Role of anterior segment optical coherence tomogram in Descemet's membrane detachment

Descemet's membrane detachment (DD) is a rare but serious complication of intraocular surgery. In rare cases where corneal edema is severe and we may not be able to visualize DD on slit-lamp examination, anterior segment optical coherence tomogram (AS-OCT) would be helpful. We describe two patients with DD, highlighting the role of AS-OCT in early diagnosis and management of patients with DD. One of the patients had DD with rolled in edge, which could only be visualized with AS-OCT. In such a situation, AS-OCT can identify the edge of detachment and show the exact position of the rolled edge, which can allow us to plan the surgical strategy to unroll the DD.     

Results of a multicentre UK‐wide retrospective study evaluating the efficacy of pixantrone in relapsed,refractory diffuse large B cell lymphoma

Relapsed or refractory (R/R) diffuse large B‐cell lymphoma (DLBCL) in those unfit or ineligible for autologous stem cell transplantation is associated with a poor outcome and new treatment approaches are needed. Pixantrone is a novel aza‐anthracenedione which is structurally similar to anthracyclines and is licenced in R/R DLBCL and National Institute for Health and Care Excellence (NICE)‐approved following the PIX301 trial. No data exist post‐NICE approval. We performed a UK‐wide retrospective multi‐centre study of 92 R/R DLBCL who received pixantrone. Eighty‐five per cent had refractory disease and 72% had an international prognostic index (IPI) 3–5 at commencement of pixantrone. The median progression‐free survival (PFS) was 2·0 months (95% confidence interval (CI) 1·5–2·4) and the median overall survival was 3·4 months (95% CI 2·7–4·5). The overall response rate was 24% (complete response 10%; partial response 14%). We demonstrate that pixantrone has limited activity in a cohort of high risk, predominantly refractory DLBCL. Multivariate Cox regression revealed that patients who relapsed >12 months after first line treatment, those with fewer prior lines of therapy and relapsed (non‐refractory) DLBCL had improved PFS. The major population of unmet need are those with refractory DLBCL who are poorly represented within trials and in whom pixantrone appears less efficacious compared to relapsed DLBCL.     

Short turn radius colonoscope in an anatomical model: Retroflexed withdrawal and detection of hidden polyps

AIM: To evaluate the new Retro View~(TM) colonoscope and compare its ability to detect simulated polyps "hidden" behind colonic folds with that of a conventional colonoscope, utilizing anatomic colon models.METHODS: Three anatomic colon models were prepared,with twelve simulated polyps "hidden" behind haustral folds and five placed in easily viewed locations in each model. Five blinded endoscopists examined two colon models in random order with the conventional or Retro View~(TM) colonoscope, utilizing standard withdrawal technique. The third colon model was then examined with the Retro View~(TM) colonoscope withdrawn initially in retroflexion and then in standard withdrawal. Polyp detection rates during standard and retroflexed withdrawal of the conventional and Retro View~(TM) colonoscopes were determined. Polyp detection rates for combined standard and retroflexed withdrawal(combination withdrawal) with the Retro View~(TM) colonoscope were also determined.RESULTS: For hidden polyps, retroflexed withdrawal using the Retro View~(TM) colonoscope detected more polyps than the conventional colonoscope in standard withdrawal(85% vs 12%, P = 0.0001). For hidden polyps, combination withdrawal with the Retro View~(TM) colonoscope detected more polyps than the conventional colonoscope in standard withdrawal(93% vs 12%, P ≤ 0.0001). The Retro View~(TM) colonoscope in "combination withdrawal" was superior to other methods in detecting all(hidden + easily visible) polyps, with successful detection of 80 of 85 polyps(94%) compared to 28(32%) polyps detected by the conventional colonoscope in standard withdrawal(P 0.0001) and 67(79%) polyps detected by the Retro View~(TM) colonoscope in retroflexed withdrawal alone(P 0.01). Continuous withdrawal of the colonoscope through the colon model while retroflexed was achieved by all endoscopists. In a post-test survey, four out of five colonoscopists reported that manipulation of the colonoscope was easy or very easy.CONCLUSION: In simulated testing, the Retro View~(TM) colonoscope increased detection of hidden polyps. Combining standard withdrawal with retroflexed withdrawal may become the new paradigm for "complete screening colonoscopy".     

Thoracoabdominal pseudocyst of pancreas: An rare location,managed by retrocolic retrogastric Roux-en-Y cystojejunostomy

Pseudocyst formation is a common complication of acute and chronic pancreatitis. Most common site of pseudocyst is lesser sac; mediastinal extension of pseudocyst is rare. Other possibilities of posterior mediastinal cyst must be considered. This patient presented with computed tomography abdomen with thorax showing a large thoraco-abdominal pseudocyst with right sided pleural effusion. It was confirmed to be pancreatic pseudocyst by analyzing fluid for amylase and lipase during surgery. In our patient, the pseudocyst was accessible transabdominaly. Cystogastrostomy was not possible as it was causing twisting of cardio-esophageal junction; we did retrocolic and retrogastric Roux-en-Y cystojejunostomy. Only two such cases were reported in literature.     

Nora��s lesion of the second toe

Bizarre parosteal osteochondromatous proliferation, otherwise known as Nora’s lesion, is surface tumor of bone with high probability of local recurrence. The author reports a case of Nora’s lesion of the proximal phalanx of the second toe, successfully managed by en bloc excision of the swelling. At four-year follow-up there was no evidence of recurrence.     

Evaluation of Compressive Strength Index of the Femoral Neck in Caucasians and Chinese

Compressive strength index (CSI) of the femoral neck is a parameter that integrates the information of bone mineral density (BMD), femoral neck width (FNW), and body weight. CSI is considered to have the potential to improve the performance of assessment for hip fracture risk. However, studies on CSI have been rare. In particular, few studies have evaluated the performance of CSI, in comparison with BMD, FNW, and bending geometry, for assessment of hip fracture risk. We studied two large populations, including 1683 unrelated U.S. Caucasians and 2758 unrelated Chinese adults. For all the study subjects, CSI, femoral neck BMD (FN_BMD), FNW, and bending geometry (section modulus [Z]) of the samples were obtained from dual-energy X-ray absorptiometry scans. We investigated the age-related trends of these bone phenotypes and potential sex and ethnic differences. We further evaluated the performance of these four phenotypes for assessment of hip fracture risk by logistic regression models. Chinese had significantly lower FN_BMD, FNW, and Z, but higher CSI than sex-matched Caucasians. Logistic regression analysis showed that higher CSI was significantly associated with lower risk of hip fracture, and the significance remained after adjusting for covariates of age, sex, and height. Each standard deviation (SD) increment in CSI was associated with odds ratios of 0.765 (95% confidence interval, 0.634, 0.992) and 0.724 (95% confidence interval, 0.569, 0.921) for hip fracture risk in Caucasians and Chinese, respectively. The higher CSI in Chinese may partially help explain the lower incidence of hip fractures in this population compared to Caucasians. Further studies in larger cohorts and/or longitudinal observations are necessary to confirm our findings.     

Antibacterial activity of Lawsonia inermis Linn (Henna) against Pseudomonas aeruginosa

Objective

To investigate the antibacterial activity of henna (Lawsonia inermis Linn) obtained from different regions of Oman against a wide array of micro-organisms.

Methods

Fresh henna samples were obtained from different regions of Oman as leaves and seeds. 100 g fresh and dry leaves and 50 g of fresh and dry seeds were separately soaked in 500 mL of ethanol for three days, respectively, with frequent agitation. The mixture was filtered, and the crude extract was collected. The crude extract was then heated, at 48 °C in a water bath to evaporate its liquid content. The dry crude henna extract was then tested for its antibacterial activity using well-diffusion antibiotic susceptibility technique. Henna extracts were investigated for their antibacterial activity at different concentrations against a wide array of different micro-organisms including a laboratory standard bacterial strain of Pseudomonas aeruginosa (NCTC 10662) (P. aeruginosa) and eleven fresh clinical isolates of P. aeruginosa obtained from patients attending the Sultan Qaboos University Hospital (SQUH). 2-Hydroxy-p-Nathoqinone-Tech (2-HPNT, MW=174.16, C₁₀H₆O₃) was included as control (at 50% concentration) along with the henna samples tested.

Results

Henna samples demonstrated antibacterial activity against all isolates but the highest susceptibility was against P. aeruginosa with henna samples obtained from Al-sharqyia region.

Conclusions

Omani henna from Al-sharqyia region demonstrates high in vitro anti-P. aeruginosa activity compared with many henna samples from different regions of Oman.