Congenital Eventration of Diaphragm Presenting As Diaphragmatic Hernia: A Case Report.

Eventration of diaphragm is an abnormal elevation of diaphragmatic musculature while retaining normal attachments to the sternum, ribs and dorsolumber spine. It is a rare anomaly where the continuity of diaphragm remains intact. Pathological process can affect either all or only a portion of hemidiaphragm. Symptoms vary according to size of the defect. Large defect may mimic diaphragmatic hernia. The present case represents a full term female newborn that developed respiratory distress, cyanosis and feeding difficulties since 1st day of life. Clinical features and chest imaging of this case was assumed to be left sided diaphragmatic hernia which was found wrong in the operation theater. She was found to have left sided eventration of diaphragm to create symptom. Successful plication of ipsilateral diaphragm was done on 13th day of life. Supervised post operative ventilatory support along with other postoperative care improved the condition of this neonate. A large defect with eventration of diaphragm may be life threatening but a timely good management can save neonate from such condition.

Organophosphorus Compounds Poisoning in a Neonate: A Case Report.

Organophosphorus compounds (OPC) are widely used insecticides. Such poisoning is very rare in neonate. A 23 days old infant was admitted with severe respiratory distress, excessive secretion from nose and mouth, bluish discoloration of extremities and poor feeding for 4 hours. He was pale, cyanosed and lethargic with gasping respiration. Frothing was coming through mouth and nose. There was watering of eyes, pupils were pin pointed and light reflex was sluggish. The baby was hypothermic, hypotonic with altered sensorium. Capillary refill time was <3 sec. The neonate was gasping; there was crepitation over lung fields. Precordium and abdomen was normal. An odor of OPC was smelt on clothing and secretions of the infant. The baby was wrapped with a cloth that was ware during pesticide spraying in the field. In addition to general measures, decontamination of skin and clothing and gastric lavage was done. Empirical antibiotic, injection atropine and pralidoxime were given. Patient showed clinical improvement with disappearance of cholinergic signs. The baby was discharged on 7th day of admission after full recovery.

Off-Label Medication in Children: Responsibilities of Pediatrician and Neonatologist.

Use of drug in pediatrics and neonatology should be rational. There are clinical situations when the use of unlicensed medicines or use of medicines outside the terms of license (i.e., 'off-label') may be judged by prescriber in the best interest of the patient. Off-label prescribing is clinically appropriate when the benefits outweigh the potential risks. Such practice is particularly common in pediatrics and neonatology where development of age-appropriate formulations is difficult. Before going to prescribe a drug on off-label basis, the clinician should be satisfied that an alternative medicine would not meet the patient's needs. The clinician should be satisfied that there is sufficient evidence base safety and efficacy on off-label drug use. Communication with legal guardian with sufficient information about proposed treatment is needed. The clinician has a responsibility to monitor the off-label use of drug. He should submit a report on suspected adverse drug reactions if he observes to the authorized body.

A study of adherence to DOTS regimen among pulmonary tuberculosis patients in West Tripura District.

BACKGROUND: Noncompliance to the DOTS regimen leads to treatment failure, relapse, MDR tuberculosis, XDR tuberculosis etc. requiring more prolonged & expensive therapy. AIM: To assess the adherence rate among pulmonary tuberculosis patients in west Tripura district and to study the factors affecting adherence to DOTS regimen among pulmonary tuberculosis patients. MATERIAL AND METHODS: This community based cross-sectional study was conducted among 220 pulmonary tuberculosis patients registered for treatment with DOTS therapy; under six randomly selected DMC of West Tripura District. RESULTS: The study revealed that the adherence rate among the pulmonary TB patients was 84.50 percent. Male tuberculosis patients had 87.10 percent less chance of being adherent to the DOTS regimen in reference to females, and Cat I patients were 8.96 times (C.I. 2.689-29.857) more adherent to the therapy compared to the retreatment cases. Again, patients whose continuation phase was supervised as per the guidelines of DOTS were 12.07 times more adherent to the therapy. PTB patients who had the knowledge of supervised therapy in DOTS and curability of the disease, were 4.70 times (C.I. 1.39-15.79) and 9.39 times (C.I. 1.03-85.99) more adherent to the therapy, respectively. CONCLUSION: The study showed good adherence to the regimen among pulmonary tuberculosis patients in spite of being a difficult area. It may also help in planning and implementation of tuberculosis control measures by addressing and overcoming the barriers regarding treatment completion.

Electroencephalogram (EEG) in the management of epilepsy in children.

Electroencephalogram (EEG) has an important role in the management of seizure disorder in children. It helps in diagnosis and classification of epilepsy, choosing of antiepileptic medication and prediction of prognosis. When history of epilepsy is unclear, EEG can help to distinguish epileptiform discharges from its counterpart. But EEG has limitations. In epilepsy, EEG has variable range of sensitivity and specificity. Hereby, during interpretation of EEG, clinical situation should not be ignored. Interictal EEG has important diagnostic and prognostic value in epilepsy. But caution is needed during evaluation of significance of interictal epileptiform discharge (IED). Methods like recording of EEG in awake and sleep state, hyperventilation and photic stimulation enhances the yield of interictal EEG. Long term EEG recording has an important role in the assessment of patients who present diagnostic or management difficulties following clinical evaluation and routine EEG.

Optic nerve cysticercosis.

Optic nerve cysticercosis is rare but causes significant visual morbidity. A high index of suspicion is warranted for patients in endemic areas who present with sudden vision loss. Visual morbidity can be prevented by early imaging studies and therapeutic interventions.

The Ahmed Glaucoma Valve in refractory glaucoma: experiences in Indian eyes.

PURPOSE: To evaluate the efficacy of the Ahmed Glaucoma Valve implant in refractory glaucomas in Indian eyes. MATERIALS AND METHODS: A retrospective review was conducted on the charts of 122 eyes of 122 patients with refractory glaucoma treated with Ahmed Glaucoma Valve implant placement at Guru Nanak Eye Centre, New Delhi between January 1996 and December 1999. The main outcome measure was success at the last follow-up. Success was defined as an intraocular pressure (IOP) of 22 mmHg or less and 5 mmHg or more and at least a 30% reduction in IOP without visually devastating complications or additional glaucoma surgery. RESULTS: The mean postoperative IOP (17.29+/-3.79 mmHg) was significantly (P<0.001) lower than the mean preoperative IOP (31.47+/-7.86 mmHg) at last follow up (mean 12.51+/-8.37 months; range 3-24 months). The cumulative probability of success by Kaplan-Meier analysis was 85.95% at 12 months and 82.83% at 24 months. The mean number of postoperative antiglaucoma medications (0.75+/-0.80) was also significantly lower (P<0.001) than the mean preoperative number of antiglaucoma medications (2.83+0.72). The most common complication was corneal-tube contact, which occurred in five (4.10%) eyes. Retinal detachment occurred postoperatively in one eye with the clinical diagnosis of neovascular glaucoma secondary to Eale's disease. Two patients had tube extrusion requiring repositioning and reinforcement with scleral patch graft. CONCLUSIONS: Ahmed Glaucoma Valve implantation is an effective and relatively safe therapy for the treatment of refractory glaucoma in Indians.

Tuberculous osteomyelitis and optic neuritis.

This case report describes a rare instance of bilateral optic papillitis associated with histologically and bacteriologically proven tubercular osteomyelitis of the right sphenoid and temporal bone of the orbit in a 30-year-old woman. This case also highlights the usefulness of computerized axial tomography of the orbits, skull, and paranasal sinuses to evaluate optic neuritis and its pathophysiology in the event of no obvious cause or contributing systemic disease.

A comparative study of small incision trabeculectomy avoiding tenon's capsule with conventional trabeculectomy.

BACKGROUND AND OBJECTIVE: The purpose of this study was to compare the results of small incision trabeculectomy (SIT) avoiding Tenon's capsule vis-à-vis conventional trabeculectomy, and find a safe, effective alternative to conventional trabeculectomy with or without pharmacological wound modulation. PATIENTS AND METHODS: A controlled prospective study was conducted on 80 consecutive open-angle glaucoma patients requiring glaucoma filtration surgery. They were divided into two groups: Group I (n = 40): patients undergoing conventional trabeculectomy; and Group II (n = 40): patients undergoing limbal approach SIT. Patients were followed up serially for a minimum of 12 months and their intraocular pressure was monitored. Success of the procedure was defined as an intraocular pressure (IOP) <22 mm Hg with no additional antiglaucoma medication or surgery, and achieving at least a 30% reduction from the initial IOP at which optic disc cupping and/or visual field changes occurred. RESULTS: A significant fall (P <0.0001) in the final mean IOP was present in both groups at all time intervals in comparison to their preoperative values. The final mean intraocular pressure achieved with conventional trabeculectomy was 18.90 +/- 4.86 mm Hg versus 16.60 +/- 5.93 mm Hg with SIT. The final success rate of 90% was obtained with SIT vs 80% with conventional trabeculectomy. No major complications were encountered with either procedure although complications such as shallow anterior chamber and progression of cataractogenesis were seen more often in patients undergoing conventional trabeculectomy. CONCLUSION: Small incision trabeculectomy avoiding Tenon's capsule is a low-cost and safe alternative to conventional trabeculectomy that effectively reduces IOP in 90% of cases. The use of a small 2.5 mm limbal incision, which obviates the dissection of Tenon's capsule and absence of any major complication, suggests that this procedure be used more often in glaucomatous eyes needing filtering surgery.

Rhinosporidiosis and peripheral keratitis.

Report of a case of peripheral keratitis caused by Rhinosporidium seeberi. The patient was seen in a referral practice. Corneal scraping was performed on a middle-aged female patient presenting with peripheral keratitis and progressive nasal obstruction that revealed spores suggestive of rhinosporidiosis. The patient was started on topical amphotericin B 0.15% eye drops. Ear, nose, and throat (ENT) examination showed presence of a polypoid lesion in the left nostril for which a polypectomy was performed. Histopathological examination confirmed rhinosporidiosis. Complete resolution of the keratitis was observed. Topical amphotericin B is an effective drug in the management of this condition. Keratitis secondary to rhinosporidial infection has not been described although occasional patients with limbal and scleral involvement have been reported. Corneal scraping was effective in helping us make a tentative diagnosis.

Small incision trabeculectomy: experiences with this new procedure for glaucoma surgery in Indian eyes.

PURPOSE: The purpose of this study was to evaluate the potential advantages and disadvantages, success rate and complications of this new procedure for glaucoma surgery, which includes the formation of a filtration fistula without any dissection of the Tenon's capsule; as an alternative to trabeculectomy with or without pharmacological wound modulation. METHODS: Small Incision Trabeculectomy avoiding Tenon's capsule was performed in 40 glaucomatous eyes through a 2.5 mm limbal incision and intraocular pressure was monitored serially over a period of 12 months. RESULTS: The mean postoperative intraocular pressure (16.60+/-5.93 mmHg) at 12 months follow-up was significantly lower than the mean preoperative IOP (30.20+/-10.70 mmHg). Thirty-six eyes (90%) had IOP less than 22 mmHg without antiglaucoma medications at the end of the 12-month follow-up. Blebs were pale and diffusely elevated. No serious complications were encountered. CONCLUSION: This new technique is a low-cost and safe alternative to conventional trabeculectomy that effectively reduces intraocular pressure. The use of a small 2.5 mm incision which obviates the dissection of the Tenon's capsule and subsequent subconjunctival fibrosis, the absence of requirement of any sophisticated instruments, and the absence of any major complications which are encountered with the use of anti-metabolites entails that this procedure be performed more often in glaucomatous eyes needing filtration surgery.

Lateral rectus split in the management of Duane's Retraction Syndrome.

This case reports Type I Duane's Retraction Syndrome with marked upshoot of the globe in adduction. An 18-year-old patient presented with complaints of not being able to move his left eye outwards since childhood. A 'Y' split of the lateral rectus muscle was performed in the affected eye. There was marked cosmetic and functional improvement in the patient which was stable after 6 months of follow-up. Y splitting of the lateral rectus muscle is a simple technique that can be used effectively in the treatment of marked upshoot or downshoot in Duane's Retraction Syndrome.

Limbal papilloma with massive corneal extension.

The authors report a case of limbal papilloma with extensive corneal involvement. The limbal lesion was excised completely, leaving a clear corneal bed. Histopathologically, the lesion was found to be a limbal papilloma. Massive superficial involvement of the cornea by papilloma is rare. Simple excision is effective in treating the condition with restoration of vision and cosmesis.

Correlation of anthropometric measurements of mothers and their newborns.

This cross-sectional study was designed to assess the influence of the nutritional status of the mother upon the anthropometric measures of their babies. It was conducted at three different hospitals of Dhaka city during a short period of 5 weeks in 1992. One hundred and fifty mothers with their newborns were studied to correlate their anthropometric measurements. Weight, height/length and mid-arm-circumference were measured. The study showed that the correlation between weight of mother and weight of her newborn was stronger than that between heights (length) and mid-arm-circumferences of the mothers and the newborn. Correlation between mid-arm-circumference of mother and newborn was statistically insignificant whereas correlations of other variables were statistically significant. Height of mother and length of newborn daughter were less well correlated than height of mother and length of newborn son which showed relatively significant correlation (p < 0.05). The study indicates that the anthropometric measures of the newborn babies might be an outcome of the nutritional status of the mother.

PIP: The influence of maternal nutritional status on infant anthropometric measures was investigated in a cross-sectional study conducted at three hospitals in Dhaka, Bangladesh, in a 5-week period in 1992. Weight, height/length, and mid-arm circumference were measured in 150 mother-infant pairs. Of strongest significance was the association of maternal weight with birth weight, especially in male infants. Also significant were positive correlations between maternal height and the length of male newborns, maternal weight and the length of both male and female infants, maternal height and birth weight, and maternal mid-arm circumference and birth weight. The only nonsignificant association was that between maternal and infant mid-arm circumferences.

Comparative study of incidence of diarrhea among children in two different environmental situations in Calcutta.

PIP: 100 children under age 5 in 1 Calcutta slum and an equal number of children the same age in multistory buildings having better sanitray facilities and belonging to low socioeconomic class were followed up for a 10 month period. Episodes of diarrhea/child in slum and multistory buildings were 1.6 and 1.4 respectively, indicating no difference in incidence. Water supply and provision of latrines were not effective in reducing the incidenceof diarrhea in children. Education level of the mothers, and health knowledge of parents influenced the incidence of diarrhea in children. Malnourished children had more episodes of diarrhea than the normal. Similarly, partially breastfed children suffered more than those fully breastfed.^ieng