Corneal Toxicity due to Datura Inoxia

Purpose: To report corneal toxicity following intentional inoculation of the juice of crushed leaves of datura (Datura Inoxia). Case Report: A 70-year-old male presented with diminished vision, redness, watering, and photophobia in his right eye one day before his presentation. The patient had instilled the juice of datura leaves in his right eye to treat his ocular problems. Slit lamp examination revealed mild conjunctival and circumcorneal congestion, corneal edema, and folds in Descemet’s membrane. The left eye was pseudophakic with an otherwise unremarkable examination. The patient was treated with dexamethasone, cycloplegics, and lubricants. The cornea did not sufficiently recover after one month of treatment leaving him with permanent corneal decompensation that required a referral for keratoplasty. The patient was followed up for six months. We hypothesize damage to the corneal endothelial Na+/K+-ATPase pump by tropane alkaloids as a cause for corneal decompensation. Conclusion: Awareness about toxicity of this commonly grown plant in the tropics and subtropics is essential in order to avoid blindness due to accidental or deliberate use

Duxorubicin-induced cardiotoxicity

The survival rate of cancer patients has greatly increased over the last 20 years. However, to achieve this result, a considerable price has been paid in terms of the side-effects associated with the intensive anticancer treatment. Cardiotoxicity of anticancer drugs is a serious problem. It is defined, by the National Cancer Institute, as the “toxicity that affects the heart.” This definition not only includes a direct effect of the drug on the heart, but also an indirect effect due to enhancement of hemodynamic flow alterations or due to thrombotic events. Cardiotoxicity can develop in a subacute, acute, or chronic manner. The risk for such effects depends upon: cumulative dose, rate of drug administration, mediastinal radiation, advanced age, younger age, female gender, pre-existing heart disease and hypertension. Anthracyclines, such as doxorubicin (DOX), cause serious cardiac side-effects. Acute tachyarrhythmias and acute heart failure (HF) may occur after high doses, but these reactions are now rare due to changed dosage schemes (e.g. slower infusion) with the aim to prevent this. However, the sub-acute or chronic cardiac effects of anthracyclines remain a clinical problem. Clinically, anthracycline induced cardiotoxicity manifests itself as left ventricular failure, which develops insidiously over months to years after completion of the anthracycline based chemotherapy and may result in congestive HF. The mechanism of anthracyclin induced cardiotoxicity is not totally unraveled. It is likely that the decline in myocardial function is related to apoptosis of cardiac myocytes that occurs apparently at random in the myocardium. Anthracyclin induced formation of reactive oxygen species (ROS) in the presence of intracellular iron, impaired homeostasis of intracellular iron and calcium (that may facilitate the apoptosis induced by the ROS) have been put forward as mechanisms. Cardiac protection can be achieved by limitation of the cumulative dose. Further, addition of the antioxidant and iron chelator dexrazoxane to anthracycline therapy has shown to be effective in lowering the incidence of anthracycline induced cardiotoxicity

Mean Tip Apex Distance in Patients undergoing Dynamic Hip Screw Fixation for Pertrochanteric Fractures without using Traction Table: A Descriptive Cross-sectional Study

Introduction: Dynamic Hip Screw fixation has shown to be equally effective compared to cephalomedullary nailing. The effectiveness of dynamic hip screw fixation for pertrochanteric fractures without using traction table is not well investigated. This study aimed to find out the mean tip apex distance in patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table. Methods: A descriptive cross-sectional study was conducted among patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table between 1 September 2021 and 30 June 2022, after getting approval from institutional review committee (Reference number: IRC-2021-08-23-02). All patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table were included in the study. Patients with pre-existing ipsilateral or contralateral hip deformity, contra-lateral hip prosthesis, bilateral hip fractures, and history of prior ipsilateral hip surgeries were excluded. Point estimate and 95% confidence interval were calculated. Results: Among 45 patients, the mean tip apex distance was 20.45±6.13 mm (18.66-22.24 mm, 95% Confidence Interval). Among 45 patients, 24 (53.33%) were males and 21 (46.66%) were females. The average age of the participants was 67.75±21.33 years. Conclusions: The mean tip apex distance in patients undergoing dynamic hip Screw fixation for pertrochanteric fractures without using traction table was similar to that reported in other international studies

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Visual satisfaction and spectacle independence with monofocal intraocular lens with enhanced intermediate vision and trifocal intraocular lenses in the prepresbyopic age group patients with cataracts

AIM: This aims to study visual satisfaction and spectacle independence in prepresbyopic age patients with cataracts after the implantation of either monofocal intraocular lens (IOL) with enhanced intermediate vision or trifocal IOL. SETTING: Private practice. MATERIALS AND METHODS: This prospective, observational case study was conducted on patients in the prepresbyopic age group with cataracts. Patients were allocated to one of the two groups. Thirteen patients (26 eyes) received monofocal IOL with enhanced intermediate vision (intermediate vision group), and 12 patients (24 eyes) received diffractive multifocal IOLs (trifocal group). Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity, Uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA) values, defocus curves, and contrast sensitivities (CS) of the two groups were compared 3 months' postsurgery. Their spectacle independence and visual satisfaction were also assessed. RESULTS: The study patients were aged 35–45 years and comprised 14 males and 11 females. No significant difference was observed in UDVA (intermediate vision group: 0.02 ± 0.01, trifocal group: 0.02 ± 0.01; P = 0.22) and UIVA (intermediate vision group: 0.20 ± 0.10, trifocal group: 0.19 ± 0.10; P = 0.12). However, a statistically significant difference was observed between the groups in terms of UNVA (intermediate vision group: 0.32 ± 0.10, trifocal group: 0.80 ± 0.10; P = 0.01). The mean CS in monofocal IOL with enhanced intermediate vision and trifocal groups were 1.577 ± 0.3 and 1.550 ± 0.2, respectively (P = 0.40). None of the patients experienced photic phenomena. In total, 10 of 13 patients in the monofocal IOL with enhanced intermediate vision group required spectacle correction for near visual acuity in the range of +1.00 to +2.00 D. CONCLUSION: This study found that there was no significant difference in distance and intermediate vision between the two groups. However, the trifocal group had better uncorrected near vision compared to the monofocal group that had enhanced intermediate vision. The conclusion is that using trifocal IOLs for both eyes provided complete independence from wearing glasses. In addition, no visual disturbances were observed after implanting the new-generation trifocal IOLs

Conventional dacryocystorhinostomy in a failed Trans-canalicular laser-assisted dacryocystorhinostomy

We report the success rate and problems associated with conventional dacryocystorhinostomy (DCR) in failed cases of Trans-canalicular, laser-assisted DCR (TCLADCR). Out of 50 patients operated by the TCLADCR technique during the period 2005 – 2006, 33 patients had failure, which was confirmed on syringing of the nasolacrimal passage. Before considering them for conventional DCR, a thorough ear, nose, throat (ENT) examination was done by an ENT surgeon, to rule out a nasal pathology. All the patients were operated by the conventional standard DCR method at a medical college. While performing the surgery, the problems that came across were identified and noted. The success rate was found to be 91% in this study in a follow-up period of one year, with no major intra-operative problems. Conventional DCR is still a gold standard and should be considered as a procedure of choice in failed cases of TCLDCR