven (9%) were primary failures, two post rejection, four done for failed PK did not clear, four due to worsening of preexisting glaucoma, and one noncompliant failed eventually. Average endothelial cell density reduction was 26.3% (mean preop donor 2419 to postop 1779 cells/mm2; P = 0.000). Conclusion: Our study shows good long?term clinical outcome of DSAEK using Taco technique through a 2.8?mm clear corneal incision in a tertiary hospital

Role of probiotics and synbiotics on inhibiting Streptococcus mutans level in saliva of children A randomized controlled trial

Background: Probiotics and synbiotics through its direct and indirect interactions interferes with biofilm formation, competes with oral microorganisms thereby creating better oral health. Aim: This study aims to assess the effectiveness of Probiotics and Synbiotics on inhibiting Streptococcus mutans level in saliva of children after 15 days of daily intake of probiotic and synbiotic curd. Methodology: A double-blind randomized controlled trial was planned. Salivary samples at baseline were collected from forty children in the age group of 6–12 years who were divided into two groups of 20 each to receive probiotic and synbiotic curd respectively for 15 days. Salivary samples were collected after intervention and S. mutans levels were estimated. Statistical Analysis: The collected data were analyzed using Statistical Package for Social Sciences (SPSS) version 22. Intra- and inter-group comparison of mean S. mutans levels for both the groups were done using the paired and unpaired t-test respectively. The statistical significance was set at P ? 0.05. Results: A statistically significant reduction in salivary S. mutans counts was observed in both the groups after 15 days (P < 0.001). A significantly higher inhibition of S. mutans growth was present in the probiotic compared to synbiotic group (P < 0.001). Conclusion: Probiotics and Synbiotics were effective in inhibiting salivary S. mutans level of children. However, inhibition of S. mutans growth was found to be better in children who consumed Probiotic curd than the Synbiotic curd.

Manuka Honey versus Antibiotic Ear Drops in Healing of Post-Operative Mastoid Cavity: A Prospective Randomized Trial / 대한이비인후과학회지

Background and Objectives@#This study investigates the role of manuka honey in the healing of postoperative mastoid cavity.Subjects and Method This was a single centre prospective study on 40 consecutive patients of chronic otitis media undergoing canal wall down mastoidectomy. Manuka honey soaked in gel foam was kept in the mastoid cavity for the study group and antibiotic soaked gel foam was kept for the control group. Culture swabs from mastoid granulations were sent at various times from both groups. The healing of the mastoid cavity was assessed in the follow up period. @*Results@#Preoperatively 15 out of 20 patients (75%) had a positive aural swab culture in the study group while 11 out of 20 (55%) in the control group had a positive aural swab culture. The most common organism isolated was Pseudomonas aeruginosa and Proteus mirabilis. One month after mastoidectomy only 4 patients (20%) had sterile culture and 16 patients (80%) had grown organisms; in the control group, 7 patients (35%) had sterile culture and 13 patients (65%) had growth on culture. The mean merchant scores for the study group and the control were 2.61 (2-5) and 2.05 (1-4), respectively. At 3 months 13 patients (65%) with sterile culture and 7 patients (35%) had growth on culture; in the control group, 16 patients (80%) had sterile culture and 4 had shown persistent growth on culture (p=0.28). All positive cultures were aerobic in both groups. The mean merchant scores for the study group and the control were 1.03 (0-4) and 0.7 (0-3), respectively (p=0.09). @*Conclusion@#Healing of mastoid cavity was almost similar in both groups (p>0.05). Manuka honey exhibited antibacterial activity against Pseudomonas, Proteus, Klebsiella, Escherichia coli, Staphylococcus.

Cell Block or Centrifuged Smear: A Comparative Study from a Tertiary Care Center

Cellblock technique (CB) is one of the oldest techniques of preparing materials for microscopic examination by paraffin embedding of sediments of fluids. CB enables retrieval of small tissue fragments from fluids, improving the cellular yield and diagnostic accuracy. The main advantage of CB is the potential to make many sections for special stains and ancillary techniques like IHC. Objective: To compare the efficacy of cellblock vs. centrifuged smear examination in effusions and fluids from cystic lesions. Methods: A total of 220 samples which included effusions (pleural, peritoneal, pericardial and synovial fluids), CSF, BAL fluids and fluids from cystic lesions were studied and categorized by both routine centrifuged smear and cellblock preparation by fixed sediment method. For CB categorization, volume of fluid and presence of pellet were given due importance. Results: Majority of the samples were pleural fluids (34.1%) followed by peritoneal fluids (29.1%) and fluids from cystic lesions (22.1%). Male to female ratio was 1.2:1 with peak age between 40- 70 years. On CS 86.8% were benign, 1.8% were suspicious for malignancy, 8.2% were positive for malignancy and 3.3% were inadequate for opinion. CBs were non-contributory in 65.9%, in 27.2%, CBs confirmed CS diagnosis and in 4.5% they established a specific diagnosis. (Sensitivity 63%, specificity 71.7%, PPV 80%, NPV 94.6%)(Kappa value = 0.175, p value=0.001). Volume of the fluid did not matter in malignant effusions and material on CB was seen in majority of these fluids with the presence of pellet formation.Among the non-neoplastic fluids material on CB was seen with volume >10ml with a good pellet formation. Conclusion: CBs were complementary to CS in the overall categorization of benign and malignant groups. However, they appeared to be more useful in diagnosis of malignancy by better-preserved architectural patterns and provided material for ancillary techniques like histochemistry and IHC.In CB, presence of pellet after centrifugation may be an indicator for the availability of material.

Diagnostic Accuracy of Xpert MTB Compared to Smear Microscopy in Pulmonary vs Extrapulmonary Tuberculosis

Introduction: Mycobacterium tuberculosis is the mostsignificant infectious disease causing death worldwide.Inability to rapidly diagnose and treat the affected patientsleads to increased morbidity and mortality, developmentof secondary resistance. There is sparse data which showthe accuracy of diagnosis of tuberculosis by Gene Xpert inpatients. There is limited data on the usefulness of XpertMTB in the diagnosis of extrapulmonary TB. Study aimedto evaluate the diagnostic accuracy of XpertMTB comparedto smear microscopy in pulmonary and extra pulmonarytuberculosis.Material and methods: Prospective observational studyconducted from May 2017 to July 2017. The study wasconducted in Department of medicine, Department ofpulmonology at R.L.Jalappa hospital and research centre,Kolar. 139 tubercular suspects who were not human immunedeficiency virus (HIV) positive were included in the study.Result: Out of 139 patients 72 were males and 67 were females.99 pulmonary samples and 40extrapulmonary samples wereobtained. 93 pulmonary samples and 24 extrapulmonarysamples were culture positive. Smear microscopy has lowersensitivity in diagnosing pulmonary TB (46.2%) as well asextrapulmonary TB(16.6%).Conclusion: The Xpert MTB is a rapid, sensitive and areliable diagnostic test for TB than smear microscopy in bothpulmonary as well as extra pulmonary TB. The diagnosisof extrapulmonary TB should not solely depend on theresults of Xpert MTB and should be subjected to culture ofMycobacterium.

Determination Of Piperine Content In Pepper By Using Different Organic Solvents: Through Hplc

Chromatography can be described as a mass transfer process involving adsorption using a nonpolar stationary phase and a mobile polar phase titrating through the column. The active component of the column, the sorbent or the stationary phase , is typically a granular material made of solid particles (e.g. silica, polymers, etc.,). The component of the sample mixture are separated from each other by means of mobile phase and different degrees of interaction with the sorbent particles based on their relative polarity. In the present study we have extracted piperine from grounded pepper using different chemicals such as petroleum ether, acetone and methanol. Petroleum ether extraction showed higher piperine content of 9.12% than methanol and acetone 3.15% and 3.37% respectively.

Spectrum of electrocardiographic and echocardiographic changes inacute stroke – Our experience

Background: Vascular diseases remains the chief cause of death and disability in industrialised countries. Clinical and experimental data suggest that some kind of neurologically mediated myocardial injury exists especially in subarachnoid hemorrhage but not as a manifestation of joint ischemic heart disease. Objectives: To study the spectrum of changes in ECG and echocardiographic patterns in the cases of cerebrovascular disease and to assess these different changes have got any prognostic significance. Materials and methods: 100 patients with acute stroke were considered, and ECG and the 2D echo of these patients were done within 24 hours of admission. In-hospital follow-up was done to know the prognosis of all the patients. Results: ST segment depression (53.1%) and U-waves (56.2%) followed by QTc prolongation (0.5±0.7 ms) were the most common abnormalities in haemorrhage group. Whereas in infarct type of stroke U-wave was the most common ECG finding (50.0%) among infarct group followed by QTc (0.45±0.08 ms) and T-wave inversion (29.4%). None of the ECG changes had much significance on mortality and was statistically insignificant (p>0.05) with either ischemic or hemorrhagic stroke. LV dysfunction, the most common abnormality was (29.4%) in infarct and haemorrhage (46.9%) stroke. LV dysfunction did not show significant impact on mortality in either of stroke subtypes (p>0.05). Conclusion: In our experience, both ECG and ECHO abnormalities in stroke patients do not have any prognostic significance predicting mortality in CVA

Evaluation of colorimetric nitrate reductase assay for rapid detection of methicillin resistance in clinical isolates of Staphylococcus aureus.

Background & objectives: Methicillin resistant Staphylococcus aureus (MRSA) remains a major cause of health care-associated infections. Rapid detection of MRSA facilitates the early initiation of appropriate treatment and infection control. Hence, the present study was undertaken to standardize and evaluate the performance of rapid colorimetric nitrate reductase assay (NRA) for determining methicillin resistance in S.aureus. Methods: A total of 160 clinical isolates of S. aureus, (80 each of methicillin susceptible and methicillin resistant) were included in the study. Minimum inhibitory concentration (MIC) was determined by NRA and reference broth micro dilution (BMD) methods. Results of NRA were compared with BMD and analyzed. Results: For MRSA, the MIC values ranged from 4 to ≥ 16 μg/ml and for MSSA, ≤ 0.5 to 2 μg/ml. Category and essential agreement for NRA as compared with BMD were found to be 99.4 and 89.7 per cent, respectively. No minor or major discrepancy was observed. A single resistant isolate showed very major discrepancy. Interpretation & conclusions: Colorimetric NRA being an inexpensive test requiring no special equipment can be employed as an alternative method for rapid detection of MRSA in resource limited settings.

Worrisome trends in rising minimum inhibitory concentration values of antibiotics against methicillin resistant Staphylococcus aureus - Insights from a tertiary care center, South India

ABSTRACT INTRODUCTION: Appearance of isolated reports of resistance to anti-methicillin-resistantStaphylococcus aureus (MRSA) drugs is worrisome underscoring the need to continuously monitor the susceptibility of clinical MRSA isolates to these drugs. Hence, the present study is conducted to determine the susceptibility of MRSA isolates to various classes of anti-MRSA drugs such as vancomycin (glycopeptide), daptomycin (lipopeptide), tigecycline (glycylcycline), and linezolid (oxazolidinone) to determine the MIC50 and MIC90 values, and to observe MIC creep over a three year period, if any, with respect to these drugs. METHODS: A total of 200 isolates of MRSA obtained from clinical specimens were included. MIC was determined by E-test for anti-MRSA antibiotics vancomycin, linezolid, daptomycin, and tigecycline. Non-parametric methods (Kruskal-Wallis and Chi-square test) were used to assess MIC trends over time. In addition, MIC50 and MIC90 values were also calculated. RESULTS: No isolate was found resistant to vancomycin, daptomycin, or linezolid; five isolates were resistant to tigecycline. Seven VISA isolates were encountered with the MIC value for vancomycin of 4 µg/mL. MIC values for vancomycin, tigecycline, linezolid showed a definite increase over a 3-year period which was statistically significant with p-values <0.0001, 0.0032, 0.0242, respectively. When the percentage of isolates with a median MIC value less than or equal to that of the index year was calculated, the change was most striking with vancomycin. The proportion of isolates with higher MIC values was greater in 2014 than 2012 and 2013. CONCLUSION: MIC creep was notably observed with vancomycin, and to some extent with tigecycline and linezolid. Selection pressure may result in creeping MICs, which may herald the emergence of resistant organisms.

Chronic anemia in adult patients with cardiovascular diseases, diagnosed clinically and by trans-thoracic-2-dimensional echocardiography: a semi-urban tertiary care teaching hospital study.

Anemia is one of the major health challenges to global development in this century and this Non-Communicable Disease is rapidly rising in both developed and developing countries. Chronic anemia is a risk factor for cardiovascular diseases and affect outcome in patients with heart failure, dilated cardiomyopathy and uncontrolled hypertension. Chronic anemia’s have significant morbidity and mortality in untreated patients. This study was performed to analyze the prevalence of anemia among cardiac patients and to determine the relationship between anemia and socio demographic characteristics. Methods: We enrolled 300 adults’ cardiac patients (≥19 years) during study period. The analysis includes socio demographic data, traditional risk factors for cardiovascular diseases, laboratory test (hemoglobin and creatinine clearance measurement), and non-invasive cardiac investigations. Results: Our analysis suggests prevalence of anemia is very high in CVSD patients & more common among females, older age, diabetics, impaired clearance creatinine, hypertensive and low education level. The highest proportion belonged to valvular heart disease (77.8%), congestive heart failure (74.6%) followed by hypertension (54%), and the lowest is coronary artery disease (46%). Logistic regression reveals that low education, low clearance creatinine level, smoking and diabetes are independently associated with anemia. Conclusion: We conclude that anemia is common among cardiovascular disease patients, and worsens the prognosis of their clinical condition. Intervention policies to minimize anemia risk factors are needed.