Implication of photic sneeze reflex in ophthalmology

Background: Photic sneeze reflex (PSR) also known as autosomal dominant compelling helioophthalmic outburst is a rare condition characterized by uncontrolled sneezing in response to bright light. The exact mechanism causing this is poorly understood. However, various hypotheses have been proposed. Ophthalmic examination involves exposing the patient to bright light like slit lamp, indirect ophthalmoscopy and surgical microscope, which can trigger sneezing in PSR patients. Purpose: The purpose of this video is to draw light to this rare phenomenon and its implication in ophthalmic surgery. Synopsis: A 74?year?old male patient presented with diminution of vision in left eye. On routine slit lamp and IDO examination, patient had repeated sneezing. We diagnosed him to have photic sneeze reflex. He had pseudophakic bullous keratopathy in the right eye and senile immature cataract in the left eye. Taking into consideration his one eyed status and PSR, measures were taken accordingly and cataract surgery was performed uneventfully. We describe in this video the challenges encountered with this phenomenon and approach in such cases. Highlights: In this video, we tried to give an idea about photic sneeze reflex and its theories. Also, we tried to bring out the impact of PSR on ophthalmologic practice.

Quality of life in children with cerebral palsy

Background: Cerebral palsy (CP) is the most common motor disability in childhood. Quality of life (QOL) has emerged as an important concept in childhood, especially for children with disabilities. CP has an impact on a child’s capacity to do activities of daily living thus affecting QOL of patients and their families. Aims and Objectives: The objective of present study was to assess the QOL in children with CP. Materials and Methods: In this study, 29 children with CP in the age group of 4–12 years were evaluated for QOL was assessed using CPQOL-Child Primary Caregiver Questionnaire (4–12 years). The questionnaire was completed by one of the parents or their caregiver. Scores for each domain of QOL were converted to a scale ranging from 0 to 100 and analyzed. Results: The scores as reported by the parents were low for each of the domains with maximum effect seen in functioning domain and least in pain domain. Girls had better QOL than boys. The QOL scores were negatively related to the severity of CP which was assessed by gross motor function classification system suggesting that severity of disability had negative impact on QOL. Conclusion: QOL of children with CP was found to be poor and was influenced by age, sex and motor functioning

Heart rate recovery at 1st min after graded exercise an indicator of parasympathetic function in healthy obese young adults

Background: Heart rate recovery at 1st min (HRR 1 min) after graded treadmill exercise (GTX) is a predictor of parasympathetic function. Impaired HRR 1 min and obesity are strong predictors of metabolic syndrome and cardiovascular disorders. This study is done to asses HRR 1 min on apparently healthy obese young adults with body mass index (BMI) ?30, without any other metabolic syndrome components. Aims and Objectives: The objective of this study was to assess the parasympathetic function by estimating HRR 1 min after exercise in apparently healthy obese young adults of 18–30 years of age without any metabolic syndrome components and is compared with age- and gender-matched controls with normal BMI. Materials and Methods: Fifty obese young adults with BMI ?30 without any other metabolic syndrome component and 50 age- and gender-matched controls with BMI ?24.9 were selected and subjected to GTX according to modified Bruce protocol. Maximum heart rate reached during exercise (HRmax) and heart rate at 1st min of recovery phase (HR1min) were recorded. HRR 1 min was calculated as HRmax-HR1min and was analyzed. Results: This study showed significantly attenuated HRR 1 min in obese young adults compared to age- and gender-matched controls (mean 24.02 ± 8.87 vs. 42.42 ± 5.3, P < 0.001). Conclusion: HRR 1 min was significantly decreased in obese young adults, indicating attenuated parasympathetic function, who are at higher risk of developing chronic cardiovascular and other metabolic disorders.

An observational study of fetomaternal outcome in euthyroid women with anti-thyroid peroxidase antibodies at tertiary care hospital

Background: Several changes are observed in maternal thyroid function during pregnancy and failure to adapt to these physiological changes results in thyroid dysfunction, especially if complicated by the presence of thyroid antibodies. The presence of TPO-Ab is associated with increased rate of pregnancy complications such as miscarriage, preterm delivery, placental abruption, pregnancy-induced hypertension, intrauterine death and low birth weight. Objective of this study was to study the effect of anti-TPO Ab positivity on pregnancy outcome and estimate the prevalence of anti-TPO Ab in euthyroid obstetric women.Methods: This observational study enrolled 500 euthyroid pregnant women, age 20-35 years, up to 20 weeks gestation. Venous blood samples collected and analyzed for the anti TPO Ab levels. On the basis of anti TPO Ab positivity they were divided into two groups, anti-TPO Ab positive and Ab negative group. These two groups were followed up till delivery or abortion and compared for maternal and fetal outcomes.Results: Prevalence of anti-TPO antibody positivity was 5.2% in euthyroid obstetric women. Most of anti-TPO Ab positive women were overweight. There were higher numbers of miscarriage (11.54%) in anti-TPO Ab positive euthyroid pregnancies than (2.53%) in antibody negative women. Incidence of low birth weight babies was 4-fold higher in anti-TPO Ab positive women. More than two-fold increase in incidence of placental abruption in anti-TPO Ab positive women. Parity, anaemia, gestational hypertension, preeclampsia, GDM, PROM, PPH, low Apgar scores, NICU admission, IUD and neonatal death were not significantly associated with anti-TPO Ab positivity.Conclusions: Anti TPO Ab positivity significantly associated with pre-pregnancy BMI, miscarriage rates and low birth weight of newborns.

Study of onychomycosis

Background: Onychomycosis is one of the most common fungal nail infections caused by Dermatophytes, Non-Dermatophytic Molds (NDM) and Yeast. Though it is not life-threatening, can cause pain, discomfort, and disfigurement. It decreases the nail growth rate. Objectives: This study was carried out to document the clinico-mycological pattern and antifungal susceptibility pattern of onychomycosis.Methods: The study group included 130 consecutive patients with suspected fungal nail infections, attending Dermatology outpatient department of King George Hospital, Visakhapatnam, Andhra Pradesh during November 2012 to August 2014. The nail clippings of the patients were collected and subjected to KOH mounts for direct microscopy and fungal culture and antifungal susceptibility tests.Results: Onychomycosis was common among males (66.92%) than females (33.08%) with highest incidence was in age group 31-40 years (41.37%). Finger or toenails were exclusively involved in 32.18% and 55.18% patients respectively while these were involved concurrently in the rest of the 12.65% patients. Distal and lateral subungual onychomycosis seen in 64.36% of the patients was the most common clinical type. KOH and culture positivity were recorded in 56.92% and 48.46% cases respectively. Dermatophytes (50.58%) were predominant isolate followed by NDM (27.58%) and yeast (21.84%). Clotrimazole and ketoconazole were most effective antifungals against dermatophytes. For NDM, itraconazole, nystatin and amphotericin B and for yeast fluconazole and itraconazole were effective.Conclusions: The present study gives an insight about the aetiological agents causing onychomycosis and their anti-fungal susceptibility pattern in this region. Thus, it can help in taking adequate control measures to prevent it.

Inadvertent carotid artery cannulation with malposition of catheter tip in right ventricle in tetralogy of fallot patient undergoing total intracardiac repair – A case report

Central venous catheterization is an essential procedure in patient undergoing cardiac surgery, as it provides central venous pressure monitoring, fluid administration, and infusion of inotropes during perioperative period. In the cardiac surgery, where the patients are anticoagulated, an inadvertent arterial puncture can lead to serious complications. Hematoma following inadvertent arterial puncture is one of the common complications, which can compromise cerebral circulation. We report a rare case of inadvertent cannulation of internal carotid artery in patients of tetralogy of Fallot undergoing intracardiac repair during an attempt to cannulate internal jugular vein.

An unusual presentation of visual hallucinations with zolpidem: a case report.

Zolpidem is a hypnotic drug with rapid -onset and short duration of action. It is popularly used for the induction and maintenance of sleep in adults suffering from insomnia. It supersedes benzodiazepines with better tolerability and has fewer side effects such as less residual sedation and the potential for rebound insomnia and dependence is also less. Adverse neuropsychiatric reactions such as visual hallucinations, amnesia, sleepwalking and nocturnal eating are known to occur with zolpidem. Literature suggests higher incidence of visual hallucinations with zolpidem when used along with selective serotonin reuptake inhibitors. Furthermore, visual hallucinations are one of the causes for drug withdrawal. We are reporting a case of zolpidem induced visual hallucinations when used alone and also which disappeared with proper assurance to the patient in subsequent use.

Heavy Metals Concentration in Fish Mugil cephalus from Machilipatnam Coast and Possible Health Risks to Fish Consumers.

Heavy metals are dangerous to aquatic organisms and it can be bioaccumulated in the food chain leading to diseases in humans. Cumulative effects of metals or chronic poisoning may occur as a result of long term expore even to low concentrations. The accumulation of heavy metals conditions depending upon the species, environmental conditions and inhibitory processes. Considering the human health risk due to the consumption of fish, the concentration of heavy metals (Zn, Pb, Mn, Cu, Cr and Hg) are investigated in fish samples collected from the Machilipatnam coast. The fish was examined for metal constituents are the basis on the human nutrition in the study area. These metal concentrations were exceeding the limits set by the world health organization (WHO). The study provides an insight into the potential impact of increased levels of metals in the environmental as well as estimated of the contaminated of fish tissues with metals.

Clonazepam induced maculopapular rash: a case report.

Clonazepam is a benzodiazepine with prominent anticonvulsant action than other members of the group at equisedating doses. It especially blocks pentylenetetrazole-induced seizures. Other important actions include anxiolysis. Common adverse effects to Clonazepam include drowsiness and lethargy. In this submission we report a case of Clonazepam induced maculopapular rash in a 30 year old female treated for panic disorder.

Extracorporeal shock-wave lithotripsy success rate and complications: initial experience at Sultan Qaboos university hospital

To assess the efficacy and safety of extracorporeal shock wave lithotripsy with Modularis Vario Siemens in the management of patients with renal and ureteral stones. Between 2007 and 2009, 225 outpatients were treated with Siemens Modularis Vario lithotripter at Sultan Qaboos University Hospital. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance. Of the 225 initial consecutive patients who underwent extracorporeal shock wave lithotripsy, 192 [85%] had renal stones and 33 [15%] had ureteric stones. The mean +/- SD stone size was 11.3 +/- 4.5 mm, while the mean age of the patients was 39.9 +/- 12.8 years with 68.5% males. The mean renal stone size was 11.6 +/- 4.7 mm; a mean of 1.3 sessions was required. The mean ureteric stone size was 9.9 +/- 3 mm; and a mean of 1.3 sessions was required. Treatment success [defined as complete clearance of ureteric stones, stone-free or clinically insignificant residual fragments of <4 mm for renal stones] was 74% for renal stones and 88% for ureteric stones. Additional extracorporeal shock wave lithotripsy and ureteroscopy were the most adjunctive procedures used for stone clearance. Complications occurred in 74 patients [38.5%] with renal stones and 13 patients [39.4%] with uretetric stones. The most common complication was loin pain [experienced by 16.7% with renal stones and 21% with ureteric stones]. Severe renal colic mandating admission occurred in 2% of patients with renal stones and 6% of patients with ureteric stones. In patients with renal stone, steinstrasse occurred in 3.6% and infection post extracorporeal shock wave lithotripsy in 0.5%. Using Multivariate Logistic Regression analysis, factors found to have significant effect on complete stone clearance were serum creatinine [p=0.004] and the number of shockwaves [p=0.021]. Siemens Modularis Vario lithotripter is a safe and effective tool for treating renal and ureteric stones

Studies on influence of natural biowastes on cellulose production by Aspergillus niger.

The objective of this study was to determine the influence of natural biowaste substrates such as banana peel powder and coir powder at varying environmental parameters of pH (4-9) and temperature (20-50oC) on the cellulase enzyme production by Aspergillus niger. The cellulase enzyme production was analyzed by measuring the amount of glucose liberated in IU ml-1 by using the dinitrosalicylic acid assay method. The substrates were pretreated with 1% NaOH (alkaline treatment) and autoclaved. The maximum activity of the enzyme was assayed at varying pH with temperatures being constant and varying temperatures with pH being constant. The highest activity of the enzyme at varying pH was recorded at pH 6 for banana peel powder (0.068 + 0.002 IU ml-1) and coir powder (0.049 ± 0.002 IU ml-1) and the maximum activity of the enzyme at varying temperature was recorded at 35oC for both banana peel powder (0.072 ±0.001 IU ml-1) and coir powder (0.046 ±0.003 IU ml-1). At varying temperatures and pH the high level of enzyme production was obtained at 35oC and pH 6 by using both the substrates, respectively. However among the two substrates used for the production of cellulases by Aspergillus niger banana peel powder showed maximum enzymatic activity than coir powder as substrate.

Formulation and Evaluation of Lisinopril Dihydrate Transdermal Proniosomal Gels.

In the present study transdermal Lisinopril proniosomal gels was formulated by using Lecithin, Cholesterol as encapsulating agents, Surfactant, Span and permeation enhancers. The study methodology encompasses compatibility studies using FTIR spectra, evaluation of proniosomal gels for pH determination, Viscosity, Vesicle size analysis, rate of spontaneity, encapsulation efficiency, in vitro skin permeation studies and stability studies. The preliminary compatibility studies conducted revealed that there no interaction between Lisinopril and excipients which was as evident from FTIR spectral studies. The physical characterization of proniosomal gels was found to be within the acceptable limits. It was observed that the gel formulations showed good spreadability and viscosity. Determination of vesicle size was found to be 20.10-26.23μm. The proniosomes showed spherical and homogenous structure in optical microscopy. All formulations showed zero order drug release by diffusion mechanism. The stability studies showed that proniosomal gels were stable at 4 to 80C and 25±20C. The above results indicated that the proniosomal gels of could be formulated for controlled release of Lisinopril. The proniosomal gels are suitable for Lisinopril once a day controlled release formulation.

Determination of multiclass pesticide residues in mangoes by liquid chromatography –tandem mass spectrometry.

The Development of an analytical method for the determination of 24 multiclass pesticides in mango at the ≤10 ng g-1 level. The method involves extraction of 10 g of homogenized mango samples (2 g of Sodium chloride- +8g of Magnesium sulfate) with 10 mL of Acetonitrile; Clean up by Dispersive solid phase extraction with a combination of primary secondary amine (PSA), graphitized carbon black (GCB) and anhydrous Magnesium sulfate and final estimation by LC-MS/MS with multiple reaction monitoring (MRM) mode. The mean recoveries were in the range 80-120%. The method quantifies over a linear dynamic range of 10-100 μg/kg. The methodology has been proven to be highly efficient and robust and thus the method is suitable for monitoring the Maximum Residue Limits (MRL) compliance of a wide range of pesticides combinations.

A comparison of root canal preparations using stainless steel, Ni-Ti hand, and Ni-Ti engine-driven endodontic instruments – an in vitro study.

The main advantage of nickel titanium instruments is that they permit canal preparation with less transportation and ledging. Hand used Ni-Ti and rotary Ni-Ti instruments have a wider range of elastic deformation and greater flexibility. The aim of the present study was to evaluate and compare the preparation time, loss of working length, apical transportation, instrument deformation and fracture with stainless steel, Ni-Ti hand and Ni-Ti rotary endodontic instruments. Fifty freshly extracted human mandibular molars with curved roots were collected and stored in 10% formalin. The samples were divided into 3 groups of 15 each. The access opening was made for each tooth and the biomechanical preparation was carried out using crown down pressureless technique in all the groups. Group I was instrumented with stainless steel files, group II with hand Ni-Ti and group III with Ni-Ti rotary files. The preparation time to enlarge each canal was recorded in minutes and seconds, which included only active instrumentation. Following preparation, the final length of each canal was subtracted from the original length to give the loss of working length. SEM photographs of the deformed and fractured instruments were taken. The apical transportation was measured using computer software (Microdraw 4.1). The readings were noted and statistically analyzed. The results of this in vitro study showed that the mean preparation time was less with Ni- Ti rotary (1.85 min) when compared to hand Ni-Ti (6.33) and stainless steel files (6.73), which was statistically significant. The loss of working length was more for stainless steel group which was statistically significant (P<0.05) when compared with the other 2 groups.One instrument in stainless steel and one in Ni-Ti rotary files were fractured. Only one instrument in stainless steel file deformed permanently. Apical transportation was found to be greater in stainless steel group than other groups (P<0.01) which was statistically significant. Considering the parameters in this study, Ni-Ti rotary files proved to perform better than the other two groups.

Comparison of the demographics, semen parameters and hormone profiles in men with primary and secondary infertility

The objectives of this study were to compare the demographics, semen parameters and hormone profiles in men with primary and secondary infertility. The study was designed as a retrospective analysis of data collected from men attending a combined infertility clinic [seen together by urologist and gynaecologist] from January 2005 to December 2008 at Sultan Qaboos University Hospital, a tertiary care hospital in Oman. Ninety-eight consecutive male patients with one or more abnormalities in semen analysis were referred to the combined infertility clinic. A complete physical examination was carried out by a urologist followed by hormone evaluation of follicle stimulating hormone [FSH], luteinizing hormone [LH], testosterone [T] and prolactin [PRL]. The semen parameters and the sex hormone evaluation were not significantly different between the men with primary and secondary infertility. The men with primary infertility were younger than the men with secondary infertility. A total of 24% of the men in the primary group and 16% in the secondary group were azoospermic with normal gonadotropin values in 9 men and 1 man in the primary and secondary group respectively. Azoospermia was more common in the primary infertile group and, based on gonadotropin levels, obstructive causes seemed more prevalent in the primary group compared to secondary group

Calcium glucarate prevents tumor formation in mouse skin / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>Calcium Glucarate (Cag), Ca salt of D-glucaric acid is a naturally occurring non-toxic compound present in fruits, vegetables and seeds of some plants, and suppress tumor growth in different models. Due to lack of knowledge about its mode of action its uses are limited in cancer chemotherapy thus the objective of the study was to study the mechanism of action of Cag on mouse skin tumorigenesis.</p><p><b>METHODS</b>We have estimated effect of Cag on DMBA induced mouse skin tumor development following complete carcinogenesis protocol. We measured, epidermal transglutaminase activity (TG), a marker of cell differentiation after DMBA and/or Cag treatment and [3H] thymidine incorporation into DNA as a marker for cell proliferation.</p><p><b>RESULTS</b>Topical application of Cag suppressed the DMBA induced mouse skin tumor development. Topical application of Cag significantly modifies the critical events of proliferation and differentiation TG activity was found to be reduced after DMBA treatment. Reduction of the TG activity was dependent on the dose of DMBA and duration of DMBA exposure. Topical application of Cag significantly alleviated DMBA induced inhibition of TG. DMBA also caused stimulation of DNA synthesis in epidermis, which was inhibited by Cag.</p><p><b>CONCLUSION</b>Cag inhibits DMBA induced mouse skin tumor development. Since stimulation of DNA synthesis reflects proliferation and induction of TG represents differentiation, the antitumorigenic effect of Cag is considered to be possibly due to stimulation of differentiation and suppression of proliferation.</p>

On speed and aerodynamic forces of mosquito.

In the present investigation, speed of mosquitoes A. aegyptii (Linnè) and Culex quinquefasciatus (Say) is measured by designing and constructing a low speed wind tunnel in the laboratory. The velocity of mosquitoes is less than the other myogenic and neurogenic insects. Lift, one of the important aerodynamic forces that a flier has to develop for its efficient flight, is studied in mosquitoes by developing a simple technique using digital single pan balance. Lift, drag and their coefficients of hovering mosquito are calculated from the knowledge of body parameters by considering the wings of mosquito as harmonic oscillator. The calculated value of lift is verified with the experimental. The study throws light on morphophysiological adaptation of mosquitoes for the generation of aerodynamic forces in hovering, tethered and forward flights.

Oxygenation of crystalloid cardioplegia.

A simple economical apparatus for oxygenation of cold crystalloid cardioplegic solutions is presented. It is sterile, practically feasible for use in open heart surgery, provides a PO2 of 98.7 kPa and sustains it for a period of more than 20 minutes.