Visual outcomes of toxic optic neuropathy secondary to Ethambutol: A retrospective observational study from India, an endemic country

Purpose: Ethambutol (EMB) is one of the first?line drugs used for treating tuberculosis. Vision loss due to optic nerve toxicity is a well?known potential side effect of the drug. Our aim was to evaluate the clinical features and visual outcomes of patients with EMB optic neuropathy (EON). Methods: A retrospective, observational, single?center study of all patients who were diagnosed to have EON during January 2017–December 2019 was done. All these patients were screened in the Department of Neuro?ophthalmology at a referral tertiary eye care institution in India. Clinical features, visual outcomes, and neuroimaging findings of these patients were analyzed. Results: Two hundred and fifty?six eyes of 128 patients were included. Of these, 73 were male and 55 were female. Mean age was 50.55 ± 15 years. Mean visual acuity at presentation was 1.12 ± 0.45 logarithm of the minimum angle of resolution (logMAR). One hundred and forty three eyes had normal optic disk on presentation, 111 had disk pallor, and two eyes had disk edema. The most common field defect was central/paracentral scotoma (26.2%) followed by temporal defects (24.6%). Magnetic resonance imaging (MRI) brain and orbit showed optic nerve signals in 19.6% and chiasmal signals in 5.2%. At the final follow?up, a ?2?line vision improvement was noted in 161 eyes (62.9%), which was statistically significant. Conclusion: Multiple prognostic factors were analyzed to predict the visual recovery of EON. We observed that patients presenting with visual acuity worse than 6/60 had poor visual outcome and long duration of follow?up showed better visual recovery, proving the possibility of a gradual recovery pattern of EON. Interestingly, we found in our study that the chances of favorable visual outcome were directly proportionate to early diagnosis and cessation of EMB.

Incidental finding of esophageal inlet patch: A case report.

An esophageal inlet patch is a congenital anomaly composed of heterotropic gastric mucosa at or just distal to upper esophageal sphincter. Most often it is asymptomatic or presents as complications of acid secretion. The diagnosis is confirmed by endoscopy with biopsy. We have presented a case of 67 years old female who complained of nausea and decreased appetite. Endoscopy showed an elevated mucosal structure with superficial ulceration in the upper third of esophagus. Histopathology confirmed presence of ectopic gastric mucosa. We have presented this case as it is not diagnosed often and it is important to identify it as it helps the treatment and rarely has a malignant potential.

The validity of self-reported helmet use among motorcyclists in India.

Background: Motorcyclists are the most vulnerable vehicle users in India. No published study has assessed the validity of self-reported estimates of helmet use in India. The objectives of this study were to assess helmet use by comparing observed and self-reported use and to identify factors influencing use among motorcyclists in Hyderabad, India. Methods: Population-based observations were recorded for 68 229 motorcyclists and 21 777 pillion riders (co-passengers). Concurrent roadside observations and interviews were conducted with 606 motorcyclists, who were asked whether they “always wear a helmet”. Multivariate logistic regression analyses were conducted to determine factors influencing helmet use. Results: In the population-based study, 22.6% (n = 15,426) of motorcyclists and 1.1% (n = 240) of pillion riders (co-passengers) were observed wearing helmets. In roadside interviews, 64.7% (n = 392) of the respondents reported always wearing a helmet, 2.2 times higher than the observed helmet use (29.4%, n = 178) in the same group. Compared with riders aged ≥40 years, riders in the age groups 30–39 years and 18–29 years had respectively 40% (95% confidence interval [CI]: 0.4 to 1.0, P < 0.05) and 70% (95% CI: 0.2 to 0.5, P < 0.001) lower odds of wearing a helmet after controlling for other covariates. Riders with postgraduate or higher education had higher odds of wearing a helmet (adjusted odds ratio [OR]: 4.1, 95% CI: 2.5 to 6.9, P < 0.001) than those with fewer than 12 grades of schooling. After adjusting for other covariates, younger riders also had 40% (95% CI: 0.3 to 0.9, P < 0.05) lower odds of self-reporting helmet use, while those with postgraduate or higher education had 2.1 times higher odds (95% CI: 1.3 to 3.3, P < 0.01) of reporting that they always wear a helmet. Police had stopped only 2.3% of respondents to check helmet use in the three months prior to the interview. Conclusion: Observed helmet use is low in Hyderabad, yet a larger proportion of motorcyclists claim to always wear a helmet, which suggests that observational studies can provide more valid estimates of helmet use. Interview findings suggest that a combination of increased enforcement, targeted social marketing and increased supply of standard helmets could be a strategy to increase helmet use in Hyderabad.

An appraisal of the tuberculosis programme in India using an ethics.

This is a review of the manner in which the Revised National Tuberculosis Control Programme (RNTCP) is being implemented, with a focus on the attention being paid to ethical principles and the incorporation of these into the programme. The article elucidates how ethical principles can be applied to protect the rights of the potential beneficiaries of the RNTCP. The authors consider the RNTCP in the light of a framework that is usually applied in research to evaluate ethical principles in public health practice. The three key principles of the framework are: respect for persons, beneficence and justice. The authors propose that this framework be used to make an ethical evaluation of other pu health programmes at several levels, since this could bring farreaching benefits to society.

Periorbital dirofilariasis—Clinical and imaging findings: Live worm on ultrasound.

Ocular dirofilariasis is a zoonotic filariasis caused by nematode worm,Dirofilaria. We present a case of dirofilariasis affecting the upper eyelid in a 2-year-old child presenting as an acutely inflammed cyst, from southern Indian state of Kerala. Live adult worm was surgically removed and confirmed to be Dirofilaria repens. Live worm showing continuous movement was seen on the pre-operative high-resolution ultrasound. Ultrasound can be helpful in pre-operative identification of live worm. Imaging findings reported in literature are very few. We describe the clinical, ultrasound, and magnetic resonance imaging (MRI) findings.

Identification of conserved regulatory elements in mammalian promoter regions: a case study using the PCK1 promoter / 基因组蛋白质组与生物信息学报·英文版

A systematic phylogenetic footprinting approach was performed to identify conserved transcription factor binding sites (TFBSs) in mammalian promoter regions using human, mouse and rat sequence alignments. We found that the score distributions of most binding site models did not follow the Gaussian distribution required by many statistical methods. Therefore, we performed an empirical test to establish the optimal threshold for each model. We gauged our computational predictions by comparing with previously known TFBSs in the PCK1 gene promoter of the cytosolic isoform of phosphoenolpyruvate carboxykinase, and achieved a sensitivity of 75% and a specificity of approximately 32%. Almost all known sites overlapped with predicted sites, and several new putative TFBSs were also identified. We validated a predicted SP1 binding site in the control of PCK1 transcription using gel shift and reporter assays. Finally, we applied our computational approach to the prediction of putative TFBSs within the promoter regions of all available RefSeq genes. Our full set of TFBS predictions is freely available at http://bfgl.anri.barc.usda.gov/tfbsConsSites.

Bioallergens in the air of selected areas in Visakhapatnam.

Bacteria, fungi and organic dust become a health hazard to those exposed to heavy traffic. People routinely exposed to organic dust suffer from respiratory diseases like asthma and acute bronchitis. A survey of aerospora conducted in five selected areas of Visakhapatnam showed that bacteria and fungi were present in the order of 4 x 10(3) and 1 x10(3) respectively. Twenty one fungal species and seven bacterial species were present in the present study. Many filamentous fungi known to be aeroallergens were present, Aspergillus being the predominant species. Pathogenic bacteria like Pseudomonas and Staphylococcus were found in the study area. The threshold limit value (TLV) and biological exposure indices values should be liaised for each area in the city which will serve as a guide to control health hazards.

Design and optimization of nsaid loaded nanoparticles

The objective of the study was to design and evaluate NSAID loaded Nanoparticles drug delivery system, where Flurbiprofen [model drug] Nanoparticles with suitable size range are envisaged to concentrate at inflammation sites due to increase fragility of blood vessels at those sites and increased aggregation and prostaglandin synthesis. Materials used were surfactant [pluronic F 68] and polymer [poly lactic co glycolic acid; PLGA]. The flurbiprofen loaded nanoparticles were prepared by solvent diffusion nano-precipitation method. Experiment was carried out following 32 factorial designs, where drug-polymer ratio was varied to optimize the formulation. From I.R studies no drug-polymer interaction was found. Particles size analysis was done using Malvern Mastersizer. Two parameters, namely, drug-polymer ratio and solvent-nonsolvent ratio were chosen for optimization following the factorial design. Amount of drug loading and surfactant were kept constant, and only polymer load was varied. The in-vitro drug release profile from nanoparticles was found to follow Higuchi square root kinetics implying a diffusion dependent release as is expected of an insoluble, non-swellable nature of PLGA. It indicated that nanoparticles formed were matrix in nature, in which flurbiprofen dispersed uniformly. Suitable polynomial models were generated and statistically validated using ANOVA for the different responses, namely drug release [maximization] and particle size [minimization]. Those models were solved numerically and simultaneously to optimize the required formulation. Optimized formulation were found to have a polymer-drug ratio of 18.89:1 and manufactured at a nonsolvent-solvent ratio of 4:1 to maximized release after 8 hrs and minimized particle size. The methodology avoids the use of organic solvent and thus provides a safe, reproducible and fast method of production of nanoparticles. The study collaborates on the feasibility and suitability of aqueous polymeric drug delivery system, employing statistical design to develop a clinically useful Nanoparticle system with targeting potential

Cell mediated immunity in children with scar-failure following BCG vaccination.

OBJECTIVE: To find out the incidence of BCG-scar failure, in BCG vaccinated children and assess their in vitro cellular response. DESIGN: Four year prospective cohort observational study. SETTING: Immunization centers at: (a) State Tuberculosis Center; (b) Tuberculosis Association of Andhra Pradesh; and (c) Niloufer Hospital for Women and Children in Hyderabad. METHODS: Healthy children brought to the immunization centers for BCG vaccination and were followed up till 6 months of age for scar failure. These 655 BCG vaccinated children were classified into three groups based on the age at vaccination: (i) 0 day-1 day; (ii) 2 days-30 days; and (iii) 31 days-90 days. Of these children, in vitro leukocyte migration inhibition (LMI) levels against PHA/PPD were investigated in 228 of them. RESULTS: Of the 655 children, 591 (90.2%) showed presence of scar. Out of the three groups, number of children belonging to the first group in whom the scar was absent, was highest. Of 591 children with scar, LMI was performed in 34, 110 and 43 of them in the three different age groups, respectively out of whom 88.2%, 87.2% and 86% had positive response (> or = 20%) to PPD. Of 64 children who failed to develop a scar, LMI was performed in 17, 19 and 5 in three different age groups out of whom 88.2%, 94.7% and 80% had positive (> or = 20%) in vitro response to PPD. CONCLUSION: Scar failure may occur in 10% of BCG vaccinated and is more common with immunization within 48 hours of life. Failure of formation of BCG-scar at the site of BCG vaccination may not necessarily imply failure of immunization because majority of them do elicit positive in vitro LMI response.

Dermal toxicity of hexachlorocyclohexane (HCH) in rabbit.

Application of HCH (25 mg/kg) on dorsal, ventral and thigh regions of the skin of male rabbits resulted in poisoning and mortality of animals. Morphological changes in skin, liver, kidney, testes and cerebellum together with highly significant alterations in serum and liver enzymatic activity and residue in blood suggested that absorption of HCH and its toxicity could be severe when the pesticide comes in contact with the skin of thigh region of body.