Aakash Aggarwal

Folding mirror schlieren diffraction interferometer.

We demonstrate the use of a mirror as a viewing diaphragm to generate a built-in diffracted reference beam in schlieren diffraction interferometry (SDI). The use of a mirror edge as a diffracting element instead of a conventional knife edge considerably enhances the contrast of the schlieren pattern, and it is shown to be equal to that of a phase knife edge. This increase in contrast is due to the fact that the otherwise unutilized diffracted beam in SDI is recombined in the described folding mirror geometry.

A new facial expression to botox

Botulinum toxin (Botox) injection into the lower esophageal sphincter (LES) has been used for the treatment of achlasia cardia since the 1990s. Currently it is indicated for patients who are not candidates for definitive therapy like Hellers myotomy or pneumatic dilation and in those who have recurrence of symptoms after definitive treatments. We present a case of severe anaphylaxix due to Botox. The purpose of this case is to highlight one of the under-reported adverse effects of Botox. Anaphylactic reactions to Botox are very rare with only one other case being reported and have not been emphasized enough to be widely known in clinical practice.

Hiatal hernia squeezing the heart to flutter

An 80-year-old woman presented to the emergency department with failure to thrive and weakness for 14 days. Medical history was significant for polio. On admission her electrocardiogram showed atrial flutter, and cardiac enzymes were elevated. Echocardiogram revealed a high pulmonary artery pressure, but no other wall motion abnormalities or valvulopathies. Chest x-ray showed a large lucency likely representing a diaphragmatic hernia. Computed tomographic scan confirmed the hernia. Our patient remained in atrial flutter despite rate control, and thereafter surgery was consulted to evaluate the patient. She underwent hernia repair. After surgery, the patient was taken off rate control and monitored for 72 hours; she did not have any episode of atrial flutter and was discharged with follow up in a week showing no arrhythmia. Her flutter was caused directly by the mechanical effect of the large hiatal hernia pressing against her heart, as the flutter resolved after the operation.

Standard anticoagulation for mesenteric vein thrombosis, revealing a ‘zebra’ diagnosis: hereditary haemorrhagic telangiectasia—the dripping truth!

A 60-year-old man was treated in the hospital for mesenteric vein thrombosis and discharged home on anticoagulation. On warfarin the patient started to bleed profusely from the nose and tongue. He was evaluated by ENT (ears, nose and throat); a nasal endoscopy revealed several vascular ectasias. Subsequent detailed history and general physical examination established the diagnosis of hereditary haemorrhagic telangiectasia also known as Osler-Weber-Rendu syndrome. On further evaluation, pulmonary arteriovenous malformations were diagnosed on imaging and treated by intervention radiology. In hindsight, the diagnosis could have been made in the general practitioners office with just a routine thorough history and a physical examination at a new patient visit. We report this case to stress upon the importance of vigilant clinical, medical and family history and a thorough examination to establish an early diagnosis of this not-so-rare entity.

Multiplexed Restricted Aperture Reflection Holograms For Display Holography

A method for recording high efficiency multiplexed reflection holograms has been discussed. The image diffraction efficiency of reflection holograms has been enhanced by recording hologram of a real image of the object projected by another master off-axis hologram whose effective aperture is limited by a suitably shaped stop. The limited viewing area offered by these holograms is gainfully exploited for incoherent multiplexing of several objects on same recording plate. A technique for multiplexing reflection holograms is presented where the well known property of mirror like behaviour of interfering fringes is used. Two schemes of horizontal and vertical plane multiplexing have been discussed where the different multiplexed images do not overlap in the final viewing. Optimization of different experimental parameters to compensate for holographic reciprocity law failure and to achieve uniform diffraction efficiency in multiplexed restricted aperture reflection holograms has also been carried out.

Isolated PTH Renal Resistance Pseudohypoparathyroidism 1b: A Rare Cause of Hypocalcemia.

A case of Pseudohypoparathyroidism 1b is reported, who presented with signs and symptoms of hypocalcemia. Causes, diagnosis and management with new insight into genetic novel mutations in PHP are discussed. The objectives are to provide information regarding problems of Calcium balance, causes and making diagnosis of pseudohypoparathyroidism, learn complexities of PTH cellular interactions and calcium homeostasis and learn the genetic novel mutations of various types of PHP.

A rare cause of exercise induced ventricular tachycardia.

Coronary fistulas are anomalous shunts from a coronary artery to a cardiac chamber or great vessel, bypassing the myocardial circulation. A 42-year-old Asian man with no significant history of cardiac disease presented with exertional chest discomfort in the form of chest tightness over the precordial area. The patient had no cardiac risk factors, but given the duration and persistence of symptoms, we did a stress echocardiogram. The exercise led to a ‘coronary artery steal phenomenon’ caused by the coronary fistula, which diverted the blood from the left anterior descending artery to the pulmonary artery thereby producing the ischemic symptoms and ventricular tachycardia. Transcatheter coil embolization was unsuccessful, but the fistula was eventually closed surgically. A repeat stress echocardiogram before discharge was completely normal. We emphasize the need to individualize treatment, taking into consideration all factors in a particular patient.