Vertical rectus transposition procedures for lateral rectus palsy: A systematic review

Multiple transposition procedures have been described for management of lateral rectus palsy. However, relative effect and indications of each procedure are unclear. This systematic review was planned to evaluate functional and anatomical outcomes of vertical rectus transposition (VRT) surgery in patients with lateral rectus palsy. We searched databases in English language, namely, MEDLINE, PubMed Central, EMBASE, Google Scholar, Scopus, and Index Copernicus without any date restrictions in electronic searches, using the search words 'vertical rectus transposition for lateral rectus palsy,” “vertical rectus transposition for abducens palsy,” “superior rectus transposition,” “inferior rectus transposition,” and “Hummelsheim procedure.” References of the selected publications were also searched to find any relevant studies. We searched for studies that provided data on single VRT and double VRT surgeries for lateral rectus palsies. Three authors independently assessed the related studies gathered from electronic and manual searches. We found 27 studies which were relevant to the review question. As there were no randomized control trials (RCTs) available related to our study question, nonrandomized studies were used to arrive at summarization of outcomes of different transposition procedures. There is a need for prospective RCTs to investigate the different types of transposition procedures for lateral rectus palsy.

Macular hole following phakic intraocular lens implantation and its management

A 28-year-old male presented to retina clinic with complains of blurring and distortion in right eye for past 1 week. There was history of implantation of phakic intraocular lens (pIOL) bilaterally 4 months back. Ophthalmic examination revealed a full-thickness macular hole in the right eye. Pars plana vitrectomy with inverted internal limiting membrane flap was planned. Post-operatively, patient had a good gain in vision (20/40) with closure of the hole. Macular hole is an unusual complication of pIOL. A detailed pre-operative fundus screening is indispensable. Early presentation and timely intervention can optimize the visual outcome.

Insecticide susceptibility status of Phlebotomus argentipes, a vector of visceral leishmaniasis in different foci in three states of India.

Background & objectives: Phlebotomus argentipes is the vector for visceral leishmaniasis in India. The development of resistance in kala-azar vector to DDT has been reported from various parts of India. The main objective of this study was to generate information on insecticides susceptibility status of P. argentipes to DDT, malathion and deltamethrin in different parts in three states of India. Methods: Phlebotomus argentipes were collected from different villages, identified and used to investigate the susceptibility status against DDT, malathion and deltamethrin as per the WHO standard methods. Results: Phlebotomus argentipes was resistant to DDT in different areas, viz. PHCs Murumgaon in Maharashtra; Ramgarh in Jharkhand; Kodah, Falka, Mahua and Lalganj in Bihar. In Phulwari Shareef PHC of Patna district in Bihar, DDT produced 89% mortality in P. argentipes, indicating resistant/tolerance (verification required) to DDT. The corrected percent mortality to malathion (5%) in different areas ranged between 98 and 100%; and to deltamethrin (0.05%) between 98.4 and 100%. The results showed that the tested P. argentipes are susceptible to malathion and deltamethrin. Conclusion: Phlebotomus argentipes are still susceptible to malathion and deltamethrin, but resistant to DDT. The susceptibility status of P. argentipes should be monitored regularly in diversified situations to ascertain the judicious use of insecticides being used for indoor residual spraying in the programme for rational use of appropriate insecticide.

Indocyanine green clearance test (using spectrophotometry) and its correlation with Model for End Stage Liver Disease (MELD) score in Indian patients with cirrhosis of liver.

Background: Child Turcotte Pugh (CTP) score and Model for End Stage Liver Disease (MELD) are used commonly to assess the prognosis of liver disease but the disadvantage of these static tests is their inability to identify the functional reserve of the liver. Among all quantitative liver function tests indocyanine green (ICG) clearance test is most widely used and has been used to determine operative risk before hepatectomy and to assess prognosis of patients with cirrhosis. Aim: To correlate indocyanine green (ICG) clearance test with MELD score in patients with cirrhosis of liver. Methods: Forty patients with cirrhosis of liver were included and divided into two groups according to their CTP scores. Group A had 20 patients with CTP class A and group B had 20 patients with CTP class B. After ICG injection, ICG retention at 15 minutes (ICGR15) and ICG clearance rate were calculated. Results: In group A, the mean ICGR15 was 32.86% + 6.4% while in group B it was 51.08% + 12.8% (p <0.001). ICG clearance rates were 4.3% + 2.8% and 3.5% + 3.8% per minute in group A and B respectively. MELD score had a strong positive correlation with ICGR15 but a negative correlation with ICG clearance rate. On ROC curve analysis, AUC for MELD was 0.805 vs. 0.88 for ICGR15 in assessing prognosis of patients with cirrhosis. The sensitivity and specificity of MELD score was 60% and 80% respectively while that of ICGR15 was 85% and 90% respectively. Conclusion: ICGR15 has a higher sensitivity and specificity than MELD score in assessing the prognosis of patients with cirrhosis of liver.

Situation Analysis of Malaria in Godda District of Jharkhand During Malaria Epidemic.

The epidemiological and entomological investigations were carried out in 18 tribal villages of Godda district of Jharkhand state revealed average slide positivity rate (SPR) 9.9% and slide positivity rate for Plasmodium falciparum (SfR) 5.0%, respectively. P. falciparum was the dominant parasite accounting 51.2 per cent of the total infections. All the villages are situated in the deep forest and forest fringes. A total of 416 blood slides were collected and examined. Out of which 41 slides were found positive for malaria parasite (21 positive for P. falciparum and 20 positive for P. vivax). All the positive cases were treated with Blister Packs of anti-malarial of chloroquine and primaquine as per NBVDCP schedule to prevent further transmission of malaria, which were available. Rapid diagnostic Kits were used selectively only on the recommendation of the Physician/Medical Officer. Results of house to house fever survey indicated the presence of high percentage of symptomatic carriers of malaria parasites in the local population and in our study Pf % is more than reported data by District Malaria Office, Godda district, Jharkhand. In entomological studies, for mosquito fauna with reference to both Anopheline, 11 species belonging to one genus Anopheles were collected and identified during the survey; among them some species were most prevalent. A total of 599 mosquitoes were recorded and average density of mosquitoes recorded was 13.19 in human dwellings and 86.11 in cattle sheds.

Hepatitis E epidemic with bimodal peak in a town of north India.

INTRODUCTION: An epidemic of viral hepatitis occurred in Mandi Gobindgarh town of Punjab in northern India during year 2005-06. An attempt was made to study the outbreak clinically, serologically, and etiologically. METHODS: Line listing and spot mapping of all cases of jaundice presented to civil hospital was done. An active search of cases was made through house-to-house visit with the help of 33 teams and 6 supervisors. Twenty two blood samples collected from acute cases were tested for anti-HAV IgM and anti-HEV IgM by ELISA. HEV specific PCR was also carried out. Sanitary survey was also done and water samples were tested for coliforms. RESULTS: In house to house survey 3170 cases of jaundice were reported; of them 2171 (68.5%) were males. Mean age was 28.8 years. Overall attack rate was 5.2%. The epidemic continued for more than a year and bimodal peak was observed. Civil hospital campus which has separate water supply had no jaundice case. About 95% blood samples from icteric patients were found to be positive for IgM and IgG antibodies of HEV. Eighteen persons died during the epidemic, mostly in old age group. Case fatality ratio was 0.57%. No deaths occurred among 17 pregnant women who had developed hepatitis. CONCLUSION: The epidemic was caused by hepatitis E virus, which was transmitted due to faecal contamination of municipal water supply.

Studies on mosquito larvicidal properties of Eucalyptus citriodora Hook (family-Myrtaceae).

Hexane extract obtained from leaves of Eucalyptus citriodora Hook was tested against larvae of Anopheles stephensi Liston, Culex quinquefasciatus Say and Aedes aegypti Linn to assess its toxicity and growth inhibiting activity. The results showed better activity of hexane extract against larvae of An. stephensi Liston as compared to the larvae of Cx. quinquefasciatus Say and Ae. aegypti Linn. The LC50 values against IVth instar larvae of three species were 69.86, 81.12 & 91.76 ppm respectively after 24 hours and 26.7, 29.9 & 38.8 ppm respectively after 72 hours. At lowest concentration viz. 10 ppm, 73% larvae of An. stephensi Liston failed to emergence as adult mosquito while in Cx. quinquefasciatus Say and Ae. aegypti Linn only 10 & 6% larvae failed to emerge. Further observations showed some morphological abnormalities in same pupae which could not moult normally. These results clearly indicated growth inhibition effect of the hexane extract of Eucalyptus against mosquito larvae, particularly Anopheles species. Thus Eucalyptus citriodora Hook, which is commonly found in Northern India, has a great potential for the development of an eco-friendly herbal insecticidal product for control of mosquito breeding.

Benign recurrent intrahepatic cholestasis (BRIC) in an adult.

Benign recurrent intrahepatic cholestasis is a rare hereditary disorder characterised by recurrent episodes ofcholestasis. We report the case of a young male patient with benign recurrent intrahepatic cholestasis who presented to us with recurrent cholestatic jaundice and pruritus with negative work up for all possible aetiologies and a liver biopsy consistent with intrahepatic cholestasis. He improved on treatment with ursodeoxycholic acid and ondansterone and is doing well on follow up.

Insulin tolerance test is comparable to homeostasis model assessment for insulin resistance in patients with nonalcoholic fatty liver disease.

INTRODUCTION: Insulin resistance (IR) is common in patients with nonalcoholic fatty liver disease (NAFLD). We compared the performance of insulin tolerance test and the homeostasis model assessment (HOMA) for measuring IR in such patients. METHODS: In a prospective study, IR was determined using both insulin tolerance test and HOMA in 22 patients with NAFLD. Rate constant for insulin tolerance test (KITT) was calculated using the formula KITT (%/min) = 0.693/t(1/2), where t(1/2) was calculated from the slope of plasma glucose concentration during 3-15 minutes after administration of intravenous insulin. IR was assessed using HOMA as the product of fasting insulin (microU/L) and fasting plasma glucose (mmol/L) levels divided by 22.5. RESULTS: All the 22 patients had IR. Results of KITT and HOMA-IR for determining IR showed a fair correlation (r = 0.55; p = 0.03). CONCLUSIONS: Insulin tolerance test may be a useful method for assessing IR in patients with NAFLD.