Outcomes of accelerated collagen cross linking in progressive paediatric keratoconus

Purpose: To determine the efficacy and safety of pediatric accelerated cross linking (CXL). Methods: A prospective study on progressive keratoconus (KC) cases under ?18 years of age. Sixty four eyes of thirty nine cases underwent epithelium?off accelerated CXL protocol. Visual acuity (VA), slit?lamp examination, refraction, pentacam reading of keratometry (K), corneal thickness, and thinnest location pachymetry were noted. Cases were followed up on days 1, 5, and at 1st, 3rd, 6th, and 12th?month post procedure. Results: Statistically, significant improvement of the mean aided VA, K, and mean corneal astigmatism (p < 0.0001) was noted. Mean Kmax reading reduced from 55.5 ± 5.64 (47.4–70.4) diopter (D) preoperatively to 54.41 ± 5.51 (46–68.3) D at 12 months postaccelerated CXL. Two cases had progression. Complications encountered were sterile infiltrate and persistent haze. Conclusion: Accelerated CXL is effective and efficacious in pediatric KC.

Retinal perfusion density can predict cardiovascular disease risk in patients with retinal vein occlusion

Purpose: To correlate microvascular changes and assess the relationship between microvascular changes and cardiovascular disease (CVD) risk in patients with retinal vein occlusion (RVO). Methods: Patients over 40 years of age with unilateral RVO were included in this prospective study. Those known to have cardiovascular disease were excluded. A detailed medical history was taken and physical exam was done to measure the height, weight, body mass index (BMI), and systolic blood pressure (SBP). A comprehensive eye check?up was followed by optical coherence tomography angiography (OCTA). Microvascular indices such as vessel density (VD) and perfusion density (PD) were noted. A statistical model was developed for prediction of CVD risk and was integrated with the World Health Organization (WHO)’s risk prediction charts. Results: This study included 42 patients with RVO and 22 controls with an age range of 42–82 years. There were 40 males (62.5%) and 24 females (37.5%). Along with age, SBP, and gender, perfusion density was found to have significant impact on CVD risk (P = 0.030). Reduction in PD was associated with increase in CVD risk. PD had a greater influence on CVD in <50 years age than in >70 years group. Using linear regression, a model with accuracy of 72.1% was developed for CVD risk prediction and was converted into color coded charts similar to WHO risk prediction charts. Conclusion: These findings suggest a significant correlation between microvascular parameters and CVD risk in RVO patients. Based on these parameters, an easy?to?use and color?coded risk prediction chart was developed

A Rare Variant of Oral Lichen Planus-Bullous Form.

Lichen planus (LP) is an immune-mediated chronic inflammatory disease that is seen mainly affecting the skin, nails, hair, and mucous membranes. Oral LP (OLP) has about 0.4‑5.3% potential to be malignant. If the disease is sufficiently characterized, the diagnosis can be made from the clinical features alone; but a biopsy is recommended to confirm the diagnosis and to exclude the presence of dysplasia and malignancy. OLP seems to be mediated by an antigen-specific mechanism, thereby activating the cytotoxic T-cells and non-specific mechanisms such as degranulation of mast cells and activation of matrix metalloproteinase. Pathogenesis of OLP may involve both antigen-specific and nonspecific mechanisms. Here, we report a case of bullous LP in a 44-year-old female patient, discussing clinical features and etiopathogenesis.

Characterization of hospital acquired methicillin resistant staphylococcus aureus.

Methicillin Resistant Staphylococcus aureus (MRSA) strains have emerged as one of the most important nosocomial pathogens. The MRSA can cause a wide range of diseases, which is associated with its production to large number of extracellular toxins and other virulence factors. The diseases are toxic shock syndrome, scalded skin syndrome and food poisoning. Hospital-acquired MRSA (HA-MRSA) in persons who have had frequent or recent contact with hospitals or healthcare facilities within the previous year, has recently undergone an invasive medical procedure, or is immunocompromised. Mostly HA-MRSA are transmitted most frequently through direct skin-to-skin contact or contact with shared items or surfaces that have come into contact with someone else’s colonized or infected skin. Panton Valentine Leukocidin (PVL) is a biocomponent toxin has been shown to induce lysis of host defence cells. The absence of the PVL gene confirms the MRSA as HA-MRSA. Slime layer plays a remarkable role in bacterial colonization of exterior surfaces by adhesion and production of slime factor plays an important role in antibiotic resistance. Beta lactamases render bacteria resistant to beta-lactam antibiotics by hydrolyzing the beta lactam ring of penicillin’s and cephalosporins.There is a linear correlation between beta-lactamase activity and the level of resistance of bacteria to penicillins. The phage groups II and III were present in hospital acquired MRSA which colonizes on the normal skin and enter the body through cut/wound or by fracture and cause osteomyelitis and bacterial arthritis. Bacteriophage typing of MRSA strains is an epidemiological marker and is a successful method in strain characterization.

A hospital based study of Hereditary Hemolytic Anaemias in Davanagere district of Karnataka, India.

Background: Hereditary hemolytic anaemias constitute important cause of mortality and morbidity in developing countries next only to infection and malnutrition.These group of anaemias have various clinical presentations starting from their age of onset of symptoms, failure to thrive, anaemia, prostration, jaundice, splenomegaly, cholelithiasis, cardiomegaly, congestive cardiac failure, severe life threatening infections and chronic disabilities leading to distress in the families. Methodology: An analysis of 40 cases of hereditary hemolytic anaemia in the age group of 2 months to 12 years was done in the present study. On the basis of clinical presentations, physical findings, routine hematological investigations and hemoglobin electrophoresis pattern in hemoglobin defects were carried out to identify the type of hemolytic anaemias. Results: This clinocohematological study of hereditary hemolytic anaemia showed membrane defects- Hereditary spherocytosis in 4 cases (10%). The remaining 36 cases were having diseases affecting hemoglobin molecule which included Sickle cell anaemia-5 cases (12.5%), Sickle cell trait- 1 case (2.5%), Sickle cell/􀈕 thalassemia-1 case (2.5%), 􀈕 thalassemia major- 23 cases (57.5%) and 􀈕 thalassemia trait 6 cases(15%). Hereditary hemolytic anaemia with enzyme defects were not observed in this study. Majority of these cases presented with progressive pallor and hepatosplenomegaly. Peripheral blood smear examination showed microcytic hypochromic anaemia (87.5%) in majority of the cases. All cases were associated with reticulocytosis. Hemoglobin electrophoresis confirmed the diagnosis. Conclusion: Inspite of advanced diagnostic inestigations, the basic hematological investigation remains first panel or step towards the approach to diagnose hereditary hemolytic anaemia and hemoglobin electrophoresis will help in confirming the diagnosis.