A unique coexistence of a plurihormonal pituitary adenoma with granulomatous hypophysitis

Dual pathology in the pituitary gland is a unique phenomenon. Coexistence of a pituitary adenoma with primary hypophysitis has been reported rarely with very few cases in the literature. Among the primary hypophysitis, primary granulomatous subtype has been proposed to be idiopathic and autoimmune in nature. Plurihormonal pituitary adenomas produce hormones of more than one different pituitary cell lineage. Pituitary adenoma with a single hormonal content has been documented with concurrent primary granulomatous hypophysitis. The present case describes the unique coexistence of a plurihormonal adenoma showing somatotroph, lactotroph, and corticotroph lineage with primary granulomatous inflammation in the sellar region in a 36-year-old woman.

Pain and Physiological Stress During Minimally Invasive Surfactant Therapy (MIST) in Very Preterm Infants

Objectives: To evaluate the pain or physiological stress caused during minimally invasive surfactant therapy (MIST) to very preterm neonates. Methods: In this prospective observational study conducted in a tertiary NICU, very preterm neonates were assessed for pain using Premature Infant Pain Profile-Revised (PIPP-R) score before, during and after MIST. Changes in the heart rate and oxygen saturation were also recorded during the procedure. Results: 23 neonates who received MIST were assessed for pain using PIPP-R. Mean (SD) PIPP-R score during MIST was 3.87(1.3), before; 12.83 (1.9), during; and 6.26 (1.0), after the procedure, respectively (all P<0.001). Heart rate and oxygen saturation were also significantly reduced during MIST (P<0.001). Conclusion: The high PIPP-R scores during surfactant administration suggest that MIST can cause moderate to severe pain/discomfort and significant physiological stress in very preterm infants.

Extra-adrenal peripheral neuroblastic tumors: A clinicopathological study of 18 cases

Background: Peripheral neuroblastic tumors arise from the sympathoadrenal lineage of the neural crest. They have been classified according to the International Neuroblastoma Pathology Committee (INPC) into Four categories according to International Neuroblastoma Pathology Committee (INPC): a) Neuroblastoma (NB) b) Ganglioneuroblastoma (GNB), nodular c) Ganglioneuroblastoma, intermixed, and d) Ganglioneuroma (GN). Because of the rarity of extra-adrenal peripheral neuroblastic tumors, limited information is available regarding the chemotherapy of NB and GNB. A few case reports or case series with a small number of patients have been documented in the literature. Aim: To describe the clinicopathological characteristics of extra-adrenal peripheral neuroblastic tumors. Materials and Methods: Clinical, histopathological, and immunohistochemistry (IHC) findings of 18 cases were retrieved. Immunohistochemistry at the time of diagnosis was performed using Ventana Benchmark XT. The mean value was calculated using the Microsoft Office Excel 2019 software. Results: The posterior mediastinum was the most commonly affected extra-adrenal site in our study. Neuroblastoma consisted of eight cases (six in children, two in adults), of which four cases were poorly differentiated and the other four cases were differentiating. Two cases had favorable histology. The bone marrow and cervical lymph node metastasis were documented. Of the four GNB cases, one patient developed bone metastasis. All patients of NB and GNB received combination chemotherapy. One out of six GN patients presented with a large retroperitoneal mass encasing the aorta and renal vessels, mimicking a sarcoma. Conclusion: Extra-adrenal peripheral neuroblastic tumors do not pose any diagnostic issue in adequate tissue sampling. In limited material, immunohistochemistry is needed. The chemotherapy regimen has not been standardized due to rarity. Further molecular testing and targeted therapy may be of help in the future.

Implementation of National Leprosy Eradication Programme during COVID-19 era: A qualitative research

Introduction: The COVID-19 pandemic imposed new challenge to the implementation of the National Leprosy Eradication Programme. According to national data, after lockdown due to COVID-19, there was a 29% reduction in total leprosy cases reported in the first quarter (April-June) of 2020 in comparison to 2019. Objectives: To explore the difficulties faced by different stakeholders of the National Leprosy Eradication Programme like policy makers, doctors, grass root level health workers as well as leprosy patients during COVID-19 pandemic with respect to programme implementation and access to leprosy care. Materials and Methods: Qualitative research was undertaken including two focus-group-discussions held among six leprosy patients diagnosed after lockdown and nine ASHA workers as well as six in-depth interviews of doctors, leprologists, and programme managers. Ethics committee approval was sought and informed consent was obtained from all participants. All focus-group-discussions were electronically recorded and the in-depth interviews telephonically recorded, transcribed and translated from Bengali-to-English. Transcripts were separately coded by researchers and thematically analysed with the help of Visual-Anthropac software version 1.0. Results: Solitary focus on COVID-19 control, capacity building and information, education and communication, leprosy case search & surveillance, co-infection among health workers, transportation issues were the themes explored from focus-group-discussions of health workers and ASHA workers. Similarly, the present study identified six themes from in-depth interviews of programme manager, leprologists, programme manager as diagnostic difficulty, operational issues, rehabilitation issues, capacity building & information education and communication activities and way forward. Limitations: The research reveals the perceptions of rural population of Eastern India with high leprosy prevalence, which might not be applicable for urban areas or low prevalent districts Conclusion: The solitary focus of the administration towards COVID and shifting the infrastructure and human resource only towards the management of COVID can lead to resurgence of the leprosy. Having an organised framework of operations, catering to the need of the front-line workers in rendering services, utilizing the digital platform and social media, and focusing on rehabilitation would be needed to overcome the crisis

Estimate the Serum Trace Minerals of Female Black Bengal Goats at Different Stages

Serum hormone level was estimated to find out FSH, LH and total estrogen for all the animals under three treatment groups from 20 to 55 week. The FSH level (from 0.56 to 1.32 ng/ml; 0.91 to 1.91 ng/ml and 0.46 to 1.36 ng/ml for first, second and third treatment group, respectively) was higher in the second group; and third group had lowest level out of the three groups. The serum LH level (0.46 to 1.40 ng/ml and 0.27 to 1.91 ng/dl in first and second treatment group, respectively) showed similar pattern like FSH. The total estrogen was higher in the first treatment group (1.08 to 4.2 pg/ml) than that of the second group (0.14 to 2.30pg/ml) and third group ((0.04 to 2.37 pg/ml)). The serum biochemical profiles of the animals under three groups were estimated by serum glucose, total protein in blood and serum cholesterol levels. The glucose level varied from 65.66 to 77.11, 50.03 to 63.78 and 55.22 to 68.66 mg/dl for the first, second and third group, respectively, with higher value at the time of service. The total protein level did not vary much among the animals under three treatment groups (64.45 to 78.55 g/l). The serum cholesterol level varied between 50.17 to 110.05 mg/dl among all the animals irrespective of groups. During prepubertal period this value was low, but it was higher during pubertal period, time of several other services and towards pregnancy for all groups of animals. Regarding the serum trace mineral status, serum copper level showed higher value from 7 months onwards; serum zinc and iron level were almost similar in first and second group; and the third group showed lower value for all the trace minerals. All the good effects noticed in the first treatment group were due to the non-hormonal factors applied to them through nutrition and buck. The effects in the second group of animals was due to the nutritional effect, whereas, the third group showed poor performance without any support from nutrition and social interaction through buck.

Stabilization of refraction and timing of spectacle prescription following manual small-incision cataract surgery

Purpose: To determine the stabilization of refraction at 2 weeks following MSICS by comparing the difference in spherical, cylindrical component and also spherical equivalent of refraction of 2 weeks follow-up with that of 6 weeks following surgery. Methods: The difference of spherical, cylindrical component and also spherical equivalent of refraction at 2 weeks and 6 weeks follow-up of 194 eyes that underwent uncomplicated MSICS with implantation of PMMA IOL conducted by a single experienced surgeon were compared to find out the amount of change and its significance was statistically tested by Wilcoxon-Signed Rank Test. Results: The difference in spherical power (0.04 � 0.30), cylinder power (0.03 � 0.40), and spherical equivalent (0.06 � 0.34) were very small and not significant statistically (P-value ?0.05). Conclusion: Necessary spectacle correction can safely be prescribed after 2 weeks following MSICS as subjective refraction stabilizes by that time without undergoing significant change. However, our observation was applicable in patients who had an uneventful cataract surgery without any risk factor, which can delay wound healing or cause poor visual outcome.

EXPLORING ACTUAL CAUSES OF SUICIDE: LIVED EXPERIENCE OF SUICIDE SURVIVORS IN KOLKATA, INDIA

Background: An increasing rate of suicide by different age groups of people is a grievous social problem in the world. India is not an exception. This study aims to identify the actual causes of suicide by analysing the lived experiences of suicide survivors and explore the preventive strategy. A phenomenological approach wa Methodology: s used. As study participants, nine suicide survivors selected through snowball sampling were face to face interviewed. The Results: lived experience of suicide survivors is summarized into four themes: the first theme is feelings during suicide attempts, the second theme is the perception of triggers, the third theme is behavioural changes and the fourth theme is expectations. At the time of attempting suicide or before it if people get support from society, and feel desired and loved they won't attempt suicide. Strong informal social connectedness to preve Conclusion: nt suicide is not only relevant but essential to prevention efforts.

Antimicrobial Sensitivity Pattern of Bacterial Isolates Associated with Urinary Tract Infection in a Tertiary Care Hospita

Introduction : Urinary Tract Infection (UTI) is a common infection and a major health problem. Considering the bacterial resistance developed globally, knowledge regarding sensitivity and resistance pattern of isolated uropathogens in a defined area becomes critically important for choosing appropriate antimicrobial agents for treatment. Objectives : We conducted this study to detect the common UTI causing microorganisms and to evaluate their culture sensitivity pattern in a Tertiary Care Hospital. Methods : This retrospective record based observational study was conducted over a period of two months (January and February, 2021). Patients in the General Ward in the Department of General Medicine, Medical College, Kolkata whose urine samples were collected within 48 hours of admission were included. Identification of bacteria was done by standard microbiologic methods and using Kirby disc diffusion test their antimicrobial susceptibility test was performed. The causative organisms for UTI along with its antibiotic sensitivity pattern were retrospectively reviewed and analysed. Results : Among 150 culture positive samples 34.67% were from male and 65.33% were from female with highest prevalence in the age group of 21-30 years (22.67%). Most prevalent uropathogens isolated was Escherichia coli (E coli) (60.66%) followed by Enterobactor (21.33%) and Klebsiella (9.33%). E coli showed most sensitivity against ceftazidime, clarithromycin, piperacillin-tazobactam and clindamycin (100% in all cases). Resistance (>70%) of E coli was found against levofloxacin and cefotaxime. Conclusion : The present study reveals microbiological profile regarding UTI in patients attending our hospital. As resistant to first line antibiotic is increasing, antibiotic stewardship programme should be strengthened. Antibiotic policies agreed among Clinicians, Microbiologists and Pharmacologists will guide good prescribing, provide maximum coverage for treating infections and ensure antibiotic cycling.

Duration of screen time and its effect on reaction time in 1st year MBBS students in a medical college of Southern Odisha

Background: Smartphones, PC, tablets, and TV have become integral parts of our lives. The smartphone in particular is the lifeline of everyone, regardless of their age group. Overuse of smartphones is increasing, resulting in a great deal of physical and psychological effects. It is found to negatively impact health and increase the risk of stress, depression, and anxiety. In addition to this, sleep disorders, restlessness, and fatigue are also being reported which can lead to cognitive impairment. The reaction time (RT) is the interval between the application of a stimulus and the response. It is an indication of neural processing between a stimulus and the response which is expressed in milliseconds. Aims and Objectives: The primary objective of this study was to estimate screen time, auditory and visual RTs, and the association between screen time and RT (visual reaction time [VRT] and auditory reaction time [ART]). Materials and Methods: The present cross-sectional study was conducted on 232 1st year MBBS students in the age group of 18–23 years. Average screen time was noted from their respective gadgets. RT for the targeted stimulus, yellow light for the VRT and beep sound for the ART, was determined using the Biochart application system by Biostar Health care (Computer software) on the laptop. The task was to press the space bar as soon as the stimulus was presented. Average RT for both the stimuli (ART and VRT) were calculated using ten readings for each. Data obtained were analyzed. Results: Our study shows that ART is faster than VRT for both males and females. Screen time with VRT has a moderate positive significant relationship (P < 0.001), while for the ART, it has a weak positive relation. Conclusion: Based on our findings, it can be concluded that there is a positive correlation between screen time and RT. Screen time alone has a 21% effect on the RT as per our study. It also suggests that ART is faster than VRT. The females have a higher RT than the males in a similar age group.

Isolation and characterization of native Rhizobium from root nodules of raikia french bean growing area of Odisha-Supplementary Data

Injudicious application of nitrogenous fertilizers leads to soil quality deterioration which results into yield loss. The application of biofertilizer containing native efficient rhizobia enhances the nodular properties, N-fixation and soil quality. Therefore, fifty strains of Rhizobium were isolated from root nodule of Raikia french bean and among them only two isolates viz., RBHR-15 and RBHR-21 were confirmed as Rhizobium. The isolates were unable to grow under anaerobic conditions and failed to produce ketolactase enzyme, showed a negative response for gelatin liquefaction and Simmon’s citrate agar test, responded positively towards the indole test, MR-VP, TSI test and could produce NH4+ from peptone in the growth medium. The isolate RBHR-15, could reduce H2S and nitrate whereas, RBHR-21 could not. The growth of both isolates was luxuriant in the nutrient broth containing 1% NaCl and decreased with an increase in the concentration of NaCl and grew profusely in the pH range of 6-8. The generation time of RBHR-15 and RBHR-21 were 16.4and 10.6 h, respectively. The 16s rRNA of both isolates was sequenced and submitted to the National Center for Biotechnology Information (NCBI). The isolates RBHR-15, and RBHR-21 were assigned accession numbers MN480514 and MN480516.

Isolation and characterization of native Rhizobium from root nodules of raikia french bean growing area of Odisha

Injudicious application of nitrogenous fertilizers leads to soil quality deterioration which results into yield loss. The application of biofertilizer containing native efficient rhizobia enhances the nodular properties, N-fixation and soil quality. Therefore, fifty strains of Rhizobium were isolated from root nodule of Raikia french bean and among them only two isolates viz., RBHR-15 and RBHR-21 were confirmed as Rhizobium. The isolates were unable to grow under anaerobic conditions and failed to produce ketolactase enzyme, showed a negative response for gelatin liquefaction and Simmon’s citrate agar test, responded positively towards the indole test, MR-VP, TSI test and could produce NH4+ from peptone in the growth medium. The isolate RBHR-15, could reduce H2S and nitrate whereas, RBHR-21 could not. The growth of both isolates was luxuriant in the nutrient broth containing 1% NaCl and decreased with an increase in the concentration of NaCl and grew profusely in the pH range of 6-8. The generation time of RBHR-15 and RBHR-21 were 16.4and 10.6 h, respectively. The 16s rRNA of both isolates was sequenced and submitted to the National Center for Biotechnology Information (NCBI). The isolates RBHR-15, and RBHR-21 were assigned accession numbers MN480514 and MN480516.

Effectiveness and safety of 0.5% timolol solution in the treatment of pyogenic granuloma: A randomized, double-blind and placebo-controlled study

Introduction: Pyogenic granulomas are benign vascular lesions of the skin and mucosa which are often a source of concern because of their recurrent bleeding even with minimal trauma. Current treatment for pyogenic granuloma is ablative; no medical therapy is standardized to date. Timolol, due to its vasoconstrictive effect, vascular growth factor inhibition and apoptosis promotion properties, is a potential therapeutic option. Objectives: To assess the effectiveness and safety of topical timolol in the treatment of pyogenic granulomas. Methods: A two-centre, double-blind and placebo-controlled trial (Registration CTRI/2019/04/018581) was conducted. Patients of either sex were recruited with pyogenic granuloma lesions of less than eight weeks duration. Topical treatment with 0.5% timolol or matching glycerin placebo was continued for six weeks. Changes in color, size, bleeding tendency, physicians’ and patients’ global assessments and adverse events were assessed. Results: Forty subjects were randomized between the two groups which were comparable in age, sex, duration of illness and baseline lesion size.Significant improvement was noted with timolol, with color change from first follow-up onwards and lesion size reduction from second follow-up onward. Patients’ assessment of bleeding tendency also showed imrovement from the second visit onward. Between-group comparison showed significant difference with respect to percentage reduction in size (timolol 40.9%, placebo 3.4%; P = 0.002). Rescue treatment (electrosurgery) was required in five patients on placebo and in one in the timolol group (P = 0.182). Complete resolution occurred in 2 (10%) patients with timolol and in no patients on placebo (P = 0.231). Limitations: We observed effects of treatment for only six weeks. Conclusion: Topical timolol may be a treatment option for early pyogenic granulomas but complete resolution is unlikely in six weeks. Studies of longer duration are required to assess resolution and recurrence rates

A clinical study of management of wounds using vacuum assisted dressings

Background: The application of controlled levels of negative pressure has been shown to accelerate debridement and promote healing in many different types of wounds. Vacuum assisted closure (VAC) has proved its efficacy for wound dressing leading to faster wound healing and shorter hospital stay. The aim of the study was to determinethe advantage of vacuum assisted closure over conventional dressing in SCBMCH hospital.Methods:The study was conducted at general surgery wards of SCB Medical College hospital. After debridement of the wound vacuum assisted dressing was applied. Control group was given conventional dressing.Results:In the study sample 10% patients were less than 40 years,76% belonged to 41-60 age group and 7% were more than 61 years of age, 60% male and 40% female. Wounds were located in the foot 27 (54%), leg 19 (38%), sole 2 (4%) and forearm 2 (4%). Patients with sterile pre (VAC), culture and sensitivity was not turning non sterile after VAC, but 90% non-sterile turns sterile after vacuum assisted dressing. In 5 days 25% of granulation tissue formed in VAC dressing whereas only 10% in case control. Similarly, in 10 days it was 40% for VAC and 25% in case of control. Finally, in 15 days it was 70% in case of VAC and 40% in case of control.Conclusions:VAC results in better healing, with few serious complications, and a promising alternative for the management of various wounds.

A study to assess anxiety, stress and depression among private medical practitioners during COVID-19 pandemic: An observational study

Objectives: This study aims to assess the magnitude of anxiety, stress, and depression among private practitioners during the COVID pandemic 2020. Materials and Methods: A descriptive, observational and cross-sectional study was done using a semi-structured questionnaire through electronic media in the form of Google Forms. Patient health questionnaire 4 (PHQ4) and Perceived Stress Scale-10 were incorporated into the questionnaire to assess the psychological status in November 2020. Results: A total of 157 private practitioners participated in the study. Males constituted 60%. Participants have mean age (SD) of 44.2 (6.9) years with work experience and a mean (SD) of 16.3 (6.78) years. The anxiety and depression subscales of the PHQ-4 scale showed that 54.7% of the private practitioners have anxiety subscale ?3 and 28% have depression subscale >3 needing further psychiatric evaluation. Significant predictors of anxiety and depression were female gender, younger and less experienced, and those providing inpatient services in COVID care isolation facilities. Conclusion: There is a high prevalence of anxiety, stress, and depression among private practitioners comparable with other countries.

Soft tissue aneurysmal bone cyst of left hemithorax: An extremely rare case

Aneurysmal bone cyst (ABC) is a benign expansile cystic lesion that can affect any bone of the skeleton, especially the femur, tibia, and humerus. Lesions with histologic features of an ABC can be originated within soft tissue in exceedingly rare cases. Extra-skeletal ABC may mimic a variety of benign and malignant lesions and can be confused with other common or rare giant cell-rich tumors of soft tissue. Clinical, radiological and histologic correlation are crucial in reaching the correct diagnosis. Here we report a case of an extra-skeletal ABC arising in left hemithorax in a 13-year-old girl and discuss the common differential diagnosis of this rare entity.

Knowledge, Attitude and Practices Regarding Leprosy and its Management among Leprosy Patients, Their Relatives and the Medical Interns: An Institution Based Cross-Sectional Study

The study aims at evaluating the knowledge, attitude and practices regarding leprosy and its management among patients, their caregivers (relatives), and future healthcare providers (medical interns). Question- naire-based study was approved by Institutional Ethics Committee and participants were recruited after obtaining informed consent. Validated Questionnaire (face-validity and content-validity, content-validity- ratio cut-off 0.75) was used after pilot-testing for reliability (Chronbach's alpha>0.8 accepted). Vernacular- version of the questionnaire was developed by translation and back-translation. The questionnaire administered to clinically-diagnosed cases of leprosy, their caregivers (relatives), and future healthcare providers (medical interns) of BS Medical College Bakura, (a tertiary care rural medical college hospital). The calculated sample size was 88 for patients and their caregivers, considering 95% confidence interval, 10% allowable error and 35.67% response rate. The figures regarding knowledge about leprosy, and its treatment ranged between 71.6% to 26.1% among patients and between 85.2% to 37.5% among their caregivers for different knowledge domains. Lack of proper knowledge was also found in upto 52% of medical interns. Myths prevailed in upto 12.5% of patients, 23.9% caregivers, 6.7% of medical interns. There was attitudinal crisis and stigma in upto 45.5% of patients, 56.8% of caregivers, and 33.3% of medical interns. The stigma resulted in 33.4% of patients losing their job, 25% separated in their own home and 16.7% divorced. Awareness about leprosy is still lacking among patients and their caregivers despite repeated public health campaigns by NLEP. The absence of knowledge regarding leprosy among a few medical interns and even the presence of myths in their minds is an ominous sign. More effective awareness programmes and counseling involving the general population are necessary to eliminate stigma from the society

Omicron and vaccine booster dose – an update

Mutations in coronavirus is not unheard off. The variant, Omicron B.1.1.529 has overall 50 mutations and is considered as a variant of concern. Though the new variant has shown changes throughout its genome, S gene changes predominate. Significant changes in the S encoding gene, S gene, influences not only the transmissibility properties of SARS-CoV-2 but also the efficacy of existing vaccines. Increased transmissibility and ability of this variant to evade host immune responses conferred either due to past infections or due to vaccination driving increase in number of infections. However, the severity of the infections is low in comparison to its predecessors. A meta-analysis of ten studies analyzing the effect of COVID-19 vaccine booster dose, it was found studies report 10-to-42-fold increase in omicron neutralization. COVID appropriate behaviors, if followed rigidly can bring a meaningful change in the viral spread and resultant health impacts.

Early Accelerated versus Delayed Conservative Rehabilitation Protocol after Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial / Protocolo de reabilitação acelerada precoce versus conservadora retardada após reconstrução do ligamento cruzado anterior: Um ensaio prospectivo randomizado

Abstract Objective To compare the effectiveness of the early accelerated rehabilitation and delayed conservative rehabilitation protocols after arthroscopic anterior cruciate ligament reconstruction, in terms of the International Knee Documentation Committee (IKDC) score, pain (according to the Visual Analog Scale), laxity, and stiffness one year postoperatively to determine the best outcome. Materials and Methods A total of 80 subjects were divided into 2e groups (early accelerated group and delayed conservative group), which were analyzed by the Pearson Chi-squared and Wilcoxon rank-sum tests. Results One year postoperatively, knee laxity was significantly higher (p = 0.039) in the early accelerated group compared with the delayed conservative group. Regarding postoperative pain (according to the Visual Analogue Scale) and IKDC scores, both groups presented similar results. The postoperative range of motion was better in the early accelerated group, but this was not statistically significant (p = 0.36). Conclusion One year postoperatively, the early accelerated rehabilitation protocol was associated with significant knee laxity compared to the delayed conservative rehabilitation protocol.

Resumo Objetivo Comparar a eficácia dos protocolos de reabilitação acelerada precoce e de reabilitação conservadora retardada após reconstrução artroscópica do ligamento cruzado anterior, em termos da escala do International Knee Documentation Committee (IKDC), da dor (segundo a Escala Visual Analógica), da frouxidão e da rigidez no pós-operatório de um ano para determinar o melhor desfecho. Materiais e Métodos Um total de 80 participantes foram divididos em dois grupos (grupo da acelerada precoce e grupo da conservadora retardada), que foram analisados pelos testes do Qui-quadrado de Pearson e da soma dos postos de Wilcoxon. Resultados A frouxidão do joelho no pós-operatório de 1 ano foi significativamente mais alta (p = 0,039) no grupo da acelerada precoce do que no grupo da conservadora retardada. Em termos de dor pós-operatória (pela Escala Visual Analógica) e pontuações no IKDC, ambos os grupos apresentaram resultados similares. A amplitude de movimento pós-operatória foi melhor no grupo da acelerada precoce, mas isso não foi estatisticamente significativo (p = 0,36). Conclusão O protocolo de reabilitação acelerada precoce foi associado com uma frouxidão significativa do joelho em um ano de pós-operatório em comparação com o protocolo de reabilitação conservadora retardada.

Transconjunctival botulinum toxin injection into the lacrimal gland in crocodile tears syndrome

Purpose: To determine the efficacy and safety of botulinum toxin injection into the lacrimal gland as a symptomatic treatment of crocodile tear syndrome (CTS). Methods: Our study included six patients of unilateral gustatory hyper lacrimation following either an episode of facial paralysis or post trauma or any related surgery that posed a risk of damaging the facial nerve. Detailed history regarding previous trauma, duration of facial paralysis, previous significant surgery, and duration of steroid use following facial paralysis was noted. Schirmer抯 test was done at baseline and 3 months follow?up. Patients� consent was taken prior to treatment with botulinum toxin injection in the lacrimal gland. Repeat injection of 5 U botulinum toxin (type A) was administered into the lacrimal gland of all patients transconjunctivally within an interval of 1 week. All patients were followed up with Schirmer抯 test at 6 weeks and 3 months. Any complications during treatment were recorded. Results: All six patients showed complete or partial disappearance of reflex lacrimation while chewing following botulinum injection measured by a significant reduction in Schirmer抯 value. When comparing Schirmer test values before (27.8 � 3.58 mm) and after (11.6 � 2.28 mm) BTX?A injection, the differences observed (P = 0.002) were statistically significant (P < 0.05). Only two patients developed mild transitory ptosis. No other complications were noted. Conclusion: Transconjunctival botulinum toxin injection into the lacrimal gland is an effective and safe method to decrease reflex lacrimation during eating or chewing in CTS or gustatory hyper?lacrimation syndrome.