Clinical profile of anterior uveitis in tertiary health centre of central India

To study the clinical profile of anterior uveitis in patients attending the Ophthalmology department of tertiary health centre of central India A cross-sectional, observational study was done in the department of Ophthalmology of tertiary health centre from January 2017 to July 2019. A total of 199 cases of anterior uveitis were studied to assess their clinical presentation and etiology. After thorough history taking, demographic data and clinical pattern were documented. Comprehensive ophthalmic evaluation, necessary laboratory investigations and radiological imaging were performed to establish the etiology. The maximum number (n=79; 39.7%) of patients were in the age group of 21-40 years and the mean age of the study subjects was 36.9+21.8 years. The male to female ratio was 1:1.42 (117 females, 82 males). Uniocular disease was found in 91.95% cases and majority (n=175; 87.93%) of the patients had acute presentation with 95.47% cases having non granulomatous uveitis. A specific diagnosis could not be made in 62.8% cases. Trauma (21.7%) was the most common cause in patients with a specific diagnosis. Persistent posterior synechiae was the most frequently seen complication (21.08%) although majority of the patients (66.8%) did not reveal any major complications.Patients with anterior uveitis most commonly had acute presentation. The disease was rarely bilateral and was mostly non-granulomatous in presentation. It was mostly idiopathic and among the known etiological factors, trauma was the most common cause.

An Audit on Gastrointestinal Perforation in a Tertiary Care Teaching Hospital Based in Northern Part of India: A Study of 100 Cases

Background: A prospective study was conducted on 100 patients of perforation peritonitis: To find out the incidence of gastro intestinal perforation in various age groups, sex, riral or urban, socio economic status, To find out the various causes and sites of gastra intestinal perforartions, To determine various types of procedures being done to treat gastro intestinal perforations.Methods:The study population consisted of 100 patients of perforation peritonitis admitted at surgical wards of Rajindra Hospital, Patiala. Patients underwent necessary investigations such as Blood counts, biochemical analysis and urine analysis. X-ray Abdomen and chest / USG Abdomen/Pelvis CT-Abdomen (as and when required). All diagnosed patients were subjected to surgery. In all cases, operative findings and postoperative course were followed up for three months. Final outcome was evaluated on the basis of clinical, operative and radiological findings. In pre-pyloric and duodenal perforation, GRAHAM’S PATCH REPAIR carried out. In Ileal and Jejunal perforations, primary closure or exteriorization done depending upon the condition of the gut and duration of the symptoms. The patient outcome was assessed by duration of hospital stay, wound infection, wound dehiscence, leakage/entero-cutaneous fistula, intra-abdominal collection/abscess, ileostomy related complications and reoperation. Wound infection was graded as per SSI grading.Results:Most common age group for perforation was 21-40 years (50%) followed by 41-60 (33%) years in present study. Mean age of the patients is 37.91 + 13.15 years with male predominance (78%) in our study. 4% of the patients were of upper socio-economic status while 32% of the patients were of middle and 64% of the patients were of lower socio-economic status.Abdominal pain was seen in 100% of the patients while abdominal distension was present in 69% of the patients. Nausea/Vomiting was seen in 61% of the patients while Fever and Constipation was seen in 53% and 86% of the patients respectively. Diarrhoea was seen in 3% of the patients. Tenderness, guarding & rigidity, distension, obliteration of liver dullness and evidence of free fluid were present in 100% of the patients. Bowel sounds were not detected in all the patients. Most common perforations were Duodena(37%), Ileal (25%), Gastric (25%) followed by Appendicular (9%), Jejunal (4%) and Colonic perforation (2%). The most common etiology of gastrointestinal perforations was Peptic ulcer followed by Typhoid, Appendicitis, Tuberculosis, Trauma, Malignancy and non-specific infection.In Gastric perforations, Peptic ulcer was the most common cause of perforation followed by Trauma. In Ileal perforations, Typhoid was the most common cause of perforation followed by Tuberculosis and non-specific infection. In Appendicular perforations, most common cause was Appendicitis. In Jejunal perforations, most common cause was Trauma. In Colonic perforations, most common cause was Malignancy.Conclusions:The incidence of gastrointestinal perforations was common in 21-40 years age group followed by 41-60 years age group with male preponderance in our study. The most common site of perforations was Gastro-duodenal followed by Ileal perforations and the most common cause for these perforations was peptic ulcer followed by typhoid. The most common procedure done to treat gastrointestinal perforations was primary closure, resection and anastomosis, appendectomy and stoma formation. However, small sample size and short follow up period were the limitations of the present study.

One Obstacle among Many: The Filibuster and Majority Party Agendas

In today’s hyper-partisan environment, scholars and commentators contend that the filibuster poses a nearly insuperable obstacle to a Senate majority party’s agenda, limiting Congress’s output to non-controversial measures. Drawing on data about congressional majority party agenda priorities from 1985 to 2020 we identify when and how majority party legislative efforts fell short of success and take stock of the degree to which the filibuster was the primary culprit. Not surprisingly, our data confirm that the filibuster is a significant problem for majority party agendas. But an even more common cause of failure is the majority party’s inability to agree among themselves. Despite increased voting cohesion generally, parties in the polarized era still routinely struggle to bridge their own internal divides.

Antisense oligonucleotide-based therapeutic strategy for progranulin-deficient frontotemporal dementia

Loss-of-function GRN mutations result in progranulin haploinsufficiency and are a common cause of frontotemporal dementia (FTD). Antisense oligonucleotides (ASOs) are emerging as a promising therapeutic modality for neurological diseases, but ASO-based strategies for increasing target protein levels are still relatively limited. Here, we report the use of ASOs to increase progranulin protein levels by targeting the miR-29b binding site in the 3′ UTR of the GRN mRNA, resulting in increased translation.

Fluorescence Molecular Targeting of Colon Cancer to Visualize the Invisible

Colorectal cancer (CRC) is a common cause of cancer and cancer-related death. Surgery is the only curative modality. Fluorescence-enhanced visualization of CRC with targeted fluorescent probes that can delineate boundaries and target tumor-specific biomarkers can increase rates of curative resection. Approaches to enhancing visualization of the tumor-to-normal tissue interface are active areas of investigation. Nonspecific dyes are the most-used approach, but tumor-specific targeting agents are progressing in clinical trials. The present narrative review describes the principles of fluorescence targeting of CRC for diagnosis and fluorescence-guided surgery with molecular biomarkers for preclinical or clinical evaluation.

UROVAGINAL FISTULA IN TERTIARY HOSPITAL OF WEST JAVA INDONESIA

Objective: This study was conducted to find out the frequency and characteristics of urovaginal fistula patients. Material & Methods: This study design used a retrospective descriptive research design conducted at a tertiary hospital in West Java, Indonesia (Hasan Sadikin General Hospital) from 1 January 2010 to 31 December 2016. Results: Of all 22 urovaginal fistula patients, the majority in the age range of 41-50 years, and there was one patient in the age range of 61-70 years. Fourteen patients (63.6%) had defects in the bladder, and 36.5% of patients had defects in the ureters. There were nine patients (40.9%) who had urovaginal fistula after undergoing a hysterectomy procedure. The other causes were cervical carcinoma (40.9%), difficult labor (9.1%), radiotherapy (4.5%), carcinoma rectum (4.5%), cesarean section procedure (9.1%), and other gynecological procedures such as myomectomy or cystectomy (9.1%). Based on the type and location of the fistula, the majority of patients had vesicovaginal fistula/VVF (59%), ureterovaginal fistula/UVF (36%), and a combination of ureterovesicovaginal fistula (5%). The causes of VVF and UVF are different from each other. In patients with VVF, the most common cause is cervical carcinoma (35.7%). Meanwhile, the most common cause of UVF is hysterectomy (75%). Conclusion: Of the various types of urovaginal fistulas, vesicovaginal fistulas are the most frequently encountered. In general, the characteristics of urovaginal fistula patients in Hasan Sadikin General Hospital is slightly different from the literature, especially the cause of fistula. At Hasan Sadikin General Hospital, vesicovaginal fistulas are mostly caused by cervical cancer, not a hysterectomy. For ureterovaginal etiology, the characteristics of patients in Hasan Sadikin General Hospital are caused mainly by hysterectomy.

New Horizons for Personalised Treatment in Gastroesophageal Cancer

Gastric and gastroesophageal junction adenocarcinoma (GEA) is still responsible for a huge health burden worldwide, being the second most common cause of cancer-related death globally [...]

Point-of-Care Urine Gram Stain for Managing Febrile Urinary Tract Infection in Adults

Background Febrile urinary tract infections (fUTIs), which include pyelonephritis, prostatitis, and urosepsis, are the most common cause of sepsis. However, the treatment has become more complex because of the world-wide increase in antimicrobial resistance (AMR). The objective of this study was to clarify whether point-of-care Gram stain (PCGS) of urine contributed to fUTI diagnosis and treatment in adults. Methods This hospital-based observational study was undertaken between January 2013 and March 2015 in Okinawa, Japan. All enrolled patients were adults who had been admitted to the Division of Infectious Diseases with suspected fUTI. The usefulness of PCGS results were compared for urinalysis (U/A) and urine cultures (U/Cs). The targeted therapy type and its effectiveness based on PCGS were analyzed, and each was investigated in two groups: the uncomplicated pyelonephritis group and the complicated pyelonephritis/prostatitis group. Results Two hundred sixty-six patients were enrolled. The results of PCGS were closely correlated with those of U/A for pyuria and bacteriuria, and moderately correlated with the results of U/C for bacterial types. In the uncomplicated group, narrow-spectrum antimicrobials such as cefotiam were initially selected in 97.9% (47/48) of patients, and their effectiveness was 97.9% (47/48). In the complicated group, the effectiveness was 84.2% (186/221) (p=0.009) despite frequent AMRs (14.7%; 32/218) and low use of broad-spectrum antimicrobials such as carbapenems (7.7%; 17/221). Conclusion Urine PCGS led to a more precise fUTI diagnosis and prompted clinicians to select narrower-spectrum antibiotics with high effectiveness.

In Vitro Efficacy of Cyclosporine A and Various Antiseptics and Antiviral Drugs on Adenovirus Genotype 8, a Common Cause of Epidemic Keratoconjunctivitis

Purpose: To evaluate the in vitro efficacy of cidofovir, ganciclovir, povidone iodine, chlorhexidine, and cyclosporine A on adenovirus genotype 8 Methods: Conjunctival samples were collected from patients with adenoviral conjunctivitis and cultured in A549 cells. Adenovirus diagnosis was confirmed by RT-PCR. For each drug, the 50% cytotoxic concentration (CC₅₀) was determined. Subsequently, the antiviral activity was tested at concentrations below CC₅₀, and the 50% inhibitor concentration (IC₅₀) of drugs was determined.Results: While the IC₅₀ of cidofovir against adenovirus genotype 8 was 3.07 ± 0.8 µM, ganciclovir, povidone iodine, chlorhexidine, and cyclosporine A were not found to be effective against adenovirus genotype 8 at concentrations below the CC₅₀ value.Conclusions: Cidofovir was found effective and the IC₅₀ value was within the ranges in the literature. Ganciclovir and cyclosporine A were found to be ineffective at doses below the cytotoxic dose, povidone iodine and chlorhexidine were found to be highly cytotoxic.

Medical errors — causes and contradictions

Studying and improving the theory of errors of doctors has always been important, and today it has become especially relevant.The article lists the main provisions of the advanced version of the theory of errors of doctors. The main content of the articleis devoted to four important aspects of the problem of physician errors. The article states the main contradiction of the problemof errors in medicine. The structure of general objective and subjective causes of medical errors is shown. The main optionsfor doctors to experience errors that complicate doctors’ mutual understanding in this problem are formulated. For the fi rsttime, the reasons for the denial of errors by doctors are summarized. These aspects and conclusions on them are the result ofan analysis of publications on the problem of errors in medicine, repeated discussions of the problem on professional medicalsites. The content of these aspects was based on its own material on error analysis and observation from practice. The aboveaspects and their conclusions need not so much to be confi rmed by special studies, but rather to refl ect on their role and placein the problem of errors. The general objective and subjective reasons for the occurrence of medical errors are shown inconnection with their possible "guilt". Lack of experience is presented as the most common cause of medical errors. Variousoption for doctors to experience errors are presented as a reason that makes it diffi cult for doctors to understand this problem.