Assessment of pulmonary function test and its variability among different socio-demographic status of healthy school children of age group 9� years

Background: Pulmonary function test (PFT) is used to diagnose the underlying cause of respiratory symptoms in children and adolescents. It is also used to monitor the status of those with chronic lung diseases. In clinical practice, spirometry is the investigation of choice for the overall assessment of pulmonary function and is equated with the PFT in day to day practice the assessment of lung function. Aim and Objective: The aim of the study was to determine pulmonary function (as measured by FEV1 and FEV6) among school going children of age group 9� years and its variability with age, sex, height, and regional difference. Materials and Methods: This cross-sectional study was conducted among 703 normal healthy school children (335 boys and 368 girls) of Thiruvananthapuram city aged 9� years during 2015�16. The study group included both South Indian and North Indian children. Height, weight, and BMI were measured. All included children were tested in a sitting position with the head straight after taking written consent from parents. Spirometry was done using the instrument 揤italograph- COPD 6.� It displays FEV1 and FEV6. The FEV6 is used as a surrogate marker of FVC. Results: FEV1 and FEV6 were found to be statistically significant in the study group. Both FEV1 and FEV6 were higher in boys than girls. In both boys and girls, FEV1 and FEV6 values showed strong positive correlation with age, and height which was found to be statistically significant (P < 0.001). North Indian children have got higher FEV1 and FEV6 values than South Indian children. This was also found to be statistically significant (P < 0.001). Conclusion: Variables such as FEV1 and FEV6 values showed strong positive correlation with age and height in both sexes. By regression analysis, it was found that age, gender, and height were the significant predictors for both FEV1 and FEV6.

A study of pure tone audiometry in adults with hypothyroidism

Background: Thyroid hormones are important for overall growth and maturation. Hypothyroidism is associated with many symptom complexes, one of them being hearing loss. Aim and Objectives: Evaluating the hearing loss in hypothyroid patients of the age group of 18� years and comparing them with those in healthy people. Materials and Methods: A case-control study was conducted in subjects aged between 18 and 45 years, in which 80 hypothyroid cases were selected after proper exclusion and informed consent and 80 age-and sex-matched healthy controls were studied. Hearing loss was assessed by pure tone audiometry. Statistical Package for the Social Sciences version 18 was used for statistical analysis. Results: SNHL was the common type of hearing loss seen. The prevalence of hearing loss was found to be 66.3% in cases. Hearing loss was mild, bilateral, and commonly affected the high frequency. Conclusions: Hypothyroid patients were more prone to sensorineural hearing loss. In patients with thyroid disorders, hearing evaluation helps in the detection of hearing loss earlier and thus treatment could be started.

Comparative study of lipid profile anomalies in thyroid dysfunction

Background: Thyroid hormones play a major role in the metabolism of lipids and deranged lipid profile can, in turn, result in various cardiovascular diseases. The association between elevated LDL and coronary artery disease (CAD) risk is well established. However, the correlation between the changes in the thyroid hormone levels and lipid profile needs to be studied in detail. Aim and Objectives: This study was conducted with the objective of estimating the serum levels of total cholesterol, triglycerides, LDL, HDL, and VLDL in hyperthyroid and hypothyroid individuals and to compare it with the euthyroid population. Materials and Methods: A cross-sectional study was conducted among 165 study subjects who included newly diagnosed patients with untreated hypothyroidism and hyperthyroidism and controls were selected from the bystander population. Serum TSH, serum total cholesterol, serum LDL, serum triglycerides, serum VLDL and serum HDL were assessed. The baseline characteristics and blood investigation values were compared among the three groups using ANOVA and were expressed in mean � standard deviation. The association between the various parameters in different groups was evaluated using Pearson抯 correlation coefficient. P < 0.05 was considered statistically significant. Results: Among the 165 subjects studied, majority belonged to the age group of 30� years and majority of the study subjects were females. The mean serum levels of total cholesterol (216.86 � 21.99 mg/dl), LDL (142.49 � 19.09 mg/dl), triglycerides (156.31 � 26.33 mg/dl) and VLDL (31.26 � 5.25 mg/dl) were significantly higher in the hypothyroid group compared to the control subjects (P = 0.000). The mean serum levels of total cholesterol, LDL, triglycerides, and VLDL were significantly higher in the hypothyroid group compared to the control subjects (P = 0.000). Conclusion: Hypothyroidism demonstrates an atherogenic lipid profile with a positive correlation with serum TSH values and lipid profile. Since altered lipid profile can predispose to cardiovascular diseases, screening for these in individuals with thyroid dysfunction especially hypothyroidism needs to made mandatory.

Lateral elongation of flat irregular pigment epithelial detachment: A novel optical coherence tomography biomarker in polypoidal choroidal vasculopathy

Purpose: To explore novel Optical Coherence Tomography (OCT) biomarkers and precursor lesions in Polypoidal Choroidal Vasculopathy (PCV). Methods: This retrospective cohort study included 76 treatment na飗e fellow eyes of PCV. Focus was given to analyse the various morphological changes in the clinically unaffected fellow retina during the follow-up period. Results: 11 fellow eyes (14.47%) developed disease activity in the form of Sub Retinal Fluid (SRF) or Intra Retinal Fluid (IRF) within a mean follow-up of 17 months. All 11 eyes (100%) showed the presence of flat irregular pigment epithelial detachment (FIPED) and a peculiar property of lateral elongation of FIPED during disease activity. A positive correlation with the disease progression was found for the same (P < 0.0001). The mean horizontal dimension of the flat irregular PED at the enrolment was 1984 � 376u and the mean expansion of FIPED at SRF formation was 461 � 152u. ICG taken at the time of disease activity in the fellow eye revealed branching vascular network (BVN) in 9 (81.8%) eyes, polyps in 7 (63.6%) eyes, a combination of both in 5 (45.4%) eyes. Type one BVN with interconnecting channels showed faster disease progression than type two BVN. Eye tracking ICG illustrated that BVN corresponded to the FIPED in OCT and polypoidal lesions developed at the end of expanding FIPED. Conclusion: Flat irregular pigment epithelial detachment with its characteristic property of lateral elongation may be considered as a precursor lesion for PCV and as a novel OCT biomarker for the disease activity. Fellow eyes with FIPED need close monitoring to identify development of disease activity at the earliest.

Spontaneous formation and closure of full thickness macular hole after treatment with anti-vascular endothelial growth factor therapy in polypoidal choroidal vasculopathy

Full-thickness macular hole (FTMH) formation in Polypoidal choroidal vasculopathy (PCV) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment is a rare complication. Spontaneous closure of FTMH following anti-VEGF therapy has not been described in PCV till date. We present a case of Asian woman with PCV who developed a FTMH following treatment with intra-vitreal anti-VEGF injections which subsequently closed spontaneously on further course of treatment.

Smartphone guided wide-field imaging for retinopathy of prematurity in neonatal intensive care unit – a Smart ROP (SROP) initiative

Purpose: To suggest a low cost, non-contact smartphone-based screening system in retinopathy of prematurity (ROP), and to illustrate its potential clinical application as a potential future tool for teleophthalmology. Methods: Neonatal intensive care unit (NICU)-based bedside ROP screening done between January 2018 and May 2018. Documentation of ROP was done by using a smartphone and +40D, +28D, or +20D indirect non-contact condensing lenses. By using the coaxial light source of the phone, this system works as an indirect ophthalmoscope that creates a digital image of the fundus. With smartphone-based camera we extracted high-quality still images extracted from the video clip. Results: Total of 228 eyes of 114 infants screened for ROP between January 2018 and May 2018. Incidence of total ROP was 23.68%, out of which incidence of type 1 ROP was 8.77%. After initial screening with indirect ophthalmoscope, we uesd smartphone imaging to document ROP in 28 eyes out of 55 eyes having ROP. Image quality was good in 89.28% eyes. Field of view vary from 46°, 53°, and 90° with +20D, +28D, and +40D indirect condensing lenses, respectively, which gives excellent images for bedside ROP documentation. Conclusion: The described technique of smartphone fundus photography is a light weight, cost-effective, user friendly, high-quality wide-field fundus photographs for bedside documentation of ROP in NICUs using readily available instruments that are handy and portable with simple power sources. Smartphones has the potential to be operated with only one hand. It can also be used as a future telescreening device.

Neonatal Intensive Care Unit-based screening program for retinopathy of prematurity and its treatment in an Indian population

Purpose: The purpose was to study the incidence, risk factors, and anatomical outcomes after laser treatment in retinopathy of prematurity (ROP). Methods: A retrospective observational study was carried out. Infants admitted to Neonatal Intensive Care Unit of 12 referral hospitals between April 2016 and September 2017 were screened according to the latest Indian guidelines based on the International Classification of Retinopathy of Prematurity. Results: The incidence of ROP in 1648 eyes screened was 25.36% (418 eyes), out of which high-risk prethreshold ROP (type 1) was observed in 9.95% (164 eyes). Decreased hemoglobin (P < 0.001), oxygen requirement (P = 0.008), and number of blood transfusions (P = 0.037) were significant with type 1 than type 2 (low-risk prethreshold) ROP. Stages 1, 2, and 3 were observed in 82 (32.28%), 154 (60.62%), and 18 (7.08%) eyes, respectively. Aggressive posterior ROP (APROP) was observed in 20.73% eyes with type 1 ROP. Ten eyes showing APROP were treated at an early gestational age of 29 weeks. All infants with type 1 ROP were treated with laser photocoagulation only. Conclusion: One-fourth of the infants showed ROP and one-tenth needed laser photocoagulation, the outcome of which was excellent. Risk factors predisposing to ROP were anemia, high oxygen supplementation, increased number of blood transfusions, and septicemia. ROP screening in infants ?1700 g birth weight associated with various systemic risk factors may be beneficial in the Indian population.

Focal choroidal excavation: Cause or effect?

We report the imaging characteristics of focal choroidal excavation (FCE) and associated choroidal neovascular membrane (CNVM) and interpret the probable etiopathogenesis of FCE through findings in four patients detected by spectral-domain optical coherence tomography (SD-OCT). FCE was found as an acquired entity in two of our cases subsequent to treatment of CNVM, whereas in the two other cases FCE was pre-existing. Furthermore, association of FCE with pachychoroid spectrum is reaffirmed through this case series.

Long-term efficacy and safety of verteporfin photodynamic therapy in combination with anti-vascular endothelial growth factor for polypoidal choroidal vasculopathy

Purpose: The aim of the study was to analyze the outcomes of photodynamic therapy (PDT) with intravitreal anti-vascular endothelial growth factor (anti-VEGF) for patients with polypoidal choroidal vasculopathy (PCV) having visual acuity (VA) better than 20/60 in a real-world scenario in India. Methods: Retrospective review of 42 eyes of 40 patients (mean age 64.3 years) with best-corrected VA (BCVA) 20/60 or better and mean follow-up of 40 months (median 38 months; range 12� months) treated with PDT and anti-VEGF or triamcinolone for indocyanine green angiography (ICGA)-proven subfoveal PCV. Results: Mean BCVA improved from 0.22 logMAR at baseline to 0.15 at last visit (P < 0.001). On ICGA, polyp was observed in 42 eyes (100%) and branching vascular network (BVN) in 37 eyes (88.1%). Polyp regressed in 33 (78.6%) of 42 eyes and BVN in 26 (70.3%) of 37 eyes after combined therapy at 3 months. Mean greatest linear diameter reduced significantly (P < 0.001) from 7.22 mm to 4.11 mm. Standard-fluence PDT was performed in 35 eyes and reduced-fluence in 7 eyes. The mean number of PDT was 1.17 with mean number of injections being 6.38 at the end of follow-up. In five eyes, more than one PDT was administered. Of 42 eyes, 40 showed complete resolution of serous macular detachment (SMD) after the combined therapy at 3 months; 17 (42.5%) of the 40 eyes showed no recurrence of fluid on spectral domain optical coherence tomography till the last visit with a mean follow-up of 27 months. On long-term follow-up, SMD reoccurred in 23 eyes with a mean follow-up period of 9.64 � 5.24 months. Of 38 eyes having a double-layer sign (DLS) on optical coherence tomography at baseline, 37 eyes were having regression of the DLS, that is, it either reduced or resolved at the final visit. At the final visit, 66.7% (P < 0.001) eyes were having fluid-free retina. No complication of subretinal hemorrhage was noted. Of the 42 eyes, only one eye had BCVA worse than 20/60 on the final visit. Conclusion: To the best of our knowledge, this is the first study to look into the long-term effect of combined PDT with anti-VEGF in PCV in eyes having good VA. Long-term effect of combined PDT appears to be a safe and effective treatment for PCV in eyes having good VA with better outcomes in real-world setting. This study further strengthens the superiority of the combined treatment modality for treatment of subfoveal PCV with no or minimal risk of complication on long-term follow-up.

Fatal meningitis caused by vancomycin-resistant enterococci: Report of two cases from south India.

Vancomycin-resistant enterococci rarely cause meningitis and present a therapeutic challenge. Antimicrobial susceptibility testing was done for strains of Enterococcus species isolated from CSF samples of patients with meningitis by phenotypic methods. Multiplex polymerase chain reaction was performed to determine the genetic basis of vancomycin resistance of such isolates. We report here two cases of enterococcal meningitis caused by vancomycin-resistant Enterococcus species. One of the isolates was identified as Enterococcus faecalis and the other as Enterococcus gallinarum. We also report the simultaneous presence of vanC1 and vanA resistance genes in the strain of E. gallinarum. To the best of our knowledge, this is the first report of vanA resistance gene in an isolate of E. gallinarum from the Indian subcontinent. This is also the first Indian report of vancomycin-resistant Enterococcus causing meningitis.

Effect of papaya (Carica papaya linn) on pregnancy and estrous cycle in albino rats of Wistar strain.

The antifertility effects of Carica papaya were investigated by feeding adult cycling and pregnant rats with different components of its fruits. No attempt was made to force-feed the animals. The results indicate that unripe fruits of papaya interrupt estrous cycle and induce abortions. The abortifacient property seems to decrease as the fruit becomes stale or ripe. Exogenous progesterone counteracts partially the adverse effects on pregnancy and the surviving foeti are without any distinct malformations.