Microwave-assisted organic synthesis, antimycobacterial activity, structure-activity relationship and molecular docking studies of some novel indole-oxadiazole hybrids.

Multidrug-resistant tuberculosis (MDR-TB) is a severe threat to mankind because most drugs are ineffective in inhibiting tubercular strains. Due to the increase of MDR-TB, many first and second-line drugs are ineffective against tubercular strains. To combat the resistance of currently accessible drugs, structural changes must be made on a regular basis. Thus, in the search for new antimycobacterial drugs, a series of 1-(2-(1H-indol-3-yl)-5-phenyl-1,3,4-oxadiazol-3(2H)-yl)-3-phenylprop-2-en-1-ones (5a-o) have been developed, synthesized, characterized, and screened for antimycobacterial activity. The synthetic approach includes imine generation and cyclization using both conventional and microwave methods to create hybrid molecules with indole and oxadiazole motifs. The set of synthesized compounds have demonstrated some promising activity against tubercular strains of Mycobacterium tuberculosis (ATCC 25177) and M. bovis (ATCC 35734). Compound 5l inhibited M. bovis strain 100% in 10 µg/mL concentration, while compound 5m inhibited M. tuberculosis strain 90.4% in 30 µg/mL concentration. Molecular docking study against mycobacterial enoyl reductase (InhA) could provide well-clustered solutions to the binding modes and affinity for these molecules as compound 5l showed glide score of -12.275 and glide energy of -54.937 kcal/mol.

Management of bio-medical waste: awareness and practices in a district of Gujarat.

With the objective of assessing the level of awareness about the various aspects of biomedical waste and disposal practices by the medical practitioners this study was conducted. It was a cross sectional study. 30 hospitals with more than 30 beds minimum were randomly selected from Sabarkantha district, Gujarat. The doctors and auxiliary staff of those 30 hospitals were the study population. While all the doctors knew about the existence of the law related to biomedical waste but details were not known. Doctors were aware of risk of HIV and Hepatitis B and C, whereas auxiliary staff (ward boys, ayabens, sweepers) had very poor knowledge about it. There was no effective waste segregation, collection, transportation and disposal system at any hospital in the district. There is an immediate and urgent need to train and educate all doctors and the staff to adopt an effective waste management practices.

Simultaneous spontaneous and primary surgical repair of eyelids.

Fifteen patients with suspected malignant lesions of the lower eyelids or inner canthal region, needing large excisions, were managed as day cases with spontaneous repair and simultaneous subtotal primary surgical reconstruction under local anaesthesia. For lesions confined to the lower eyelid, only those patients requiring full-thickness margin-inclusive (FTMI) excisions of more than half the horizontal extent of the eyelid are included in this study-the largest excision being 21 x 6 mm. For malignant lesions of the inner canthus, only those patients needing moderate to large excision of inner canthal skin and orbicularis with simultaneous FTMI excision of the medial one-third (8 x 5 mm) of the upper as well as the lower eyelid are included. The 16th patient had traumatic loss of inner canthal tissue. The final cosmetic and functional results in all 16 patients were satisfactory and comparable with the results of competent and in-toto primary surgical reconstructions. For large excisions at the inner canthus spontaneous with partial primary surgical repair allows the use of a less extensive and less elaborate surgical procedure that is within the capabilities of most ophthalmic surgeons.

Spontaneous reformation of upper eyelid.

Twenty-six patients with lesions of upper eyelids were treated with simple surgical excision under local anaesthesia as day cases. Three other patients with eyelid injuries had full-thickness margin-inclusive lacerations of upper eyelids. In all these 29 patients the upper eyelid wounds were allowed to heal solely by spontaneous repair. The cautious study began with small extramarginal skin excisions and progressed gradually via moderate sized juxtamarginal excisions of skin and orbicularis lamella to full-thickness margin-inclusive excisions. The wounds healed satisfactorily in all the 29 patients without ocular or palpebral complications. The functional results were normal. Cosmetic results were excellent in 27 patients and acceptable in 2, one of whom subsequently underwent a secondary oculoplastic repair. This study demonstrates that, for upper eyelids, full-thickness margin-inclusive excisions of up to 10 mm in horizontal extent and 5-6 mm in height, and moderate sized 13 X 10 mm juxtamarginal excisions of the skin and orbicularis lamella, yield near normal results with solely spontaneous repair. Immediate surgical reconstruction of such wounds is assumed to be mandatory by current tenets of oculoplastic surgery.

Aplasia cutis congenita presenting as a familial triad of atrophic alopecia, ocular defects and a peculiar scarring tendency of the skin.

We report two siblings with atrophic alopecia, ocular defects and an abnormal tendency to cutaneous scarring. To our knowledge this appears to be the first report of this familial oculocutaneous association and of this peculiar cutaneous scarring.

Day surgery management of senile ptosis.

Corrective surgery for senile ptosis under local anaesthesia as day cases was carried out on 162 patients. All had 10 to 14 mm resection of the levator complex with an attached 2 mm strip of tarsal plate, always via a conjunctival approach. If indicated, simultaneous blepharoplasty was also performed. To simplify the surgical and parasurgical management, the author has progressively introduced modifications in the techniques of local anaesthesia, and in the surgical technique. These enable clear and clean isolation of the various tissue planes. The local anaesthesia including facial nerve block is given at least 30 minutes pre-operatively to prevent blepharospasm. Orbital compression is applied to achieve orbital decongestion, and an hypotensive avascular surgical field. This coupled with the use of microsurgical instruments for surgery under 3 times spectacle magnification allows proper delineation of surgical planes. The average surgical time is 20 minutes. Patients are allowed home within 2 hours of surgery, are seen for first dressing at 48 hours, and then for suture removal on the 7th post-operative day. There have been no corneal or other complications in any patient. Suboptimal cosmetic results in 2 patients were corrected by further surgery under local anaesthesia as day cases.

A new use of K-Y jelly as a gonioscopy fluid.

Methylcellulose drops varying in strength between 0.3% and 2.0% and isotonic saline are the fluids currently used for gonioscopy and posterior segment examination of the eye with diagnostic contact lenses. The author reports the use of K-Y jelly for such examinations in over 80 patients after having it used on his own eyes without any immediate or delayed ill effects. No observable difference was found between saline drops, methylcellulose drops of 0.3% and 2.0%, and K-Y jelly as regards the visibility of the anterior and posterior segments of the eyes. The more viscous fluids of 2% methylcellulose and K-Y jelly were more convenient to use, as they rarely allowed interposition of air bubbles between the cornea and the contact lens. K-Y jelly was well tolerated by all subjects.

Spontaneous reformation of lower eyelid.

Eleven consecutive patients with tumours involving the lower eyelid margin were treated with margin-including full-thickness excision of the eyelid and suturing of bleeding vessels as the sole primary surgical procedure, needing less than 10 minutes. The resulting defects of 2/5 to 7/8 of the horizontal extent of the eyelid and varying in height from 4 to 7 mm were allowed to heal spontaneously. In all the 11 patients the wounds healed, without ocular or palpebral complications in about 6 weeks and underwent further cosmetic improvement for the ensuing 6--8 weeks. Cosmetic results were excellent in 8 patients with excisions of 2/5 to 1/2 of the eyelid. All procedures including the secondary reconstructions were carried out on day-case basis under local anaesthesia. Histology confirmed complete tumour clearance in all the patients. Apart from being the first report of a planned study of spontaneous repair of full-thickness surgical wounds of the lower eyelid this study shows that the conventional method of dressing such wounds can be replaced by the less expensive and convenient 'dressing' of a cartella shield with an improvised central hole.

Innovations in eyelid surgery. New concepts in the management of patients.

A new technique of full-thickness skin graft fixation utilizing central and paracentral sutures between the graft and the depths of the recipient bed is described. The intrinsic fixation provided by these sutures eliminates the potential dead space, and the shearing strains that jeopardize a successful take. The validity of Hering's law in levator surgery and other clinical implications of reciprocal innervation of the levator muscles of the two upper eyelids are demonstrated. The traditional teaching of oculoplastic surgery considers it obligatory that defects created by margin-including full-thickness excisions of the lower eyelids be surgically reconstructed immediately, but it is shown that spontaneous reformation after such excisions gives satisfactory results.

Biodegradation of nylon loops of intraocular implants in children.

In none of the 418 first-stage intraocular implant insertions with intracapsular cataract extractions I have carried out in adults is there any clinical evidence of nylon loop degradation. Although there are no previous reports of clinically observable implant loop degradation, clinically detectable biodegradation was found in eleven eyes of seven children and four adults among the 34 second-stage iris-clip or iridocapsular implants I inserted after aspiration of cataract in children and young adults. The degradation has not produced any uveitis, keratopathy, or instability of the implants in any of these patients. Two children had unilateral glaucoma in the eye containing an iris-clip implant. One of them had dense amblyopia in that eye and the iris-clip implant was removed at the time of trabeculectomy. Scanning electron microscopy of this implant is reported. Active search for nylon particles in the trabeculectomy specimen of the second child has shown the presence of strongly birefringent particles in the trabecular tissue. The possible mechanism of biodegradation of the nylon loops is discussed.

A new method of full thickness skin graft fixation.

A technique of free full thickness skin graft fixation utilising central and paracentral sutures between the graft and the depths of the recipient bed is described. The intrinsic fixation provided by these sutures allow larger free grafts, thus eliminating the need to use local flaps. These sutures also allow double free grafts-mucosal and dermal-for full thickness lower eyelid reconstructions. Patients do not need hospital admission and can resume normal activity immediately after the operation. One hundred and nine skin grafts secured by this technique have yielded very satisfactory results.

The contralateral upper eyelid in ptosis: some observations pertinent to ptosis corrective surgery.

The validity of Hering's law in corrective surgery for ptosis is demonstrated for the first time. It is also shown how Hering's law has been utilised in corrective surgery for unilateral ptosis to elicit a predominant response from the unoperated contralateral upper eyelid. Other implications of reciprocal innervation of the 2 upper eyelids are discussed and a tentative hypothesis is postulated that in a case of true unilateral levator ptosis the fellow upper eyelid will show compensatory retraction.

Primary repair of eyelid lacerations.

A brief outline of the principles of repair of eyelid wounds is given. The undesirable consequences of inexpert primary repair are contrasted with the near normal function and cosmesis obtained after repair carried out with the author's 5-layer suturing technique described here for the first time. It is emphasized that, provided there is no ocular perforation, waiting up to 48 hours to obtain optimal conditions for the operation does not affect the outcome.

Assessment of major intraocular and extraocular surgery performed as day cases.

A review of 473 patients operated upon as day cases indicates that such surgery is safe, effective, and practicable. The surgical procedures included strabismus and ptosis correction in 265 children; major oculoplastic surgery for subtotal full-thickness eyelid reconstruction; and intraocular surgery in adults for trabeculectomy, cataract extractions with or without simultaneous intraocular implant introduction, and cataract extractions combined with trabeculectomy. No modification in surgical technique was required for strabismus and ptosis surgery. Slight modification was necessary for cataract surgery, and certain innovations were made in oculoplastic surgery.