The ocular surface after simple limbal epithelial transplant (SLET): A high-resolution OCT study of the early postoperative period

Simple limbal epithelial transplantation (SLET) is an emerging technique for treating unilateral limbal stem cell deficiency. We report the high-resolution, anterior segment optical coherence tomography (OCT) features of the first 2 weeks of a patient undergoing SLET for an old acid injury of the right eye, repeatedly from postoperative day 1 through day 14. Three out of 11 explants with the subjacent human amniotic membrane (hAM) and the overlaid bandage contact lens were imaged. The hAM was intact and of the same thickness throughout the study period; the sub-hAM space increased from day 3 to 9 and disappeared by day 10; the explants started thinning from day 3 with the fibrin around them starting to decrease from day 2 and completely disappeared by day 4. Epithelialization occurred between day 8 and 14 and proceeded more rapidly towards the limbus than centrally. There was no change of the corneal stromal thickness or reflectivity. This case report uses high-definition, spectral-domain OCT to document the events on the ocular surface after a successful SLET surgery and opens up an avenue to study epithelialization in a convenient and noninvasive manner.

Primary limbal stem cell transplantation in the surgical management of extensive ocular surface squamous neoplasia involving the limbus

Purpose: To determine the role of primary limbal stem cell transplantation (LSCT) in managing extensive ocular surface squamous neoplasia (OSSN) with more than 3 quadrants of limbal involvement to prevent manifestations of limbal stem cell deficiency. Methods: A multi-center, comparative, and interventional clinical study of cases and historical controls was done. Patients with a limbal mass suggestive of OSSN involving more than 3 quadrants of limbus (> 9 clock hours) and no local, regional or systemic metastasis, who underwent primary surgical excision with or without adjuvant chemotherapy and had a minimum follow-up of 12 months were included in this study. Two historical controls underwent tumor excision with only amniotic membrane grafting. Three cases underwent tumor excision along with LSCT in the form of conjunctival limbal autograft (CLAG) or simple limbal epithelial transplant (SLET). Results: None of the eyes had any recurrences of OSSN during the follow-up period. Cases with primary LSCT with tumor excision showed better ocular surface stability in the long term. Conclusion: Concomitant LSCT either in the form of CLAG or SLET appears to provide better long-term outcomes and is advocated while excision of extensive OSSN involving the limbus.

Herpes simplex esophagitis in immunocompetent individuals.

Herpes simplex esophagitis commonly occurs in immune-compromised individuals. We report the condition in two immunocompetent individuals (one presenting with retrosternal pain and diarrhea and the other with dysphagia and fever) and in two patients with obstructive airway disease who had received corticosteroid therapy. The first two did not receive treatment, one was lost to follow up and the other is asymptomatic two years later. The latter two patients received acyclovir therapy.

Adrenal histoplasmosis.

A 60 year old diabetic was admitted with the history of low grade fever and weight loss of six weeks duration. After investigations, he was detected to have bilateral adrenal masses which on biopsy proved to be due to histoplasmosis. He was treated with itraconazole and made complete recovery.

Lymphocytic interstitial pneumonitis associated with autoimmune hepatitis.

A 49-year-old woman was diagnosed as autoimmune hepatitis and started on steroids and azathioprine. Subsequently, she developed fever; chest radiograph showed lower lobe nodular opacities. Bronchoalveolar lavage and transbronchial lung biopsy confirmed the diagnosis of lymphocytic interstitial pneumonitis.

Clear cell hidradenoma of the eyelid: a case report.

Sweat gland tumours are extremely rare in the eyelids. We report a case of a clear cell hidradenoma (nodular hidradenoma) in an elderly female, who had presented with a nodular swelling in a eyelid. Clear cell hidradenomas arise as intradermal nodules from eccrine sweat glands. Ultrastructural and enzyme histochemical studies have shown nodular hidradenomas to be intermediate between eccrine poroma and eccrine spiradenoma. No apocrine differentiation has ever been observed in these tumours. Malignant forms are distinctly unusual. This case is being documented for the extremely uncommon presentation of this tumour as an eyelid mass. Complete primary excision is advocated and local steroid preparations should bot be used.

Oxygen therapy for children. Need-based preparation and evaluation of a self-instructional module for staff nurses on care of a child receiving oxygen therapy.

The present study was carried out with the objectives of determining the learning needs of Staff Nurses regarding care of children receiving Oxygen Therapy; finding association between learning needs and selected variables: age, total years of experience, experience in Paediatric Ward, married with or without children; determining validity of self-instructional module, on "care of child receiving Oxygen Therapy", and evaluating the effectiveness of the self-instructional module or SIM. The study was conducted in two phases. A survey approach was used for Phase-I and one group pre-test post-test design was adopted for Phase-II. The total sample of the study was 30 Staff Nurses, of 6 months experience in Paediatric Ward. The findings of the study showed high learning need status in most of the areas and the Staff Nurses also expressed the desirable need for learning in detail. It was found that age, total years of experience, experience in Paediatric Ward and married with or without children were independent of their learning need. SIM was effective in terms of gain in knowledge score as well as acceptability and utility scores of Staff Nurses.

Physical growth parameters in thalassemic children.

Various growth parameters of 233 (140 boys, 93 girls) thalassemic children were compared with 74 (45 boys and 29 girls) non-thalassemic siblings, ICMR and NCHS norms. Weight and height were retarded in thalassemic children. The difference between thalassemic and non-thalassemic siblings, was evident from 9+ years in both boys and girls. Growth parameters seemed to be adversely affected with the advancing age. Among head, chest and mid arm circumferences, the mid arm circumference was more affected than head and chest circumferences. Height and weight were more severely retarded in children with hemoglobin levels of less than 8 gm/dl. The findings seemed to suggest that press of retardation was probably secondary to chronic hypoxia and iron overload.

Development of secondary sex characteristics in multitransfused thalassemic children.

Secondary sex characteristics were evaluated in thalassemic children (41, boys and 30 girls), who were on regular transfusion therapy and were above 11 years of age. The results of this study indicate that the development of secondary sex characteristics in thalassemic children is markedly delayed as compared to their non-thalassemic siblings and to the expected development criteria. Delay in development of secondary sex characteristics appears to be secondary to chronic hypoxia and iron overload.

Recent kala-azar cases in India: isozyme profiles of Leishmania parasites.

In this study, three WHO recommended reference strains of Leishmania donovani (DD8), L. tropica (K27) and L. major (5 ASKH) were compared by isozyme analysis of 9 soluble enzymes using cellulose acetate electrophoresis (CAE). The isozyme profile of the three species showed distinct electrophoretic mobilities of the enzymes studied. This technique was applied to study the enzyme patterns of 8 clinical isolates of visceral leishmaniasis (VL) and two post kala-azar dermal leishmaniasis (PKDL) collected from the present epidemic (1990s to date). They were seen to be similar to the two isolates of the 1970s epidemic. Interspecies differences were observed in different reference Leishmania species whereas no intraspecies difference was observed amongst the clinical isolates (8VL + 2PKDL) and all of these were found to be similar to L. donovani isolates of 1970s epidemic.

Effect of five-membered heterocycles against Leishmania donovani infection.

Impact of change of heteroatom in pentavalent heterocycles, viz., pyrroles, isoxazoles, imidazoles and crotonates on the profile of antileishmanial activity against amastigotes of L. donovani using in vivo test system and macrophage-amastigote culture system has been studied. Sixty-three compounds were tested. Nine imidazoles showed marginal activity in vivo, whereas 3 out of 10 compounds of isoxazolone series and 2 out of 4 substituted aminocrotonates exhibited antileishmanial activity. Of the 30 substituted pyrroles, except 8 all showed antileishmanial activity in vivo on day 7 post treatment.

Microenvironment at the substrate binding subsite of the active site of UDPglucose 4-epimerase from Kluyveromyces fragilis using a fluorescent analog of UMP.

A chromophorics and fluorescent analog of uridine 5'-monophosphate (UMP), a known competitive inhibitor of UDPglucose 4-epimerase was synthesised. This analog, namely 2',3'-O-(2,4,6-trinitrocyclohexadienylidene) uridine 5'-monophosphate, was found to be a powerful reversible inhibitor of UDPglucose 4-epimerase indicating its interaction with the substrate binding site of the enzyme. The extreme sensitivity of the fluorescence emission spectrum of this analog to solvent polarity makes it an excellent probe for the study of the environment at the active site of the enzyme. We report here the effective use of this UMP analog to demonstrate that the hydroxyl groups of the ribose moiety of UMP and presumably the substrates (UDPgalactose and UDPglucose) do not reside in a hydrophobic milieu.

Metabolic analysis of galactose toxicity in Escherichia coli with 2-deoxygalactose as the probe.

Biochemical basis of galactose toxicity has been studied in gal T mutants (CGSC 4974) using 2-deoxygalactose, a non-metabolizable analogue of galactose, as the probe. It is found that biochemical features of toxicity in wild type cells either with 2-deoxygalactose or with 2-deoxyglucose are very similar to the picture obtained with gal T mutants and the observed bacteriostasis is probably due to futile phosphorylation and not due to any specific inhibitory effect of phosphorylated galactose.

Exploration of antileishmanial activity in heterocycles; results of their in vivo & in vitro bioevaluations.

A total of 51 imidazoles, pyrroles, quinolines and isoxazolines compounds were screened for antileishmanial activity in vivo and in vitro, using Leishmania donovani as the test parasite. The screening revealed hitherto unknown antileishmanial activity in these heterocycles. Three of the compounds screened (one belonging to isoxazoline series and two from pyrrole series) showed significant anti-leishmanial activity, ranging from 86-91 per cent inhibition in hamsters. When tested in vitro, using macrophage amastigote culture system, these compounds showed inhibition of 62-78 per cent at 30 micrograms/ml concentration.

Cellular blue nevus with nevus cells in regional lymph nodes: a lesion that mimics melanoma.

We report the case of a young man who had a large, firm, nodule covered by darkly pigmented skin over the outer aspect of the right ankle and palpable right inguinal lymph nodes. The mole had enlarged rapidly during the past month, contained deeply pigmented cells with increased cellularity and mitotic activity and groups of intensely pigmented nevus cells within the marginal sinus of the inguinal nodes. The excised mass with inguinal lymphadenectomy was reported as benign cellular nevus with benign nevus cell aggregates in lymph nodes. The purpose of this report is to emphasize how cellular blue nevus can masquerade as malignant melanoma and to increase clinical awareness of this benign variant of melanocytic nevus. We have attempted to elaborate its natural history and comprehensive criteria for diagnosis, so that inappropriate surgery and chemotherapy can be avoided in this lesion which occurs conceivably often enough to be more than just a curiosity.