Results of fusional vergence therapy in managing consecutive esotropia: A case series

Purpose: To analyze the efficacy of fusional vergence therapy (FVT) in management of consecutive esotropia with diplopia after intermittent exotropia (IXT) surgery. The current study is carried on how FVT affects the duration of treatment, sensory fusion, and exotropic drift. Methods: This was a retrospective study for the medical record of 11 patients with consecutive esotropia after IXT surgery of 543 patients over the period of 5 year, with mean surgery age of 9.5 (range: 4–33 y). FVT was planned after minimum 6 weeks of surgery and was considered for maximum 24 weeks. Patients underwent a combination of office-based and home-based FVT. Successful outcome of therapy was considered where diplopia resolves in free space and achieves sensory fusion, stereopsis with no manifest deviation. Results: Record of 543 patients who had horizontal muscle surgery for IXT were identified and reviewed. Records of 11 patients who showed consecutive esotropia of 10 prism diopter (PD) or more with normal retinal correspondence, with or without diplopia complaint, after 6 week of surgery and had undergone vision therapy management were reviewed. A successful outcome of binocular single vision with good sensory and motor fusion with no manifest deviation or prism requirement was achieved with in the mean duration of 4.8 month of therapy. With a mean duration of 4 weeks of therapy, the mean angle of deviation reduced by 53% for distance (17 PD to 8 PD) and 27% for near (11 PD to 8 PD) and mean stereopsis improvement by 80% with 94% patients demonstrating sensory fusion on Bagolini test and 94% of patients having no symptoms of diplopia or squint. Conclusion: With nonsurgical management involving refractive error correction, FVT, and prism, consecutive esotropia was resolved in 74% cases. Management of consecutive esotropia with FVT can result in satisfactory sensory fusion and successful motor alignment.

Clinical and socio-demographic profile of substance abusing persons seeking treatment at a teaching hospital in Garhwal hills of Uttarakhand

Background: The substance abuse is gradually becoming one of the major public health issues of present day India. Many factors influence the pattern of substance abuse, including age, sex, educational level, social support, cultural factors, availability of drugs and the presence of cognitive or psychiatric problems. This study was planned to find out the clinical and socio-demographic profile of substance abusing persons.Methods: The study was conducted in the Out-patient facility of the Department of Psychiatry, Veer Chandra Singh Garhwali Government Institute Of Medical Science and Research, Srinagar (Uttarakhand), starting from 23 September 2015. One hundred consecutive treatment seeking subjects fulfilling International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), criteria for Mental and behavioural disorders due to psychoactive substance use were included in the study. All the participants were required to sign an informed consent approved by the institutional ethical committee before being enrolled in the study. All the subjects included in the study were administered a self-structured proforma to elicit the clinical and socio-demographic variables.Results: One hundred patients consisting of 95 men (95%) and 05 women (05%) were included. The average age of the sample was 39.68 years (SD=11.97). As for the socio-demographic variables other than age, 87% of the patients were married, 62% patients were living in nuclear families and 66% belonged to the rural areas. 79% patients were educated up to high school and above and only 06% were illiterate. Alcohol was the most frequently abused substance seen in 78% patients followed by tobacco smoking in 58% of the study subjects. Peer Pressure was cited as the most common reason for the initiation of substance abuse by 75 (75%) patients.Conclusions: Alcohol was the most commonly abused substance. Substance abuse was higher in married, educated males from rural areas living in nuclear families.

An adaptive clinical trial on patients with non variceal upper gastrointestinal bleed with the help of endoscopy

Background: Acute upper gastrointestinal hemorrhage (UGIH) is a common condition worldwide frequently leads to hospital admission also has a significant associated morbidity and mortality, especially in the elderly. A systematic diagnostic and definite therapeutic approach is essential to establish a diagnosis, relevant to specific investigations for appropriate treatment in tertiary medical care center.Methods: A comparative trial was done on n=109 cases with an objective to find out the different causes of UGI bleed in population, to assess the requirement of blood transfusion in patients with massive GI Bleed and to compare the treatment outcome of Proton pump inhibitors over Tranexamic acid and Octreotide in non-variceal UGI bleed. The cases were assigned to three different groups by lottery system. Proton pump inhibitors (Omeprazole), Somatostatin (Octreotide), Anti-fibrinolytic (Tranexamic acid), outcome was assessed after complete treatment and follow up.Results: Out of 150 cases, 109 were diagnosed with non-variceal GI bleed, 35 cases were treated with Omeprazole out of which 11.42% cases received blood transfusion, and 4 had history of re bleeding, Mean Duration of stay in hospital was 4.4±1.75, when compared to the other two group the duration of hospitalization was least as the P value was <0.0001.Conclusions: In this study it was demonstrated the use of PPI in case of Non-Variceal Bleeding significantly reduces the need of blood transfusion. Even it reduces the cases of re bleeding and duration of hospital stay.

Vitamin D deficiency in patients with tuberculosis and its correlation with glycemic status

Background: Comorbidity of diabetes and tuberculosis has serious health implications. Presence of diabetes at least three times increases the risk of tuberculosis which may be mediated by an abnormal innate immune response due to hyperglycaemia or low vitamin D levels.Aim of the study- Present study was carried out to investigate whether lower serum 25(OH) D might be associated with higher prevalence of pulmonary or extra pulmonary tuberculosis which might provide an evidence for a role of vitamin D in the comorbidity of these two diseases and does it have any correlation with glycemic status.Methods: In a hospital based cross sectional study, 264 patients with newly diagnosed tuberculosis were enrolled and according to glycemic status they were divided into three groups. They were assessed for vitamin D deficiency in addition to routine laboratory and biochemical parameters.Results: The patients with diabetes had significantly lower vitamin D levels. The prevalence of severe vitamin D deficiency was highest in patients who had diabetes with tuberculosis. There was negative correlation between vitamin D levels and Hba1C and extensiveness of pulmonary tuberculosisConclusions: Serum vitamin D levels were significantly lower in tuberculosis patients with pre-diabetes and type 2 diabetes compared with those, who had normal glycemic status. We suggest that there is a need to pay more attention to vitamin D status in this country and if there is coexisting diabetes or impaired glucose intolerance, emphasis on vitamin D supplementation can be of utmost importance.

Role of serum phosphate level in cardiovascular events in non-CKD patients

Background: Serum phosphate level correlate with atherosclerosis in both animal models and humans with advanced chronic kidney disease and coronary calcification is a known impact of higher serum phosphate, but whether this relationship exists among individuals with Non-CKD is unknown. we conducted this study to observe role of higher serum phosphate level in cardiovascular comorbidities like MI and CHF in Non-CKD patients.Methods: In this observational study, 300 patients were enrolled, half of the patients having Clinical features or positive biochemical markers (Troponin-I for MI and serum BNP for CHF) suggestive of myocardial infarction and heart failure were taken as case group and half of the subjects were taken as control group with similar baseline characteristics. All participants in this study were consenting and more than 18 years of age.Results: The mean value of serum phosphate level in case group was 4.41±1.40 while in control group was 3.19±1.07 showing statistically significant difference (p-value <0.001). In case group 65% patients were having MI with higher serum phosphate level (4.22±1.40).Conclusion: Higher serum phosphate level is related to increased cardiovascular morbidities even in non-CKD patients.

A case of resolution of inferior wall myocardial infarction and varying degrees of atrioventricular block: a case report.

Inferior wall myocardial infarction (IWMI) complicating with high degree atrioventricular (AV) block had been a subject of discussion for a long time. Also the transient nature of these AV blocks in the presence of IWMI is well known to us. However our case presented with IWMI with right ventricular MI (RVMI) and in complete heart block and subsequently post thrombolysis developed varying degrees of AV block and reverted back to sinus rhythm. We found it as an incidence not much reported and thus reporting the case herewith.

Unifocal bony lesion of langerhans cell histiocytosis of tibia in a child mimicking osteomyelitis : A diagnostic challenge.

Langerhans cell histiocytosis (LCH) is a rare proliferative histiocytic disorder of unknown etiopathogenesis. The clinical presentations range from unifocal or multifocal bony lesions to disseminated form of the disease with multiorgan involvement. The unifocal bony lesion (Solitary eosinophilic granuloma) carries a good prognosis. We report such a case of unifocal bony lesion of LCH involving tibia in a 8 years old female child. The clinical and radiological manifestations were non specific, enlightening the suspicion of osteomyelitis. A curettage excision biopsy was performed which on microscopy revealed sheets of eosinophils in milieu of Langerhans cells, giant cells, lymphocytes and plasma cells. Langerhans cells showed strong immunoreactivity for S-100 and CD1a antigen thus establishing the diagnosis of LCH. LCH of long bones may be a rare entity but it must be kept in mind as a differential diagnosis whenever a child presents with features of osteomyelitis.

Eradicating Polio: It's Feasibility in Near Future.

Continuous wild poliovirus transmission despite 12 years of intensive surveillance has raised serious questions about the feasibility of polio eradication programme with current strategy in near future. At present most of the cases are confined to four endemic countries, which are causing sporadic outbreaks in non-endemic areas. India has experienced a significant increase in number of cases reported in 2006 compared to previous year. Outbreaks originated in western UP which was due to the accumulation of susceptibles between the last outbreak in 2002 and early 2006. Substantial improvement has been observed in strategies of polio eradication but still there are gaps in the programme implementation which needs immediate attention so that goal of polio eradication can be achieved at the earliest opportunity. Even though there are many issues but there are also many factors, which favour polio eradication. These factors include new tool in form of m OPV, natural immunity due to recent outbreak, limiting international spread of polio, new researches to guide programme in right direction, political commitments from endemic countries, etc. 2008 presents the best opportunity ever to interrupt wild polio virus transmission which will lead to global eradication of Polio. Since global eradication is within sight, it is scientifically possible to eradicate the disease in near future.

Spectrum of stones composition: a chemical analysis of renal stones of patients visiting NMCTH.

A general observation of clinicians suggests that the prevalence ofurolithiasis is fairly high in Kathmandu but so far no systematic study has been undertaken here to explore the etiopathogenesis of disease in this region. In this preliminary communication, we present herewith the qualitative composition of 47 renal stones collected from surgical patients admitted to NMCTH over a period of 13 months (July 2005 to July 2006). All stones were of mixed type. Calcium was present in all stones. Oxalate, phosphate and uric acid were present in 95.7%, 87.2% and 34.0% patients respectively. The probable composition, as construed from analysis, suggests that calcium oxalate stones are predominant. Strikingly, the prevalence was very high in e"20 yrs age group.

Epidemiology and etiopathogenesis of urinary calculi in western Nepal (Pokhara).

Urinary stone disease is recorded in the literature from the dawn of the history and has spared no segment of society irrespective of age, gender, occupation and socio-economic status. It is still termed as "Refractory Disease" as complete medical management to prevent occurrence or recurrence is not so far available. We conducted a preliminary survey from the Manipal Teaching Hospital and carried out urinalyses to ascertain risk factors in the local population. This preliminary survey indicates the prevalence of stone disease is in moderate zone. Hyperoxaluria is an important risk factor in more than one fourth of the stone formers; and hypernatriuria is distinctly most common potentiating risk factor.

Oxidative stress and antioxidant status in cancer patients and healthy subjects, a case-control study.

Since raised oxidative stress (OS) or weak antioxidant defence or both are considered to be important players in multimechanistic pathogenesis of cancer, the present study was undertaken to evaluate their possible involvement in the pathogenesis of this disease in the local population. Levels of plasma vitamin C, vitamin E, total antioxidant activity (TAA) and thiobarbituric acid reacting substances (TBARS) as a marker of OS were measured in 20 cancer patients (Mean age 63.1 + 9.3 yr.) and 20 age, sex and socioeconomically matched healthy subjects (Mean age 63.7+7.8 yr.). Significantly low level of vitamin C (p <0.001), vitamin E (p <0.001) and TAA (p <0.003) were observed in cancer patients, whereas OS was significantly increased in patients as compared to control (p <0.003). Smokers had significantly lowered TAA and significantly raised OS than non-smokers, in both case and control groups. Tobacco chewer patients had raised OS as compared to control. This study supports the thesis that OS is a risk factor in carcinogenesis and that smoking, an established risk factor in cancer, at least partly appears through it.