Rhinosporidiosis – A Clinical Survey

Background: Rhinosporidiosis is a chronic inflammatory granulomatous disease caused by the organism Rhinosporidiumseeberi. This causal organism was once believed to be a sporozoan, but is now considered to be a fungus. The disease ispresent all over the world except in Australia. However, it is endemic only in India and Sri Lanka; more than 95% of reportedcases are from these two countries. The most common site of manifestation of rhinosporidiosis in man is the nose accountingfor about 70% of cases. Surgical excision remains the mainstay of treatment today even though dapsone and ketoconazolehave been tried to some extent in preventing recurrence after surgery.Aim of the Study: The aim of the study was to study the prevalence, distribution, clinical behavior, results of various forms oftreatment and to provide a baseline clinical data and to supplement information for ongoing studies in the field of rhinosporidiosis.Materials and Methods: A total of 20 patients diagnosed as rhinosporidiosis, who attended the ENT Outpatient Department ofMedical College Hospital, Calicut, during the period from December 1998 to November 1999. Detailed history was recorded andpatients were subjected to thorough otolaryngological examination. Special attention was given to the site of lesions and type ofattachment. Details were also collected with particular reference to bathing habits, occupation, contact with animals, and occurrenceof similar illness in the family or in the neighborhood. Investigations included regular blood and urine and blood grouping. All thepatients underwent surgical excision of the lesions. The diagnosis was confirmed by histopathological examination of specimenobtained postoperatively. 100 mg of dapsone was administered daily (50 mg daily in children), 6 days a week, for a period of 6 months.All patients were reviewed for follow-up at the end of 1 month, 2, 4, and 6 and 9 months and on completion of a year after surgery.Observations and Results: In this study, the average age of patients suffering from rhinosporidiosis was 30.6 ± 2.80 years and theage varied between 8 and 52 years. The sex incidence was as follows: Males 17 (85%), females 3 (15%). Male predominance wasseen in this series and the male to female ratio was 5.66:1. Most of the subjects suffering from rhinosporidiosis were manual laborers7 (35%) out of 20, of which 2 (10%) were agricultural workers. The other major group was students accounting for 5 (25%) out of20 cases. The external appearance of the nose was normal in all patients. Partial nasal obstruction was seen in 13 cases (65%),on the left six, on the right five, and bilateral two cases. The total obstruction was seen in 5 cases (25%) – left two, right two, andbilateral one. Both nasal cavities were patent in only two cases. The vestibule showed the presence of mass in four cases (20%).Conclusions: Rhinosporidiosis is not an uncommon disease encountered in day-to-day ENT practice. The occurrence of thedisease does not bear any relation to the occupation of the patient. The maximum incidence of rhinosporidiosis is seen inthe age group of 21–30 years and males predominate. Rhinosporidiosis is more common in the rural population. There is asignificant association between dip baths in ponds and the occurrence of disease.

Very Early (<2 h) Versus Early (12 h) Administration of Caffeine Citrate for Reducing Need for Mechanical Ventilation within 24 h of Life in Preterm Infants on Continuous Positive Airway Pressure

Background: Auditory neuropathy, auditory dys-synchrony, and auditory neuropathy spectrum disorder (ANSD) are variableterms used to describe an auditory disorder seen in patients ranging in age from infants to adults. The prevalence of ANSD indeaf schoolchildren is 2.46% within the age range of 6–12 years. In children, they are detected by the presence of otoacousticemissions (OAEs) in the absence of ABRs. In older age group, difficulty hearing in noise, fluctuating hearing, and speechperception performance not predict ed by the level of residual hearing have been reported. The multitude of etiologies forANSD results in heterogeneous group of patients – making the management strategies even more challenging. The commonetiologies put forward are – prematurity, neonatal insult, genetic abnormality, ototoxic drugs, and head injury.Aim of the Study: This study aims to study the audiological profile in ANSD in a tertiary care hospital and to study the etiologyof ANSD cases.Materials and Methods: A total of 42 patients attending the ENT Outpatient Department of Government Medical College,Kozhikode, with ANSD were included in the study. An ethical committee clearance was obtained before the commencement ofthe study. An ethical committee cleared consent form was used for the study. All ANSD patients were evaluated with a detailedhistory including perinatal and development history, ototoxic drug exposure, head trauma, neurodegenerative conditions, andfamily history. Following clinical evaluation which included general examinations, ENT examination, and central nervous systemexamination, an audiological evaluation, which included pure tone audiometry, speech audiometry, immittance evaluation, OAE,and auditory brainstem response, was done. Radiological investigation (magnetic resonance imaging brain with inner ear – focusingon any structural anomalies; cochlea, vestibulocochlear nerve, and internal auditory canal) was done. Patients were counseledregarding the rehabilitation options based on their audiological and radiological results and the need for follow-up was explained.Observation and Results: A total of 42 patients attending the ENT Outpatient Department (OPD) of Government MedicalCollege, Kozhikode, with ANSD were included in the study. Among the 42 patients, 21 (50%) were in the age group of 11–20 yearsfollowed by 13 patients who were between 0 and 10 years (30.95%). The remaining 8 were aged above 20 years (19.04%).The youngest patient was 10 months old and the oldest was aged 38 years with a mean age of 10.35 ± 2.10 years. Therewere 29 (69.04%) females and 13 (30.95%) males. 3/42 (7.14%) patients gave a history of exposure to ototoxic drugs suchas streptomycin, gentamicin, and kanamycin, but never had a history of loss of hearing before that. History of premature birthwas noted in 10 (23.80%) patients and the remaining patients did not show premature birth history. Among the 42 patients ofthis study group, 23 (54.76%) had low birth weight, of which 2/42 (4.76%) were <1.5 kg. 21/42 (50%) patients had birth weightabove 1.5 kg. 10/42 patients (23.80%) gave a history of neonatal intensive care unit (NICU) admissions at the time of their birth.Conclusions: The major risk factor identified in this study for ANSD was low birth weight with prematurity, NICU admissions,and viral infections having significant contributions. On audiological evaluation, hearing loss was of mild-to-moderate rangewith a low-frequency loss. There was no statistical correlation between pure audiometry values and speech audiometry whichwas a characteristic observation. OAEs were present in the majority of patients with absent cochlear microphonics (reversepolarity) and acoustic reflexes.

Prolonged constriction of sciatic nerve affecting oxidative stressors & antioxidant enzymes in rat.

Background & objective: This study was carried out to determine the effects of reactive oxygen species in the balance between the pro-oxidant and antioxidant levels in experimental peripheral constriction injury induced by silver wire looping of sciatic nerve of rats. Methods: Rats were divided into experimental group 1 (silver wire ligated) and group 2 (control, sham operated). Functional and behavioural activities were assessed by a modifi ed Basso Beattie Bresnahan (BBB) locomotory rating scale. Mechanical pain intensity was measured with Randall and Selitto apparatus. Foot positioning, toe spread, paw withdrawal threshold and paw withdrawal latency were carried out on days 1, 3, 7, 14, 21 and 28 in rats with chronic pain. Oxidative stress markers such as malondialdehyde (MDA) and advanced oxidation protein products (AOPP) were measured along with antioxidants such as glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT) and reduced glutathione (GSH) on day 30 after constriction in sciatic nerve, spinal cord, dorsal root ganglion, dorsal root and ventral root. Results: Signifi cant : Signififi (P<0.05) increase in MDA, AOPP, SOD and GPx and decrease in the GSH and catalase activities in sciatic nerve, spinal cord, dorsal root ganglion, dorsal root and ventral root were observed in experimental group rats compared to control group. There was no recovery in foot positioning and toe spread. Reduced paw withdrawal threshold and paw withdrawal latency was observed in ligated rats compared to control rats. Interpretation & conclusion: Foot positioning, toe spread, paw withdrawal threshold and paw withdrawal latency with no recovery until day 30 confi rmed locomotory defi cits, hyperalgesia and neuronal impairment. Oxidative stress evidenced by increased MDA, AOPP and decreased GSH and catalase support the generation of reactive oxygen species in constriction model. The present experimental model for chronic pain induced by silver wire spirally coiled around sciatic nerve may be useful for future studies.

Water quality studies of TV station reservoir at Davangere City, Karnataka (India).

Studies were carried out to assess the water quality of TV station reservoir at Davangere City, Karnataka (India). The study revealed that there were variations in physico-chemical concentrations during the rainy season. Except turbidity, all the other physico-chemical characteristics were found within the permissible limits. The results were compared with the standards given by ISI for water quality.

Association of apolipoprotein E (RFLP) polymorphism with myopia.

BACKGROUND: Myopia or nearsightedness is a spherical error of refraction, whereby the images are focused in front of retina. Eye, being an organ rich in activated oxygen species, requires a high level of antioxidants to protect the unsaturated fatty acids. Apolipoprotein E (APOE) is one of the proteins that is produced by Muller cells within the retina and is also endowed with antioxidant properties. Genetic polymorphism of APO E is controlled by three common alleles e3, e2 and e4 and rare e1, e4v at the APOE structural gene locus. Different isoforms of APO E differ in their antioxidant properties, and the e4 allele has lesser ability to combat oxidative stress. AIMS: Myopia being a disease influenced by oxidative stress, the present study was undertaken to find association of myopia with APO E polymorphism. MATERIALS AND METHODS: A total of 187 myopic cases and 192 controls were genotyped for apolipoprotein E polymorphism. RESULTS: In both controls and myopic cases, E3/3 genotype was found to be the most frequent one. There was an increase in E3/4 genotype frequency among male probands, high myopia cases and probands with early age at onset, suggesting that the E3/4 genotype might confer risk for myopia development. CONCLUSION: This association with E3/4 genotype might predispose susceptible individuals to develop high myopia and early onset myopia.

Retinitis pigmentosum co-segregating with Enamel Hypoplasia (Amelogenesis Imperfecta)-A new Syndrome.

A family with the segregation of retinitis pigmentosum (RP) in combination with enamel hypoplasia (amelogenesis imperfecta - AI) is recorded. Family information collected over three generations revealed expression of the condition in two of the cousins born to half sibs. Parents of both the patients are cousins and are phenotypically normal. None of the sibs and other relatives of the patients are affected with any ophthalmic condition or dental anomalies. Ophthalmic evaluation of the patients revealed retinitis pigmentosa with nystagmus and optic atrophy and dental examination showed the presence of AI with hypoplastic enamel,' severe attrition of incisors and molars with narrowing of root canal and pulp chambers. Retinitis pigmentosum is a highly heterogeneous condition with 11 genes identified for an autosomal dominant, 13 for autosomal recessive and 5 for X-linked inheritance. Amelogenesis imperfecta is also a genetically heterogeneous condition showing all the three types of segregation. To the best of our knowledge co-segregation of RP with AI has not been reported. The family reported here may be considered as a new syndrome caused by a rare autosomal recessive gene with pleitropic effect affecting the retina and as well as the normal dentition. Alternatively it could also represent a rare coincidence of the two conditions.

Marfan Like Syndrome With Multiple Ocular Abnormalities.

An 18 year old female with multiple ocular disorders showed more or less cardinal features similar to that of an autosomal dominantly inherited Marfan Syndrome. Related features with variable symptoms were seen in her sibs. Major and minor manifestations of MFS like cardio-vascular, respiratory problems, spine deformities, arachnodactyly were not observed. Pedigree analysis showed high incidence of consanguinity.

Effect of Chemotherapy on Malondialdehyde levels in Leukaemias.

Leukemia are the family of hematological malignancies of bone marrow resulting in uncontrolled proliferation of white blood cells. We have analyzed the MDA levels in 108 leukaemic patients. In the present study, the mean of the plasma MDA levels in leukaemic patients were found to be significantly elevated (572.41+11.79) as compared to that of the normal controls (375.84+5.48) indicating the possible role of invivo peroxidation of membrane lipids in the etiology of leukaemias. Sexwise comparision of the MDA levels in the leukaemic groups showed an elevated levels of lipid peroxidatrion byproducts among the affected males (588.23+14.49) as compared to that of the femeles (541.61+ 19.57). With respect to the age, the MDA levels were seen to be progressively increasing with advancing age. The highest levels of MDA were found in the age group of 30-40 years in an the types of leukaemia. In general the treated group showed comparatively low levels of MDA (543.13+13.46) to that of the untreated group (631.21+20.05) indicating the effect of chemotherapy on MDA levels. With respect to stage, the M5 stage among the AML type (619.67+28.22), L3 among the ALL type (769.00) and blast crisis among the CML group (619.67+112.89) were exhibiting elevated levels of MDA.

Coronary stenting without pre-dilatation: an observational study.

Conventional coronary stenting is done after pre-dilatation of the lesion. The bleeding complications and incidence of subacute stent thrombosis have been reduced significantly by the use of antiplatelet agents and high pressure balloon inflation to ensure complete stent expansion. Elective stenting also can be done without pre-dilatation by "stent alone technique." This approach significantly reduces the procedural cost and ischaemia time, avoiding potential complications such as abrupt vessel closure because of extensive dissection after conventional angioplasty and prior to stent deployment. Eighty patients of stable angina pectoris suitable for coronary angioplasty underwent stenting without pre-dilatation. Out of the 100 stents used, 38 were hand-crimped and 62 were pre-mounted. The target vessels were left anterior descending artery in 56 percent, right coronary artery in 32 percent and left circumflex in 12 percent. The procedure was successful in 88 percent lesions. In 12 percent stenting could be done only after pre-dilatation. In all these, there was proximal tortuosity and calcification. The fluoroscopy time was 10.2 +/- 4.5 minutes. The average number of balloons used per lesion was 1.08. Stent embolisation occurred in only one patient. There were no major adverse cardiac events in any of the patients. Thus stenting without pre-dilatation is safe. Patients who are eligible for stenting without pre-dilatation are those with stable angina pectoris without fluoroscopically visible calcium or coronary artery tortuosity and with lesions of moderate complexity.

Molecular anatomy of the transcription complex of Escherichia coli during initiation.

Transcription is the foremost event in gene expression in which the enzyme RNA polymerase copies the genetic information from DNA to RNA. Much of our understanding of this process have come from studies carried out in Escherichia coli. A faithful and efficient transcription machinery of E. coli can be reconstituted in vitro with purified RNA polymerase and promoter-containing DNA. It is generally believed that in E. coli and most other organisms, the control of gene expression lies with the initiation of transcription. In this review, an attempt has been made to understand the mechanistic details of the initiation of transcription from the structural point of view of the promoter and the RNA polymerase. Allosteric nature of the enzyme has also been discussed at the end.

Low dose metoprolol in acute myocardial infarction.

A study of the effects of low dose Metoprolol was undertaken in 37 patients with acute myocardial infarction. These patients were randomly divided into three groups depending on the dose of the drug per kg body weight. Group I, consisting of 18 patients, received 0.36 to 0.65 mg per kg per day, Group II (10 patients) received 0.66 to 0.99 mg/kg/day, and Group III (9 patients) 1 to 1.81 mg/kg/day. To assess the degree of beta blockade achieved, the parameters that were evaluated were the fall in blood pressure and heart rate. There was a fall in systolic blood pressure which ranged from 7 to 17%, and fall in heart rate of 6.6 to 12.8% in the 3 groups over the 48-hour study period. These observations were compared with the results obtained from the Goteberg Metoprolol trial and Metoprolol in acute myocardial infarction (MIAMI) trials wherein 200 mg of Metoprolol per day were used. Our preliminary observations suggest that Indian patients may not need such a high dose, and Metoprolol at 50-100 mg per day would probably be sufficient to get the desired effect.