Collateral damage: Corneal injury due to mask use during the COVID-19 pandemic - A case series

Though masks are the best shield against COVID-19, they can be a source of discomfort and ocular side effects. We discuss three cases of corneal injury due to mask use. Three patients, who were healthcare workers, presented with discomfort, photophobia, and pain in the eyes. While adjusting the mask, they had an ocular injury. There were multiple superficial linear abrasions in the eyes. They recovered with treatment. Though masks are imperative during the COVID-19 pandemic, it is important to be aware of a possible mask injury.     

Nonlinear Optical Limiting and Radiation Shielding Characteristics of Sm2O3 Doped Cadmium Sodium Lithium Borate Glasses

Strong nonlinear absorption (NLA), reduced optical limiting (OL) thresholds, and high radiation shielding parameters are required for the effective use of glasses in the laser radiation and nuclear radiation protecting materials. In view of this, the efficacy of Sm₂O₃ on the nonlinear optical (NLO) and OL properties were ascertained (at 532 nm) along with radiation shielding characteristics. The open and closed aperture Z-scan profiles revealed the presence of positive NLA and nonlinear refraction (NLR) phenomena respectively. OL measurements showed the existence of limiting behavior in the studied glasses. The NLA and NLR coefficients were improved while the OL thresholds were decreased as the doping of Sm₂O₃ elevated to a higher doping level. These improvements in NLA, NLR coefficients and OL efficiencies were attributed to the non-bridging oxygens and high polarizable Sm³⁺ ions. The NLA and OL results clearly suggest the high (5 mol %) Sm₂O₃ doped glass (Sm5CNLB) glass is beneficial to protect the delicate devices and human eye by suppressing the high energy laser light. The theoretical linear attenuation coefficients (LAC) values of the presented SmxCNLB glasses were obtained with the help of Phy-X software between 0.284 and 1.333 MeV. At 0.284 MeV, the maximum values occur and take values between 0.302 (for Sm0CNLB) and 0.409 cm⁻¹ (for Sm5CNLB). We found that the LAC for the presented SmxCNLB glasses is a function of Sm₂O₃ content, where the LAC tends to increase, corresponding to the high probabilities of interaction, as the content of Sm₂O₃ changes from 0 to 5 mol %. The effective atomic number (Z_eff) for the presented SmxCNLB glasses was examined between 0.284 and 1.333 MeV. As the amount of Sm₂O₃ is added, the Z_eff increases, and this was observed at any energy.     

Outcome after decompressive craniectomy in patients with dominant middle cerebral artery infarction: A preliminary report

Introduction:

Life-threatening, space occupying, infarction develops in 10-15% of patients after middle cerebral artery infarction (MCAI). Though decompressive craniectomy (DC) is now standard of care in patients with non-dominant stroke, its role in dominant MCAI (DMCAI) is largely undefined. This may reflect the ethical dilemma of saving life of a patient who may then remain hemiplegic and dysphasic. This study specifically addresses this issue.

Materials and Methods:

This retrospective analysis studied patients with DMCAI undergoing DC. Patient records, operation notes, radiology, and out-patient files were scrutinized to collate data. Glasgow outcome scale (GOS), Barthel index (BI) and improvement in language and motor function were evaluated to determine functional outcome.

Results:

Eighteen patients between 22 years and 72 years of age were included. 6 week, 3 month, 6 month and overall survival rates were 66.6% (12/18), 64% (11/17), 62.5% (10/16) and 62.5% (10/16) respectively. Amongst ten surviving patients with long-term follow-up, 60% showed improvement in GOS, 70% achieved BI score >60 while 30% achieved full functional independence. In this group, motor power and language function improved in 9 and 8 patients respectively. At last follow-up, 8 of 10 surviving patients were ambulatory with (3/8) or without (5/8) support. Age <50 years corresponded with better functional outcome amongst survivors (P value –0.0068).

Conclusion:

Language and motor outcomes after DC in patients with DMCAI are not as dismal as commonly perceived. Perhaps young patients (<50 years) with DMCAI should be treated with the same aggressiveness that non-DMCAI is currently dealt with.Key Words: Craniectomy, dominant, middle cerebral artery, outcome, stroke     

EUS-guided angiography: a novel approach to diagnostic and therapeutic interventions in the vascular system

BACKGROUND: Indications for diagnostic and therapeutic procedures under EUS guidance continue to expand. OBJECTIVE: To assess the feasibility and safety of EUS-guided angiography in a live porcine model. SETTING: Five acute experiments under general anesthesia. DESIGN AND INTERVENTIONS: A linear echoendoscope was advanced into the stomach. Thoracic and abdominal aorta, celiac axis, superior mesenteric and splenic artery, splenic, portal, and hepatic veins were injected with contrast by using FNA needles under fluoroscopy. The animals were then killed for postmortem examination. MAIN OUTCOME MEASUREMENTS: Ability to achieve angiography without complications. RESULTS: All vessels were identified and punctured without technical difficulties. Injections of the large-caliber vessels resulted in a blush of contrast, whereas selective injection of the smaller vessels (splenic artery, hepatic veins) demonstrated clear vascular opacification. Injection of contrast was technically easiest with the 19-gauge FNA needle and most difficult with the 25-gauge needle. There were no changes in vital signs and hemodynamic parameters during vascular injection of any vessel. At necropsy, the 25-gauge FNA needle did not cause any visible vascular injury or bleeding. The 22-gauge needle left a visible puncture mark without active bleeding. In 1 of 5 pigs, the 19-gauge needle caused a localized vascular hematoma around large-caliber vessels and 150 mL of intra-abdominal blood. LIMITATION: Technical challenges remain to achieve an adequate flow rate of contrast for prolonged visualization of large vessels. CONCLUSION: EUS-guided angiography is technically easy and safe and has potential for a wide array of diagnostic and therapeutic vascular interventions.     

Pleural empyema due to S. typhi: a case report

In a 35 year old immunocompetent male, clinically diagnosed as a case of hydropneumothorax of left side, Salmonella typhi was isolated as the causative agent of pleural empyema.     

Insecticidal and larvicidal activities of medicinal plant extracts against mosquitoes

In recent years, use of environment friendly and biodegradable natural insecticides of plant origin have received renewed attention as agents for vector control because they are rich in bioactive chemicals, active against a limited number of species including specific target insects, and biodegradable. The present study was carried out to evaluate the adulticidal, repellent, and larvicidal activity of crude hexane, ethyl acetate, and methanol extracts of eight plants, viz. Aristolochia indica L., Cassia angustifolia Vahl, Diospyros melanoxylon Roxb., Dolichos biflorus L., Gymnema sylvestre (Retz) Schult, Justicia procumbens L., Mimosa pudica L., and Zingiber zerumbet L., were tested against adult and early fourth instar larvae of Culex gelidus Theobald and Culex quinquefasciatus Say (Diptera: Culicidae). The effective adult mortality was observed in methanol extract of A. indica, ethyl acetate extract of D. biflorus, and ethyl acetate and hexane extract of Z. zerumbet against C. gelidus and C. quinquefasciatus (LD₅₀ = 37.75, 78.56, 129.44, 86.13, 80.06, 112.42, 53.83, and 46.61; LD₉₀ = 166.83, 379.14, 521.50, 289.83, 328.18, 455.72, 181.15, and 354.50 ppm, respectively). Complete protections for 150 min were found in hexane and methanol extract of A. indica and Z. zerumbet at 1,000 ppm against mosquito bites. The highest larval mortality was found in the hexane extract of Z. zerumbet, ethyl acetate extract of D. biflorus, and methanol extracts of A. indica against C. gelidus (LC₅₀ = 26.48, 33.02, and 12.47 ppm; LC₉₀ = 127.73, 128.79, and 62.33 ppm) and against C. quinquefasciatus (LC₅₀ = 69.18, 34.76, and 25.60 ppm; LC₉₀ = 324.40, 172.78, and 105.52 ppm), respectively, after 24 h. The plant extracts are potential to be used as an ideal eco-friendly approach for the control of the Japanese encephalitis vector, C. gelidus, and lymphatic filariasis vector, C. quinquefasciatus.     

Metastasis suppressor 1 (MTSS1) expression is associated with reduced in-vivo metastasis and enhanced patient survival in lung adenocarcinoma

Metastasis suppressor 1 (MTSS1) has been shown to be a metastasis suppressor in a number of cancers. However, its role in lung adenocarcinoma is largely unknown. To evaluate the significance of MTSS1 expression on lung adenocarcinoma metastatic properties, the gain or loss of MTSS1 in in vivo and in vitro experiments were employed. Using an in vivo orthotopic mouse xenograft model mimicking human disease progression, stable overexpression of MTSS1 in lung adenocarcinoma cells resulted in a significant decrease in metastatic burden. Stable overexpression of MTSS1 in NCI-H1299 decreased in vitro lung adenocarcinoma invasion and migration while knockdown of MTSS1 in A549 resulted in a significant increase in cell invasion and migration. Using The Cancer Genome Atlas dataset of over 500 patient lung adenocarcinoma specimens, we demonstrated a 20% increase in 5-year survival associated with preserved intratumoral MTSS expression. MTSS1 expression in lung adenocarcinoma is associated with decreased metastatic burden, as assessed by an in vivo orthotopic model, and correlates with a 20% survival advantage at 5 years following diagnosis. In vitro data suggests MTSS1 regulates lung adenocarcinoma through augmentation of cell invasion and migration.     

Idiopathic chronic subdural hematoma,MCA infarct and cortical atrophy with status epilepticus in infants

Spontaneous chronic subdural hematomas in infants are extremely rare. A very limited number of cases are known and reported in literature. The clinical presentation can be myriad varying from asymptomatic cases to gross neurological deficits. We report the cases of 2 infants who presented to us with repeated episodes of generalized tonic clonic seizures since birth. No etiology could be established for either of them. Subsequent imaging revealed chronic subdural hematoma, MCA infarct and cortical atrophy in both the cases. Both the cases improved following evacuation of the chronic subdural hematoma. One of the infants had secondary craniosynostosis for which additional coronal suturectomy had to be done. The management of such cases and a brief review of literature are discussed.