Netarsudil monotherapy as the initial treatment for open-angle glaucoma and ocular hypertension in Indian patients: A real-world evaluation of efficacy and safety.

Purpose: Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40-80. The best way to manage primary open-angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. Methods: An open-label, real-world, multicentric, observation-based 3-month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first-line therapy. Diurnal IOP measurements, best-corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day-1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Results: Four hundred and sixty-nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once-daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. Conclusion: We found that netarsudil 0.02% w/v solution monotherapy when used as the first-line treatment in primary open-angle glaucoma and ocular hypertension was both safe and effective.

Study of the Role of Cerebrospinal Fluid C-reactive Protein and Adenosine Deaminase to differentiate Various Types of Meningitis.

OBJECTIVE: (1) To study cerebrospinal fluid (CSF) adenosine deaminase (ADA) and CSF C-reactive protein (CRP) levels in the differentiation of viral, pyogenic, and tuberculous meningitis (TBM). (2) To estimate the borderline levels of CRP in CSF in viral, pyogenic, and TBM. METHODS: A prospective and cross-sectional study was conducted at the Department of Medicine, SRN Hospital, Prayagraj, Uttar Pradesh, India, between August 2016 and September 2018. In this study, a total of 100 patients with meningitis were included applying specific inclusion and exclusion criteria after proper ethical approval. RESULTS: Out of 100 patients, 61 were TBM, 31 were pyogenic meningitis, and eight were viral meningitis (VM). CSF CRP level was significantly increased in pyogenic meningitis (1.05 ± 0.36 mg/dL) compared to nonpyogenic meningitis [TBM (0.42 ± 0.13 mg/dL) and VM (0.37 ± 0.09 mg/dL)]. At the cut-off level of CRP in CSF > 0.6 mg/dL, its diagnostic sensitivity in pyogenic meningitis was 93.55% and specificity 94.20%. While CSF ADA levels were higher in the TBM group (13.32 ± 3.21 U/L) compared to the other two groups [pyogenic meningitis (6.15 ± 1.27 U/L) and VM (4.86 ± 0.88 U/L)]. At a cut-off, CSF ADA level of >10 U/L, its diagnostic sensitivity for TBM was 91.67% and specificity 90%. CONCLUSION: Cerebrospinal fluid (CSF) CRP levels were found to be raised in pyogenic meningitis, and CSF ADA was found to be elevated in TBM. While both ADA level and CRP level in CSF are found low in VM.

Association of Serum Prolactin Levels with Glycemic Control in Type 2 Diabetes Mellitus & its Correlation with Diabetic Nephropathy.

INTRODUCTION: As per 2015 IDF estimate, 415 million adults were affected by diabetes, by 2040 this figure is expected to rise to 642 million. As per estimates 20-40% of diabetic patients develop diabetic nephropathy. AIM: The present study was conducted to establish the relationship between S. prolactin level with glycemic control in Type 2 DM & its association with Diabetic Nephropathy. MATERIALS: A cross sectional study was conducted on 100 diabetic patients at OPD/IPD in SRN Hospital affiliated to MLN Medical college, Prayagraj between July 2021 & August 2022. Blood samples were taken to estimate CBC, HbA1C, FBS, PPBS, S. Prolactin, S. creatinine, S. lipid profile. UACR & Urine R/M was done. USG whole abdomen with KUB was done to assess kidney size and echotexture. Data was collected, entered in MS Excel Spreadsheet & appropriate statistical package was applied. RESULT: Out of 100 diabetic patients, 37 patients (37%) had diabetic nephropathy. Diabetic nephropathy patients had significantly lower Hb, eGFR & significantly higher S. creatinine & UACR levels. Serum prolactin levels of patients with Diabetic nephropathy was significantly higher as compared to those without diabetic nephropathy (53.36±13.45 vs. 12.67±7.84 ng/ml). Among diabetic patients without diabetic nephropathy, S. prolactin levels of patients with good glycemic control was significantly higher than that of poor glycemic control for all glycemic parameters i.e. HbA1c (19.48±5.29 vs. 11.23±7.56 ng/ml), FBS (21.88±7.23 vs. 9.53±5.13 ng/ml) & PPBS (21.86±6.45 vs. 8.39±3.60 ng/ml) but was still within normal range for the study population.' CONCLUSION: Patients with diabetic nephropathy had higher S. prolactin level, so it can be used as a surrogate marker for assessing progression of diabetic nephropathy. References Fard AA, Abbasnezhad P, Makhdomi K, et al. Association of serum prolactin concentrations with renal failure in diabetic patients. Rom J Diabetes Nutr Metab Dis 2017;24(3):179-185. Chahar C, Chahar K, Ankit BS, et al. Association of serum prolactin level with impaired glucose regulation and diabetes. J Assoc Physicians India 2017;65(3):34-39.

Design of a COVID-19 treatment facility in a sustainable health-care environment.

Due to the recent pandemic situation that has erupted all around us, healthcare facility design is a must. Healthcare providers and administrators must concentrate on the changes that must be made in existing healthcare facilities. The isolated healthcare facilities are essential because the corona virus is spread mainly through close contact (within six feet), such as handshaking (if someone's hands are infected) or touching contaminated surfaces. Healthcare facilities are most susceptible to the spread of the corona virus due to the high number of symptomatic patients admitted. Coronavirus is the leading cause of infectious disease morbidity and mortality worldwide. Thus, if the pandemic situation worsens, new plans and designs for existing healthcare facilities will be required, as well as temporary versions. Societal gains from increased research in this area. In the coming years, healthcare workers will be better trained, and healthcare facilities will be upgraded. This paper proposes new plans and designs to address the issues raised.

Determining the Best Screening Strategy for Patients with Mycobacterium Tuberculosis Infection and Glucose Intolerance and Associated Dyslipidemia in a Tertiary Care Hospital in North India.

To determine prevalence of glucose intolerance and dyslipidemia in patients with mycobacterium tuberculosis infection. MATERIAL: A prospective study done on 164 patients infected with MTB were enrolled in the study. Patients with tuberculosis (TB) were selected from Medicine and Pulmonary Medicine departments in MLN Medical College Prayagraj. Patients were screened for glucose intolerance using A1C, FPG and 2h-PP at baseline, 3 months, and 6 months, and then further, divided into two categories on the basis of glucose tolerance; abnormal glucose tolerance (AGT) and normal glucose tolerance (NGT). OBSERVATION: A total of 164 patients with TB were taken in the study, AGT group had 76 patients, which include patients with 50 impaired glucose tolerance (IGT), and who were newly diagnosed to have 26 diabetes mellitus, and 88 patients in NGT group. The mean age of the patients in AGT group was 44.65 years. Any of the 3 criteria (FPG and/or, PPG and/or, A1C) revealing dysglycemia the true sensitivity was 77.63%, 100% and 98.68% at baseline, 3months and 6months interval. Using FPG alone as the criteria, the sensitivity was 43.42%, 81.58% and 68.42%, where as A1C alone as the criteria, the sensitivity was 77.63%, 100% and 98.68% baseline, 3 months and 6 months intervals respectively whereas specificity was 100%. Among AGT and NGT, dyslipidemia was found to be statistically significant among AGT group (p=0.01). Mean Serum triglycerides (165.11, p <0.001) and LDL cholesterol (99.65, p<0.001) in AGT group. CONCLUSION: There is increased prevalence of prediabetes and newly diagnosed DM in patients with TB and they are more to develop dyslipidemia.

Evaluation of Results of Ponseti Technique in Idiopathic Clubfoot using Clinical Evaluation and Radiological Assessment.

Background: Congenital clubfoot (congenital talipes equinovarus) occurs in approximately one in 1000 live births and is one of the most common congenital birth defects. The Ponseti method is at present a well-established method of treatment for idiopathic clubfoot deformities. Aim: The aim of the present study was to evaluate the results of serial casting in clubfoot deformity with Ponseti method on the basis of Pirani's scoring and radiological findings before and after completion of treatment. Materials and Methods: A total of 30 patients were enrolled in the study and were treated with Ponseti's casting after grading the severity of deformity clinically by Pirani's scoring and radiological assessment by calculating the talo-first metatarsal angle in anteroposterior (AP) view and talocalcaneal angle in AP and lateral views. The same clinical and radiological assessment was done at the end of treatment before putting a patient on foot abduction orthosis (FAO). Results: The average number of casts applied before full correction was 5.56 (range: 5-8). The average duration of treatment was about 6.65 weeks before the patient was put on FAO. Pirani score significantly improved from an average of 5.50 (range: 4-6) on presentation to 0.24 (range: 0-2) after correction of deformity. Conclusion: The Ponseti method is an excellent method for the correction of all four deformities associated with congenital idiopathic clubfoot, and we found that the addition of radiographic to clinical evaluation helps in the better assessment of correction. It provides statistically significant results both clinically as measured by Pirani severity score and radiologically assessed by talocalcaneal and talo-first metatarsal angle.

Morphological and Morphometric Analysis of the Orbital Aperture and Their Correlation With Age and Gender: A Retrospective Digital Radiographic Study.

Purpose Precise knowledge about clinically observed bony orbital aging is needed for surgical planning for acceptable cosmetic results. The effect of age and gender on the facial skeleton and orbital aperture has been appreciated earlier, but its quantification remains ignored. The purpose of this study was to evaluate age- and sex-related changes in the shape of the orbital aperture and construct a reference data set for the aging phenomenon in Indians. Methods Two hundred digital radiographs (Water's/frontal view) of the skull, obtained for various reasons, were evaluated. The radiographs comprised 107 males and 93 females aged between 10 and 60 years (10-59 years). Orbital shape, height/width, and interorbital/biorbital distances were noted, and orbital indices (OIs) were calculated. Orbital parameters thus obtained were compared between right and left sides and males and females. The relation of the parameters with age and gender was analyzed. Results Four types of orbits, round (33.5%), elliptical (30.5%), rectangular (27.5%), and square (9.5%), were noted in the study population. The average value of height and width of the right orbit was found to be higher than that of the left (p > 0.05). Male patients had higher (p > 0.05) and wider (p > 0.05) orbits than females. The right OI (81.55 ± 5.30) was higher than the left (80.75 ± 4.80) (p > 0.05). When comparatively evaluated between gender, both orbits were found to be of the microseme type with a mere difference (p > 0.05). The average interorbital/biorbital distance was 1.27 ± 2.11 and 9.78 ± 4.40 cm, respectively, without any gender difference. No significant relation was found between the age change and the parameters defined (p > 0.05), except in one age group (10-19 years). Conclusions Orbital dimensions showed no association with age and gender except in one age group (10-19 years); a pubertal growth spurt in females might be causing this phenomenon. The morphometric data may be useful in forensic anthropology and better planning for reconstructive surgeries in the orbito-maxillary region.

Uttar Pradesh Association of Physicians of India Position Statement: Betel Quid (Paan) and Diabetes.

Betel quid (paan) chewing is common in India, especially in Uttar Pradesh. Betel quid has multifaceted relationship with health, including metabolic and psychosocial health. The current recommendations have been released keeping in view the public health and clinical importance of this addictive behavior. The objective of this document is to offer clinical guidance for screening, diagnosis and management of co-occurring betel quid chewing among persons with Diabetes Mellitus (DM). The document aims to provide education and guidance to clinicians engaged in care and management of persons with DM, and improve access to treatment for co-occurring betel quid chewing among persons with DM. The current recommendation grades are based on published evidence, and categorized as strong, intermediate, weak and no evidence. The strength of these recommendations is based on the level of evidence.

Radiological Manifestations of Pulmonary Tuberculosis - A Comparative Study between Immunocompromised and Immunocompetent Patients.

INTRODUCTION: Pulmonary tuberculosis has atypical radiological manifestations in patients with underlying immunocompromised disease like diabetes and human immunodeficient virus infection. Computed tomography has important role in such patients for early diagnosis of disease and management to minimize complication. AIM: To evaluate and compare the computed tomography chest features of pulmonary tuberculosis in between immunocompromised patients and immunocompetent patients. MATERIALS AND METHODS: This cross-sectional study was conducted in the hospital on newly diagnosed 60 pulmonary tuberculosis patients of which 30 patients had no underlying disease (Immunocompetent Group) and 30 patients had diabetes mellitus or were human immunodeficiency virus seropositive (Immunocompromised Group). CT scan of chest were evaluated for each patient. RESULTS: In immunocompetent patients, 36.7% had radiologically atypical presentation,90% had nodular opacities, 73.3% had consolidation, 23.3% had lymphadenopathy, 60% had cavitation and cavitatory lesion were single in 94.4% patients. Isolated upper lung field were involved in 60% patients. In immunocompromised patients 76.7% had radiologically atypical presentation, 66.7% had nodular opacities, 46.7% had consolidation, 63.3% had lymphadenopathy, 20% had cavitation and cavitatory lesions were multiple in 60% patients. Isolated lower lung field were involved in 23.3% patients. CONCLUSION: We concluded that immunocompromised patients have more atypical involvement of lung fields, higher prevalence of lymphadenopathy as compared to immunocompetent patients. Diabetic patients have multiple cavitatory lesions as compared to non-diabetic patients. HIV seropositive patients have more prevalence of lymphadenopathy as compared to HIV seronegative patients.

Imaging Evaluation of Enhancement Patterns of Flat Gall Bladder Wall Thickening and Its Correlation with Clinical and Histopathological Findings.

INTRODUCTION: Gall bladder Wall Thickening (GWT) is caused by wide spectrum of diseases. Initially Ultrasound (USG) was used as imaging modality for screening of acute abdomen because of its high sensitivity and real time character. Now, Computed Tomography (CT) is used because of its high temporal and spatial resolution. AIM: Evaluation of GWT and its enhancement patterns on contrast enhanced CT scan in a bid to differentiate benign from malignant causes and to correlate the imaging features with clinical and histopathological findings. MATERIALS AND METHODS: It was a hospital based prospective study in which USG was done as an initial modality for screening and Multi Detector Computed Tomography (MDCT) scan was done later on for detailed evaluation of enhancement patterns of GWT. The study cases were then divided into five CT patterns according to enhancement patterns. The diagnostic performance of MDCT was compared with histopathological and serological findings. Relevant history, clinical examination and routine investigations were done. RESULTS: The one layered pattern with a heterogeneously enhancing thick layered pattern (Type 1) was significantly associated with gall bladder cancer (p<0.001). The sensitivity and specificity of Type 1 enhancement pattern on CT for predicting the Gall Bladder (GB) malignancy were 90.476% and 97.43% respectively. The positive and negative predictive values were 95% and 95%, respectively. Focal wall thickening, irregular margin character and hepatic infiltration by GWT and lymphadenopathy were other findings that predict malignancy (p-value<0.05). CONCLUSION: MDCT enhancement patterns of a thickened GB wall and associated findings were helpful in differentiating malignant GWT from benign GWT.

Colour Doppler Evaluation of Extracranial Carotid Artery in Patients Presenting with Acute Ischemic Stroke and Correlation with Various Risk Factors.

INTRODUCTION: Stroke is defined as an abrupt onset of neurologic deficit due to vascular cause. It is one of the leading causes of mortality and morbidity all over the world making early diagnosis and treatment inevitable. Lesions of extra cranial carotid arteries are implicated in majority of cases of acute ischemic stroke. Carotid Doppler is a non-invasive imaging technique, with sensitivity approaching that of angiography. Computed Tomography (CT) plays a major role to assess the site and nature of the lesion in patients with acute ischemic stroke. AIM: To evaluate the role of carotid Doppler sonography in patients presenting with acute ischemic stroke and find association between carotid artery stenosis and risk factors such as diabetes mellitus, hypertension, hyperlipidemia, smoking and age. MATERIALS AND METHODS: The present study was conducted on 50 patients. CT scan was done to diagnose acute ischemic stroke in patients who presented to emergency medicine with symptoms of acute ischemic stroke. Retrospectively CIMT and plaque characterization were done by gray scale ultrasound. Site and severity of stenosis were assessed on colour Doppler. All these findings were correlated with clinical presentation and risk factors. The collected data was statistically analyzed and multivariant logistic regression (R-value) test of significance was applied by using SPSS 16.0 version software. RESULTS: On carotid Doppler, ICA/CCA PSV ratio was good predictor of stenosis and ratio above three indicates significant stenosis (>60%). Carotid bulb was most common location of plaque formation. Hypertension and diabetes were the most prevalent risk factors for cerebral ischemic stroke. Out of total 50 patients, 32 had hypertension (64%) and 22 had diabetes (44%). Hypertension and hyperlipidemia showed maximum mean R-values (0.275 and 0.048 respectively) and positive correlation with stenosis and increased CIMT in acute ischemic stroke patients. CONCLUSION: The present study highlights the importance of Doppler sonography in acute ischemic stroke patients through surveillance of atherosclerosis.

Uttar Pradesh Association of Physicians of India Position Statement: Tobacco Use and Metabolic Syndrome.

Tobacco use is one of the main preventable causes of mortality and morbidity worldwide. The global disease burden due to tobacco use is huge with projected mortality of eight million lives per year by 2030. Metabolic syndrome (MS) is defined as a constellation of cardiovascular and endocrine risk factors such as insulin resistance, obesity, raised blood pressure, and abnormal lipid profile. The relationship between tobacco use and MS has been well established. Also, the causal association between tobacco use and development of individual components of MS is well established. The Uttar Pradesh Association of Physicians of India (UP API) has drafted this position statement on managing tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). This position statement presents evidence-based recommendations as described below. Scope and purpose The objective of this position statement is to offer clinical recommendations for screening, diagnosis and management of tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). The purpose of this document is to aid in identification and treatment of maladaptive patterns of tobacco use i.e. tobacco use disorder (tobacco dependence, harmful use, abuse) in person with or at risk of developing MS. Intended Audience The position statement is targeted at the clinicians engaged in care and management of person with or at risk of developing Metabolic Syndrome (MS). This might also be of relevance to the policy makers considering the public health burden of both MS and tobacco use disorders.

An atypical case of meconium periorchitis as paratesticular mass in a neonate.

A 20-day-old boy was presented with left scrotal swelling, clinically diagnosed as hydrocele. Ultrasonographic findings suggested hydrocele with paratesticular mass. Intraoperatively we found paratesticular mass, separate from left testis. Specimen revealed fibroconnective tissue with mucoid degeneration and focal areas of calcification suggesting meconium periorchitis. It is important to consider meconium periorchitis as one of the etiologies, thereby avoiding unnecessary orchidectomies.

Cardiac Pseudoaneurysm- A Death Defying Entity.

A pseudoaneurysm refers to a contained rupture of the myocardium with a tenuous pericardium walling off the leak. It needs to be differentiated from a true aneurysm by the fact that there is lack of myocardial tissue in the wall of a pseudoaneurysm. The differentiation between the two is pertinent as true aneurysms can be treated medically while pseudoaneurysms require urgent surgical treatment. Untreated pseudoaneurysms carry a high risk of rupture and mortality. We report a case of cardiac pseudoaneurysm developing in a 46-year-old male who had suffered myocardial infarction four months back. The patient now presented with chest pain and dyspnoea. CECT chest revealed a partially thrombosed large pseudoaneurysm arising from the posterior wall of left ventricle. While the clinical diagnosis of this entity is difficult, CECT plays a pivotal role in the non-invasive detection of pseudoaneurysms.

Vitamin D levels and microvascular complications in type 2 diabetes.

BACKGROUND: Vitamin D has important actions on glucose metabolism. These include improved insulin exocytosis, direct stimulation of insulin receptor, improved uptake of glucose by peripheral tissues, improving insulin resistance. It has got various pleiotropic effects like suppression of cell mediated immunity, regulation of cell proliferation, stimulation of neurotropic factors such as nerve growth factor, Glial cell line-derived neurotrophic factor, neurotropin, suppression of RAAS, reduction of albuminuria, immunomodulatory effects, and anti-inflammatory effects. Thus, vitamin D is implicated in many ways in the pathogenesis of retinopathy, neuropathy and nephropathy. OBJECTIVES: To study the correlation of vitamin D levels with microvascular complications in type 2 diabetes. MATERIALS AND METHODS: Cross-sectional case-control study of 18 patients (18-70 years), who met the American Diabetes Association 2011 criteria for type 2 diabetes, was conducted. Age and sex matched healthy controls were taken. Subjects were evaluated for the presence of microvascular complications by clinical evaluation, urine examination, fundus examination, nerve conduction studies, and various biochemical tests. 25-OH cholecalciferol levels were done for each. Cut off level for vitamin D deficiency was 20 ng/ml. RESULTS: Mean vitamin D was lower in type 2 diabetics than healthy subjects (19.046 vs. 27.186 ng/ml). Prevalence of vitamin D deficiency and insufficiency was found to significantly higher in diabetics when compared to healthy subjects (P = 0.0001). Vitamin D deficiency was found to be significantly associated with neuropathy (χ(2) = 5.39, df = 1, P = 0.020), retinopathy, (χ(2) = 6.6, df = 1, P = 0.010) and nephropathy (χ(2) = 10. 52, df = 1, P = 0.001). Lower levels of vitamin D were found to be associated with increasing prevalence of combinations of microvascular complications namely neuropathy with retinopathy (P = 0.036), neuropathy with nephropathy (P = 0.029), retinopathy with nephropathy (P = 0.022) and neuropathy with retinopathy with nephropathy (P = 0.0001).