Predictive factors for seizures and efficacy of antiepileptic drugs in patients with Aneurysmal Subarachnoid Hemorrhage

Objectives@#To identify factors that predict the occurrence of seizures in patients with aneurysmal subarachnoid hemorrhage (SAH) and to evaluate the efficacy of antiepileptic drugs (AEDs) in preventing in-hospital seizures among patients who undergo clip occlusion of ruptured intracranial aneurysms.@*Methods@#In this retrospective study, the medical charts of 205 patients admitted for aneurysmal SAH in Philippine General Hospital (PGH) and who underwent craniotomy and clipping of aneurysm from January 2011 to June 2014 were reviewed. Demographic, radiologic, and clinical factors were converted into categorical variables and their association with the occurrence of seizures analyzed. The incidence of seizures among patients who received an AED (AED cohort) and those who did not receive an AED (No AED cohort) were compared. Secondarily, the effects of seizures and AED use on early postoperative outcomes were determined using the Glasgow Outcome Scale (GOS) on the day of discharge. @*Results@#Among 205 patients with aneurysmal SAH, 31 (15.1%) developed seizures. 21 (10.2%) had seizures at onset of SAH and only seven (3.4%) had in-hospital seizures. Aneurysm re-rupture (OR 5.26, p-value 0.045) and the presence of a parenchymal clot (OR 2.90, p-value 0.043) were independent predictors for seizure occurrence. There was no significant difference in the incidence of seizures in the AED cohort and in the No AED cohort (4/100, 4% vs. 3/99, 3%, p-value 0.714). AED use was associated with a higher proportion of patients with a discharge GOS score of 3 or less (28.0% vs 12.1%, p-value 0.005). @*Conclusion@#The results of the study do not support the routine use of AEDs in patients with aneurysmal SAH.

Colonization of Serratia fonticola on phylloplane of tomato and its impact on leaf cytoplasmic protein profile

Aim: The aim of the present study was to understand the impact of human enteric pathogen (Serratia fonticola) colonization on cytoplasmic protein profile of tomato leaves. Methodology: Aseptically grown plants were inoculated with S. fonticola and sampled at different interval of time. Colonization pattern was studied by leaf impression technique. Changes in cytoplasmic protein profile were studied by protein-protein crosslinking method followed by separation through SDS PAGE. Results: The colonization pattern study revealed that maximum colonies were found at 24 hr post inoculation which gradually decreased with time, showing the survival of the pathogen on phylloplane. Electrophoretic separation of cytoplasmic proteins showed crosslinking of some proteins in treated samples at 48, 72 and 96 hr post inoculation. Interpretation: This study will help in understanding the molecular changes in cytoplasmic protein profile and survival of pathogen on phylloplane, thus limiting the growth of bacteria, Serratia fonticola on phyllosphere.

Prevalence of ocular morbidity among tribal children in Jawadhi hills, southern India: A cross-sectional study

Purpose: Childhood blindness is second to cataract in terms of blind person years; population-based prevalence of ocular morbidity among tribal children has not been studied. We conducted this study to determine the prevalence of ocular morbidity in tribal children age 15 years or younger in Jawadhi hills, southern India. Methods: A population-based cross-sectional study was conducted in four tribal villages where all children below 15 years of age were invited to participate in the study. After appropriate consent/assent, an optometrist assessed uncorrected vision refraction and best-corrected visual acuity using suitable techniques. A comprehensive ophthalmic examination was also done by an ophthalmologist to determine the presence of ocular morbidity. Children requiring cycloplegic refraction or further treatment were referred to the base hospital. Results: Among 260 children examined, the prevalence of ocular morbidity was 10.8% [95% confidence interval (CI): 6.3–13.7]. Vitamin A deficiency (VAD) was the foremost morbidity: 4.6% (95% CI 1.6–6.3) followed by refractive error (2.7%). Three (10.7%) children had more than one ocular morbidity. Nearly 1 in 10 tribal children suffer from ocular morbidity and 1 in 57 had low vision. Conclusion: VAD is a public health problem in this tribal region which requires immediate intervention with prophylaxis and treatment. Uncorrected refractive errors in school-age children also need to be attended.

Facilitating factors in overcoming barriers to cataract surgical services among the bilaterally cataract blind in Southern India: A cross-sectional study

Purpose: To effectively address cataract blindness, increasing sight-restoring surgeries among the bilaterally blind are essential. To improve uptake of surgical services among this group, evidence regarding the problems of access is vital. Barriers in accessing eye care services have previously been reported but not specific to bilaterally cataract blind patients. Further, there is a gap in knowledge regarding factors facilitating access to eye care. Our aims were to (1) report proportion of bilaterally cataract blind patients undergoing surgery and sight restoration rate (SRR) and (2) analyze barriers and factors enabling access to eye care services among bilaterally cataract blind patients. Methods: Retrospective analysis of interview and clinical data of bilaterally cataract blind patients undergoing surgery through outreach services at the base hospital, from June 2015 to May 2016, was performed. Demographic data, vision, postoperative visual outcomes, barriers, and facilitating factors in accessing cataract surgical services were obtained. Results: Bilateral cataract blindness was present in 196/3178 (6.2%, 95% confidence interval 5.4–7.06) patients. SRR was 6.5%. Fear of surgery (24.2%) and lack of family support/escort (22.9%) were the most common barriers. Neighbors and acquaintances (28.6%), general health workers (20.2%), and persons who had undergone cataract surgery (19.6%) were the most common facilitating factors. Conclusion: Proportion of bilaterally cataract blind people undergoing surgery and consequently SRR were low. The most common barriers were at the individual level while facilitating factors at the community level were instrumental in promoting uptake of services. Interventions involving community-based support for the blind may be useful in overcoming barriers to eye care.

Incorporating primary eye care into primary health care: Piloting a perceived visual disability questionnaire based model in rural southern India – An observational study

Purpose: Over 20% of the world's visually impaired and blind populations live in India. Integration of primary eye care (PEC) into existing primary health care by trained personnel could address access-related barriers. We piloted an unreported, modified WHO disability questionnaire-based model for community health workers (CHWs) to screen and refer persons with perceived visual impairment instead of the traditional visual acuity model. The objective of the study was (1) to determine the prevalence of perceived visual impairment, rate of follow-up postreferral, distribution of ocular morbidity, visual impairment, and proportion of appropriate referrals and (2) to compare results of this intervention with those of existing services. Methods: CHWs were trained in administering a questionnaire for identification and referral of persons with perceived visual impairment in 7 rural villages and 22 tribal hamlets from the institutional database. In this cross-sectional study, patients screened and referred to PEC services from September 2014 to March 2015 underwent comprehensive ocular examination by an optometrist and ophthalmologist. Data collected from their records were analyzed retrospectively. Results: Of 18,534 individuals screened, 3082 (16.64%, 95% confidence interval: 16.06–17.14) complained of perceived visual impairment and were referred; 463 (15%) of these followed up for examination. Correct referrals were noted in 452 (97.6%) cases. Cataract (52.3%) and refractive error (15.8%) were the most common morbidities. There was a 39.6% increase in uptake of eye care services from baseline. Conclusion: The questionnaire-based screening tool administered by CHWs can lead to appropriate identification and referral of persons with ocular morbidity impacting uptake of eye care services

Bone marrow oxalosis: An unusual cause of cytopenia in end-stage renal disease; report of two cases

Systemic oxalosis can be either primary or secondary hyperoxaluria. Oxalosis is a phenomenon in which calcium oxalate crystals deposit in various visceral organs leading to bone marrow (BM) failure and recurrent renal stones. We describe two rare cases of BM oxalosis. Hyperoxaluria is strongly associated with nephrolithiasis and nephrocalcinosis. Both the patients presented with recurrent renal stones and a variable degree of BM failure. BM oxalosis should be considered as a possible diagnosis in patients in recurrent nephrolithiasis and cytopenia.

Posterior Spinal Artery Aneurysm Presenting with Leukocytoclastic Vasculitis

Rupture of isolated posterior spinal artery (PSA) aneurysms is a rare cause of subarachnoid hemorrhage (SAH) that presents unique diagnostic challenges owing to a nuanced clinical presentation. Here, we report on the diagnosis and management of the first known case of an isolated PSA aneurysm in the context of leukocytoclastic vasculitis. A 53-year-old male presented to an outside institution with acute bilateral lower extremity paralysis 9 days after admission for recurrent cellulitis. Early magnetic resonance imaging was read as negative and repeat imaging 15 days after presentation revealed SAH and a compressive spinal subdural hematoma. Angiography identified a PSA aneurysm at T9, as well as other areas suspicious for inflammatory or post-hemorrhagic reactive changes. The patient underwent a multilevel laminectomy for clot evacuation and aneurysm resection to prevent future hemorrhage and to establish a diagnosis. The postoperative course was complicated by medical issues and led to the diagnosis of leukocytoclastic vasculitis that may have predisposed the patient to aneurysm development. Literature review reveals greater mortality for cervical lesions than thoracolumbar lesions and that the presence of meningitic symptoms portents better functional outcome than symptoms of cord compression. The outcome obtained in this case is consistent with outcomes reported in the literature.

Epidural Blood Patch Performed for Severe Intracranial Hypotension Following Lumbar Cerebrospinal Fluid Drainage for Intracranial Aneurysm Surgery. Retrospective Series and Literature Review

Intracranial hypotension (IH) can occur following lumbar drainage for clipping of an intracranial aneurysm. We observed 3 cases of IH, which were all successfully treated by epidural blood patch (EBP). Herein, the authors report our cases.

A Rare Case Report on Benign Recurrent Intrahepatic Cholestasis.

Benign recurrent intrahepatic cholestasis is an inherited and occasionally sporadic disease presents as recurrent episodes of obstructive jaundice without any obstruction in billiary channel with intervening symptom free periods. Here we are presenting a case of 20-year-old male with a recurrent jaundice and pruritus who later diagnose as BRIC.

Cefotaximase and AmpC-producing Shigella flexneri in case of dysentery from southern India.

Diarrhoea and dysentery caused by Shigella spp. are major public health concerns. Emerging multidrug resistance (MDR) in this pathogen further complicates this disease. Extended spectrum β-lactamases (ESBLs) have been described in this pathogen, which significantly compromises the treatment options for shigellosis. The usual ESBLs seen are sulfhydryl variable (SHV)-type; cefotaximases (CTX-M) are very uncommonly detected. Here, we report a CTX-M type and AmpC-producing Shigella flexneri from a three-year-old boy residing in Central Kerala, South India.

Synthesis and in vitro antibacterial activity of Cephradine Benzoate.

Aims & Methods: The present study was undertaken to compare the antibacterial activity of a cephradine derivative with that of the parent antibiotic cephradine. Cephradine was converted to its benzoyl derivative by Schotten-Baumann method for the first time. Disc diffusion method was employed to find out the antibacterial activity against EPEC, ETEC, E. Agg, Salmonella typhi, Salmonella group B, Shigella boydii, Shigella dysenteriae 1, Shigella dysenteriae 2, Shigella flexinariae and Shigella sonnei. Melting point, TLC, HPLC, UV, FTIR and 1H NMR studies were carried out to check the purity and confirm that the derivative was cephradine benzoate. Results: The benzoyl derivative showed promising activity against tested bacteria. The results obtained from the study demonstrate that the benzoyl derivative could be a potential antibacterial agent.

Cell culture isolation can miss the laboratory diagnosis of HSV ocular infection / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: We compared polymerase chain reaction (PCR) to cell culture isolation for the laboratory diagnosis of ocular herpes simplex virus (HSV) disease.METHODS: Laboratory and medical records of consecutive patients were reviewed for results of (1) HSV PCR testing, (2) HSV cell culture isolation, and (3) clinical diagnosis. PCR results were statistically compared to cell culture isolation and patients initially diagnosed for ocular HSV infection.RESULTS: Of 581 cases submitted for laboratory testing,520 were PCR negative, cell culture negative (89.6％); 0 was PCR negative, cell culture positive (0％); 27 were PCR positive, cell culture negative (4.6％); and 34 were PCR positive, cell culture positive (5. 8％). PCR tested more positive than cell culture isolation (McNemar's, P=0.0001 ). Of 47 HSV PCR positive cases with complete medical records, 19 were cell culture negative for HSV and 28 were cell culture positive for HSV. Fourteen of 19 cell culture negative cases (74％) (Without PCR, 5 cases of HSV would be missed) and 25 of the 28 cell culture positive cases (89％) ( Laboratory testing was necessary for diagnosing 3 cases) were clinically diagnosed with HSV at the initial examination.CONCLUSION: PCR was a more definitive test for diagnosingHSVocularinfectionthancellculture isolation. Cell culture isolation alone can miss an atypical presentation of HSV ocular infection.

Susceptibilidad de lutzomyia verrucarrum a piretroides en zonas endémicas de enfermedad de Carrión de Ancash / Pyrethroids susceptibility of Lutzmoyia verrucarum in endemic areas of Carrion disease from Ancash

La enfermedad de Carrión es una infección metaxénica endémica del Perú, el control vectorial de la Lutzomyia verrucarum con insecticidas es una de las formas más usadas para reducir su morbilidad. Se determinó la susceptibilidad de este vector a los piretroides más usados (cyflutrina, alfacipermetrina y deltametrina) en dos zonas endémicas altoandinas de Ancash (Llumpa: 3200 msnm y Maya: 2600 msnm), Perú en junio de 1999. Se expuso a 50 mosquitos por cada zona e insecticida usando la prueba de contacto para anophelinos modificada. Se encontró una mortalidad del 100 por ciento para cada piretroide ensayado. Si bien se demostró una susceptibilidad total de L. verrucarum es necesario implementar la vigilancia de la resistencia a insecticidas como se hace con otros vectores en el Perú.

Carrion disease is an endemic vector-borne infection of Peru, the vector control of the Lutzomyia verrucarum with insecticides is one of the most commonly used to reduce morbidity. It was determined the susceptibility of this vector to the most pyrethroids widely used (cyfluthrin, alfacypermethrin and deltamethrin) in two endemic areas of highlands from Ancash (Llumpa: 3200 and Maya: 2600 meters above sealevel), Peru in June 1999. Were exposed to 50 mosquitoes from each area and insecticide, using an anopheline contact test modified. Wefound a mortality rate of 100 per cent for each pyrethroid tested. While total susceptibility of L. verrucarum showed, is necessary the implement of surveillance to insecticides resistance as is done with other vectors in Peru.

Clinicoepidemiological profile and predictors of severe illness in young infants (< 60 days) reporting to a hospital in North India.

OBJECTIVES: To describe the clinical and epidemiological profile of young infants reporting to a hospital and assess previously proposed simple clinical signs for their value in enabling health workers to detect young infants with severe illness warranting hospital admission. METHODS: Observational study of infants less than 2 months of age presenting consecutively to a large public hospital in South Delhi who were evaluated by a health worker (nurse), on a standardized list of signs and symptoms, and the ability of these were evaluated against the need for hospital admission which was assessed by an independent pediatrician. RESULTS: Of the 1624 young infants triaged, 878 were enrolled into the study. Of these 100 (11%) were below 7 days of age, for whom the common reasons for seeking care were jaundice (52%), not feeding well (6%) and fever (5%). The remaining 778 (89%) were 7-59 days of age with respiratory symptoms as the main presenting complaints (29.1%). The primary clinical diagnoses in infants with serious illness needing admission to hospital in the age group <7 days (n = 66) were hyperbilirubinemia (56%) and sepsis (21%). In those between 7-27 days of age (n = 60), primary diagnoses were sepsis (27%), pneumonia (13%), diarrhea, dysentery or dehydration (10%), while in the age group 28-59 days of age (n = 47) pneumonia (40%), sepsis (19%) and diarrhea or dehydration (13%) were the common primary diagnoses. Signs that had at least a prevalence of 5% and were strong predictors for all the age categories studied were history of difficult feeding (OR 6.8 for 0-6 days, 15.1 for 2-27 days and 6.2 for 28-59 days age groups), not feeding well on observation (OR 13.7, 27.6 and 20.9 respectively for the 3 age groups), temperature > 37.5C (OR 21.8, 14.6 and 30.0 respectively for the 3 age groups) and respiratory rate > 60 per minute (OR 6.8, 15.1 and 21.0 respectively for the 3 age groups). Additional strong predictors with > 5% prevalence were history of convulsions (OR 7.9, only in 0-6 day age group), lethargy (OR 26.1, only in 7-27 day age group), and history of diarrhea (OR 3.0 for 2-27 days and 2.2 for 28-59 days age groups). CONCLUSIONS: Simple clinical signs are useful in hands of health worker for identifying neonates with serious illness warranting hospital admission. These will be of use in the further development of clinical algorithms for the national integrated management of childhood illnesses.

Distribution of heavy metals in vegetation surrounding the Blackstone River, USA: considerations regarding sediment contamination and long term metals transport in freshwater riverine ecosystems.

The Blackstone River, a 74 km interstate stream located in South Central Massachusetts and Rhode Island (USA), has had a long history of problems due to high concentrations of metals such as copper and lead. The river has been subjected to metals load that include contributions from urban runoff, wastewater discharges, contaminated sediments, and also resuspension of contaminated sediments in the river-bed. All of these effects lead to elevated concentrations of metals such as lead, copper, zinc, chromium, cadmium and arsenic. Furthermore, the contaminated sediments located behind impoundments become especially important when higher flows cause resuspension of the previously deposited sediments and associated metals. While it is known that high metals concentrations in this river are found in the bottom sediments, the fate of the metals and impact on the ecosystem are not well known. This paper addresses the potential impacts that metals may have on vegetation and plant tissues in the vicinity of the river Plant tissues (primarily mosses), were collected from a number of sampling sites along a 14 km stretch of this river. At each site, samples were collected from multiple distances from the riverbank. Laboratory analyses made use of both wet digestion and dry ashing digestion methods, followed by analysis using an atomic absorption spectrophotometer. The wet and dry ashing digestion methods yielded similar results, although the results afforded by the dry ashing methods were slightly lower than the results obtained from the wet method. The results showed that the metals concentrations in vegetation (as determined from plant tissue analyses) were generally inversely related to the distance between the vegetation and the riverbank, with higher metals concentrations existing in plant tissues located close to the riverbank. In addition, it was found that the transport of metals concentrations to the terrestrial vegetation adjacent to this section of the Blackstone River was affected by the river morphology and flow characteristics (including velocity, flow rate and depth of flow, which can govern the potential for plant submergence, as well as the dynamics of flow and transport in the soil near the river). The analyses help to provide an improved understanding of metals transport and potential significance of metals contamination in a terrestrial ecosystem that is located adjacent to a river.

A customised portable LogMAR chart with adjustable chart illumination for use as a mass screening device in the rural population.

AIM: To develop a customised, portable, cost-effective (logarithmic minimal angle resolution) LogMAR chart with adjustable illumination for use as a mass vision-screening device in the rural population. MATERIALS AND METHODS: Visual acuity of 100 individuals was evaluated with a customised chart and compared with the standard Early Treatment Diabetic Retinopathy Study (ETDRS) chart and Snellen's Chart. Bland and Altman analytical techniques were used for analysis. RESULTS: Test-retest variability of the customised chart was just a one-line difference (95% CI for agreement), and so were the results with the standard ETDRS charts; a variability of 3-line was noted with Snellen's chart. Two-line differences were observed when comparison was made with Standard ETDRS chart and 2 to 3-line differences with Snellen's chart. CONCLUSION: The customised portable LogMAR chart with adjustable illumination shows less test-retest variability and better agreement with standard ETDRS chart; therefore, it can be used as a mass vision-screening device in rural settings.

Knowledge of epidemiology and statistics for an ophthalmic practitioner.

Ophthalmologists are frequently confronted with treatment options that claim to be better than those currently in use. Statistically significant P values are invariably provided by way of proof. For many ophthalmologists a simple look at this revered P value is enough evidence that a statistically significant result has indeed been obtained. Unfortunately, traditional interpretation of a study based on the P value at an arbitrary cut-off (P<0.05 or any other value) limits the ability to fully appreciate clinical implications. In this article the authors introduce the reader to and illustrate the use of "confidence intervals" as opposed to P values in examining the applicability of study results. Further, what is statistically significant may not necessarily be clinically significant; perhaps not enough for the practitioner to change from the currently preferred method of treatment. To resolve this, the authors have also used common ophthalmic examples to introduce the "number needed to treat", as a simple clinical approach for the practising ophthalmologist wishing to assess the clinical significance of treatment options.

Histopathology of skin lesions in chronic arsenic toxicity--grading of changes and study of proliferative markers.

Chronic arsenic toxicity (CAT) manifests predominantly as cutaneous lesions in the form of melanosis, keratosis and neoplastic changes. We have studied skin biopsies from 42 patients of CAT. Histological study of H/E stained sections showed--hyperkeratosis in 13, parakeratosis in 13, acanthosis in 12, papillomatosis in 24, elongation of reteridges in 21, increased basal pigmentation in 27 and dysplastic changes in 8 cases. Squamous cell carcinoma was present in 2, basisquamous in 1 and basal cell carcinoma in 1 case. Changes of skin lesions after drug DMSA and DMPS therapy compared to placebo were studied. The result was inconclusive. Proliferative activity of skin lesions in CAT were studied by AgNOR stain to assess the biological behaviour of the lesions. AgNOR score showed--normal control 1.08, benign changes (e.g. Hyperkeratosis, parakeratosis, acanthosis, papillomatosis etc.) without dysplasia--1.35, mild to moderate dysplasia--1.735, severe dysplasia--3.0 and carcinoma--3.56. Thus, AgNOR score gives some idea on the biological behaviour of CAT lesions. It is suggested that AgNOR staining should be done regularly along with H&E staining for proper assessment of the cases.

Effect of vitamin A excess on germ cell development in prepubertal rat testis.

Vitamin A in graded doses of 125, 250 and 375 U.S.P./kg body wt, po, for 10 days (d 21-30) drastically reduced the testicular weight by 25 to 62% and seminiferous tubular diameter by 14 to 35% in prepubertal rats in lowest and highest doses of the treatment. The treatment induced disproportionate enlargement of nuclei and cytoplasm of the germ cells; predominantly the preleptotene and pachytene spermatocytes. These abnormal germ cells, often with 2 or 3 nuclei displayed vacuolated cytoplasm surrounding pyknotic or granulated or dispersed chromatin granules within the nuclei in a dose proportionate manner. The round spermatids were the most sensitive cell types which completely disappeared in two higher doses of treatment. Vacuolation of Sertoli cell cytoplasm in about 25% of the tubules with associated increase in intertubular space was also observed in rats treated with the highest dose of the vitamin. Circulatory levels of FSH, LH and testosterone remained unaltered following the vitamin excess treatment. Therefore, it is suggested that excess vitamin A even for shorter duration like the present one is detrimental to developing cell types and prevents the progress of the spermatogenic process beyond the round spermatid stage.

Regulatory role of cortisone and dietary carbohydrate energy in prepubertal rat mammary gland growth and development.

Role of cortisone and regulated carbohydrate energy in mammary gland growth, based on studies of morphometric and certain growth and energy related biochemical parameters has been evaluated in the adrenalectomized prepubertal female rat. Results showed improvement or restoration of mammary features like fat pad weight, area, duct system and sprouting of end and lateral buds by cortisone treatment from adrenalectomy induced suppressed state. Similarly the hormone rectified the gland nucleic acids, glycogen and rate of tissue oxidation of glucose levels, reduced under adrenalectomy. Adrenalectomy caused loss of appetite (33.5% less than normal intake). This amount of diet restriction to normal intact did not affect the gland morphology but reduced nucleic acids, protein, glycogen and glucose oxidation rate. Provision of dextrose mixed diet to the adrenalectomized rats showed variable improvements of these biochemical parameters except the gland protein level in association with increase in appetite. However, cortisone therapy under provision of dextrose supply, restored gland protein level and increased further in nucleic acids, glycogen and glucose oxidation rate. The morphological growth parameters with dextrose and cortisone also showed further improvements. Results suggested that glucocorticoid was essential mammary growth factor during prepubertal ages. The hormone appeared to operate via tissue metabolism and stimulating energy intake through appetite stimulation.