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Introduction  Ventriculoperitoneal shunt (VPS) is the most common procedure used for cerebrospinal fluid (CSF) diversion in hydrocephalus. Over the years, many technical, procedural, and instrument-related advancements have taken place which have reduced the associated complication rates. Shunt block is a very common complication irrespective of the shunt system used. The abdominal end of the shunt tube gets blocked usually due to plugging of omentum onto the shunt catheter. We describe a technique of catheter fixation and placement under vision coupled with omentopexy done laparoscopically to prevent this complication. Materials and Methods  This technique was used in 23 patients (11 female, 12 male; range 16–73 years) afflicted with hydrocephalus from June 2016 and December 2019 after obtaining an informed consent, and the outcomes were noted in terms of shunt patency, complications, if any, and the need for revision. Results  The median operation time was 90 minutes (range 35–160 minutes). All shunt catheters were still functional after a mean follow-up of 16.5 months (range 1–34 months) and none required revision. Conclusion  Laparoscopic placement of shunt tube along with omental folding is a safe and effective technique for salvaging the abdominal end of VPS and may be helpful in reducing shunt blockage. [ABSTRACT FROM AUTHOR]

Due to ongoing pandemic, majority of the academic teaching is executed on online platforms, leading to extended screen time. Anecdotal evidence suggests long-term ophthalmic impact of extended screen time. Present study was carried out to document eye related problems amongst adult university/college students undertaking online classes to document the effects of online teaching. An online survey method was undertaken in the month of July, 2020 amongst university/ college students of Gujarat using google form. All possible social media platforms were used to collect the data from students of Gujarat. Epi Info and SPSS were used and both descriptive and inferential analysis was performed. A total of 620 students from the various streams participated in the study where around 56.5% were female respondents. The majority of students (88% of participants) had noticed eye problems out of that 39.1% of participants felt that online teaching as a reason. Headache (54.0%) was the most common problem experienced by the participants followed by Pain in eyes (34%) and Watering (26.3%). To conclude online teaching has led to increased eye strain and other eye-related problems in university/college going students and risk factors for severity included sessions attended per day, the distance at device kept, and the enjoyment level. In spite of the high incidence of ophthalmic issues, none of the respondents contacted any ophthalmologist for the same. [ABSTRACT FROM AUTHOR]

Juvenile Dermatomyositis is the most common inflammatory myositis in children, distinguished by proximal muscle weakness, a characteristic rash and Gottron's papules. The oral lesions most commonly manifest as diffuse stomatitis and pharyngitis with halitosis. We report a case of an 8 year old male with proximal muscle weakness of all four limbs, rash, Gottron's papules and oral manifestations. Oral health professionals must be aware of the extraoral and intraoral findings of this rare, but potentially life threatening autoimmune disease of childhood, for early diagnosis, treatment, prevention of long-term complications and to improve the prognosis and hence, the quality of life for the patient. [ABSTRACT FROM AUTHOR]

Background:Physostigmine has long been recognized as an antidote to reverse anticholinergic delirium. However, its effectiveness, safety profile, and dosing have been disputed. Objectives:To describe effectiveness, adverse events, and dosing associated with the use of physostigmine to reverse anticholinergic delirium. Methods:A retrospective cohort study of hospitalized patients reported to a regional poison center system between 2003 and 2012 who received physostigmine to reverse an anticholinergic toxidrome. Data extraction ofa prioridefined variables were recorded with concurrence of investigators. The cases were stratified by the primary ingestant as the presumed causative agent and associations for response were performed using odds ratios (ORs), 95% confidence intervals (CI’s), andpvalues. Results:Of the 1422 cases identified, 191 met the inclusion criteria. Patients exposed to non-diphenhydramine antihistamines (n = 14), antipsychotics (n = 4), and tricyclic antidepressants (n = 3) had 100% response to physostigmine, whereas anticholinergic plants (n = 46/67; 68.7%, OR: 0.70; CI: 0.36–1.35), diphenhydramine (n = 43/56; 64.2%, OR: 1.30; CI: 0.63–2.68), and combination products (n = 8/10; 80%, OR: 1.48; CI: 0.30–7.24) had partial response rates. Of the included patients, 142 (74.3%) were treated with physostigmine alone, and 16 (8.4%) of these patients were discharged directly from the emergency department (ED). Discussion:Most patients, 182 (95.3%), had no documented adverse effects. Four patients (2.1%) experienced emesis, two experienced QTc prolongation (1.0%), and two experienced seizures (1.0%). There was a single fatality 6 h after physostigmine administration. Average initial total doses of physostigmine ranged from 1.0 to 1.75 mg. Most patients were admitted to the ICU (n = 110; 57.6%), however, 36 (18.8%) patients were discharged directly from the ED. Conclusions:In this retrospective cohort study, physostigmine administration to reverse anticholinergic delirium had a good safety profile, and often improved or resolved anticholinergic delirium when administered in doses less than 2 mg. [ABSTRACT FROM PUBLISHER]