Aims and Objectives: To describe the diversity of clinical manifestations, laboratory findings, and outcome of scrub typhus in hospitalized patients of Tirumala Hospital, Vizianagaram, during 2014–2015. Materials and Methods: All cases of acute febrile illness diagnosed as scrub typhus were analyzed. Diagnosis was made by ELISA-based IgM serology. Observations and Results: A total of sixty patients were included in the study. All of them presented with fever; the other major symptoms were headache, cough, dyspnea, and myalgias. On examination, patients had hepatosplenomegaly, lymphadenopathy, and eschar. On investigation, elevated serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase with normal and elevated bilirubin levels were the most common findings. Other laboratory findings were thrombocytopenia and deranged renal function tests.Other complications were multiorgan dysfunction syndrome, acute respiratory distress syndrome, hypotension, and meningoencephalitis. Majority responded to doxycycline. Conclusion: Scrub typhus though prevalent is under-reported in our country. It should be considered as an important differential diagnosis in a febrile patient with thrombocytopenia, deranged liver or renal functions, Early diagnosis and appropriate treatment is rewarding and prevents morbidity and mortality.

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Glaucomatous visual changes and defects are almost irreversible, with the visual field changes of glaucoma being noticed by the patient after significant disease progression due to a relative lack of alerting symptoms. Reduction of elevated intraocular pressure (IOP) is the only as yet proven approach to protect against visual field loss in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). When they first entered the ophthalmic market about 10 years ago, prostaglandins were viewed skeptically as a potential first-line therapy for glaucoma patients. Yet in less than a decade, glaucoma specialists' preferences have changed, with most reporting that they prefer prostaglandins over beta blockers as their patients' initial medication. Latanoprost has truly withstood the test of time and has indeed proved to be one of the best anti-glaucoma medications when used as monotherapy or as adjunctive therapy. Bimatoprost 0.01% has a similar overall safety profile, a favorable hyperemia profile, and less overall discontinuation compared with Bimatoprost 0.03%. In lieu of its poor efficacy, Unoprostone has lost its hold in the anti-glaucoma palate. Travatan Z (travoprost) is a new formulation of Travatan solution in which benzalkonium chloride is replaced with Sofzia, a robust ionic buffered preservative system that is gentle to the ocular surface. Tafluprost, the newest addition to the prostaglandin brigade, is a fluorinated analogue of prostaglandin-F 2α and is available as a sterile ophthalmic solution of 0.0015% (0.015 mg/ml) being approved by the US-FDA on 10th February, 2012. A new futuristic glaucoma therapeutic management paradigm where clinical success is no longer simply measured by achieved level of intraocular pressure control but also long-term preservation of visual function and patient's quality of life is expected to dramatically improve upon current treatment algorithms for ocular hypertension and glaucoma.

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Often employed in the treatment of malignancies with high cellular proliferation rates, including acute lymphoblastic leukemia, choriocarcinoma, trophoblastic tumours, and carcinomas of the breast, tongue, pharynx, and testis; and certain nonmalignant conditions like rheumatoid arthritis, psoriasis, asthma, sarcoidosis, and transplantation therapy, methotrexate is an antifolate agent. It works by inhibiting the enzyme dihydrofolate reductase. The molecule inhibits DNA synthesis by depletion of nucleotide precursors and is associated with a number of diverse side effects. The present series comprises of 4 patients: Each demonstrated significant drug-induced side effects even though their serum methotrexate levels were found to be normal.

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Proton pump inhibitors, the most potent and safest acid inhibitory agents available, irreversibly bind and inhibit H⁺, K⁺-ATPase. They inhibit all phases of gastric acid secretion. Proton pump inhibitors are considered extremely safe and are regularly prescribed. They may, however, have side effects. They affect the clearance of other medicines. And the reactions to them may mimic other conditions and side effects of other medicines.

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Von Hippel–Lindau (VHL) disease is a rare phakomatosis with autosomal dominant inheritance. It is the result of inactivation of tumor suppressor gene located on short arm of chromosome 3 and is characterized by the development of a variety of benign and malignant tumors of various organs. These include retinal and central nervous system hemangioblastomas, renal cysts and renal cell carcinoma, pheochromocytomas, pancreatic cysts and tumors, epididymal cystadenoma, and ductal ectasia of rete testis. Imaging plays a key role in the diagnosis of VHL disease. It is also useful for screening of patients with family history of VHL disease and in follow-up after treatment. This coupled with advanced surgical management helps in reducing the morbidity and mortality in VHL. The aim of this pictorial essay is to demonstrate the imaging spectrum of VHL disease.

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We report a case of an anomalous unilateral single right pulmonary vein resembling a scimitar sign on chest X-ray. Only a few cases have been reported in the literature describing this interesting rare anomaly that is often confused with arteriovenous malformation and hypogenetic lung syndrome (scimitar syndrome). This report briefly discusses the embryology of the pulmonary veins, classification of the pulmonary venous anomalies, and various causes of scimitar sign.

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Introduction: Micellar Electrokinetic Chromatography, sometimes referred as Affinity Capillary Electrophoresis, is a useful tool to the characterization of the drug partitioning in different vehicle systems such as micelles and microemulsions using the capacity factor as hydrophobicity parameter. Bile acids, because of their important role in biological systems, are applied widely in ACE method to characterization of partition properties of solutes. In this paper the interaction of some hydrophilic and lipophilic vitamins with micellar systems consisted of bile salts and phospholipids was considered using ACE. Material and Methods: Three mixed micelles and one microemulsion were employed. The samples were filtered through a 0.45 μm filter. 13 vitamins, consist of 4 lipophilic and 9 hydrophilic vitamins were investigated. Each vitamin was solved in different micellar systems (0.1 mg/ml). Then, using ACE, the electropherogram of samples was obtained under certain run conditions. The capacity factor for each sample was calculated according the migration times in the electropherogram. DMSO and Sudan red were used as EOF tracer and micelle tracer respectively. All experiments were carried out with certain instrumental conditions. Results and Discussion: The results show that the migration times of lipophilic vitamins are equal to migration time of micellar tracer and consequently the capacity factor of all of them tends to infinity. In fact these vitamins, concerning the hydrocarbonic chain in their chemical structure, are incorporated in the inner oil core of mixed micelle or microemulsion and moved with it. Four hydrophilic vitamins (niacinamid, pyridoxine, D-panthenol and cyanocobalamin) have different affinity to Micellar systems. But for each vitamin the affinity to different system is almost same. K′ zero means that vitamin has not any affinity to micelle, remains in aqueous phase and moves with EOF. Five hydrophilic vitamins (ascorbic acid, folic acid, riboflavin, biotin and thiamin) had charged behavior. The electrophoretic mobility of all these vitamins was negative, except thiamin which has positive mobility. Two important parameters that may influence these migration behaviors of charged solutes are pH and micelle concentration. Distribution properties of molecules mostly change depending to pH value of the media because of the effect of pH on the chemical interaction. In the other hand, it might be that the negative charge of bile salt's micelle increases by mixing with phospholipids, and causes to stronger repulsion between negative charged micelle and anion analyte. So the electrophoretic mobility of anionic vitamins in presence of micelle would be reduced. Conclusion: The MEKC technique as a method of ACE was employed to determination partitioning pattern of various kinds of vitamins in a micellar solutions. The affinity of both hydrophilic and lypophilic vitamins to micellar system was investigated by calculation the capacity factor. This value for lypophilic vitamins is infinite, because they incorporate with micelle compositions and moved with them. In contrast hydrophilic vitamins exhibited different partitioning behaviour in micellar solution. The negative value obtained for anionic hydrophilic vitamins can be corrected by change some condition like micellar concentration and the pH of media.

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Background: Synthetic graft materials are needed for ossicular reconstruction in chronic otitis media (COM) when autografts are inadequate. This study aims to analyze and compare the outcome of ossiculoplasty in terms of hearing gain using titanium (Ti) and hydroxyapatite (HA) prostheses in patients with COM. Study Design: Quasi-randomized study. Materials and Methods: Seventy patients of COM with air-bone gap (ABG) >40 dB were divided into two equal groups. The first group was reconstructed with Ti and the second group with HA prostheses. Hearing thresholds were evaluated postoperatively at 3rd and 12th month at the four frequency averages of 0.5/1/2/4 kHz. Results: There was no significant difference in ABG closure when intergroup comparison is made (P > 0.05 at 3rd and 12th months); however, intragroup ABG closure was significant in both groups, at the end of the 3rd month and 12th month (P < 0.05). Conclusion: Both prostheses give comparable hearing gain in ossicular reconstruction. These prostheses are a good alternative in longstanding cases of COM without any available ossicular autograft for hearing reconstruction.

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Anterior spinal artery syndrome is caused by occlusion of the anterior spinal artery, which supplies the anterior two thirds of the spinal cord. Here, we report a 14 year old boy, who presented with progressive limb weakness, and urinary retention.

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Primary osteochondromas are very rare tumors of the spine, which account for about 4% of bony tumors of the spine. They rarely cause any symptoms. Here, we report a case of a young male patient who presented with cervical compression of the spinal cord. He was treated successfully with complete excision of the lesion, and the diagnosis was proven histopathologically.

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A rarely reported condition, tropical myositis is a microbial condition. Caused most commonly by Staphylococcus aureus, it may also be triggered by Streptococci and Gram-negative bacilli like Klebsiella. A pocket of pus, identifiable on ultrasound or magnetic resonance imaging is the usual hallmark. We present a rare case of the disease in a 32-year-old patient who had tropical myositis without any pus collection. The disease ran an extremely aggressive course and despite not being immunocompromised, the patient succumbed to the condition.

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Gossypiboma or textiloma is a rare avoidable surgical disaster having medicolegal repercussions. It is a mass lesion due to a retained surgical cotton sponge accompanied by foreign body reaction. The time of presentation may range from early postoperative period to several decades later. A correct diagnosis can be made only in one-third of cases. We report an unusual case of gossypiboma in a 56-year-old female which was mistaken for pelvic cystic lesion. The diagnosis of gossypiboma was confirmed only during surgical exploration. Retained foreign body should be one of the differential diagnosis of any postoperative patient presenting with pain, infection, or palpable mass.

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