Case series of scleral patch grafts during COVID-19 pandemic

Scleral graft is done for clinical conditions as scleral melt post pterygium surgery, immune or infection related scleral melt, for covering the tubes of Ahmed glaucoma valve implant, for covering the orbital implants post enucleation, etc. A review of literature revealed the use of sclera for corneal perforations in the past, but became obsolete after the cornea being used for patch grafts. Now in this COVID-19 time, due to scarcity of corneal tissue, this technique of scleral patch grafts can be considered as an alternative to corneal patch grafts, which serves well the tectonic/therapeutic purpose and helps salvage the eye.

Spectroscopic Studies on the Interaction of Naphthyridines with DNA and Fluorescent Detection of DNA in Agarose Gel

Four new naphthyridine derivatives (R1-R4) possessing amino acid or boronic acid moieties have been synthesized and characterized using ¹H and ¹³C NMR, FT-IR, and mass spectral techniques. The mechanism of binding of these probes with calf thymus DNA (CT-DNA) has been delineated through UV-Vis, fluorescence, and circular dichroism (CD) spectral techniques along with thermodynamic and molecular docking studies. Small hypochromicity in absorption maximum of the probes without any shift in wavelength of absorption suggests groove binding mode of interaction of these probes with CT-DNA, confirmed by CD and 1H NMR spectral data competitive binding assay with ethidium bromide (EB). CT-DNA quenches the fluorescence of these probes via a static quenching mechanism. In the case of R1 and R4, the observed ΔH^o < 0 and ΔS^o > 0suggest that these probes interact with CT-DNA through H-bonding and hydrophobic interactions, while in the interaction of R2 and R3, van der Walls and H-boding forces are found to be dominant (ΔH^o < 0 and ΔS^o < 0). Results of molecular docking investigations corroborate well with that of spectral studies, and these probes bind in the minor groove of DNA. These probes are found to be effective fluorescent staining agents for DNA in agarose gel in gel electrophoresis experiment with sensitivity comparable to that of EB, and DNA amounts as low as 37.5 ng are visually detectable in the gel.

Spectroscopic investigations on DNA binding profile of two new naphthyridine carboxamides and their application as turn-on fluorescent DNA staining probes

Two new 10-methoxydibenzo[b,h][1,6]naphthyridine-2-carboxamide derivatives (R1 and R2) have been synthesized and characterized using different spectral techniques. The binding of these probes with DNA was investigated using spectral (Electronic, fluorescence, ¹H NMR and circular dichroism) and molecular docking studies. These probes exhibited a strong fluorescence around 440 nm upon excitation around 380 nm. Electronic and competitive fluorescence titration studies, in HEPES [(4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid)] buffer/dimethyl sulfoxide (pH 7.4) medium, suggest that these probes bind strongly to DNA, which is substantiated by ¹H NMR study. The binding constants are calculated to be 5.3 × 10⁷ and 6.8 × 10⁶ M^-1 for R1 and R2, respectively. From the results of spectral studies, it is proposed that the mechanism of binding of these probes with DNA is through minor groove binding mode, which is further confirmed by circular dichroism and molecular docking studies. Initial cell viability screening using MTT (3-[4,5-methylthiazol-2-yl]-2,5-diphenyl-tetrazolium bromide) assay shows that normal Vero cells are viable towards these probes at nano molar concentration, which is the concentration range employed in the present study for DNA staining (IC₅₀ in the order of 0.023 mM). The enhancement in fluorescence intensity of these probes upon binding with DNA enables the staining of DNA in agarose gel in gel electrophoresis experiment. The sensitivity of these probes is comparable with that of ethidium bromide and DNA amounts as low as 4 nano gram are detectable.Communicated by Ramaswamy H. Sarma.

Achalasia in siblings in infancy

Achalasia is rare in children, more so familial. We report two siblings with familial achalasia who presented in their infancy with vomiting and failure to thrive. Achalasia can be misdiagnosed as upper gastrointestinal obstruction as happened in one of our siblings. Esophageal contrast roentgenography is diagnostic. Both the children were treated successfully by transabdominal esophagomyotomy with fundoplication.

Spontaneous biliary perforation presenting as gastric outlet obstruction

Spontaneous biliary perforation (SBP) is a rare, surgically correctable cause of jaundice in neonates. The presenting feature is usually biliary ascites, and in rare cases, biliary peritonitis. This article reports a case of SBP, which presented with features of gastric outlet obstruction, leading to an erroneous preoperative diagnosis. Most probably this is the first report of such an unusual presentation of SBP. The child underwent exploratory laparotomy and a bilio-enteric bypass with drainage of the right subhepatic space, which led to a prompt resolution of the symptoms.

Osteolipoma of the skull base

Although lipomas are the most common benign tumours of the head and neck, the involvement of the skull base is rare and it is also very rare for a lipoma to undergo osseous metaplasia to become an ossifying lipoma or osteolipoma. We present a case of a solitary osteolipoma involving the skull base in a 17-year-old girl. A few cases of osteolipoma involving the head and neck have been reported, but this may be the first reported case of a solitary osteolipoma involving the skull base with extension to the infratemporal fossa and parapharyngeal space. The computed tomography (CT) scan helped to clinch the diagnosis and the histopathology confirmed it. The clinical presentation, role of CT scan, surgical approach used, histological features and the review of literature are discussed.

Rosai-Dorfman disease of the subglottis

A case of subglottic narrowing caused by an extranodal deposit of sinus histiocytosis in a 29-year-old man is reported. The characteristic features of Rosai-Dorfman disease, such as massive painless cervical lymphadenopathy, fever, raised erythrocyte sedimentation rate and raised white cell count, were all found to be absent. However, typical histological features, such as diffuse lymphoplasmacytic infiltrate, Russel bodies, foamy histiocytes and histiocytes with emperipoiesis, confirmed the diagnosis. Rosai-Dorfman disease is an uncommon disorder and its presentation with progressive subglottic narrowing is extremely rare. Our experience in the management of this condition is reported and the review of literature is discussed.

Intraperitoneal abscess in a new born secondary to Klebsiella septicaemia--a case report

A five day old female baby was admitted with distension of abdomen since birth and nonbilious vomiting, fever of one day duration. Blood culture grew Klebsiella pneumoniae. Abdominal exploration revealed thick walled cavity containing purulent fluid grew klebsiella pneumoniae which was sensitive to various antibiotics including gentamycin. The child was treated with injection gentamycin and ceftazidime. The child had uneventful recovery and is doing well 3 years post operatively.

Rectal stricture: a complication of tuberculosis

Tuberculosis of the rectum is rarely reported, even from areas where tuberculosis, and gastrointestinal tuberculosis in particular, is prevalent. The authors report a case of long tubercular stricture of the rectum and distal part of the sigmoid colon in a 12-year-old girl. Because of nonspecific symptoms and noncharacteristic radiological and endoscopic features, the diagnosis of this rare entity rests mainly on histological evidence of the classical tubercle in a surgical biopsy specimen.

Cystic teratoma of the pancreas

Cystic teratoma of the pancreas is an extremely rare entity: only 11 cases have been described so far in the world literature. We report the 12th case, in a 4-month-old girl.

Retrograde intussusception: a lead-point for prograde intussusception

Retrograde intussusception is an extremely rare entity. The authors report a case of retrograde jejuno-jejunal intussusception in a 12 year old. The features of interest are (1) the retrograde intussusception mass acting as a lead-point for a second prograde jejuno-jejunal intussusception, (2) the anastomotic suture line of a previous resection-anastomosis acting as the lead-point for the retrograde intussusception, and (3) the presence of a "reverse claw sign" (on a barium meal study) caused by the intussusceptum of the retrograde intussusception.

Spontaneous umbilical fistula: a rare complication of ventriculoperitoneal shunt

Although complications following ventriculoperitoneal shunt for hydrocephalus are not uncommon, leak of cerebrospinal fluid from the normal umbilicus following ventriculoperitoneal shunt is very rare. One such case is reported.

Bacteriology of peritoneal fluid in paediatric surgical emergencies

This study deals with the incidence of aerobic and anaerobic organisms of the peritoneal fluid of 60 consecutive children subjected to emergency celiotomy. Two-thirds of the cases were below the age of year. Peritoneal fluid was collected immediately after entering the peritoneal cavity and inoculated both for aerobic an anaerobic cultures. Bacterial growth occurred in 34 (57%) of the specimens. Anaerobic bacteria alone grew in 3 (5%) of the specimens, aerobes alone in 22 (37%) of specimens. A mixed aerobic and anaerobic bacteria grew in 9 (15%) of the specimens. There were 44 aerobic and 19 anaerobic isolates. All anaerobes were sensitive to metronidazole while most of the aerobes were sensitive to gentamycin. Culture was positive in 20 out of 42 (47.6%) specimens, where the peritoneal fluid was clear and there was no evidence of peritoneal contamination at the time of surgery.

Pilomatricoma: report of two cases in children

Two children with pilomatricoma are reported. The characteristics of this benign tumor and general principles of treatment (surgical excision) are described.

Meckel's diverticulum in children

Twenty one surgically documented cases of Meckel's diverticulum in children treated at Kasturba Hospital, Manipal since 1981 are reviewed. Of them, 14 presented with intestinal obstruction, 2 with pain abdomen, 2 with Littre's hernia and 2 were found incidentally. Only one patient presented with gastrointestinal bleeding. The clinical profile of these patients is analyzed.

Lingual dermoid

Dermoid cysts are congenital lesions derived from ectodermal differentiation of multipotential cells. Only 7% of all dermoid cysts occur in the head and neck region and about a quarter of them are seen in the floor of mouth. Dermoids confined to the tongue are rare entities. Only 13 such cases, mostly in infants, have been reported in literature. One such case of an infant with intralingual dermoid and feeding difficulty, relieved following cyst excision, is reported.

Ovarian tumors in the second decade of life

A study of 28 adolescents aged 10-20 years admitted with ovarian tumors during a 5-year period revealed that 75% had malignant ovarian tumors, with germ cell tumors being most frequent. The high incidence of malignancy was due to our hospital being a referral centre. One case of mixed germ cell tumor (mainly choriocarcinoma) presented with precocious puberty, and one case of arrhenoblastoma showed signs of virilization. Tumor markers were found useful in diagnosing choriocarcinoma and endodermal sinus tumor. Amongst the malignant ovarian tumors, the best prognosis was noted with dysgerminomas. Tumors were found more frequently on the right side. Optimal surgery at initial laparotomy, followed by adjuvant chemotherapy or radiotherapy were found to offer the best change of cure.

Cysticercosis of the tongue

Cysticercosis is a condition where man forms the intermediate host for the proglottids of Taenia solium. The common sites of cysticercosis are brain, skeletal muscle and subcutaneous tissues, but they can be found at any site. An unusual case of lingual cysticercosis is being reported.

Intra-abdominal lymphatic cysts in children

Ten children with intra abdominal lymphatic cysts operated in the last 8 years are reported. They formed 0.50% of all pediatric surgical admissions and 33.3% of all intra-abdominal cystic lesions. The mean age was 5 1/2 years and the male-female ratio was 1:1. Half the cysts were in the mesentery and 30% in the omentum. The other 2 cysts were located at unusual sites. Two children having mesenteric cysts presented as abdominal emergencies. Three of them were wrongly diagnosed and treated for tuberculous ascites before laparotomy. Four mesenteric cysts were excised along with the adjoining intestinal segment, and one was drained by tube marsupialisation. All 3 omental cysts and the two cysts at unusual sites were excised in toto. There was no mortality or morbidity.

Cecal volvulus in a 2-month-old baby

A case of primary cecal volvulus in a 2-month-old boy is reported. He is probably the youngest patient to be reported with this condition.

Intraperitoneal ascariasis

Seven children with intraperitoneal ascariasis are reported. One of them had two episodes. There were four instances of free worms in the peritoneal cavity, whereas others had peritoneal abscesses containing round worms. It is suggested that peritoneal ascariasis should be suspected whenever a child presents with peritonitis and/or an inflammatory abdominal mass having evidence of ascarial infestation.

Sudoriparous angioma--regression following intravascular aethoxysclerol, a sclerosing agent

We report a case of sudoriparous angioma on the dorsum and plantar aspect of the left foot which increased in size on standing, and which was accompanied by sweating in the overlying epidermis and throbbing pain. The lesion regressed considerably following intravascular injection of 1% aethoxysclerol.

Systolic time intervals in pilots and non-pilots during 70 degree head-up tilt

Nine highly experienced Indian fighter pilots in current flying practice and 11 healthy non-pilots underwent head-up tilt (HUT) to 70 degrees for 20 min. Heart rate and blood pressure response to tilt stress was similar in the two groups as was the contractile function of the left ventricle measured by systolic time intervals. The highest PEP/LVET ratio of 0.402 seen at the end of HUT was considerably lower than the values seen in other studies (5,11). This suggests that myocardial contractility of Indians adjusts better to tilt stress than that of western subjects not adapted to heat.

Orthostatic tolerance of normal Indians and those with suspected abnormal cardiovascular reflex status

There were 143 healthy Indian males subjected to 70 degrees headup tilt (HUT) for 20 min on 166 occasions to evaluate their cardiovascular response. They responded with a significant rise in heart rate, diastolic pressure, and mean arterial pressure. Pulse pressure fell significantly. Heart rate and diastolic pressure during the tilt were significantly (p less than 0.05) and positively correlated to the height of the subjects. None of the subjects had syncope, which has been reported in normal individuals elsewhere. Of the 57 subjects with suspected abnormality of the cardiovascular reflex status, who were also investigated by the tilt test, 13 (22.8%) developed various degrees of orthostatic intolerance. Of these 13 subjects, 10 had had syncope in the past. In view of these observations, it is concluded that 70 degrees head-up tilt is an important clinicophysiological investigation in the assessment of subjects with a suspected abnormality of their cardiovascular reflex status.