Clinical and Etiological Profile of Cerebral Venous Sinus Thrombosis

Introduction: Cerebral Venous Thrombosis is an importantcause of stroke in the young. The importance of recognisingthis condition is that it carries a good prognosis if recognisedand treated early. Study objective was to analyse the clinicaland etiological profile of Cerebral Venous Sinus Thrombosis.Material and Methods: Prospective cross sectional studyin patients attending OPD or emergency at a tertiary referralcentre in eastern Tamilnadu with history suggestive of CVTand in whom the diagnosis of CVT confirmed by imagingof brain (MRI and MRV) were included in the study aftermeeting the inclusion criteriaResult: Among the 33 patients included in the study, majorityaffected were young males, most common clinical presentationwas headache and most common sinus involved was superiorsagittal sinus. Pro thrombotic state was observed in 27% ofcases and alcohol addiction was found to highly prevalent inthe study population.Conclusion: Cerebral Venous Thrombois is found to besignificantly high in males and alcoholics. Compared to otherIndian studies there was not much disparity in clinical profileand risk factors.

Retrospective study of changes in ocular coherence tomography characteristics after failed macular hole surgery and outcomes of fluid-gas exchange for persistent macular hole

Purpose: The aim is to study the changes in ocular coherence tomography (OCT) parameters of large (?400 ?) full-thickness macular holes (FTMHs) after a failed surgery and evaluate the outcome of fluid-gas exchange (FGE) in the treatment of persistent macular hole and role of OCT in predicting outcome after the secondary intervention. Methods: Changes occurring in the OCT parameters of FTMH after a failed vitrectomy were evaluated. FGE was done in an operating room with three pars plana sclerostomy ports. The anatomical and functional outcomes of FGE for these persistent macular holes were also assessed. Anatomical closure was defined as the flattening of the hole with resolution of subretinal cuff of fluid. Anatomical success after FGE was defined as flattening of macular hole with the resolution of subretinal cuff of fluid and neurosensory retina completely covering the fovea. Functional success was defined as an improvement of at least one line of best-corrected visual acuity (BCVA). Results: Twenty-eight eyes (28 patients) were included in the study. After the failed vitrectomy, OCT showed an increase in the base diameter, opening diameter, and height of the hole. After the secondary procedure, anatomical closure was achieved in 89.3% eyes. Mean BCVA improved from logMAR 0.88 � 0.24 (20/152) to logMAR 0.66 � 0.24 (20/91) (P < 0.001). Eight (28.6%) patients achieved final BCVA ?20/60. Functional success was obtained in 19 patients (67.9%). There was no association between anatomical success after FGE and any of the pre-FGE OCT parameters or indices. Conclusion: Unsuccessful surgery causes swelling of the outer and middle retinal layers with retraction of inner layers of the retina. Performing FGE while visualizing the retina is a good option for the treatment of large persistent macular holes as it causes complete drying of the macula, better success rates, and a reduced complication rate. Pre-FGE OCT does not help in predicting the outcome of FGE for persistent macular hole.

Polypoidal choroidal vasculopathy: Pearls in diagnosis and management

Polypoidal choroidal vasculopathy (PCV) is increasingly recognized as an important cause of exudative maculopathy in Asians as against Wet age-related macular degeneration in Caucasians. A panel of retinal experts methodically evaluated pertinent updated literature on PCV with thorough PubMed/MEDLINE search. Based on this, the panel agreed upon and proposed the current consensus recommendations in the diagnosis (clinical and imaging), management and follow-up schedule of PCV. Diagnosis of PCV should be based on the gold standard indocyanine green angiography which demonstrates early nodular hyperfluorescence signifying the polyp with additional features such as abnormal vascular network (AVN). Optical coherence tomography is an excellent adjuvant for diagnosing PCV, monitoring disease activity, and decision-making regarding the treatment. Current treatment modalities for PCV include photodynamic therapy, anti-vascular endothelial growth factor agents, and thermal laser. Choice of specific treatment modality and prognosis depends on multiple factors such as the location and size of PCV lesion, presence or absence of polyp with residual AVN, amount of submacular hemorrhage, presence or absence of leakage on fundus fluorescein angiography, visual acuity, and so on. Current recommendations would be invaluable for the treating physician in diagnosing PCV and in formulating the best possible individualized treatment strategy for optimal outcomes in PCV management.

To evaluate efficacy of local Amikacin therapy as an adjuvant to parenteral antibiotics in control of surgical site infection compared to parenteral antibiotic alone in a tertiary care centre

Background: Surgical site infection is a common cause of morbidity for the operated patients. Hence a cost effective and simple method was formulated and studied on cases of laparotomy and appendicectomy patients which can be categorized as dirty and contaminated wounds. Materials and methods: 25 cases and adequately matched controls were selected from patients who underwent laparotomy or appendicectomy which can be categorized as dirty or contaminated wounds. Cases were given local application Inj. Amikacin over the subcutaneous plane preoperatively and for the subsequent three post-operative days through a subcutaneously placed feeding tube along with systemic iv antibiotics. The control patients only received systemic IV antibiotics. ASEPSIS scoring was used to grade the post-operative surgical site infection in the cases and the corresponding controls, at the end of the first and second week after surgery. Various criterions were specifically evaluated such as the isolation of microbe from the wound site or the requirement of change of antibiotic at the end of the 1st or 2nd week and the tendency of prolonged stay in the hospital for more than 2 weeks. Results: It was observed that the cases that received the local Amikacin application as an adjuvant to systemic antibiotic showed significantly lesser incidence and/ or grading of SSIs in the first week and A.K. Rajendran, C. Arun Babu, Gnana Sezhian. To evaluate efficacy of local Amikacin therapy as an adjuvant to parenteral antibiotics in control of surgical site infection compared to parenteral antibiotic alone in a tertiary care centre. IAIM, 2018; 5(2): 64-71. Page 65 also lesser, but not statistically significant reduction of SSIs in the second week. The incidence of antibiotic change, hospital stay and isolation of microbe from the wound site was statistically found be to lesser in the study group compared to their controls. Conclusion: It is observed that the local therapy as an adjuvant is cost effective and without any significant local or systemic adverse effects in the prevention of SSIs in dirty and contaminated patients. But it was also observed that it did not have sustained effect for prolonged period beyond its time of administration (as evidenced by its lesser effect in the second week after surgery). It may be suggested that a further combination of suction drainage of the subcutaneous DT along with local antibiotic treatment may have added advantage in further preventing SSIs.

Diversity of wild fruits in Nilgiri Hills of the Southern Western Ghats- Ethnobotanical Aspects.

Nilgiri Hills are situated in the Western Ghats of India, one of the eight hottest hotspot of the world is known for its rich biodiversity. In view of the rich plant diversity in areas with a predominantly tribal population. Ethnobotany is an important tool to assess the wild edible species in plant genetic resources. The present survey resulted in the collection of 70- species belonging to 48 genera comes under 27- families. The present ethnobotanical aspects on wild and less- known plants of the Nilgiri region can be used to determine collection priorities and conservation strategies.

Extraction of Chromium from Tannery Effluents Using Waste Egg Shell Material as an Adsorbent.

In the present era, due to industrial revolution in the developing country like India, the ground water system has been largely polluted, especially with heavy metals like chromium. The removal of such heavy metals from industrial effluents and from wastewater has become a subject of keen interest. This paper deals with the removal of chromium from its aqueous solution using egg shell, a waste material as an adsorbent. Experimental results vividly demonstrate that this extraction method was found to be cheaper, quicker and more efficient than other conventional techniques. The results are interpreted in the light of Loggergren’s model.

Antimicrobial activity of leaf extract of passiflora incarnata L.

Ethanolic extract of leaves of leaves of Passiflora incarnate included in Passifloraceae family were screened for phytochemical constituents and antimicrobial activities towards nine bacteria eight fungi. Among all extracts, ethanolic leaf extract of P. incarnate showed the highest antimicrobial activity when compared with other extracts. Phytochemical analysis of all the extracts revealed that the antimicrobial activity of the plant material is due to the presence of phenolic compounds.

Anti inflammatory activity of passiflora incarnate L in rats.

The Ethonolic extract of Passiflora incarnate L was tested to study the anti- inflammatory activity using the technique of carrageenan induced paw edema in albino rats. The extract showed significant anti-inflammatory activity comparable to the reference Standard Ibruofen.

Sedative and hypnotic activity of Passiflora Incarnata L.

Ethanolic extract of leaves of Passiflora incarnata.L (Passifloraceae) (200 mg/kg, p.o) exhibited significant Hypnotic activity (3.5 mg/kg i.p) being comparable to that of lorazepam (0.5 mg/kg) respectively.

High intensity exercise training programme following cardiac transplant.

A 26-year-old male patient who presented with symptoms of end stage cardiac failure as a result of dilated cardiomyopathy, had an orthotopic cardiac transplantation. A comprehensive cardiac rehabilitation programme was provided to him and he was introduced to a sport (tennis). The exercise training programme progressed from low intensity training to high intensity programme over a period of 15 months. A cardio-pulmonary exercise test done 22 months after surgery suggested that he was able to achieve the aerobic capacity comparable to that of a normal South Indian subject. He participated successfully in the World Transplant Games in Sydney and returned safely. This suggests that after a proper cardiac rehabilitation programme, patients undergoing heart transplantation can achieve normal physiological responses to lead a normal active life.

Pre-operative short-term pulmonary rehabilitation for patients of chronic obstructive pulmonary disease undergoing coronary artery bypass graft surgery.

The role of pre-operative short-term pulmonary rehabilitation in patients with chronic obstructive pulmonary disease who undergo coronary artery bypass graft surgery has been assessed for the first time prospectively. Forty-five patients posted for coronary artery bypass graft surgery were randomised to receive either short-term pulmonary rehabilitation (group I) or no such programme (group II). Patients of both the groups were evenly matched with respect to age, sex, body surface area, duration and severity of chronic obstructive pulmonary disease and coronary artery disease. Normal individuals who evenly matched with the study group were assessed for normal respiratory function parameters. Pre-operative and post-operative peak expiratory flow rate, inspiratory capacity, post-operative ventilation time, post-operative pulmonary complication and hospital stay were determined in both the groups. Peak expiratory flow rate (220.0 +/- 12.9 and 324.3 +/- 84.3 in group I, 218.0 +/- 16.4 and 260.5 +/- 35.2 in group II) and inspiratory capacity (844.0 +/- 147.4 and 1100.0 +/- 158.1 in group I, 830.0 +/- 117.4 and 1090 +/- 137 in group II) were significantly lower before and after surgery respectively in both groups compared to normal values. Even though both groups showed a significant rise in post-operative peak expiratory flow rate and inspiratory capacity after surgery, the post-operative peak expiratory flow rate and inspiratory capacity in group I was significantly higher than in group II. In group I, the post-operative ventilation time (24.5 +/- 6.00 hours), post-operative complications (n = 4) and hospital stay (12.4 +/- 3.6 days) were significantly lower than in group II (35.2 +/- 22.3 hours, n = 11, 18.8 +/- 6.6 days respectively). These data suggest that short-term pulmonary rehabilitation is feasible and effective in improving pulmonary functions before and after surgery and in reducing surgical morbidity and cost of medical care significantly.

An evaluation of the future role of non-governmental organizations currently engaged in leprosy control in India.

The mass implementation of short term multi-drug therapy in India, has led to dramatic falls in the prevalence of leprosy. This paper addresses the future role of non-governmental organizations currently involved in leprosy control. This evaluation is based on current trends in leprosy control, projected health needs in the future and the necessity to maximize health care outputs in the face of limited resources.

The use of topical phenytoin as an adjunct to immobilization in the treatment of trophic leprosy ulcers.

A total of 30 leprosy patients (controls n = 16; topical phenytoin n = 14) with trophic ulcers on the feet were investigated to ascertain the efficacy of topical phenytoin powder in the healing of ulcers. The ulcers in the two groups were matched for initial size. Healing patterns were assessed by determining changes in depth and planar (surface) dimensions at weekly intervals over a three week study period. Results indicate that while immobilization of the ulcer site is effective in promoting ulcer healing, additional use of topical phenytoin accelerates the healing process. There may however be non-responders to topical phenytoin.

Significance of the tuberculin skin test in pulmonary tuberculosis in Jamaica: comparisons of culture-positive, culture negative and non-tuberculous patients

The results of tuberculin skin tests with PPDS-S done on patients with pulmonary tuberculosis seen over a three-year period (1979-1981) were compared with the results of similar tests done during the same period in a group of persons without tuberculosis. Ninety per cent of patients with culture-positive tuberculosis had positive tuberculin skin tests, compared to 83% of positive tests in the non-tuberculous group. The presence of such a large proportion of positive tuberculin reactions in persons without active disease indicates that the skin test reaction cannot be used on its own to establish the diagnosis of had negative sputum smears and cultures for acid-fast bacilli. Eighty-two per cent of these patients had positive tuberculin skin tests. Invasive diagnostic tests and newer serological diagnostic methods are likely to increase the yield of confirmed positive cases of tuberculosis in the future