Analysis of surgical outcome and review of literature of schwannomas arising from the extremities

Background: Schwannoma is a benign peripheral nerve sheath tumour derived from Schwann cells. Also known as Neurilemoma, it can affect any nerve in the body. They usually present as a painless swelling or paresthesia over the sensory distribution of the affected nerve. Although it is classically described that schwannomas are well encapsulated and can be completely enucleated during excision, many of them have fascicular involvement and could not be completely shelled out. The aim of this work is to present our experience in operative management of schwannomas located in extremities.Methods: Authors conducted a retrospective review for 18 adult patients with schwannoma, from June 2012 to June 2018.  There were 10 men and 8 women, ranging from 20 to 68 years of age, with a mean age of 46 years old. All patients had excision done for the tumour and histopathological examination confirmed schwannoma. All patients were preoperatively evaluated both clinically and radiologically. FNAC was also done to confirm the origin of the swelling.Results: The mean follow up period has been 2 years. Complete excision with preservation of nerve was done in all cases except for one case in which nerve graft was used.Conclusions: Use of preoperative MRI, magnification and good surgical technique will help to enucleate the tumour completely without any collateral damage or recurrence. The possibility and option of nerve graft should be discussed with patients prior to schwannoma excision, so that nerve grafting could be directly proceeded with patient consent in case there is fascicular involvement of tumour found intraoperatively

Presentation and treatment of congenital constriction ring syndrome: case series of 12 patients

Background:We intend to present our experience of varied presentation and treatment of 12 cases of congenital constriction ring syndrome.Methods: A prospective study of patients presenting with the characteristics of the congenital constriction ring syndrome was undertaken. Twelve patients made up of 7 males and 5 females were seen. The age at presentation ranged from nine days to 5 years with a mean age of 12.9 months. Nineteen limbs were affected, made up of four right upper limbs, six left upper limbs, six right lower limbs and three left lower limbs. In the upper limb malformations involved total 36 digits, arm in one case and forearm in one case; in the lower limb malformations involved total 27 toes, foot in one and leg in four cases. Types of lesions which were found: constriction rings, intrauterine amputations, simple syndactyly.Results: Treatment options ranged from observation to multi-staged operations. Surgical correction of the constriction ring was done by excision and w-plasty to prevent or alleviate lymphoedema, multiple release incisions over distal limb to reduce the edema.Conclusion: Congenital constriction ring syndrome is of uncertain aetiology and could cause morbidity in the new-born. The syndrome and its complications are amenable to corrective surgery with good results. Early intervention is desirable for a successful outcome

Novel technique for reconstruction of challenging defects around knee joint: distally based split vastus lateralis myocutaneous flap and review of literature

Background: Reconstruction of soft tissue defects around the knee joint is often challenging because of exposed bone or tendon, infected wound, open joint or exposed implant or prosthesis. The aim of the study was to analyse feasibility of distally based split vastus lateralis myocutaneous (VL-MC) flap for covering soft tissue defects around knee joint and To report a new technique for coverage of soft tissue defects around knee joint with distally based split Vastus Lateralis myocutaneous (VL-MC) flap and to assess functional and aesthetic outcome.Methods: A total of 3 distally based split Vastus Lateralis myocutaneous flaps were used for reconstruction of soft tissue defects and exposed implant around knee and upper third of tibia. Defect sizes ranged from 5x7 cm to 12x10 cm size. A systematic review of Literature was done using key words of distally based split vastus lateralis myocutaneous flap and various articles were reviewed. The patients were followed up in postoperative period for assessment of this flap considering functional and aesthetic parameters.Results: The flap survived well without any loss in all 3 cases. The donor site was closed primarily in all the cases. Complete functional recovery was achieved by 4 weeks. Patients were satisfied with aesthetic appearance as well.Conclusion: Distally based split VL-MC flap is a safe and reliable option for reconstruction of the complex defects around knee.

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

FORMULATION AND EVALUATION OF OPHTHALMIC GEL BASED ON DRUG-POLYMER-POLYMER TERNARY INTERACTION

 Objective: The objective was to enhance the amount of active substance reaching the target tissue or exerting a local effect in the cul-de-sac, theapproach we use is the application of in-situ gelling systems or phase transition systems, which are instilled in a liquid form and shift to a gel or solidphase in the cul-de-sac. The present study will focus on the development of formulation of ophthalmic gels. The polymer physicochemical propertieswere studied for the improvement in gel characteristics.Methods: The formulations were varied by the amount of the anionic and cationic polymer concentration. The 10 and 20-fold excess anionic polymerwere used. The 10 and 20-fold excess anionic polymer were used. Further cationic polymers were utilized to see any ternary interaction betweendrug and polymers.Results: From the present study it could be shown that most of the formulations were isotropic and could be clearly separated from the anisotropicones which were situated at the cationic side of the phase diagram only as well as at 10% polyvinyl alcohol. Furthermore, excess 20HA, 10PAA, and20PAA as well as HCS (HCS/20PAA) contributes to improve drug release control.Conclusion: The above formulation of were found to be quite stable and useful in the novel format of sol-gel transformations. Further, the physicalcharacteristics gels show better tolerability with anionic and cationic polymer.Keywords: Cationic, Anionic, Poloxamer, Sol-gel

Retrospective analysis of surgical outcome in orbital tumour cases

Background: Eyes, being an important sensory organ, plays vital role in Daily life of human beings. No wonder it has been described by writers often as window of the soul or mirror of the mind. The main aim of the study was to study retrospective analysis of surgical outcome in orbital tumour cases.Methods: This study was carried out in 21 cases of orbital tumours with varied pathology. All patients were subjected to surgical intervention.Results: Vision improved in 9 out of total 21 cases. Cosmetic appearance improved in 17 out of 21 cases. Only one case of recurrence was noted.Conclusion: Surgical intervention in orbital tumour cases was very useful in improving cosmesis and improving/maintaining visual function

ESTIMATION OF THE DRUG-DRUG AND DRUG-POLYMER OPHTHALMIC COMPLEX AT STOICHIOMETRY BY TERNARY PHASE BEHAVIOUR

Objective: The study focus on the drug-drug and drug-polymer interaction and their estimation at stoichiometry when such systems were formed. In this discovery we tried to make use of the latest research and novel concepts to explore the drug-polymer-polymer Ionic ternary InteractionMethods: Partial ternary phase diagrams were constructed and the stoichiometry of the ciprofloxacin/anionic polymer interaction was assessed in distilled water by means of dialysis equilibrium. The polymers were completely hydrated in distilled water by gentle stirring at room temperature and studied for viscosity and turbidimetric measurements.Results: Comparing the partial ternary phase diagrams of the different anionic to each other. PAA exhibited the largest gel area even with low polymer content. The anionic polymers HA and PAA showed good capability to interact with the drug giving soluble drug/polymer complexes; moreover they were able to form polymer/polymer complexes with Poloxamer and HCS, with a stoichiometry depending on the polymers involved.Conclusion: From the results of the present study, it can be concluded that formulations were made isotonic and favours corneal permeation of both the drug. Ocular Irritancy denotes formulations were quite stable & useful in novel format of sol-gel transformations.Â

Metal-free N-doped ultrafine carbon fibers from electrospun Polymers of Intrinsic Microporosity (PIM-1) based fibers for oxygen reduction reaction

Synthesis of nitrogen-doped carbon fibers (CF) has been proved to be one of the most promising oxygen reduction reaction (ORR) catalysts which can replace the state-of-art Pt catalyst for non-noble metal-free light-weight devices. Polymers of Intrinsic Microporosity (PIM-1) is soluble in common organic solvents and can be tailored by functionalization owing to nitrile groups in the backbone. PIM-1 was functionalized to amide (hydrolyzed PIM-1), amine and amidoxime groups. The modified PIM-1s were electrospun into ultrafine fibers and pyrolyzed to obtain CF. The present article investigates the influence of different functional groups on the properties of PIM-1 based CF and their nitrogen-doping. Particularly, their ORR performance has been evaluated. Interestingly, CF from hydrolyzed PIM-1 have the highest pore volume with small pore size among the CF based on PIM-1, amine and amidoxime PIM-1. The amount of nitrogen-doping in these CF shows the trend according to the functional groups as PIM-1 > amine > amidoxime > amide. Among all these PIM-1 based CF; CF from hydrolyzed PIM-1 has the highest percentage of pyridinic and graphitic nitrogen, furthermore, electrocatalysis revealed that ORR processed through four-electron with the onset potential 985 mV vs. reversible hydrogen electrode (RHE) which is comparable with the standard Pt/C catalysts. © 2020 Elsevier B.V

DETERMINATION OF RESIDUAL DIMETHYL SULFATE IN METHOXSALEN DRUG SUBSTANCE BY PRE-COLUMN DERIVATIZATION WITH STATIC HEADSPACE GAS CHROMATOGRAPHY

Objective: Dimethyl sulfate has been highlighted as potential genotoxic and carcinogenic impurity. A sensitive Headspace gas chromatography (HS-GC) method with pre-column derivatization was developed and validated for the determination of dimethyl sulfate impurity in methoxsalen active pharmaceutical ingredient.Methods: HS-GC method on the column Agilent DB-5, 30m X 0.53 mm, film thickness 1.5 µm, with flame ionization detector (FID) was used. Derivatization reagent concentration, time of reaction and pH of the solution were optimized during method development. This analytical method was evaluated by performing method validation as per ICH guideline.Results: The proposed method was specific, linear, accurate, rugged and precise. The calibration curves showed good linearity over the concentration range of 0.5 μg/ml to 3.0 μg/ml and the correlation coefficient was 0.999. Method had very low limit of detection (LOD) and limit of quantification (LOQ) 2.0 μg/g and 5.0 μg/g respectively. Accuracy was observed within 98.1%–104.5%.Conclusion: The developed method was demonstrated to be accurate, robust and sensitive for the determination of dimethyl sulfate impurity in methoxsalen drug substance

Clinical Study to evaluate efficacy of Mustadi Basti in the management of Amavata w.r.t. Rheumatoid Arthritis

Rheumatoid Arthritis is a chronic autoimmune inflammatory disease that causes to pain, stiffness and swelling of the joints. It affects different parts of the body, mainly effects the joints. Amavata (Rheumatoid Arthritis) has been a challenging problem to the medical field. Various treatment protocols are applied in this disease with partial success. In present clinical study, 30 patients of clinically proven Amavata (Rheumatoid Arthritis) were treated with Mustadi Basti to evaluate its efficacy. Mustadi Basti contains Kwatha Dravyas viz. Musta, Ushira, Balamoola, Argawadha and Rasna with other Kalka and Prakshepa Dravyas. Ayurvediya Nidanadi parameters and American Rheumatism Association guidelines for Rheumatoid Arthritis were followed. Analysis was done and results were calculated statistically using paired ‘t’ test. Results obtained are encouraging and indicate the efficacy of Mustadi Basti over Amavata (Rheumatoid arthritis), exploring many aspects of this clinical entity