Spontaneous extrusion of subconjunctival cysticercous cyst: a case report.

Ocular cystericosis is the common occurrence among the people of lower socioeconomic status and poor personal hygiene in developing countries. However, spontaneous extrusion of subconjuctival cysticercous cyst is a rare incidence. The present case report describes a spontaneous extrusion of subconjunctival cyst in a 12 year old boy in our clinical set-up. The histopathological examination revealed subconjunctival cysticercous cyst. The extrusion was associated with improvement in clinical sign and symptoms. Cysticercosis should be considered in any case of inflammatory swelling of subconjunctival space especially in people of lower socioeconomic status and poor personal hygiene.

Association of primary glaucomas with retinal vein occlusion.

AIMS AND OBJECTIVES: To determine the association of Primary glaucoma with retinal vein occlusion. METHODOLOGY: A prospective cross-sectional study was carried out in B.P. Koirala Lions Centre for Ophthalmic Studies from April 2002-July 2003. All diagnosed cases of retinal vein occlusion were evaluated in detail for the presence of primary glaucoma. Detailed history was taken. Best corrected visual acuity was recorded, slit-lamp evaluation of anterior segment was performed, intraocular pressure was assessed with the help of applanation tonometer, gonioscopy was done and fundus evaluation was done under full mydriasis. RESULTS: Out of 50 patients, 19 (38%) were central retinal vein occlusion and 31(62%) were branch retinal vein occlusion. Majority of the retinal vein occlusion patients were in the age group of (61-70 years) 12 out of 50 patients (24%). There were 12 patients of primary glaucoma in 50 patients of retinal vein occlusion. Out of which 11 patients had primary open angle glaucoma and 1 patient had primary angle closure glaucoma. CONCLUSION: This study shows association of primary glaucoma as a risk factor of retinal vein occlusion. Evaluation of retinal vein occlusion patients for primary glaucoma would be worthwhile for early detection and prevention of blindness.

Association of systemic diseases with retinal vein occlusive disease.

Retinal vein occlusion (RVO) is the second commonest vascular disease of the eye, second only to Diabetic Retinopathy. The association of the retinal vein occlusion with other systemic disease likes hypertension, diabetes mellitus and others has been well documented. With the increase in persons being affected from these disorders, patients with retinal vein obstruction are also increasing. Hence, a study was designed to evaluate all cases of RVO to find out its association with systemic disorders. A total of 100 patients (106 eyes) were enrolled in the study. Out of which, 66 cases reported to have Brach Retinal Vein Occlusion (BRVO) and rest 34 cases with Central Retinal Vein Occlusion (CRVO). Among the associated systemic diseases, hypertension and diabetes mellitus accounted for 84% cases. Isolated hypertension (54%) was most commonly seen followed by diabetes mellitus (8%). The prevalence of BRVO was almost twice as compared to CRVO. The high association of various systemic disorder especially Hypertension and diabetes further supports the need of early and periodic eye examination for those suffering from these disorders.

Epidemiological situation of Japanese encephalitis in Nepal.

A human Japanese encephalitis (JE) case is considered to have elevated temperature (over 380 C) along with altered consciousness or unconsciousness and is generally confirmed serologically by finding of specific anti-JE IgM in the cerebro spinal fluid. No specific treatment for JE is available. Only supportive treatment like meticulous nursing care, introduction of Ryle's tube if the patient is unconscious, dextrose solution if dehydration is present, manitol injection in case of raised cranial temperature and diazepam in case of convulsion. Intra venous fluids, indwelling catheter in conscious patient and corticosteroids unless indicated should be avoided. Pigs, wading birds and ducks have been incriminated as important vertebrate amplifying hosts for JE virus due to viremia in them. Man along with bovines, ovines and caprines is involved in transmission cycle as accidental hosts and plays no role in perpetuating the virus due to the lack of viremia in them. The species Cx tritaeniorhyncus is suspected to be the principal vector of JE in Nepal as the species is abundantly found in the rice-field ecosystem of the endemic areas during the transmission season and JE virus isolates have been obtained from a pool of Cx tritaeniorhyncus females. Mosquito vector become infective 14 days after acquiring the JR virus from the viremic host. The disease was first recorded in Nepal in 1978 as an epidemic in Rupandehi district of the Western Development Region (WDR) and Morang of the Eastern Region (EDR). At present the disease is endemic in 24 districts. Although JE as found endemic mainly in tropical climate areas, existence and proliferation of encephalitis causing viruses in temperate and cold climates of hills and valleys are possible. Total of 26,667 cases and 5,381 deaths have been reported with average case fatality rate of 20.2% in an aggregate since 1978. More than 50% of morbidity and 60% mortality occur in the age group below 15 years. Upsurge of cases take place after the rainy season (monsoon). Cases start to appear in the month of April - May and reach its peak during late August to early September and start to decline from October. There are four designated referral laboratories, namely National Public Health Laboratory (Teku), Vector Borne Diseases Research and Training Center (Hetauda), B.P. Koirala Institute of Medical Sciences (Dharan) and JE Laboratory (Nepalgunj), for confirmatory diagnosis of JE. For prevention of JE infection; chemical and biological control of vectors including environmental management at breeding sites are necessary. Segregate pigs from humans habitation. Wear long sleeved clothes and trousers and use repellent and bed net to avoid exposure to mosquitos. For the prevention of the disease in humans, safe and efficacious vaccines are available. Therefore immunize population at risk against JE. Immunize pigs at the surroundings against JE. 225,000 doses of live attenuated SA-14-14.2 JE vaccine were received in donation from Boran Pharmaceuticals, South Korea for the first time in Nepal. Altogether 224,000 children aged between 1 to 15 years were vaccinated in Banke, Bardiya and Kailali districts during 1999. From China also, 2,000,000 doses of inactivated vaccine were received in 2000 and a total of 481,421 children aged between 6m to 10 yrs were protected from JE during 2001/2002. Ministry of Agriculture, Department of Livestock Services has vaccinated around 200,000 pigs against JE in terai zone during February 2001.

An unusual presentation of giant cell tumour (osteoclastoma).

The number of well-documented true giant cell tumours arising in any of the craniofacial bones is small, but they do exist. A 19 year old female, Ms. KS, presented with complain of progressive enlargement of facial bones especially jaw bones, then orbit symmetrically since the age of 7. There was bilateral gross enlargement of mandible, maxilla, orbital walls, causing displacement of eye medially and upwards. The visual acuity of both eyes were 6/36 and 6/18 with best correction. Extra ocular movements were restricted because of bony growth and conjunctiva over inferior fornix were keratinized due to exposure. Fine needle aspiration (FNAC) from the side of bony growth showed plenty of osteoclasts with multinucleated giant cells. The level of serum alkaline phosphatase were highly increased. She underwent orbitotomy and a part of tissue was sent for biopsy which revealed multiples of mononucleargiant cells and tumour cells.

Serum level of low-density lipoprotein cholesterol in hypertensive retinopathy.

Increased serum level of low-density lipoprotein is associated with coronary artery disease. There are, however, no reports on whether the same is true in hypertensive retinopathy. A cross-sectional comparative study was carried out to evaluate the serum level status of low-density lipoprotein in hypertensive retinopathy, including 30 randomly selected subjects with hypertensive retinopathy; age and gender matched 26 hypertensives without fundus changes. Serum low-density lipoprotein cholesterol (LDL-C) levels were assessed in all subjects. Results showed statistically significant (p < 0.0196) higher serum levels of LDL-C in hypertensive patients with retinopathy (mean +/- SD = 2.45 +/- 1.76 mmol/l, SE = 0.33 and 95% CI = 1.79-3.11 vs mean +/- SD = 1.6 +/- 0.4 mmol/l, SE = 0.08 and 95% CI = 1.44-1.76). An increased serum level of LDL-C is associated with hypertensive retinopathy.

Etiological spectrum of acute sporadic viral hepatitis amongst adults in Chandigarh.

All 77 HBsAg positive and 94 of representative HBsAg negative sera derived from 253 adult patients with acute sporadic viral hepatitis during 1987 at Chandigarh were tested for serological markers of hepatitis B virus (HBV) and hepatitis A virus (HAV) infections. The HBsAg positive patients could be classified as acute hepatitis B (64%); chronic hepatitis B with exacerbation, or liver damage by other infectious or noninfectious agent/s over a chronic HBsAg carrier state (35%); and coinfection of HBV and HAV (1%). Among the HBsAg negative hepatitis group, acute hepatitis B was diagnosed in 4 per cent of patients and acute hepatitis A in another 4 per cent.