Relation of Serum Cholinesterase with Clinical Severity and Treatment Outcomes of Organophosphorus Poisoning in a Tertiary Care Center, a Prospective Observational Study

Introduction: Acute organophosphorus (OP) pesticidepoisoning is widespread and is the most common poisoningin many developing countries and vary in differentgeographic regions. Organophosphorus compounds are antiacetylcholinesterase’s which exert their toxicity by interferingwith the normal function of acetylcholine. So the present studywas done to assess the serum cholinesterase levels correlationwith clinical severity to determine the treatment outcome(Need for mechanical ventilation and mortality).Material and methods: A cross-sectional study wasconducted among 100 patients admitted with OPC poisoningin the department of general medicine, Velammal MedicalCollege Hospital and Research Institute, Madurai fromJanuary 2016 to July 2019. The diagnosis was made basedon history or evidence of exposure to OP compound within24 hours; Clinical severity was assessed and categorizedaccording to POP scale. Serum Cholinesterase values weredefined as per Proudfoot classification. IBM SPSS version 22was used for statistical analysis.Results: OP poisoning predominantly affected males in theage group 21 to 40 years. The majority had a moderate gradeof poisoning with Serum cholinesterase levels between 2001to 5000 (IU/l). In this study, the mortality was 25%, and 40%of patients had to be ventilated. There was no statisticallysignificant relationship between age, gender, clinical severity,time-lapse, Serum cholinesterase levels, mortality withmechanical ventilation. Mortality rate showed a statisticallysignificant relation with clinical severity (p<0.001).Conclusion: Clinical severity was associated with treatmentoutcomes. No particular trend of the association was observedbetween clinical severity and serum cholinesterase levels.Serum cholinesterase levels had shown no association withoutcomes

Subconjunctival bevacizumab and argon laser photocoagulation for preexisting neovascularization following deep lamellar anterior keratoplasty

We report a rare case of deep anterior lamellar keratoplasty (DALK) neovascularization managed with combination of subconjunctival bevacizumab and argon laser photocoagulation. A 24 year old male underwent Deep anterior lamellar keratoplasty for corneal stromal opacity following presumed viral keratitis. Deep corneal neovascularization was observed postoperatively which was successfully managed using a combination of subconjunctival bevacizumab and argon laser photocoagulation within one week of DALK. The neovascularization resolved by 3 months and at 2 years follow up, patient maintained good visual acuity of 6/12 Snellen's without recurrence of vascularization. A combination of bevacizumab and argon laser may be an effective approach to manage neovascularisation in the immediate postoperative phase (Post DALK) and improve graft survival.

Unusual ulcerative keratitis caused by Prototheca wickerhamii in a diabetic patient

The purpose of the study was to report a case of ulcerative keratitis caused by an unusual algae Prototheca wickerhamii in a diabetic patient. This study design was a case report. A 46-year-old male, who was a known diabetic for 3 years, had an injury to the left cornea with the sparks of fire from wielding at work that developed into an ulcerative keratitis over a period of next 3 months as the patient was not on any medication. Corneal scraping culture report and Vitek 2 system investigation result confirmed it to be a P. wickerhamii infection. The patient was started on intensive topical 1% voriconazole and 5% natamycin for 1 month and with no improvement subsequently underwent penetrating keratoplasty. No recurrence of infection postoperatively was noted. This opportunistic algae rarely known to cause human eye infections is so far reported in either patients with severe systemic immunosuppression causing posterior segment eye involvement or as postcorneal surgery infections. We report an ulcerative keratitis by P. wickerhamii in a diabetic patient post corneal trauma with no prior ocular surgery.

Six-month bracket failure rate with a flowable composite: A split-mouth randomized controlled trial

ABSTRACT INTRODUCTION: The use of flowable composites as an orthodontic bonding adhesive merits great attention because of their adequate bond strength, ease of clinical handling and reduced number of steps in bonding. OBJECTIVE: The aim of this Randomized Controlled Trial was to comparatively evaluate over a 6-month period the bond failure rate of a flowable composite (Heliosit Orthodontic, Ivoclar Vivadent AG, Schaan) and a conventional orthodontic bonding adhesive (Transbond XT, 3M Unitek). METHODS: 53 consecutive patients (23 males and 30 females) who fulfilled the inclusion and exclusion criteria were included in the study. A total of 891 brackets were analyzed, where 444 brackets were bonded using Heliosit Orthodontic and 447 brackets were bonded using Transbond XT. The survival rates of brackets were estimated with the Kaplan-Meier analysis. Bracket survival distributions for bonding adhesives, tooth location and dental arch were compared with the log-rank test. RESULTS: The failure rates of the Transbond XT and the Heliosit Orthodontic groups were 8.1% and 6% respectively. No significant differences in the survival rates were observed between them (p= 0.242). There was no statistically significant difference in the bond failure rates when the clinical performance of the maxillary versus the mandibular arches and the anterior versus the posterior segments were compared. CONCLUSIONS: Both systems had clinically acceptable bond failure rates and are adequate for orthodontic bonding needs.

RESUMO INTRODUÇÃO: o uso de resinas compostas fluidas como agentes de cimentação em Ortodontia tem merecido grande atenção, em função de sua adequada capacidade adesiva, facilidade de uso clínico e número reduzido de etapas de colagem. OBJETIVO: o objetivo deste estudo randomizado controlado foi avaliar o índice de falhas nos 6 meses após a colagem com uma resina composta fluida (Heliosit Orthodontic, Ivoclar Vivadent AG, Schaan), em comparação com um adesivo ortodôntico convencional (Transbond XT, 3M Unitek). MÉTODOS: 53 pacientes consecutivos (23 homens e 30 mulheres) que se enquadravam nos critérios de inclusão adotados foram incluídos no presente estudo. No total, 891 braquetes foram analisados, sendo 444 colados com o Heliosit Orthodontic e 447 colados com o Transbond XT. As taxas de sobrevivência dos braquetes foram estimadas por meio da análise de Kaplan-Meier. As distribuições das taxas de sobrevivência dos braquetes em função do adesivo usado, do dente e da arcada dentária em questão foram comparadas por meio do teste de log-rank. RESULTADOS: os índices de falhas para os grupos Transbond XT e Heliosit Orthodontic foram, respectivamente, de 8,1% e 6%. Não foram observadas diferenças significativas entre os grupos quanto às taxas de sobrevivência dos braquetes (p= 0,242). Também não foram observadas diferenças estatisticamente significativas quanto aos índices de falhas quando se comparou a performance clínica nas arcadas dentárias superior e inferior, e nos segmentos anterior e posterior da boca. CONCLUSÕES: ambos os sistemas apresentaram índices de falhas clinicamente aceitáveis, podendo ser considerados adequados para a colagem ortodôntica.

Knowledge, experience & attitudes concerning electroconvulsive therapy among patients & their relatives.

Background & objectives: Electroconvulsive therapy (ECT) is used frequently in developing countries, but investigations of patients’ awareness and perception of ECT are rare. The present study thus attempted a comprehensive examination of knowledge, experience and attitudes concerning ECT among patients treated with brief-pulse, bilateral, modified ECT, and their relatives. Methods: Of the 153 recipients of ECT, 77 patients and relatives were eventually assessed using questionnaires designed to evaluate their awareness and views about ECT. Results: Patients were middle-aged, poorly-educated, often unemployed, with chronic, severe, and predominantly psychotic illnesses. Relatives were mainly parents, older, better-educated and usually employed. Apart from the very rudimentary aspects, patients were largely unaware of the procedure. Though most did not find the experience of ECT upsetting, sizeable proportions expressed dissatisfaction with aspects such as informed consent, fear of treatment and memory impairment. Although patients were mostly positive about ECT, ambivalent attitudes were also common, but clearly negative views were rare. Relatives were significantly likely to be more aware, more satisfied with the experience and have more favourable attitudes towards ECT, than patients. Interpretation & conclusions: The results endorse the notion that recipients of ECT are generally well-disposed towards the treatment, but also indicate areas where practice of ECT needs to be improved to enhance satisfaction among patients and relatives.

Two cases of subungual glomus tumor.

Glomus tumors are uncommon, small, painful, and usually benign hamartomas arising from the arterial end of the glomus body. They often present early in the subungual stage because of intense pain. Two female patients with subungual glomus tumor are reported here. The intense pain associated with this tumor had led to disuse atrophy of the upper limb in one case. Hildreth's sign and Love's test were positive in both, but imaging did not help in preoperative diagnosis. Tumors were resected by transungual approach, leaving a 3-mm-wide margin. There was no recurrence after 1-year follow-up in both instances.

Scrub typhus: a case report.

Fever with rash is a common cause for dermatological referral. The causes can range from viral to protozoal, bacterial or spirochaetal. A case of rickettsial fever is reported.

Management of pemphigus vulgaris during acute phase.

We present our experience with 21 patients of pemphigus vulgaris seen over a period of 10 years managed in service hospitals during acute phase of the disease. Age groups of patients ranged from 25-45 years. Eighteen (85.7%) were young adults, 30-40 years of age. Fifteen (71.4%) were men and 6 (28.6%) were women. All the cases were hospitalized in ICU, till the acute phase of the disease subsided. Complete hematological profile, urinalysis, serum biochemistry and repeated bacterial cultures from the skin were carried out in all patients at the time of admission and thereafter weekly. The treatment comprised of potassium permanganate lotion bath (1:10,000) and 1 framycetin gauze dressing of the denuded areas, maintenance of fluid and electrolyte balance. All suspected infections and septicemia were treated with appropriate antibiotics. The corticosteroids were usually administered as a single dose of prednisolone 1 mg/kg/day. Cyclophosphamide was given at an initial dose of 50 mg/day and the dose was escalated to 100 mg/day. Once the bulk of the lesions were healed, the dose of corticosteroids was gradually lowered by approximately 50% every two weeks and cyclophosphamide was continued till patients were symptom-free. Out of 21 patients receiving corticosteroids, cyclophosphamide and other supportive therapy, 20 (95%) had undergone clinical resolution of the disease. During follow up study 15 (71.4%) patients remained symptom-free and undergone clinical remission. Five patients (23.8%) had relapse, out of which 4 (19%) remained symptom free, after subsequent treatment. There was one death (4.7%) in our study.

Alpha-1 antitrypsin deficiency panniculitis.

A lady presented with multiple, tender discharging noduloulcerative lesions on the abdomen, following laparoscopic cholecystectomy. Histopathological features were suggestive of panniculitis. Screening of the serum for alpha-1 antitrypsin levels revealed a partial deficiency.

Benign rheumatoid nodules.

Rheumatoid nodules occur usually in advanced seropositive rheumatoid arthritis, signifying poor prognosis. However rarely rheumatoid nodules can be encountered in patients with no antecedent evidence of arthritis. Herein a case of an arthritic benign rheumatoid nodules is described.

Partial flap during laser in-situ keratomileusis: pathogenesis and timing of retreatment.

PURPOSE: To report the timing of retreatment and clinical outcomes in patients with a partial corneal flap during laser in-situ keratomileusis (LASIK), and to describe the causes of this complication. METHODS: Retrospective review of case records of four patients (4 eyes) who had a partial corneal flap during LASIK. RESULTS: The mean age of the four patients was 23 +/- 4.7 years, and mean preoperative spherical equivalent (SE) refraction was -9.1 +/- 3.1 D (range, -5.5 to -13 D). A 160 microns corneal flap was attempted during the initial treatment. Retreatment with a 180 microns corneal flap was performed at a mean of 5.1 +/- 1.6 weeks (range, 4 to 7.5 weeks) after the initial procedure. There were no intraoperative complications during retreatment. Post-LASIK mean SE refraction was -1.0 +/- 1.1 D (range, +0.38 to -2.0 D), after a mean follow up of 19 +/- 15.7 weeks (range, 7 to 42 weeks). Best spectacle-corrected visual acuity decreased in one eye from 6/5 to 6/6 and was maintained in the others. CONCLUSION: LASIK retreatment can be performed as early as one month after a partial flap, if the refraction is stable and a thicker corneal flap is created.

Malaria transmission in Nagaland, India. Part-I--Anophelines and their seasonality.

A longitudinal study on malaria transmission was conducted from January 1983 to December 1988 in two villages of Dimapur PHC in Nagaland. A diverse anopheline fauna comprising of 23 species was identified including three species viz. An. aitkeni, An. bengalensis and An. insulaeflorum which were observed in larval stages only. An. vagus was the predominant species followed by An. philippinensis, An. culicifacies and An. minimus. An. minimus though maintained relatively high density throughout the year manifested two peaks in June and October. An. fluviatilis and An. dirus though found in relatively low density their seasonal prevalence was suggestive of a post-monsoon and monsoon species respectively.

Present perspectives of malaria transmission in Boko area of Assam.

A longitudinal study on malaria transmission was conducted from January 1984 to December 1988 in three villages in Boko PHC of Assam, where indoor residual DDT spray was withdrawn during the period of study. Anopheline fauna comprising of 19 species was identified and their seasonal density estimated. Anopheles philippinensis was the predominant species followed by An. minimus. The principal role of An. minimus in the transmission of malaria and predilection for indoor resting in this area was clearly evident. Though An. dirus and An. fluviatilis were found in low density, sporozoite infection was detected in them along with An. minimus. The high malaria incidence predominantly with Plasmodium falciparum was closely related to sporozoite infection in the vectors and their densities. The biting cycle of An. minimus was maximum in the first half of the night.