Search

We describe customized therapeutic deep anterior lamellar keratoplasty (DALK) for treating a perforated Mooren's ulcer. Slit-lamp biomicroscopy revealed corneal perforation (3.5 mm × 3.0 mm) with iris prolapse. The corneal melt extended from 9.0 o'clock to 4.0 o'clock. The peripheral edge of the ulcer was sloping, whereas the medial edge showed undermining. Immunological tests did not reveal any evidence of systemic autoimmune disease. In view of extensive peripheral corneal melt with large corneal perforation, the patient needed tectonic keratoplasty. The penetrating graft is not only technically demanding but also results in a poor visual outcome. We advised customized tectonic DALK. We used two different-sized trephines to obtain appropriate-sized donor tissue and avoided manual dissection. The post-surgery period was uneventful. He was prescribed topical steroids and oral methotrexate. He achieved 6/9 aided visual acuity at 4 months and maintained it until the last follow-up at 36 months. [ABSTRACT FROM AUTHOR]

Introduction: In developing nations, one of the most common reasons for death and illness is due to infections that are brought on by intestinal parasites. People who have HIV are more likely to contract parasites that are either well-established intestinal pathogens, like Entamoeba histolytica, Giardia lamblia and Strongyloidesstercoralis, or an opportunistic pathogen like Cryptosporidium, Isospora, Cyclospora and Microsporidia. Higher prevalence of intestinal parasitic infections occurs in patients with low CD4+ cell counts. Hence, this study had been performed to know the correlation of intestinal parasitic infection in HIV/AIDS patients with reference to CD4+ cell count. Materials and Methods: The study comprised 1477 HIV-positive patients who were treated at ART Centre of Rajendra Institute of Medical Sciences (RIMS), Ranchi. All participants provided verbal informed consent before specimens were collected. Blood and stool sample were used for the identification of parasite and CD4+ T-Cell count. Results: In patients living with HIV, the prevalence of intestinal parasite infection was 12.59 per cent. In a manner parallel, the prevalence of parasitic infections was found to be 10.29% among male HIV-positive patients and 2.31% among female HIV-positive patients. Conclusions: This study has shed light that low CD4+ T-cell count appears to be a factor for intestinal parasitic infections and development of diarrhoea. Regular screening and treatment of intestinal parasitic infections is very important in overall improvement in quality of life of HIV/AIDS patients. Nevertheless, sanitary hygiene practices and deworming are needed to enhance the control of infection in the affected areas. [ABSTRACT FROM AUTHOR]

A 55-year-old woman presented with a stromal wooden foreign body (FB) in the left cornea. The deep corneal stroma wooden FB was removed using vitreoretinal FB forceps as a scoop. In this innovative technique, a 26-gauge needle was used to open the track of the wooden FB. The FB was trapped in the concavity of one limb of the vitreoretinal FB forceps. The vitreoretinal forceps were gradually withdrawn and the FB was removed. The patient was treated with gatifloxacin and voriconazole six times, and atropine 1% three times daily. The patient did not develop infiltrate or hypopyon in 2 weeks. After 2 weeks, gatifloxacin and voriconazole were reduced to four times a day; and atropine to two times a day. After 6 weeks topical medication was stopped. The patient achieved a best-corrected visual acuity (OS) of 6/9 at 8 weeks and maintained it through 7 months of follow-up. [ABSTRACT FROM AUTHOR]

Purpose: In the past few decades, candidemia has escalated to worrisome levels, leading to substantial morbidity and mortality in neonates. The rise in anti-fungal drug resistance demands prompt diagnosis and treatment. This study aimed to determine the speciation and susceptibility pattern of Candida species recovered from special care new-born units and identify risk factors for developing candidemia in neonates. Method: A total of 580 blood samples from clinically suspected septicemic neonates were collected and subjected to culture. Cultures positive for yeasts were sub-cultured on Sabouraud dextrose agar. Identification of a suspected purified colony of Candida was confirmed to the species level by both conventional and automated techniques matrix-assisted laser desorption and ionization time-of-flight mass spectrometry. Anti-fungal susceptibility of isolates was performed by an automated method (VITEK 2 system) using VITEK 2 cards. Multi-variate logistic regression analysis was used to identify risk factors associated with candidemia. Result: A total of 56 (9.66%) isolates of Candida species were recovered from 580 blood cultures. Non-albicans Candida species predominated with 82.14% of cases, whereas 17.86% of cases were caused by Candida albicans. Candida tropicalis (46.42%) was the most common isolate recovered, followed by Candida albicans (17.8%). Risk factor analyses identified a very low birth weight [odds ratio (OR) =4.05, 95% confidence interval (CI) =2.03-8.08] and prolonged antibiotic therapy (OR = 3.79, 95% CI = 1.7-8.7) among others as significant predictors of candidemia. All the Candida isolates showed 100% sensitivity to voriconazole and micafungin, whereas the overall sensitivities for fluconazole, amphotericin B, caspofungin, and flucytosine were 85.71%, 96.43%, 96.43%, and 91.07%, respectively. Conclusion: Candidemia is a life-threatening condition in neonates. Identification of Candida species and routine anti-fungal susceptibility is a must to select a suitable and effective anti-fungal therapy to revoke emerging resistance to anti-fungals. [ABSTRACT FROM AUTHOR]

Introduction: Surgical complication following esophageal atresia repair is one of the several factors known to influence the final outcomes. Early identification of such complications may help in timely institution of therapeutic measures and translate into improved prognosis. Objective: The objective of this study was to evaluate the role of procalcitonin in early prediction of the adverse events after surgery in patients of esophageal atresia and the temporal relationship with clinical manifestations and other inflammatory biomarkers such as C-reactive protein (CRP). Materials and Methods: This was a prospective study on consecutive patients of esophageal atresia (n = 23). Serum procalcitonin and CRP levels were assessed at baseline (prior to surgery) and on postoperative days (POD) 1, 3, 5, 7, and 14. The trends in the biomarker values and temporal relationships of deviation in trend with the clinical and conventional laboratory parameters and patient outcomes were analyzed. Results: Baseline serum procalcitonin was elevated (n = 23; 1.7 ng/ml: min: 0.07 ng/ml-max: 24.36 ng/ml) in 18/23 (78.3%) patients. Procalcitonin nearly doubled on POD-1 (n = 22; 3.28 ng/ml: min: 0.64 ng/ml-max: 16.51 ng/ml) followed by a gradual decline. CRP was also elevated on POD-1 (three times the baseline) and depicted a delayed peak at POD-3. POD-1 procalcitonin and CRP levels correlated with survival. POD-1 procalcitonin cutoff at 3.28 ng/ml predicted mortality with a sensitivity and specificity of 100% and 57.9% (P = 0.05). Serum procalcitonin and CRP were higher for patients who sustained complications, so was the time required for hemodynamic stabilization. Procalcitonin (baseline and POD-5) and CRP (POD-3 and POD-5) values correlated with the clinical course after surgery. Baseline procalcitonin cutoff at 2.91 ng/ml predicted the possibility of a major complication with a sensitivity of 71.4% and a specificity of 93.3%. POD-5 procalcitonin cutoff at 1.38 ng/ml predicted the possibility of a major complication with a sensitivity of 83.3% and a specificity of 93.3%. Patients who sustained major complications depicted a change in serum procalcitonin trend 24-48 h ahead of clinical manifestation of an adverse event. Conclusions: Procalcitonin is a good indicator to identify the adverse events in neonates after surgery for esophageal atresia. The procalcitonin levels in patients who sustained a major complication depicted a reversal in trend 24-48 h of clinical manifestation. POD-1 procalcitonin correlated with survival while the baseline and POD-5 serum procalcitonin predicted the clinical course. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study is to investigate the effects of combined 0.8% tropicamide and 5% phenylephrine on the corneal parameters using Pentacam. Methods: The study was performed on 200 eyes of 100 adult patients visiting the ophthalmology clinic for evaluation of refractive errors or cataract screening. Mydriatic drops (Tropifirin; Java, India) containing tropicamide 0.8%, phenylephrine hydrochloride 5%, and chlorbutol 0.5% (as a preservative) were instilled into the eyes of the patients three times every 10 minutes. The Pentacam was repeated after 30 minutes. The measurement data of various corneal parameters from different Pentacam displays (keratometry, pachymetry, densitometry, and Zernike analysis) was manually compiled on an Excel spreadsheet and analyzed using Statistical Package for the Social Sciences (SPSS) 20 software. Results: Analysis of Pentacam refractive maps revealed a statistically significant increase (P < 0.05) in the values of radius peripheral (cornea front), pupil center Pachymetry, pachymetry apex, thinnest location Pachymetry, and cornea volume. However, pupil dilation did not affect the Q-value (asphericity). Analysis of the densitometry values revealed significant increase in all zones. Aberrations maps revealed statistically significant increase in the value of spherical aberration after the induction of mydriasis, but the values of Trefoil 0º, Trefoil 30º, Koma 90º, and Koma 0º were not affected significantly. We did not observe any untoward effect of the drug, except transient blurring of vision. Conclusion: The current study showed that routine mydriasis in the eye clinics leads to a significant increase in various corneal parameters including corneal pachymetry, cornea densitometry, and spherical aberration as measured by Pentacam, which can influence the decision-making in the management of various corneal diseases. The ophthalmologists should be aware of these issues and make adjustments in their surgical planning accordingly. [ABSTRACT FROM AUTHOR]

A 62-year-old woman was referred with poor vision following manual small incision cataract surgery. On presentation, the uncorrected distance visual acuity in the involved eye was 3/60, whereas slit-lamp examination revealed a central corneal edema with the peripheral cornea relatively clear. Direct focal examination with a narrow slit upper border and lower margin of detached rolled up Descemet's membrane (DM) could be visualized. We performed a novel surgical approach, "double-bubble pneumo-descemetopexy." The surgical procedure included unrolling of DM with "small air bubble" and descemetopexy with "big bubble." No postoperative complications were observed, and best corrected distance visual acuity improved to 6/9 at 6 weeks. The patient had a clear cornea and maintained BCVA 6/9 during 18 months at follow-up. Double-bubble pneumo-descemetopexy, a more controlled technique, provides a satisfactory anatomical and visual outcome in DMD without the need for endothelial keratoplasty (Descemet's stripping endothelial keratoplasty or DMEK) or penetrating keratoplasty. [ABSTRACT FROM AUTHOR]

Congenital corneal anesthesia (CCA) is an extremely rare condition where the cornea is affected in isolation or as a part of congenital syndrome, or can be associated with systemic anomalies. This case series of 12 eyes provides an overview of various clinical presentations and their final treatment outcomes. The average age of presentation was 3.2 years with a female preponderance (75%). Fifty percent of the patients had bilateral involvement and 50% had corneal ulcers at presentation. Two eyes required therapeutic keratoplasty for corneal perforation. All patients had isolated CCA except for one who had an associated hereditary and sensory autonomic neuropathy. [ABSTRACT FROM AUTHOR]

Background: Phenothiazine consists of a three-ring structure compound in which two benzene rings are connected with nitrogen and sulfur atoms at nonadjacent sides. Phenothiazine and its substituted derivatives are abundantly able to produce a variety of important pharmacological and valuable therapeutic effects, and till now, these are under profound investigational processes. Objective: To synthesize and evaluate the antihistaminic potential of some newly synthesized dinitrophenothiazine derivatives. Materials and Methods: Different derivatives have been synthesized by the appropriate chemical scheme using dinitrophenothiazine as a basic nucleus. The completion of the chemical reactions has been monitored by thin-layer chromatography. The chemical structures of the newly synthesized products (P1–P25) were affirmed by elemental analysis and by spectral (infra-red, 1H nuclear magnetic resonance, and mass spectroscopy) findings and further examined for antihistaminic potential in guinea pigs. The synthesized products were also evaluated for their acute toxicity study and were found nontoxic. Results: The majority of the synthesized products of the dinitrophenothiazine series, namely, P07, P11, P12, P13, P15, P16, P17, P18, P19, and P20, have shown antihistaminic activity and compared with mepyramine (standard drug) at 0.8 µg/mL. Among the synthesized products, P18 was found to exhibit maximum antihistaminic activity. However, all the synthesized compounds were found to elicit a significant antihistaminic effect when compared with the standard drug. Conclusion: Therefore, dinitrophenothiazine compounds could be a good starting point to develop efficacious and potent analogues, as an antihistaminic agent in the treatment of allergic disorders. [ABSTRACT FROM AUTHOR]

Background: Glaucoma is a serious vision-threatening condition appropriately called as the silent killer of sight. The effect of postoperative fibrosis on success of filtration surgeries requires modulation of the wound healing process. Aim: The aim of the study was to compare trabeculectomy augmented with collagen matrix implant with mitomycin C in primary glaucoma. Materials and Methods: This prospective, longitudinal, hospital-based, analytical, and interventional study was conducted on 36 eyes of 36 patients. Group 1 included 18 patients who underwent trabeculectomy combined with subconjunctival collagen matrix implant and Group 2 included 18 patients who underwent trabeculectomy augmented with intraoperative mitomycin C (0.04 mg/ml) for 2 min. Each patient underwent detailed ocular examination and comparison was drawn by recording intraocular pressure (IOP), bleb characteristics, and postoperative complications. Results: The cumulative success rates at the end of our study were similar in two groups, 94.44% in Group 1 and 88.89% in Group 2 (P = 1.000). The mean reduction in IOP at 24 weeks in Group 1 was 18.67 ± 7.59 mmHg and in Group 2 was 21.32 ± 5.84 mmHg. The reduction in IOP was similar between the two groups (P = 0.290). The mean fall in IOP was 56.46% in Group 1 and 64.70% in Group 2 at 24 weeks. Mean bleb score in Group 1 was 10.33 ± 1.23 and in Group 2 was 8.89 ± 1.41, and the difference was statistically significant (P = 0.002). Shallow anterior chamber, overfiltration, and hypotony were statistically higher in Group 2 than in Group 1 (P = 0.041, 0.041, and 0.046, respectively). Conclusion: Collagen matrix implant as an adjuvant to trabeculectomy is noble, safe, and effective option as compared to mitomycin C. [ABSTRACT FROM AUTHOR]

Inflammatory myofibroblastic tumor (IMT) is an uncommon mesenchymal solid tumor documented in children and young adults. A 7-year-old boy diagnosed case of acquired aplastic anemia, referred to our hospital for hematopoietic stem cell transplantation. He was admitted to the hospital with febrile neutropenia. Blood culture showed persistent Escherichia coli infection. During hospital stay, he had bilious vomiting with tender abdomen suggestive of subacute intestional obstruction. Computed tomography of the abdomen was suggestive of ileocolic intussusception. Emergency laparotomy done which revealed a large polypoid mass involving cecum and part of ascending colon with ileocolic intussusception, child underwent ileotransverse colon resection with end-to-side anastomosis. Immunohistochemistry was suggestive of IMT. The child had persistent fever and protracted course during hospital stay and finally died. E. coli sepsis is associated with IMT and leads to protracted course in immunosuppressed patients such as aplastic anemia. As the imaging and laboratory tests are nonspecific, it should be considered in an immunocompromised children who have E. coli sepsis and abdominal complaints and rare presentation as intussusception. [ABSTRACT FROM AUTHOR]

Purpose: To describe a new technique of intracorneal scleral patch (ICSP) supported cyanoacrylate tissue adhesive (CTA) application in corneal perforations, greater than 3.0 mm secondary to rheumatoid arthritis (RA).Methods: This Prospective, non-randomized, non-comparative, interventional series included 14 eyes (14 patients). All patients had corneal perforations sized 3.5 to 4.5 mm due to RA, which were treated with ICSP supported CTA application. A partial thickness scleral patch 1.0 mm larger than diameter of corneal perforation was prepared. A lamellar corneal pocket 0.5 mm all around the corneal perforation was created. The partial thickness scleral patch was placed in the corneal perforation site and the edge was fitted into the lamellar intracorneal pocket. A minimum quantity of CTA was applied on the scleral patch to seal the perforation.Results: The corneal perforations healed in 14 eyes (100%) in a mean 7.71 ± 1.14 (range, 6-9) weeks. One eye (7.14%) had inadvertent extrusion of ICSP due to premature removal of CTA but, Seidel's test was negative, and the corneal epithelial defect healed with BCL alone. One eye each (7.14%) developed steroid induced cataract and glaucoma. None of eyes developed infective keratitis, re-opening of corneal perforation (necessitating repeat procedure) or enlargement of corneal perforation requiring penetrating keratoplasty (PKP).Conclusion: ICSP supported CTA application is a successful alternative option to emergency PKP in treating corneal perforations sized 3.5 to 4.5 mm with associated RA. [ABSTRACT FROM AUTHOR]

A 28-year-old male presented with three full-thickness stromal wooden foreign bodies vertically oriented in the left cornea. An innovative intracameral approach was used. Paracentesis was done and healon was injected into the anterior chamber. Iris repositor was introduced into the anterior chamber and the area of foreign bodies was pushed up to compress the stroma. The wooden foreign body projected above the corneal surface and were picked up one by one using McPherson forceps. One of the foreign bodies has penetrated through the Descemet's membrane resulting a corneal perforation. A corneal perforation was confirmed by observing egress of the irrigating solution, injected into the anterior chamber through the paracentesis opening. The corneal perforation was sealed with corneal glue. He achieved 6/9 BCVA (OS) at 8 weeks and maintained it during18 months follow-up. [ABSTRACT FROM AUTHOR]

A 78.year.old male underwent ultra.thin DSAEK for PBK (OS) and achieved BCVA 6/12 at 9 months. The patient developed allograft rejection 10 months postoperatively and was treated with IV methyl prednisolone, systemic, and topical steroids. The patient then improved and achieved 6/18 BCVA at 8 weeks. Topical prednisolone 1% twice daily was continued. Six weeks later, the patient developed fever and diminished vision and had high IOP, corneal edema, and keratic precipitates on endothelium. Considering it to as second episode of graft rejection, IV methyl prednisolone and topical steroids were given. Seeing no response, presumed HSV endotheliitis was considered as diagnosis and treated with steroids, oral acyclovir. The patient improved and achieved BCVA 6/24 with no subsequent recurrence during 11 months follow.up. [ABSTRACT FROM AUTHOR]

Anterior segment optical coherence tomography characteristics and management of unique spectrum of foreign bodies in cornea and anterior chamber Corneal foreign bodies (FBs) constitute a common emergency in ophthalmic practice. AS-OCT imaging is also helpful in diagnosing FBs in the anterior chamber and at the angle.[[4]] AS-OCT characteristics guide ophthalmology to customize the technique of FB removal. [Extracted from the article]

Background: Chronic Suppurative Otitis Media (CSOM) is a disease well known for its persistence and recurrence, inspite of giving treatment. The microbiology cultures show the growth of a lot of organisms, frequently multiple and these differ based on patient population, climate, and whether or not antibiotics have been recently used. Objectives: To identify the commonest causative organism of CSOM in a government hospital of northern India and identify the sensitivity to antibiotics so as to achieve early dry ear for surgical intervention. Methodology: This study was done, from March 2018 to September 2018 on 100 patients with complaints of ear discharge. Pus samples were collected from the discharging ears, subjected to culture and sensitivity and the organisms isolated were identified by morphological, cultural and biochemical characteristics. Results: Most common organism causing CSOM in our study Staphylococcus aureus, followed by Pseudomonas aeruginosa. Most patients with Staphylococcus infection were sensitive to Vancomycin followed by Linezolid and Gentamycin whereas patients with Pseudomonas aeruginosa were sensitive to Amikacin and Ciprofloxacin. Conclusion: Early and effective intervention using appropriate topical as well as systemic antibiotics can decrease the chronicity of CSOM and prevent long term complications. [ABSTRACT FROM AUTHOR]

A 28-year-old male underwent microkeratome assisted Laser-assisted in situ keratomileusis (LASIK) for, myopia. On postoperative day 1, patient had a large epithelial defect in OD. The corneal epithelial defect healed within 72 hours, but sub-optimal vision persisted. The patient was referred for further management to us. On evaluation, patient had non-healing of flap margin at 5 o'clock. Fluoroscein stain revealed no corneal epithelial defect, but a large pool of dye beneath the LASIK flap. A clinical diagnosis of non-adherence of LASIK flap was considered. Application of bandage contact lens was done. LASIK flap completely healed in 1 week. Possible etiologies are discussed and literature is reviewed. [ABSTRACT FROM AUTHOR]

Background: Reports on therapeutic plasma exchange (TPE) with the standard hemodialysis equipment are scarce, particularly from developing countries.Materials and Methods: A retrospective analysis of safety and efficacy of membrane-based TPE with a standard hemodialysis equipment for the treatment of severe Guillain-Barré syndrome (GBS) was conducted.Results: A total of 120 TPE sessions were performed in 31 GBS patients over a period of 5½ years. Each patient underwent a mean of 3.8 ± 1.5 TPE sessions. One (3.2%) patient died. Thirty (96.8%) patients survived and recovered. At 2 weeks, there was a significant improvement in the grade of power in both the upper and lower extremities (P = 0.001) and a significant decrease in the GBS disability grade (P = 0.001). Twenty four (77.4%) patients were able to walk unaided. Complications observed were: hypotension in 12 (10%), accelerated hypertension in 3 (2.5%), chills and rigors in 5 (4.2%), bleeding in 5 (4.2%), and filter clotting in 6 (5%) sessions. One patient experienced an anaphylactoid reaction and 1 patient survived a cardiorespiratory arrest. Two patients developed aspiration pneumonia and 1 patient developed catheter site infection.Conclusions: Membrane-based TPE can be conveniently delivered with the standard hemodialysis equipment. It is a safe, effective, and comparatively less expensive treatment option for GBS. [ABSTRACT FROM AUTHOR]

Background: Preauricular sinus is a congenital anomaly affecting both sexes. The sinus can be located near the tragus. The main difficulty arising in the treatment is the recurrence. Methods: A simple sinectomy technique along with dye infiltration and guidewire probing was used. Result: None intra-operative, post operative or complication related to local anaesthesia were seen, The surgical site healed well in all except for two patients who had wound infections which were managed by antibiotic therapy. Conclusion: A recurrence-free success rate could be achieved with the combination of dye infiltration, guidewire probing, and en bloc excision of the sinus tract and its branches. [ABSTRACT FROM AUTHOR]

Tubercular aneurysms of larger vessels, particularly the aorta is very rare. The first case of tubercular involvement of the aorta in the form of aortitis was reported in 1882 by Weigert and the first case of tubercular mycotic aneurysm of the aorta was reported in 1895. The preoperative diagnosis of tubercular aortic aneurysm is difficult. Even at surgery, determining the tubercular nature of the lesion is problematic. The gross appearance may not be distinctive, and acid-fast stains are unlikely to be performed. We report the case of a young female patient who was started on antitubercular treatment for pleural effusion and was found to have aortic aneurysm, which later on proved to be tubercular in origin. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) continues to be a global problem but with the arrival of new drugs it is expected to move towards exile. The health care community has finally woken up to the need to tackle this infection especially because HCV-induced hepatitis in combination with HIV has turned out to be a formidable foe. So far the management of HCV has concentrated mainly on interferon-based therapies. The focus is now increasingly on drugs targeting various other components of hepatitis C, which are essential for its survival in the host like HCV non-structural (NS) 3/4A serine protease inhibitors: Boceprevir, telaprevir, simeprevir; NS5A inhibitors (daclatasvir, ledipasvir); NS5B polymerase inhibitors (sofosbuvir), cyclophilin inhibitors and many others in the pipeline like the NS4B inhibitors and the micro-RNA122 inhibitors. These new drugs have shown excellent sustained virological response (SVR) compared to the presently available drugs and their combinations. Adding to this is the new HCV vaccine which although facing various hurdles is making good inroads and expected to meet its endpoints in the near future. This review gives a brief overview of epidemiology, pathogenesis, followed by the description of current regimens in the treatment of hepatitis C and the much eagerly awaited future all new oral anti-hepatitis C regimen, which can potentially eliminate the use of painful injections of interferon. [ABSTRACT FROM AUTHOR]

We had tried partial thickness cornea patch as scaffold initially to support cyanoacrylate tissue adhesive to treat corneal perforations larger than 3.0 mm diameter. Indian J Ophthalmol 2021;69:69-73. 3 Sharma A, Mohan K, Sharma R, Nirankari VS. Scleral patch graft augmented cyanoacrylate tissue adhesive for treatment of moderate-sized noninfectious corneal perforations (3.5-4.5 mm). Dear Editor, Authors thank Dr Srirampur et al.[[1]] for their interest in our article entitled "Intracorneal scleral patch supported cyanoacrylate application for corneal perforations secondary to rheumatoid arthritis".[[2]] We placed partial thickness scleral patch graft in the lamellar corneal pocket and applied cyanoacrylate tissue adhesive to seal corneal perforation in rheumatoid arthritis patients. [Extracted from the article]

Drug Abuse has become a major challenging problem for the society. It effects people of all countries economical strata’s and all ages. According. Monetary loss all over the world regarding drug abuse is in million dollars, it not only has an impact on human productivity and healthcare cost but also on cost of crimes conducted by these drugs and alcohol abuse. Therapeutic vaccine has come as new approach to deal with this problem, after failures in search for a pharmaceutical agent to deal with drug of abuse and alcohol. Research in field of nicotine abuse has gone a way ahead with number of vaccines being tried clinically followed by cocaine, opioids, methamphetamine, phencyclidine and alcohol. All of them have a common mechanism of action by antibody production whereas alcohol acts by genetic intervention. None have being approved yet due to poor results in phase II trials, possibly due to not able to trigger an adequate immunological response. But still quest is on for cracking the ice by developing first successful vaccine against drug of abuse, that would follow for other drugs too . It would be great step in field of therapeutic vaccines for drug abuse after similar successful vaccines being approved for other diseases like cancer. [ABSTRACT FROM AUTHOR]

Background: The aim of the following study is to find out the accuracy of clinical examination and radiological investigations in determining the organ of origin and diagnosis in cases of abdominal mass. Patients and Methods: This prospective study included patients presenting with a palpable abdominal mass. Complete detailed history and clinical examination were done prior to any investigation to find out the possible clinical diagnosis and determine the organ of origin. Radiological investigations were done by blinded senior radiologist to form a radiological diagnosis and determine the organ of origin. Final diagnosis was used to see the accuracy of both the pre-operative modalities. Results: There were 50 cases which formed the study group. Male to female ratio was 2:1. Prepubescent age was the most common age group at presentation. Right hypochondrium was the most commonly affected quadrant (18%). Most of these masses were hepatobiliary in origin. The overall accuracy of ultrasound with respect to the final diagnosis was 45/50 (90%). Ultrasonography findings correlated with a clinical diagnosis in 91% of those who were operated and in 88% in those confirmed by biopsy or other modalities. Radiological investigations in total had accuracy of 94%, which was similar to the clinical examination. Both radiological diagnosis and clinical diagnosis were correct in 47/50 (94%) cases. Conclusions: Most of the cases of abdominal mass can be well evaluated clinically in terms of the diagnosis and organ of origin. Both radiological investigation and a good clinical examination have equal sensitivity. Radiological investigations are thus only adjuvant to a good clinical examination. [ABSTRACT FROM AUTHOR]

Keywords: Corneal flap inversion; LASIK flap; microkeratome-assisted LASIK EN Corneal flap inversion LASIK flap microkeratome-assisted LASIK 3031 3032 2 12/04/20 20201201 NES 201201 A 21-year-old male with stable myopic astigmatism in OD (-1.50DS/-0.75 DCX900) and OS (-1.50DS/-0.75DCX900) underwent microkeratome-assisted laser-assisted in situ keratomileusis (LASIK). Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. Corneal flap inversion, LASIK flap, microkeratome-assisted LASIK. [Extracted from the article]

Background: HIV/AIDS pandemic is responsible for the resurgence of TB worldwide, resulting in increased morbidity and mortality. HIV and Mycobacterium tuberculosis have a synergistic interaction; each propagates progression of the other. Coinfection with HIV infection leads to difficulties in both the diagnosis and treatment of tuberculosis, increase risk of death, treatment failure and relapse. Objective: The aim of the present study is to study the clinical, radiological profile of pulmonary and extrapulmonary tuberculosis (EPTB) in HIV-seropositive patients and their relationship to CD4 counts. Materials and Methods: It was a prospective study conducted over a period of 1 year in the department of medicine, Indira Gandhi Medical College, Shimla. We examined 87 HIV-infected patients with associated tuberculosis recruited from the department of medicine and antiretroviral center and were subjected to thorough clinical examination, X-ray chest, tuberculin testing and sputum examination for AFB and necessary relevant investigations for EPTB. Results: Most common affected age group was 31-40 years. EPTB is the commonest form of TB in our study detected in 65 patients. Commonest EPTB was CNS tuberculosis. Disseminated tuberculosis was only found in patient with CD4 count less than 200/cmm. Majority of lymph node TB was diagnosed by fine needle aspiration cytology (FNAC) examination. All patients with AFB-positive lymph node had CD4 count below 200/cum. Conclusions: The results of this study provide information regarding the various forms of TB and their presentation in HIV-infected persons. Early diagnosis of tuberculosis and prompt institution of antitubercular treatment (ATT) reduces mortality and morbidity significantly. In resource-poor areas, the diagnosis can be established with cytological/biochemical analysis of fluid, histopathological examination and ZN staining of tissue coupled with radiological features and response to ATT. Therefore, adequate knowledge of the manifestations of tuberculosis in HIV-infected patients is absolutely necessary for optimal management and to reduce mortality and morbidity. [ABSTRACT FROM AUTHOR]

In the current issue, the authors describe a novel innovation, a modified IOL injector-assisted rescue technique for failed visco expression in a case of intracameral cysticercosis.[[5]] In most cases, ocular cysticercosis is associated with neurocysticercosis. Therefore, all patients having ocular cysticercosis should undergo CT scan, MRI brain, and cysticercosis serology. [Extracted from the article]

The fourth-generation Haigis formula demonstrated low variability in prediction error across the range of AL (21-28 mm) and ACD (2.25-4.25 mm) analyzed, suggesting that the Haigis formula may be good for a wide range of eyes.[[4]] As increased ACD measurements following cyclopentolate and tropicamide have been observed in the present study, ACD measurements should be taken before instilling cycloplegics. Accurate measurements of anterior segment parameters are essential for reducing the surprises following cataract surgery, phakic intraocular lenses (IOLs), and refractive surgery. [Extracted from the article]

Dear Editor, Ethnicity is known to affect the ocular and periocular measurements.[[1]] Central corneal thickness (CCT) is the most heritable trait in the human body.[[2]] Genome-wide association analysis in multiethnic Asian groups has shown genes that affect CCT and its variation between ethnic groups.[[3]] The difference in baseline CCT suggests that ethnicity may affect the prevalence and severity of certain corneal disorders. Population groups of African origin have been reported to have thinner corneas compared to the whites.[[5]] Apart from African Americans, the Japanese have been reported to have thinner corneas compared to other ethnicities.[[6]] CCT has been shown to be the strongest predictive factor for glaucoma progression, independent of intraocular pressure (IOP).[[7]] Pachymetry-adjusted IOP values play a significant role in glaucoma management.[[8]] In the Chennai Glaucoma study from South India, the urban group had a mean CCT of 520.7 ± 33.4 m and significantly lower in the rural group with glaucoma (505.9 ± 31.1 m).[[9]] Another study from a nearby urban region (Bangalore, Karnataka) found similar CCT values and significantly lower than the internationally accepted CCT value (545 m).[[10]] The authors suggested the use of local ethnic group CCT to ascertain the pachymetry-corrected IOP. [Extracted from the article]

Hepatocellular carcinoma (HCC) is a common cancer world-wide with a higher incidence in Asia. Clear cell variant of HCC (CCHCC) has a frequency ranging from 0.4% to 37%. The presence of 90-100% clear cells is rare. In the present case, a 35-year-old female patient presented with fever and a large abdominal mass in the right hypochondrium. Histology of the tumor revealed >95% clear cells and after taking multiple sections from different areas of tumor only few scattered cells with eosinophilic cytoplasm were found. Immunohistochemistry with Hep Par 1, Glypican 3 and polyclonal carcinoembryonic antigen were negative as were all other markers for metastatic clear cell tumors. Histological diagnosis was based on routine H and E sections showing a histological pattern of architecture with thickened trabeculae. We describe a rare case of CCHCC with >95% clear cells and no immunoreactivity in tumor cells in a non-cirrhotic liver. [ABSTRACT FROM AUTHOR]

The authors report acyclovir-induced alopecia in a patient treated for herpetic keratouveitis. A 32-years-old female was diagnosed with herpetic keratouveitis. She was placed on prednisolone acetate (1%) suspension four times a day, atropine sulfate (1%) thrice a day, and oral acyclovir 400 mg twice-daily. Three weeks following oral acylovir, keratouveitis improved, but she developed alopecia without any drug eruptions. Oral acyclovir was discontinued. Three months later, alopecia completely resolved. Alopecia may be considered a possible complication following oral acyclovir. [ABSTRACT FROM AUTHOR]

A 50-year-old male was referred with a previous history of conjunctival flap (CF) for a nonhealing fungal corneal ulcer with extreme corneal thinning in the right eye. The peritomy for the CF extended from 6:30 to 9:30 clock h on the cornea. The CF was disengaged, peritomy area deepithelialized, and CF was repositioned. He later underwent penetrating keratoplasty and achieved 20/40 best corrected visual acuity. The authors present a new concept for surgically repositioning CF s to the original site immediately after healing of the corneal ulcer. [ABSTRACT FROM AUTHOR]

Spectacles are routinely prescribed by the ophthalmologist and dispensed by the opticians. We investigated how frequently the spectacles are not dispensed as prescribed and whether the frequency of inaccurate spectacles would decrease if the patients, at the time of collecting spectacles, ask the optician to verify that the spectacles have been dispensed accurately. We found inaccurate spectacles in about one-third of our patients and incorrect spherocylinders more frequently with an error in the spherical element and cylinder axis. These inaccuracies decreased significantly when patients while collecting spectacles, asked the optician to verify the accuracy of the spectacles dispensed. It is suggested that while prescribing spectacles, the patients should be made aware of the possibility of dispensing errors. To decrease the frequency of incorrect spectacles, the patients while collecting spectacles, should ask the optician to check whether the spectacles have been dispensed accurately. [ABSTRACT FROM AUTHOR]

To find the optimal dosage of cyclopentolate 1% for cycloplegic refraction in hypermetropes with brown irides, we investigated the difference in cycloplegic auto-refractions obtained after one, two, and three instillations in the same patient. The mean hypermetropia found aft er three instillations was statistically signifi cantly more compared to that found aft er one instillation. There was no statistically signifi cant diff erence in the mean hypermetropia between two and three instillations. There was no signifi cant eff ect of gender, age, and the presence and type of horizontal deviation. These observations suggest that two drops of cyclopentolate 1% 10 min apart are suffi cient for cycloplegic refraction in hypermetropes. [ABSTRACT FROM AUTHOR]

Introduction: POTE (Prostate, Ovary, Testis, Placenta genes) are autosomal, non-X Testis/Germline antigen, located on pericentromeric heterochromatin region. POTE family is consisting of 13 paralogous which are dispersed on eight different chromosomes, whose members are expressed in epithelial ovarian cancer (EOC) and solid tumor malignancies. DNA methylation changes are common in EOC, and frequently consist of loss of DNA methylation genome-wide at specific repetitive DNA elements, including LINE-1, and at pericentromeric regions. Objective: Determine whether DNA methylation changes or other epigenetic mechanisms regulate POTE expression and to define the potential functional contribution of POTE expressions in ovarian cancer. Materials and Methods: Affymetrix HG 1.0ST microarrays and RT-qPCR were used to determine POTE gene expression in normal ovary and EOC tumors. DNA methylation status of POTE and neighboring pericentromeric regions, where POTE genes reside, was determined by using sodium bisulfite pyrosequencing. Cell proliferation, cell migration, and cell invasion were determined following POTE knockdown or overexpression. Results: POTE expression levels were highly elevated in EOC tumors showing global hypomethylation of LINE1 elements, as compared to EOC tumors with hypermethylation of LINE1 elements, linking global DNA methylation status to POTE expression. Methylation of pericentromeric DNA, as determined using NBL2 pyrosequencing, was also closely linked to POTE expression and methylation status. POTE gene knockdown in EOC cell lines had minimal impact on cell proliferation and apoptosis, but resulted in significantly reduced cell migration and cell invasion. Conclusion: POTE hypomethylation and expression correlate with poor prognosis in EOC. These data establish a specific oncogenic role for DNA hypomethylation in EOC, and reveal POTEs as biomarkers and therapeutic targets in this malignancy. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Is Inclusion of Sabouraud dextrose agar essential for the laboratory diagnosis of fungal keratitis?"