Delayed diagnosis of pemphigus vulgaris in rural Nepal due to healthcare inaccessibility and harmful traditional practices: A case report.

Early intervention is imperative for potentially fatal dermatologic diseases such as pemphigus vulgaris. In rural Nepal, limited public awareness, home remedies, and delays in healthcare access lead to poor outcomes. Although biopsy confirms the diagnosis, experienced dermatologists can make an accurate clinical diagnosis when characteristic skin lesions are present.

Comprehensive Review on Recent Strategies for Management of Prostate Cancer: Therapeutic Targets and SAR.

Prostate cancer is a disease that is affecting a large population worldwide. Androgen deprivation therapy (ADT) has become a foundation for the treatment of advanced prostate cancer, as used in most clinical settings from neo-adjuvant to metastatic stage. In spite of the success of ADT in managing the disease in the majority of men, hormonal manipulation fails eventually. New molecules are developed for patients with various hormone-refractory diseases. Advancements in molecular oncology have increased understanding of numerous cellular mechanisms which control cell death in the prostate and these insights can lead to the development of more efficacious and tolerable therapies for carcinoma of the prostate. This review is focused on numerous therapies that might be a boon for prostate therapy like signaling inhibitors, vaccines, and inhibitors of androgen receptors. Along with these, various bioactive molecules and their derivatives are highlighted, which act as potential anti-prostate cancer agents. This article also emphasized the recent advances in the field of medicinal chemistry of prostate cancer agents.

Management of Locally Advanced Esophageal Cancer.

Esophageal cancer is diagnosed usually at a locally advanced stage. Surgery alone has less optimal results and a multimodality approach has been established as the standard of care for cII-III stages of esophageal cancer. This review focuses on the recent evidences of management of esophageal cancer with various variations in approaches in Eastern and Western countries. The major difference is the selection of induction treatment. Till the results of some ongoing trials become available, most of the evidences support neoadjuvant chemoradiation followed by surgery for squamous cell carcinoma and perioperative chemotherapy and surgery for adenocarcinoma.

Evidence Based Surgical Approach to Locally Advanced Gastric Cancer.

Gastric cancer is endemic in China, Japan, Korea, Brazil and Former Soviet Union. Patients are diagnosed usually in locally advanced stage. Endoscopy, Positron Emission Therapy- Computed Tomography, Endoscopic ultrasound and staging laparoscopy are the tools for proper evaluation of such patients. Locally advanced gastric cancer (T2-4N0 or TanyN+) requires multimodality treatment including surgery. Resection is the cornerstone of cure for gastric adenocarcinoma; however, several aspects of surgical intervention remain controversial or are suboptimally applied at a population level. Current evidence shows a D2 gastrectomy has got the best survival results. At least 15 lymph nodes should be assessed for adequate staging. Laparoscopic resections should be performed to the same standards as those for for open resections, by surgeons who are experienced in both advanced laparoscopic surgery and gastric cancer management. Keywords: Curative surgery; gastrectomy; stomach neoplasms.

Correlation of nuclear density using the Lens Opacity Classification System III versus Scheimpflug imaging with phacoemulsification parameters.

PURPOSE: To grade nuclear cataracts using the Lens Opacity Classification System III (LOCS III) and the correlation with maximum nuclear density on Scheimpflug imaging and phacoemulsification parameters. SETTING: Tertiary care center. DESIGN: Longitudinal interventional study. METHODS: The nuclear density of significant age-related cataracts was evaluated by comparing slitlamp images with standard photographic charts of the LOCS III system. Maximum nuclear density was calculated using a Scheimpflug imaging system (Pentacam). All patients had phacoemulsification and posterior chamber intraocular lens implantation. Intraoperatively, parameters (eg, phaco time, power consumed, balanced salt solution used) were noted and compared with different grades of cataract and maximum nuclear densities. RESULTS: One hundred patients with visually significant age-related cataract were evaluated. There was a positive linear correlation between the LOCS III grading and Scheimpflug maximum nuclear density (P<.001). The LOCS III grading and Scheimpflug maximum nuclear density had a linear correlation with preoperative corrected distance visual acuity (r = 0.588 and r = 0.525, respectively), cumulative dissipated energy (CDE) (r = 0.607 and r = 0.847, respectively), total ultrasound (US) time (r = 0.627 and r = 0.802, respectively), and fluid used (r = 0.623 and r = 0.678, respectively). CONCLUSION: Both systems had a linear correlation with total US power, CDE, and fluid used; however, the Scheimpflug imaging system had a stronger correlation with these phacoemulsification parameters.

A new surgical technique using steel suture for trans-scleral fixation of posterior chamber intraocular lenses.

BACKGROUND: A new emerging complication of trans-scleral fixation of posterior chamber (PC) intraocular lens (IOL) with polypropylene suture is high rates of spontaneous dislocation of the IOL due to disintegration or breakage of suture. MATERIALS: We report a new surgical technique of trans-scleral fixation of posterior chamber intraocular lens (SF PCIOL) with steel suture to eliminate the complication of dislocation of IOL fixed with polypropylene suture in one adult and a child. RESULTS: We successfully achieved stable fixation and good centration of IOL after SF PCIOL with steel suture in these patient having inadequate posterior capsular support. Both eyes achieved best corrected visual acuity 20/40 at 18 months follow-up. CONCLUSIONS: Steel suture is a viable option for trans-scleral fixation of posterior chamber intraocular lens.

Effect of penetrating and blunt ocular trauma on the outcome of traumatic cataract in children in northern India.

BACKGROUND: We studied the demographic profile and outcome of traumatic cataract after penetrating and blunt ocular trauma in children in northern India. METHODS: We reviewed the medical records of children with penetrating and blunt ocular trauma associated with traumatic cataract who underwent cataract surgery with posterior chamber intraocular lens implantation and having more than 1 year follow up. We evaluated the demographic characteristics and visual outcome in the affected eye. RESULTS: Of the 100 children (100 eyes), 65 were penetrating trauma and 35 were blunt trauma. The common modes of injury in the penetrating group were wooden splinters in 30.8% and bow and arrow in 15.4%. Fire crackers and trauma during play with ball were seen in 34% and 11.4% of blunt eye trauma, respectively. The age ranged from 1 to 14 years (mean, 7.8 years) in the penetrating trauma and 2 to 15 years (mean, 8.3 years) in the blunt trauma group. The best corrected visual acuity of 20/40 or better was achieved in 57.6% eyes in penetrating group compared with 71.4% in the blunt trauma group. Visually significant posterior capsular opacification developed in 32.3% eyes in penetrating group and 28.6% eyes in blunt trauma group. Glaucoma was diagnosed in 4.6% eyes in penetrating group and 8.6% in blunt trauma group. CONCLUSION: Eye injuries with traumatic cataract are associated with significant visual impairment. There were more children with penetrating eye injuries as compared with blunt trauma. Cataract surgery with intraocular lens implantation is a preferred method for visual rehabilitation in these children. LEVEL OF EVIDENCE: Epidemiologic study, level IV.

Outcome of cataract surgery with primary intraocular lens implantation in children.

AIM: To report the results of paediatric cataract surgery with primary intraocular lens (IOL) implantation. METHODS: Children with congenital or developmental cataract who underwent phacoaspiration with posterior chamber (PC) IOL implantation were retrospectively studied. Group A included children with polymethyl methacrylate, group B hydrophobic acrylic and group C silicone IOLs. Outcome measures were visual axis clarity, visual outcome and refractive changes. RESULTS: There were 230 children (381 eyes) with the age ranging from 1 months to 15 years. Group A comprised 208, group B 144 and group C 29 eyes. Posterior capsule opacification was seen in 38/208 in group A and 21/144 in group B and 4/29 eyes in group C. The mean refractive error at 2 weeks, 1 year and 3 years after cataract surgery in the age group ≤2 years was +3.38±3.07 D (median +3.75 D), +1.72 D±3.19 (median +1 D) and -0.51 D±3.59 (median -0.5 D); in the age group >2-8 years +0.84±3.18 D (median+1.5 D), +0.27 D±3.14 (median +0.5 D) and -0.62 D±2.81(median -0.75D); and in the age group >8 years -0.44±1.73 D (median -0.5 D), -0.70±1.77 D (median -0.75 D) and -0.89 D±1.60 (median -0.75D) respectively. Children ≤2 years had a significant myopic shift (p<0.001). LogMAR visual acuity was ≥0.3 in 62.2% of eyes in bilateral and 30.90% in the unilateral group. CONCLUSIONS: Paediatric cataract surgery with primary PCIOL implantation is safe. Refractive changes and PCO are the main hurdles for achieving optimal visual outcome.