The faucial tonsil: its relation to focal infection with particular reference to cholecystitis

PART I. I have attempted to collect some information regarding the anatomy, comparative anatomy and the much discussed problem of the physiology of the tonsils.(b) Fifty extirpated tonsils were examined microscopically and an attempt made to summarise the pathology of chronic tonsillitis to exulain how the tonsil may act as a focus of infection.(c) Bacteriology of the tonsils has been worked out. Notes are added regarding the classification of streptococci and the various test<semployed in the present investigation. Charts containing complete data of 110 tonsils examined are added. Technique employed for the examination of tonsils is also described in detail.(d) Experiments with animals are also given. The lesions produced are tabulated.PART II. I have described the new method of "Tonsil Puncture ". This part also contains the chart showing the bacteriology of tonsil- puncture as applied to 14 cases of cholecystitis.(b) Animal experiments with organisms obtained by tonsil puncture are also added to this part.PART III. "Tonsil injection with streptococci". Direct tonsil injection in two dogs was carried out in order to see whether repeated attacks of tonsillitis, caused by a strain of streptococcus obtained from the wall of the gall- bladder or the cystic lymph gland of a case of chronic cholecystitis, produces any disease of the gall -bladder in these animals.PART IV. A set of experiments on three series of animals (rabbits) were carried out where in addition to the organisms a second factor of "lowered resistance" was also introduced. Streptococci were obtained from various sources, e.g. from extirpated gall -bladder or cystic lymph gland, by tonsil puncture in a case of chronic cholecystitis, from an extirpated tonsil of a case where the patient had no abdominal disorder. The animals were opened up and their gall- bladder and lesser curviture of the stomach traumatised. The object of this series was to see:-(i) Whether lowering of resistance of a particular organ alone determines the localisation of any particular organisms.(ii) Whether any particular organisms show a greater tendency to localisation in one organ more than the other, the two organs being under similar conditions.PART V. Contains a short description of the lesions produced in the animals by streptococcal injection during the course of this work.(b) A general discussion and summary is added at the end.APPENDIX. The clinical histories, and other experimental details of all the cases studied are put in the appendix in order to avoid confusion.Some of the naked -eye specimens have been reproduced in water colours. All of them were drawn and painted by the author himself. Several photographs have been added to illustrate statements made in the text

Vanishing retinal arterial aneurysms with anti-tubercular treatment in a patient presenting with idiopathic retinal vasculitis, aneurysms, and neuroretinitis.

BACKGROUND: Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome presents with characteristic clinical manifestations such as aneurysms at arteriolar bifurcations and optic nerve and retinal vascular inflammation. Regression of such features on treatment with anti-tubercular therapy (ATT) combined with corticosteroids has not been reported in literature. FINDINGS: A 30-year-old female with sudden painless decreased vision in the left eye was referred with a diagnosis of presumed tuberculous retinal vasculitis and a positive tuberculin skin test. Based on the clinical and angiographic features of the right eye, a diagnosis of IRVAN syndrome was made. In the left eye, the patient had vitreous hemorrhage for which pars plana vitrectomy was performed. The vitreous sample was positive for Mycobacterium tuberculosis using multiplex polymerase chain reaction, and the patient was started on standard four-drug ATT and oral corticosteroids. At 6-month follow-up, vanishing of retinal arterial aneurysms was observed. CONCLUSIONS: The pathogenesis of IRVAN syndrome is uncertain. One of the postulates is that the features of arterial aneurysms and other retinal vascular alterations occur secondary to acquired inflammatory reaction. We hypothesize that IRVAN syndrome may be a morphological diagnosis possibly associated with various entities, one of which could be ocular tuberculosis. It may be prudent to rule out intraocular tuberculosis in cases labeled as IRVAN syndrome in an endemic population

Severe androgenetic alopecia as a maker of metabolic syndrome in male patients of androgenetic alopecia: a hospital based case control study

Background: Several previous studies have investigated the association between androgenetic alopecia (AGA) and metabolic syndrome (MS), with inconsistent results. Objectives of the study were to study the prevalence of metabolic syndrome in male patients of androgenetic alopecia and compare with control population and study the relationship of metabolic syndrome with different grades of AGA.Methods: This prospective hospital based case control study included 100 new clinically diagnosed males of androgenetic alopecia, and age and sex matched control group. Assessment for presence of various components of metabolic syndrome was done following a uniform protocol in cases and controls. AGA was classified as per Hamilton –Narwood classification, grade I to III was classified as mild –moderate and grade IV and higher as severe AGA.Results: Of the 100 male AGA patients (age range 21-50, mean 34.49), 36 had grade II AGA, 24 had grade III AGA, 20 had grade IV AGA, 15 had grade V AGA and 5 had grade VI AGA. Among AGA patients, 60 of patients had mild-moderate AGA and 40 patients had severe AGA. Metabolic syndrome was statistically significantly more common in patients with AGA compared to controls. Among patients of AGA, metabolic syndrome was statistically significantly present in severe AGA compared to mild-moderate AGA. Among the evaluated parameters, like blood pressure, fasting blood sugar, dyslipedemia, abdominal obesity, all were significantly more common in AGA patients compared to controls except abdominal obesity.Conclusions: In the present study, metabolic syndrome was found to be 4.6 times more common in patients of androgenetic alopecia as compared to controls, being statistically significant, and more common in those with severe grades. This suggests that androgenetic alopecia patients especially with severe grades are at risk of metabolic syndrome and other cardiovascular diseases

A retrospective comparative study to evaluate the efficacy and safety of mifepristone with misoprostol over misoprostol alone in induction in labor

Background: The aim is to compare the improvement in pre-induction Bishop’s score, proportion of patients going in labor and induction–delivery interval after using the Misoprostol versus Mifepristone and Misoprostol as cervical ripening and labor inducing agent.Methods: It is retrospective comparative study conducted on 110 women. Women were randomized in group A and in group B of 55 patients in each group. Group A received tab Mifepristone 200 mg orally on day 1 followed by Misoprostol 25 ug after 48 hours and continued 6 hourly till maximum four tablets and group B patients received tablet Misoprostol 25ug and continued 25ug 6hrly maximum 4 doses. Women observed for improvement in Bishop‟s score, induction-delivery interval and requirement of subsequent doses of Misoprostol.Results: Present study concluded that tablet Mifepristone is an efficient cervical ripening and inducing agent of labor as pre-induction Bishop’s score was improved. 36.4%patients went into labor only with tablet Mifepristone. The mean induction-delivery interval was,19±12.2hrs in Group 1 as compare to 13.1±13.0 hrs in Group 2. Mean Bishop’s score observed in Group 1 were 2.5±1.78 and 1.67±1.25 in Group 2. It was observed that there was significant improvement in the Bishop’s score after giving Mifepristone to the patients; mean Bishop’s 24hrs after mifepristone were 4.03±1.80. Repeated dose of Misoprostol required in Group 1 was observed to be higher than group 2 as shown in table 8. Mean misoprostol doses required in group 1 was 2.56±1.15 as compared to 1.71±1.58 in group 2.Conclusions: Mifepristone with Misoprostol reduce the induction delivery interval and more potent in combination for induction of labour as compared to Misoprostol alone

CFT reconstruction of local bulk operators in half-Minkowski space

We construct a holographic map that reconstructs massless fields (scalars, Maxwell field \& Fierz-Pauli field) in half-Minkowski spacetime in $d+1$ dimensions terms of smeared primary operators in a large $N$ factorizable CFT in $\mathbb{R}^{d-1,1}$ spacetime dimensions. This map is based on a Weyl (rescaling) transformation from the Poincar\'e wedge of AdS to the Minkowski half-space; and on the HKLL smearing function, which reconstructs local bulk operators in the Poincar\'e AdS in terms of smeared operators on the conformal boundary of the Poincar\'e wedge. The massless scalar field is reconstructed up to the level of two-point functions, while the Maxwell field and massless spin-2 fields are reconstructed at the level of the one-point function. We also discuss potential ways the map can be generalized to higher dimensions, and to the full Minkowski space.Comment: Updated bibliography, Updated discussion section, 20 pages, 2 figure

Clinical profile, maternal and fetal outcome in pregnant women with COVID-19 infection: a retrospective observational study in a tertiary care hospital of Himachal Pradesh

Background: The aim of this study was to evaluate the clinical characteristics and outcomes of pregnant women confirmed with COVID-19 infections and their neonates to provide more reference to contribute in managing this noval viral disease.Methods: We conducted a retrospective study over a period of six months; 20 March, 2020 to 8 October, 2020 at SLBSGMC Nerchowk (Himachal Pradesh). Total number of pregnant women who delivered in our hospital during the defined study period was recorded and analysed.Results: The total number of women were delivered over the study period was 13, out of which caesarean sections (CS) were 7 and NVDs were 6 in number. All of them were diagnosed mild COVID-19, and none one of the patients developed severe COVID-19 or died. Their all newborns were recorded healthy except one was COVID positive and one neonate had birth asphyxia.Conclusions: Apparently no difference was observed in relation to onset of disease, symptoms, cure rates or severity in pregnant women when compared to non-pregnant women and healthy men of similar age groups. Pregnancy does not seem to deteriorate the course and prognosis of the disease. Maternal and fetal outcomes are apparently favourable in these patients. Lastly COVID-19 is not an indication of cesarean section. More multicentre studies are the need of the hour to formulate the authentic management guidelines for this novel disease

Extended reverse sural artery pedicle flap: a versatile and reproducible option for coverage of ankle and foot defects

Background: Coverage of soft tissue defects around distal third of the leg, particularly ankle and foot is a common situation faced by a plastic and reconstructive surgeon. Options available for such defects are limited due to scarcity of additional soft tissue that can be used without exposing tendons or bone. Associated conditions such as major vascular compromise, comorbidities and lack of facilities or expertise make free tissue transfer less preferred. Distally based sural artery flap has been a frequently used flap in such conditions, easy to perform and has reproducible results. We extended the reach of the flap and reproduced the results.Methods: We performed extended reverse sural artery pedicled flaps in 19 patients who presented to us between 2015 to 2017 with soft tissue defects around ankle and foot. Patients included 15 post RTA, 2 diabetic foot, 1 post resection defect and 1 post burn contracture release defect. Size of the defect ranged between 8x6cm to 14x10cm. Average follow up period was ranging from 8 months to 2.5 years.Results: All the flaps healed well without any obvious complications except one patient in whom marginal necrosis (2 cm margin of distal most flap) was observed and was secondarily treated with skin grafting.Conclusions: We observed that extended reverse sural pedicle flap is a rapid, reliable option for coverage of soft tissue defects around ankle and heel, sparing major vessel compromise and lengthy surgical procedure during free tissue transfer. This flap should be the first option for the patients with trauma and defects over weight bearing foot in whom peroneal axis vessels are preserved