Estimation Dynamic Distance Direct Ophthalmoscopy (eDDDO): A novel, objective method for the quantitative assessment of accommodation in young children

Purpose: To describe estimation dynamic distance direct ophthalmoscopy (eDDDO) and compare it with the monocular estimation method of dynamic retinoscopy (eDR) for the assessment of accommodation in children. Methods: In this prospective observational cohort study, an ophthalmologist performed eDDDO followed by eDR in children with normal eyes, and then under the partial effects of cyclopentolate and tropicamide to assess performance of eDDDO with eDR under the condition of pharmacologically induced accommodation failure. Only one eye of each child was recruited in the study. To study the inter-observer variation, two masked pediatric ophthalmology fellows performed eDDDO in the similar manner. Results: For the comparison of eDDDO with eDR, 60 eyes of 60 patients were recruited. The mean age of the patients was 10.4 years. The mean accommodation on eDDDO was 3.0D, 5.1D, 9.8D, and 11.3D at 40 cm, 25 cm, 10 cm, and 8 cm, respectively and 3.0D, 5.0D, 9.5D, and 11.0D on eDR. The eDDDO overestimated accommodation by a mean 0.17D (95% CL 0-0.48D, P = 0.5). The correlation of eDDDO with eDR was excellent (Pearson r 0.98, T value 76.0). The inter-observer difference with eDDDO was not significant (mean 1D, 95% CL 0-2.6D, P = 0.9) and the correlation between two observers was excellent (Pearson r 0.9, T value 12.7). The eDDDO and eDR were also performed on 12 eyes of 6 children with a mean age of 8.5 years (range 8-12 years) under the partial effect of cyclopentolate and tropicamide, where eDDDO overestimated the accommodation by a mean 0.3D (95% CL 0- 1.2D, P = 0.7) and the correlation was excellent (Pearson r 1.0, T value 45). Conclusion: eDDDO is a simple, reliable, quantitative, and objective technique of accommodation assessment for children. Further studies with larger sample are required to assess its performance in disorders of accommodation affecting younger children and in children with ocular comorbidities.

Expression of breast cancer type 1 and its relation with expression of estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2/neu in breast carcinoma on trucut biopsy specimens

Objective: (1) The objective is to study the immunohistochemical expression of Breast cancer type 1 (BRCA1) in breast carcinoma on trucut biopsy specimens and (2) To relate its expression with that of estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER-2)/neu and the clinicopathological parameters. Settings and Design: A cross-sectional hospital-based study was performed in Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, with collaboration of the Departments of Pathology and Surgery from the period of November 2008 to March 2010. Materials and Methods: The study group included 54 cytologically proven cases of breast carcinoma. The immunohistochemical expression of BRCA1 was studied and related with expression of ER, PR, and HER-2/neu on their trucut biopsies. Results: The altered expression of BRCA1 (i.e., reduced or absent expression) was seen in 44.4% cases of breast carcinoma while 55.6% had positive expression. About 83% of breast carcinomas with altered BRCA1 expression were larger than 3 cm in size. The breast carcinomas showing altered expression were found to be mostly high grade (63.6%). This was statistically significant. The ER and PR negativity were seen in 62.5% and 79.2% breast carcinomas with altered BRCA1 expression, respectively. The score 3 positivity of HER-2/neu was more common among carcinomas with altered BRCA1 expression (21% vs. 16.7%). The triple negativity was found in 41.7% breast carcinomas having altered BRCA1 expression. This was statistically significant. Conclusion: The combination of immunohistochemical expression of BRCA1, ER, PR, and HER-2/neu and clinicopathological details may be helpful in predicting the individuals more likely to carry BRCA1 mutations and thus selecting the candidate and family members for genetic screening for BRCA1 mutations.

Antifungal activity of cheilanthes grisea blanford.

Cheilanthes grisea Blanford, a rare fern of Kumaun hills, is a member of psinopteridaceae family of leptosporangiate group of ferns. Aq. methanolic extract (50%) of this fern was screened for antifungal activity by thin layer autobiochromatographic methods. Chemical investigation of the fern fronds of C. grisea Blanford revealed the presence of a flavonol glycoside, quercetin-3-O-β-glycosyl (1→2) rhamnoside from an antifungal active fraction of n-butanol soluble of aqueous ethanolic extract. Its structure was elucidated by UV, 1HNMR, and hydrolytic methods.

Evaluation of gabapentin in attenuating pressor response to direct laryngoscopy and tracheal intubation

Background: To evaluate effect of gabapentin in attenuation of haemodynamic responses to direct laryngoscopy and tracheal intubation. Methods: Hundred patients undergoing elective surgery were randomly allocated to two groups of 50 patients each. Patients in group A received gabapentin 800 mg and patients in group B received placebo capsules the night before and on the morning of surgery. Anaesthesia was induced with propofol and vecuronium. Systolic; diastolic; mean arterial blood pressures (SAP; DAP; MAP) and heart rate (HR) were recorded before and after the induction of anesthesia and 0; 1; 3; 5 and 10 min after tracheal intubation. Results: SAP was significantly lower in the gabapentin as compared to the control group 0; 1; 3; 5 and 10 min after intubation [121 vs 135 ( P0.001); 117 vs 132 (P0.001); 112 vs 124 (P0.001); 110 vs 118 ( P0.05) and 107 vs 112 ( P0.05) respectively]. DAP also was lower in the gabapentin group 0; 1; 3; and 5 min after intubation [77 vs 87 (P0.001); 74 vs 84 (P0.001); 70 vs 78 (P0.001) and 68 vs 74 (P0.05)]. MAP also was lower in the gabapentin group 0; 1; 3; and 5 min after intubation [92 vs 103 (P0.001); 88 vs 100 (P0.001); 84 vs 93 (P0.001) and 82 vs 88 (P0.05)]. HR also was lower in the gabapentin group 0; 1 and 3 min after intubation [90 vs 98 (P0.05); 88 vs 95 (P0.001) and 84 vs 90 (P0.05)]. Conclusion: Gabapentin; under the present study design attenuates the pressor response associated with laryngoscopy and tracheal intubation but tachycardiac response is not completely eliminated

Radicular cyst associated with a deciduous molar: A case report with unusual clinical presentation.

This article presents case report of a patient with radicular cyst associated with a primary molar with an unusual clinical presentation. The management comprised of enucleation of the cystic sac under general anesthesia.

Ultrasound guided percutaneous nephrostomy for obstructive uropathy in benign and malignant diseases

OBJECTIVE: Analyze the success rate, complications and overall benefit of ultrasound guided percutaneous nephrostomy (PCN) for the relief of obstructive uropathy in benign and malignant diseases. MATERIALS AND METHODS: PCN was performed in 50 kidneys of 32 patients. It was performed in emergency rooms totally under ultrasound guidance by general surgeons. Seldinger technique was used in all cases. Changes in renal function after the procedure were analyzed using paired t-test. RESULTS: The procedure was successfully completed in 42 out of 50 kidneys (84 percent). There has been no major complication and 28 percent minor complications. The renal function improved significantly when PCN was performed for benign conditions (mean creatinine 3.52 mg/dL before and 2.18 mg/dL after PCN), however in malignancy there has been no significant improvement in renal function (before PCN mean creatinine 6.39 mg/dL and after PCN 5.41 mg/dL). CONCLUSION: We conclude that PCN can be effectively performed under ultrasound guidance and should be the initial procedure in acutely obstructed kidneys with pyonephrosis and poor renal function. In malignant cases, however, improvement in renal function is possible only if the procedure is carried out at an early stage.

Telemedicine in ophthalmology.

Comprehensive telemedicine promises a world of medicine freed of geographic borders, time zones, and personnel shortages. It could open the door to more accessible medical delivery systems and economical widespread screening for disease. No region of the world would be too remote or too poor to receive high quality medical care. This article traces the development and current applications and initiatives in the field of telemedicine as applied to ophthalmology in the wider sense. Uses for clinical diagnosis and management, screening, research, education and peer interaction are discussed.

Prognostic significance of apoptosis in squamous cell carcinoma of oral cavity with special reference to TNM stage, histological grade and survival.

Apoptotic count was assessed in 38 cases of squamous cell carcinoma of oral cavity by light microscopy and correlated with TNM stage, histological grade and survival. A direct correlation with the TNM stage (p = 0.0166) and an inverse correlation with the histological grade (p = 0.03) was found, however no correlation was found with the survival. Apoptotic count was significantly different between well and moderately differentiated carcinoma (p = 0.347) and well and poorly differentiated carcinoma (p = 0.0190). Thus apoptotic count may have prognostic value particularly in combination with staging and histological grade.

Management of ocular perforations resulting from peribulbar anaesthesia.

PURPOSE: To analyze the clinical presentation and outcome of treatment for globe perforation secondary to peri-bulbar anaesthesia. METHODS: Eight patients (3 females and 5 males) aged 66-84 years were included in the study. Ocular perforations were suspected in 3 cases before or during surgery, in 4 cases diagnosis was established within one week and in one case at 3 weeks. Three patients underwent indirect argon laser photocoagulation to seal the retinal break, one patient had cryotherapy, 3 patients underwent a pars plana vitrectomy with fluid gas exchange and endo-laser; and one patient refused any further treatment. RESULTS: The final visual acuity after a mean follow up of 14 months was better than 6/9 in 2 patients, between 6/9-6/12 in 4 patients, and perception of light in 2 patients. CONCLUSION: If diagnosed early and treated adequately, a majority of patients with globe perforation during periocular anaesthetic could be saved.

Streptogramins: a new class of antibiotics.

Streptogramin antibiotics represent a unique class of antibacterials in the each member of the class consists of at least 2 structurally unrelated molecules: group a streptogramins (macrolactones) and group B streptogramins (cyclic hexadepsipeptides). Both group A and group B streptogramins inhibit protein synthesis at the ribosomal level, and they act synergistically against many isolates their combination generating bactericidal activities and reducing the possibility of emergencies of resistant strains. The mechanisms of acquired resistance to group B streptogramins remain unaffected by target modifications and active efflux. The pharmacokinetic parameters of group A and group B streptogramins in blood are quite similar. In addition, both the A and B group penetrate and accumulate in macrophages and in the bacterial gegetations of experimental endocarditis. Until recently, the complex and irregular composition of naturally occurring pristinamycin and virginiamycin, as well as the unavailability of soluble forms, have limited the clinical development of streptogramins. The synthesis of water soluble derivatives of pristinamycin IA and IIB has now allowed the development of injectable streptogramins with fixed compositions. This unique class of antibacterials will have a significant clinical impact in a world of increasing multidrug resistance affecting the Gram-positive cocci, especially staphylococci and pneumococci. The absence of cross-resistance to macrolides in many of these isolates and the rapid antibacterial killing against these species bright future for this class of antibiotics.

Bilateral glaucomatocyclitic crisis in a patient with Holmes Adie syndrome.

A patient with pre-existing bilateral tonic pupils presented with simultaneous bilateral glaucomatocyclitic crisis. Deep tendon reflexes were absent although they were documented to be present 6 years ago. A possibility of a progressive autonomic dysfunction in both these conditions is discussed.

Breast-feeding practices in Schedule Caste communities in Haryana state.

A study was conducted to assess exclusive breast-feeding, continued breast-feeding, bottle-feeding, predominant breast-feeding, timely complementary feeding and other breast-feeding practices in 818 children in the age group of 0-3 years belonging to the Schedule Caste communities of Haryana. The exclusive breast-feeding rate was 0.15 and the predominant breast-feeding rate 0.75 in children < 4 months. Timely complementary feeding rate was 0.42. The continued breast-feeding rate at 1 year and 2 years was 0.84 and 0.58, respectively. The bottle-feeding rate, ever breast-fed rate, timely first-suckling rate and exclusive breast-feeding rate by mother were 0.09, 1.0, 0.0 and 0.15, respectively. The median duration of breast-feeding was 16 months.