Role of dacryoendoscopy in refractory cases of congenital nasolacrimal duct obstruction.

Purpose: To highlight the importance of dacryoendoscopy in recognizing the factors responsible for failure with successful recanalization obviating the need for dacryocystorhinostomy in a few selective cases.Method: A retrospective study of 13 children undergoing dacryoendoscopy for refractory congenital nasolacrimal duct obstruction (CNLDO) was carried out during a period of 3 years from 2016 to 2018. Children with single or multiple failed probings were included in the study.Results: Out of the total 13 cases included in the study there 9 males and 4 females. The age ranged from 9 months to 36 months with the involvement of the right side in 7 cases and the left side in 6 cases. Four cases had dysgenesis of bony nasolacrimal duct (NLD), 4 cases had dacryolith, 3 cases had an intact membrane at the lower end of NLD and 2 cases had fibrosis of the lower end of NLD and the surrounding area in the inferior meatus (IM) following multiple interventions, (Table 1). Dacryoendoscopic recanalization was done in 7 cases while the endoscopic dacryocystorhinostomy (DCR) was done in 6 cases. Asuccessful outcome was achieved in all the cases and at the end of 6 months, all the children remained asymptomatic.Conclusions: Dacryoendoscopy (DEN) facilitates direct examination of the nasolacrimal system and thus has an added advantage over nasal endoscopy assisted probing in the refractory cases of CNLDO.

An Observational Study on C-Reactive Protein to Platelet Ratio in Neonatal Sepsis.

BACKGROUND: Neonatal sepsis is a serious medical condition affecting many individuals in the developing world. C-reactive protein (CRP) level in serum and platelet counts have been reported to have role in diagnosis of neonatal sepsis. OBJECTIVE: To evaluate the CRP to Platelet ratio (CPR) in relation to time and blood culture reports in neonatal sepsis patients from a tertiary care centre in the Marathwada region of Maharashtra. METHODS: The present observational study was conducted at the level III Neonatal Intensive Care Unit of a tertiary care centre in Aurangabad city of Marathwada region in Maharashtra from September 2022 to July 2023. The study included 120 neonates (delivered after completion of 28-42 weeks of gestation) with clinical/culture-positive sepsis. The newborns of seropositive mothers, neonates delivered in other hospitals, babies with congenital dysmorphic features, and babies requiring surgical procedures were excluded from the study. Blood samples for complete blood count (CBC) and CRP were collected on days 1, 3 and 5. Blood cultures were sent on day 1 of illness. Repeated measures ANOVA was used to compare the parameters of CPR, CRP, and platelet count in blood culture-positive and blood culture-negative neonatal sepsis patients on days 1, 3 and 5. RESULTS: Blood culture was positive in 37 (30.8%) cases. A repeated measures ANOVA showed a significant overall difference in the CPR across days 1, 3, and 5 (p = 0.006). The CPR was significantly higher in culture-positive neonates compared to culture-negative neonates (p = 0.042). CONCLUSION: Higher CPR in blood culture-positive neonates compared to blood culture-negative neonates supports the role of CPR in the diagnosis and management of neonatal sepsis.

Constitutive production of catalytic antibodies to a Staphylococcus aureus virulence factor and effect of infection.

Antibodies that recognize microbial B lymphocyte superantigenic epitopes are produced constitutively with no requirement for adaptive immune maturation. We report cleavage of the Staphylococcus aureus virulence factor extracellular fibrinogen-binding protein (Efb) by catalytic antibodies produced with no exposure to the bacterium and reduction of the catalytic antibody activity following infection. IgG catalytic antibodies that specifically hydrolyzed Efb via a nucleophilic catalytic mechanism were found in the blood of healthy humans and aseptic mice free of S. aureus infection. IgG hydrolyzed peptide bonds on the C-terminal side of basic amino acids, including a bond located within the C3b-binding domain of Efb. Efb digested with the IgG lost its ability to bind C3b and inhibit complement-dependent antibody-mediated red blood cell lysis. In addition to catalysis, the IgG expressed saturable Efb binding activity. IgG from S. aureus-infected mice displayed reduced Efb cleaving activity and increased Efb binding activity compared with uninfected controls, suggesting differing effects of the infection on the antibody subsets responsible for the two activities. IgG from children hospitalized for S. aureus infection also displayed reduced Efb cleavage compared with healthy children. These data suggest a potential defense function for constitutively produced catalytic antibodies to a putative superantigenic site of Efb, but an adaptive catalytic response appears to be proscribed.

A Trans-pedicle Approach to Avoid Exiting Nerve Root Injury in Full-Endoscopic Transforaminal Decompression: A Case Report.

This report aims to describe a case with an extremely low-located exiting nerve root and introduce the trans-pedicle approach for endoscopic transforaminal decompression, which can enable the safe visualization of the exiting nerve root. We present the medical history, imaging findings, and surgical procedures of a 62-year-old male who underwent left L3/4 and L4/5 endoscopic transforaminal decompression for foraminal stenosis. The patient presented with pain and numbness in the anterior and lateral aspects of the left thigh. MRI revealed left L3/4 and L4/5 foramen stenosis and endoscopic transforaminal decompression was performed. The working channel was guided and positioned at the upper lateral part of the left L4 pedicle. We observed the L3 root being compressed by scar tissues against the upper edge of the L4 pedicle. Then we used a protective diamond burr to drill the upper part of the L4 pedicle, enlarging the L3/4 foramen. Subsequently, pituitary Rongeur, Kerrison, and punches were employed to meticulously remove scar tissues around the exiting root. The same procedure was performed for left L4-5 foramen decompression. The radicular symptoms were relieved immediately after the surgery. Our proposed trans-pedicle endoscopic transforaminal approach can reduce the risk of injuring a low-located exiting nerve root. It can also help standardize the procedure, improves working channel stability, and facilitates the learning process, making it a valuable technique for full-endoscopic transforaminal decompression.