Showing papers by "Mahatma Gandhi Memorial Medical College published in 2019"

Novel technique of sutureless glueless scleral fixated intraocular lens (SFIOL).

Abstract: Purpose: To report results of a novel technique for sutureless, glueless intrascleral fixation of three-piece posterior chamber intraocular lens (IOL) using 26-G needle for management of aphakia. Methods: In this prospective series, 30 eyes of 20 patients with aphakia, subluxated IOL, or crystalline lens were included. 26-G-needle-guided intrascleral fixation of three-piece posterior chamber IOL was performed according to the described technique. The patients were evaluated on day 2, 1 week, 6 weeks, and 3 months postoperatively for change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and any other complications. The postoperative tilt of the IOL was indirectly measured by determining the lenticular astigmatism which in turn was calculated by the difference between net corneal astigmatism and refractive astigmatism. Paired t-test was used to determine the significance of any association between the preoperative and postoperative BCVA and IOP. P 0.05), which was not significant. None of the eyes developed any intraoperative and postoperative complications. The IOLs had appropriate centration and stability. Conclusion: We have developed this new technique for intrascleral IOL fixation which is quite simple, cost-effective, minimally invasive, neither requires glue nor suture and gives consistent outcome.

Acute onset clozapine-induced hyperglycaemia: A case report.

Abstract: Clozapine is an atypical antipsychotic which is described to have higher efficacy among all available antipsychotic medications. Clozapine is reserved especially for resistant schizophrenia due to its side effects. Clozapine-induced metabolic syndrome and hyperglycaemia are common long-term side effects and are responsible for increased mortality in patients with schizophrenia. In this case, a patient with resistant schizophrenia was presented with acute-onset hyperglycaemia and delirium with the use of clozapine within a week. Withdrawal of clozapine in the patient led to the improvement in delirium and hyperglycaemia without the use of any hypoglycaemic agent. This case supports the notion that in certain cases clozapine can induce hyperglycemia through possible direct pathophysiological mechanisms within a shorter time frame.

Utility of trichoscopy to diagnose early female pattern hair loss in resource-poor setting: A cross-sectional study.

Abstract: Background: Trichoscopy is a reliable instrument for diagnosis and for tracking therapy-related changes in female pattern hair loss (FPHL). Videodermoscopic diagnosis of FPHL has been established, which requires fine measurements of hair-related parameters; the method requires an expensive equipment/digital program. Aim: To determine whether a low-cost, simple USB dermoscope can ascertain the hair-related changes in early FPHL. Methods: An age-matched, cross-sectional study was performed over 3 years on subjects with less than 6-month history of hair loss and without an obvious broadening of midline hair parting. Trichoscopic analysis of the frontal and occipital scalp of the study subjects were performed, using a USB-connected dermoscope. The subjects were analyzed for the presence of microscopic hair changes in the form of anisotrichosis, vellus-like hair, single hair follicle unit, peri-pilar sign and yellow dots. Results: A total of 230 cases and 230 controls were analyzed. The dermoscopic hair changes were found to be significantly associated with the frontal scalp zone of cases. Limitations: Histopathological evaluation of the cases was not done. Conclusion: Microscopic changes recorded with the help of a simple USB dermoscope are helpful in establishing a diagnosis of FPHL even in early disease.

Radiation Induced Demyelination in Cervical Spinal Cord of the Head and Neck Cancer Patients after Receiving Radiotherapy.

Abstract: Background: Cervical spinal cord is important and radiosensitive. It is the most critical organ for the head and neck (H&N) cancer patients during radiotherapy. If the delivered dose to the cord is more than tolerance dose, demyelination may occur. Objective: Current study aims to analyze the post radiotherapy status of cord in the H&N cancer patients.Material and Methods: In this analytical study, sixty patients who received more than 50 Gray (Gy) dose for more than 10 cm length of spinal cord participated in the study. All the patients were clinically examined and magnetic resonance imaging (MRI) was performed for patients who had demyelination symptoms. Adequate medical management was provided for all the patients having demyelination. Results: Out of sixty patients, ten cases were reported with demyelination symptoms, and only six cases gave consent for this study. One patient was found to have irreversible demyelination while five patients had reversible demyelination. Conclusion: Demyelination may occur if long segment spinal cord receives dose more than tolerance limit. However target dose should not be compromised up to 54 Gy to spinal cord.

Effects and association of pro-oxidants with magnesium in patients with diabetic nephropathy.

Abstract: Diabetic nephropathy (DN) is the most common microvascular complication observed in patients with type-2 diabetes mellitus. Furthermore, magnesium (Mg) deficiency is a common problem in diabetic patients. In this study, we estimated the levels of Mg, which is an important trace element and pro-oxidant marker, and then evaluated the association between serum Mg and pro-oxidants in patients with DN. In the present study, 200 patients were enrolled and were divided into two groups. The control and DN groups consisted of 100 healthy individuals and 100 patients with DN, respectively. Serum Mg, total anti-oxidant capacity (TAC), and superoxide dismutase (SOD) levels were estimated using the Calmagite, Koracevic, and Marklund and Marklund methods, respectively. Glutathione (GSH) and malondialdehyde (MDA) levels were estimated using the Tietze F and Jean CD method, respectively. Mg levels were found to be significantly decreased in the DN group in comparison to the control group. Anti-oxidant markers were statistically significantly reduced (P <0.001), whereas MDA levels were statistically significantly elevated (P <0.001) in the DN group compared to the control group. There was a significant positive association of Mg with TAC, SOD, and GSH. A statistically significant negative association of Mg with MDA (r = -0.302, P <0.001, n = 100) was also observed. An apparent relationship was observed between hypomagnesemia and oxidative stress in patients with DN. Lower levels of Mg and oxidative stress were also strongly linked.

Incidence and risk for Cement Implantation Syndrome after hemiarthroplasty

Abstract: Background: Bone Cement Implantation Syndrome (BCIS) is a highly under-reported rare fatal complication of cementation, characterized by hypoxia, hypotension, cardiac arrhythmias, and cardiac arrest. With aim to alert surgeons about rare, but serious harm due to BCIS and its risk, clinical features, preventive measures and management, we evaluated the incidence and risk factor associated for BCIS in cemented hemiarthroplasty for fractures around hip. Material & methods: All patients of fracture neck of femur or intertrochanteric, operated with cemented hemiarthroplasty, who sustained BCIS during or within 24 hrs of the cementation were included in the study. The BCIS was diagnosed, when the patient had hypoxia (SpO2 20mm. these patients were evaluated for presence of risk factors like age, sex, osteoporosis, use of diuretics, poor preexisting physical reserve, pre-operative cardiopulmonary function etc. Results: In 430 patients of cemented hemiarthroplasty done of fractures around hip, 13 sustained BCIS. The mean age in these patients was 84.3 years. Severity was grade 1 in 7 patients, grade 2 in 4 patients and grade 3 in 2 patients. All the patients of the grade 1 and grade 2 were revived successfully, whereas none of the patients of the grade 3, could be revived. Age and poor cardiac reserves were most commonly associated with BCIS. Conclusion: BCIS is a rare, preventable, fatal complication of cementation which can diagnosed early by constant monitoring. Management is supportive and preventive is best way by surgical modification with modern cementing techniques, especially in high risk patients.

Simultaneous lateral column shortening along with differential distraction by Joshi's external stabilization system for rigid neglected clubfoot correction.

Abstract: Correction of rigid clubfoot in an older child by gradual differential distraction using the Ilizarov's device or Joshi's external stabilization system (JESS) is a time-consuming procedure. We simultaneously combined the lateral column shortening by cuboid wedge resection along with the differential distraction by application of JESS fixator for the treatment of severe, rigid, neglected, or relapsed congenital talipes equinovarus (CTEV) foot deformity in 30 feet in 18 children with mean age of 5.3 years and mean follow-up of 27.6 months. The mean pretreatment Pirani score was 5.3 which improved to mean Pirani score after treatment of 1.4. Excellent results were obtained in 22 (71.33%) feet, good results in four (13.33%) feet, and poor results in four (13.33%) feet. The average period for distraction in our series was 6.3 weeks, and total average period of fixator in place was 11.2 weeks. To conclude, lateral column shortening with JESS application simultaneously gives early good to excellent short-term results, and the combination of techniques permits rapid correction of deformity, and thus reducing the time for which the fixator is in place and hence has better acceptance by the patient.

Palliative hypofractionated radiotherapy in advanced non- small cell lung cancer: A single-institute prospective study

Abstract: Background: A Single Institute Prospective Study was carried out in 75 patients of Advanced Non Small Cell Lung Cancer using three different arms using standard regime and the hypofractionated radiotherapy regime. Methods and Materials: Between July 2010 and September 2011, 75 patients with biopsy proven NSCLC were treated with schemes 1(17 Gy in 2 fractions over 2 weeks; 25 patients), 2 (30 Gy in 10 fractions over two weeks; 25 patients), or 3 (39 Gy per 13 fractions over three weeks; 25 patients). There were 66 evaluable patients. 2 of them died during the study(treatment phase) and 6 were lost to follow up. The minimum follow-up time was 24 months. Results: There was no overall survival difference in all the three arms(p_ .2). The median survival was 6.2 months(arm A:8.5 Gy in 2 fractions one week apart) 6.7 months(arm B:30 Gy in 10 fractions) and 6.8 months(arm C:39 Gy in 13 fractions). Conclusion: Hypofractionated Palliative radiotherapy regime using 17 Gray in two fractions is as effective in alleviation of symptoms as is the standard regime of 30 Gray in 10 fractions and 39 Gray in 13 fraction with no statistical difference in overall survival.

The study of the effect of C-PAP therapy in type-II diabetic patients with obesity and obstructive sleep apnea

Abstract: Type II diabetes mellitus (T2DM) is closely associated with Obstructive sleep apnea (OSA) and obesity. Type 2 diabetes and OSA may be pathophysiologically independent conditions although the joint association with obesity or visceral adiposity. There is a consistent relationship between obesity and OSA, which has been reported in 60-90% of OSA patients. The prevalence of obesity increases with a parallel increase in the prevalence of OSA. Continuous positive airway pressure (CPAP) therapy is an effective choice of treatment for OSA, an overnight test, or titration some patients may reduce apnea events by minimizes airway collapse by CPAP. Several studies showed that the effect of drug treatment with 3 months of C-PAP in patients with type 2 diabetes. In the present study, we include 300 patients in different groups, out of the 100 patients undergoing treatment of CPAP therapy minimum for three months. Blood sugar, HbA1c, and lipid profile were measured and an overnight sleep study was done. The obtained data shows the significant effect of therapy on physiological and biochemical parameters. AHI and BMI were highly significant in group II and Group III when compared to group I. FBS, HbA1C, and Lipid profile parameters also gave significance results (p-value <0.001) in group II and group III when compared with healthy subjects (group I).

Longitudinally Extensive Transverse Myelitis (LETM) Following Varicella Infection in a 13-Year Immunocompetent Child.

Abstract: Varicella infection in children is a common self-limited illness with neurological complications in less than 0.1% of cases. Longitudinally extensive transverse myelitis (LETM) is uncommon in children following infection with varicella-zoster virus. We describe a case of 13-yr immunocompetent girl with LETM following varicella infection shown a dramatic clinical response to a combination of acyclovir and pulse steroids.