Serum albumin and total protein level as plausible marker for diagnosis of protein energy malnutrition in children under age 5 years

Background: The circulating concentration of transport protein, traditionally albumin, has been used to define protein deficiency. However, few studies have been conducted to see if there is any correlation between serum total protein and albumin levels in children with PEM. Hence the study was planned to estimate serum total protein, serum albumin levels in children with PEM and healthy controls.Methods: All the children were divided in two groups. Case Group A consist of 250 children with protein energy malnutrition and control Group B consist of healthy 250 children. Venous blood of amount 3 ml was collected with full aseptic precautions. The blood was collected in the EDTA vacutainer and test tube. Serum total protein was estimated by Biuret method, serum albumin was estimated by Bromocresol green dye method (BCG dye).Results: When the mean serum levels of albumin levels and the total protein levels were measured in the controls as well as case groups, there was decrease in levels in case group as compared to control group. This difference of decrease when evaluated statistically it was found to be statistically significant. When the albumin/globulin ratio was calculated in both the groups, it was found to be statistically lower in case group as compared to control group. PEM children have low serum total protein and albumin levels as compared to healthy controls (p<0.001), this is probably due to decreased intake of proteins and reduced biosynthesis. PEM children have lower hemoglobin levels as compared to healthy controls; this is probably due to deficiency of iron and other micronutrients, which is often found in a child with malnutrition.Conclusions: Early diagnosis and prompt management of PEM and its complications can prevent development of permanent physical and mental retardation.

A comparative study on safety and efficacy of travoprost and brimonidine/timolol fixed combination in patients of primary open‑angle glaucoma.

Background: The purpose of this study was to compare and evaluate the clinical efficacy of topically applied travoprost 0.004% eye drops versus brimonidine/timolol fixed combination eye drops in the management of primary open-angle glaucoma. Methods: In this prospective, randomized study, 65 patients received either travoprost eye drops once daily in the morning (n=33) or brimonidine/timolol fixed combination eye drops twice daily (n=32). Intra ocular pressure (IOP) was assessed at 2, 4, 8, and 12 weeks. The primary outcome measure was mean reduction in IOP. Results: The baseline mean IOP values were similar between two groups. Mean reduction of IOP in the right eye for brimonidine/timolol fixed combination group was 9±2.9 mmHg, whereas in the left eye it was 10.9±2.8 mmHg. In the travoprost group, the reduction in IOP of the right eye was 7.8±2.9 mmHg (p=0.0002) and 7.5±3.4 mmHg (p=0.0001) in the left eye. The mean reduction of IOP for the brimonidine/timolol group was 9.95 mmHg and for the travoprost group it was 7.6 mmHg (p<0.0001) in both the eyes. Conclusions: The fixed combination brimonidine/timolol twice daily demonstrated superior mean IOP lowering efficacy compared to travoprost 0.004% in patients with open-angle glaucoma.

Corneal and Conjunctival Intraepithelial Neoplasia – A Case Report.

A 65- year old male presented with a reddish mass in left eye with diminution of vision for past four months. Based on clinical examination, a probable diagnosis of ocular surface squamous neoplasia with mature cataract was made. Excision biopsy of the lesion demonstrated intraepithelial neoplasia involving cornea and conjunctiva. Post-operatively patient was put on topical mitomycin –C (0.01%) eye drops 4 times a day for 12 weeks. Cataract surgery was done in the same eye 3 months after cessation of topical Mitomycin-C (MMC) treatment. Follow-up was done for 18 months. Patient’s vision improved to 6/9 in left eye.

Silicone sling frontalis suspension for correction of congenital blepharoptosis.

There are many techniques for treating congenital blepharoptosis. A new surgical technique for ptosis with poor levator function in which Seiff Silicone Suspension set is used in frontalis sling procedure is described in a 12 year old female child with simple unilateral congenital blepharoptosis. This procedure requires less surgical time, provides good cosmesis and early recovery.

Acanthamoeba keratitis : a case report.

Acanthamoeba Keratitis (AK) is a serious sight threatening infection of the cornea. We report here a case of Acanthamoeba keratitis in a young healthy male. He presented to us with a history of minor trauma in his left eye & immediately he washed his eye with stagnant dirty water. Diagnosis was based on observation of actively motile trophozoites and cyst in normal saline wet mount preparation of the corneal ulcer scraping. Patient was treated with available antiamoebic drugs (Topical Neosporin, Clotrimazol, Tab. Ketaconazal, Polymixin-B). Patient responded extremely well to medical line of treatment.

Primary pterygium surgery –comparsion of limbal conjunctival autografting versus intra- operative mitomycin-C.

Pterygium is a fibro vascular encroachment of the conjunctival tissue on to the cornea, causing variable degree of ocular morbidity. Various surgical modalities have been developing to decrease the recurrence. The idea of study is to compare the relative efficacy of two well known procedures i.e. conjunctival autografting and intra-operative Mitomycin –C (0.02%) with reference to recurrence and complication rate.

Conventional dacryocystorhinostomy versus endonasal dacryocystorhinostomy:a comparative study.

The objective of present study was to compare the results of endonasal endoscopic dacryocystorhsrtostomy and external dacryocystorhinostomy. It was a prospective non-randomized study. forty corsecutive patients having complaints of watering with complete naso lacrimal dact obstruction were selected for the study. Dacryocystography was done in all the cases. Selection of type of operation was left to the patient’s choice. All patients had preoperative counseling and both the procedures were explained in detail with their advantages and disadvantages. Twenty patients underwent endonasal dacryocystorhinostomy and twenty had external dicryocystorhinostomy Silicon intubation was done in all cases of endonasal dacryocystorhinostomy for three months after surgery. The final follow-up was done at 12 months after surgery. The patency of lactimal passage was confirmed by syringing and patients were questioned about their symptoms. There was no significant difference in the results of both surgeries. The complication rate in both groups was almost equal. Thus we came to the conclusion that these two different dacryocyatorhinostomy techniques are acceptable alternatives.

Carotid cavernous sinus fistula presenting with pulsating exophthalmos and secondary glaucoma.

Carotid cavernous sinus fistula is abnormal communications between the carotid arterial system and the venous cavernous sinus. Carotid cavernous sinus fistula can develop either because of trauma or spontaneous causes. Spontaneous carotid cavernous sinus fistula is often associated with a pre-existing aneurysm in the intracavernous portion of internal carotid artery. However, these fistulas may be congenital arteriovenous connections that open spontaneously in the settings of collagen vascular disease, atherosclerosis, hypertension, or may develop in females during peripartum period. A case of spontaneous carotid cavernous sinus fistula in a young adult male who presented with pulsating exophthalmos and secondary glaucoma is presented. Characteristic features of arteriovenous fistula--bruit, thrill, corkscrew episcleral vessels were present. Radiological investigations were done to confirm the diagnosis. Transvenous embolisation was done to close the fistula.

Secondary malignant giant cell tumour of bone--a study of five cases with short review of literature.

Secondary malignant giant cell tumour of bone occurs as a result of previous attempts at local control of a benign giant cell tumour of bone (GCT). Out of the total 445 conventional benign GCT of bone, therapeutic irradiation was given in 39 cases as the lesions were located in the vertebrae and pelvic bones where debulking surgery was not possible and the tumours were pressing on the spinal cord. The patients were followed up for 21 years. Out of 39 cases, 5 patients developed sarcomas of which 3 were fibrosarcomas, 1 was malignant fibrous histiocytoma while 1 was an osteosarcoma. All the patients developing post-radiation sarcomas died within a few months due to lung metastasis. In conclusion, all the patients with benign GCT of bone treated with radiation must be followed life long as they are prone to develop sarcomas.