Efficacy of oral miltefosine in visceral leishmaniasis in rural West Bengal, India

Context:

Visceral leishmaniasis (VL), also known as Kala-azar (KA) is a public health problem of tropical and subtropical countries, which infects about 12 million people annually, out of which about 1.5 million are new cases. India contributes a major share of the global burden of VL. For many years leishmaniasis has been treated with pentavalent antimonials. Antimony resistance is a problem in India and in other different geographic areas of the world. Amphotericin B deoxycholate and pentamidine isethionate are effective by parenteral administration and associated with toxicities. The quest for an effective, orally administered, non-toxic and less expensive alternative resulted in the identification of miltefosine (hexadecylphosphocholine). In India, therapeutic efficacy of miltefosine in VL was assessed by many groups of scientists, mainly from Bihar and Uttar Pradesh. No such data is available from West Bengal.

Aims:

The present study was designed to observe the efficacy of miltefosine in VL in rural West Bengal.

Materials and Methods:

A total of 71 parasitologically proven VL patients participated in the study who received miltefosine in accordance with the National Vector Born Disease Control Programme (NVBDCP) of India and were followed up for the following one year.

Results:

The overall efficacy of the drug was 93% and no significant adverse side effects were observed during the study period.

Conclusions:

The study concludes that miltefosine is effective, well tolerated, and easily administrable drug in the treatment of visceral leishmaniasis at the field levels.KEY WORDS: India, visceral leishmaniasis, miltefosine     

Prospective randomized comparative study of macular thickness following phacoemulsification and manual small incision cataract surgery

Purpose: To compare macular thickness following uncomplicated phacoemulsification with foldable acrylic lens and manual small incision cataract surgery (MSICS) with non‐foldable polymethyl methacrylate (PMMA) lens implantation. Methods: Prospective study was carried out with one eye each of 224 patients with senile cataract randomized into two groups, phacoemulsification and MSICS, by simple 1:1 randomization. Following surgery by either of the two methods, macular thickness was measured by optical coherence tomography (OCT) on the 1st, 7th, 42nd and 180th postoperative day. Main outcome measure was postoperative macular thickness. Results: On the first postoperative day, central subfield mean thickness (CSMT) in MSICS group was 192.8 ± 17.9 μm and that in phacoemulsification group was 192.1 ± 27.4 μm, with no significant difference (p = 0.12). On the 7th day, CSMT in MSICS group (198.9 ± 21.4 μm) was significantly (p = 0.04) more than that in phacoemulsification group (193.1 ± 19.3 μm). On the 42nd day, CSMT in MSICS group was 207.8 ± 26.3 μm and that in phacoemulsification group was 198.3 ± 23 μm, the difference being significant (p = 0.007). Clinically macular oedema was not diagnosed in any of the patients at any visit. The increase in macular thickness was sub‐clinical and did not affect final visual outcome in any patient. Conclusion: In spite of the greater theoretical risk of increased postoperative inflammation following MSICS, there was no evidence of cystoid macular oedema, either clinically or on OCT. However, chance of sub‐clinical increase in CSMT was more following MSICS compared to phacoemulsification.     

Adenocarcinoma in Retroperitoneal Teratoma

We report a rare case of adenocarcinoma in retroperitoneal teratoma in a 38 year old female patient who attended surgical OPD with complaints of dragging pain and heaviness in left lumbar region. Straight x-ray abdomen showed few irregular calcifications in left lumbar region. USG and CT showed it to be adrenal tumor and retroperitoneal teratoma respectively. Excised specimen confirmed it as mucin secreting adenocarcinoma in a case of retroperitoneal teratoma.     

MOF derived carbon based nanocomposite materials as efficient electrocatalysts for oxygen reduction and oxygen and hydrogen evolution reactions

The escalating global energy demands and the formidable risks posed by fossil fuels coupled with their rapid depletion have inspired researchers to embark on a quest for sustainable clean energy. Electrochemistry based technologies, e.g., fuel cells, Zn–air batteries or water splitting, are some of the frontrunners of this green energy revolution. The primary concern of such sustainable energy technologies is the efficient conversion and storage of clean energy. Most of these technologies are based on half-cell reactions like oxygen reduction, oxygen and hydrogen evolution reactions, which in turn depend on noble metal based catalysts for their efficient functioning. In order to make such green energy technologies economically viable, the need of the hour is to develop new noble metal free catalysts. Porous carbon, with some assistance from heteroatoms like N or S or earth abundant transition metal or metal oxide nanoparticles, has shown excellent potential in the catalysis of such electrochemical reactions. Metal–organic frameworks (MOFs) containing metal nodes and organic linkers in an ordered morphology with inherent porosity are ideal self-sacrificial templates for such carbon materials. There has been a recent spurt in reports on such MOF-derived carbon based materials as electrocatalysts. In this review, we have presented some of this research work and also discussed the practical reasons behind choosing MOFs for this purpose. Different approaches for synthesizing such carbonaceous materials with unique morphologies and doping, targeted towards superior electrochemical activity, have been documented in this review.

Hetero-atom doped porous carbon materials derived from MOFs are efficient noble metal-free electrocatalysts.     

Hepatogenous diabetes: Knowledge,evidence, and skepticism

The diabetogenic potential of liver cirrhosis (LC) has been known for a long time, and the name hepatogenous diabetes (HD) was coined in 1906 to define the condition. Diabetes mellitus (DM) that develops as a consequence of LC is referred to as HD. In patients with LC, the prevalence rates of HD have been reported to vary from 21% to 57%. The pathophysiological basis of HD seems to involve insulin resistance (IR) and pancreatic β-cell dysfunction. The neurohormonal changes, endotoxemia, and chronic inflammation of LC initially create IR; however, the toxic effects eventually lead to β-cell dysfunction, which marks the transition from impaired glucose tolerance to HD. In addition, a number of factors, including sarcopenia, sarcopenic obesity, gut dysbiosis, and hyperammonemia, have recently been linked to impaired glucose metabolism in LC. DM is associated with complications and poor outcomes in patients with LC, although the individual impact of each type 2 DM and HD is unknown due to a lack of categorization of diabetes in most published research. In fact, there is much skepticism within scientific organizations over the recognition of HD as a separate disease and a consequence of LC. Currently, T2DM and HD are being treated in a similar manner although no standardized guidelines are available. The different pathophysiological basis of HD may have an impact on treatment options. This review article discusses the existence of HD as a distinct entity with high prevalence rates, a strong pathophysiological basis, clinical and therapeutic implications, as well as widespread skepticism and knowledge gaps.     

Subclinical thyrotoxicosis

Subclinical thyrotoxicosis as a definite entity has been recognised with the development of highly sensitive immunometric TSH assays. The condition is characterised by suppressed TSH in presence of normal T3 and T4. It may be due to exogenous or endogenous causes. The risks may be osteoporosis and atrial fibrillation. Exogenous subclinical thyrotoxicosis must be prevented by optimising laevothyroxine dosage. Endogenous subclinical thyrotoxicosis may or may not be treated depending upon the clinical situation and existing comorbidities.     

Diffuse leptomeningeal hyperintensity on fluid-attenuated inversion recovery MR images in neurocutaneous melanosis

Neurocutaneous melanosis (NCM) is a rare neuroectodermal dysplasia characterized by large or multiple cutaneous congenital pigmented nevi and benign or malignant melanocytic tumors of the leptomeninges. Although the MR manifestations of this disease have been reported in a small series of cases, the usefulness of fluid-attenuated inversion recovery (FLAIR) MR findings has not been documented. We present a case of NCM that showed diffuse leptomeningeal hyperintensity on FLAIR images. This FLAIR finding may be a clue to the detection of leptomeningeal abnormalities in NCM.