A rare case of WAGR syndrome with Peter anomaly

We report a case of the WAGR syndrome associated with the Peter anomaly. A 6-day-old baby boy was found to have bilateral corneal opacities, 360 degrees of iris hypoplasia and cataracts. Physical examination revealed bilateral undescended testicles. Family history was unremarkable and genetic testing revealed a deletion 11p11.2-13 indicating WAGR syndrome. A Wilms tumor developed and was removed at age 2 years. There was moderate developmental delay. The occurrence of WAGR syndrome with Peter anomaly has been reported in three other patients to our knowledge

One-step synthesis of hydrophobized gold nanoparticles of controllable size by the reduction of aqueous chloroaurate ions by hexadecylaniline at the liquid-liquid interface

Vigorous stirring of a biphasic mixture containing hexadecylaniline in chloroform and aqueous chloroauric acid results in the formation of gold nanoparticles of controllable size in the organic phase

Eye Movements, Strabismus, Amblyopia, and Neuro-Ophthalmology Vertical Vergence Adaptation Produces an Objective Vertical Deviation That Changes With Head Tilt

PURPOSE. To document the cyclovertical ocular motor mechanism used for vertical fusion in healthy subjects, and to explore whether vertical vergence training in healthy individuals can produce objectively confirmed vertical deviations that change with head tilt, revealing a basic mechanism that can produce a pattern of misalignment in an otherwise normal ocular motor system that is similar to superior oblique muscle paresis (SOP). METHODS. Seven subjects with normal orthoptic examinations were adapted to vertical image disparities using our tilting haploscopic eye-tracking apparatus presenting concentric circle targets without torsional cues. Static eye positions were recorded with head straight and when tilted 45 degrees to the left and right, during both binocular and monocular viewing. RESULTS. Vertical fusional vergence was accompanied by a cycloversion, with the downwardmoving eye intorting and the upward-moving eye extorting, implicating primary involvement of the oblique extraocular muscles. After adaptation to the slowly increasing vertical target separation, all subjects developed a temporary vertical deviation in the straight ahead position that increased with head tilt to one side and decreased with head tilt to the other side. CONCLUSIONS. These results not only show that head-tilt-dependent changes in vertical deviation are not necessarily pathognomonic for SOP, but also, and more importantly, suggest mechanisms that can mimic SOP and suggest a possible role for vertical vergence training in reducing deviations and thus the amount of head tilt required for fusion. Ultimately, vertical vergence training may provide an adjunct or alternative to extraocular muscle surgery in selected cases

Food and welfare in India, c. 1900–1950

In 2001, the People's Union for Civil Liberties submitted a writ petition to the Supreme Court of India on the “right to food.” The petitioner was a voluntary human rights organization; the initial respondents were the Government of India, the Food Corporation of India, and six state governments. The petition opens with three pointed questions posed to the court: * A. Does the right to life mean that people who are starving and who are too poor to buy food grains ought to be given food grains free of cost by the State from the surplus stock lying with the State, particularly when it is reported that a large part of it is lying unused and rotting? * B. Does not the right to life under Article 21 of the Constitution of India include the right to food? * C. Does not the right to food, which has been upheld by the Honourable Court, imply that the state has a duty to provide food especially in situations of drought, to people who are drought affected and are not in a position to purchase food

General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multicentre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients’ (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16–22) and failed intubation in 1 in 312 (95%CI 1 in 169–667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

Extrahepatic Portal Hypertension -Review of 40 Cases

Abstract Extrahepatic portal hypertension is usually caused by thrombosis or cavernomatous transformation of the portal vein. The salient questions concerning this disorder relate to the general prognosis, including the course of the nonshunted patient, the applicability of decompressive shunting procedures and the risk of consequent encephalopathy. Portal vein obstruction was first reported in 1868 by Balfour and Stewart, who described a patient presenting with an enlarged spleen, ascites, and 1 variceal dilatation