Management of post-operative Nocardia endophthalmitis.

Post-operative Nocardia endophthalmitis has an aggressive course and poor visual prognosis. It often masquerades as severe post-operative uveitis or toxic anterior segment syndrome due to the absence of vitreous involvement resulting in a delay in diagnosis. The poor prognosis in Nocardia endophthalmitis is due to severe intra-ocular inflammation which may lead to phthisis. Therefore, treatment with corticosteroids after appropriate antibiotics have been initiated may improve the outcome. This is an interventional case report highlighting the typical features of Nocardia endophthalmitis, which when diagnosed early and managed medically with antibiotics and steroids, resulted in an excellent visual outcome in our patient.

Measuring periodontitis in population studies: a literature review / Medição de periodontite em estudos populacionais: uma revisão de literatura

Case definitions used to identify periodontitis significantly affect the prevalence and risk estimates from population studies. A plethora of definitions has been employed by researchers since the 1940s. The variation in disease definitions affects the comparability and validity of the estimates. This study aimed to review case definitions of periodontitis in prevalence and risk population studies. PubMed and MedIine were searched for the following keywords: "Periodontitis" AND "cross sectional/case control/epidemiology". Studies were selected and reviewed. We found that there is a variety of case definitions being employed in prevalence and risk factor studies. Starting with the index systems, the definitions have been influenced by our understanding of the pathogenesis of the disease. There is a need for a uniform case definition for prevalence surveys and population-specific definitions for association studies.

A definição diagnóstica utilizada para identificar periodontite determina em grande parte a prevalência e as estimativas de risco a partir de estudos populacionais. Uma grande variedade de definições tem sido utilizada por pesquisadores desde a década de1940. Esta variabilidade de definição da doença afeta a comparação e a validade das estimativas. Este estudo teve por objetivo revisar as definições de periodontite em estudos populacionais de prevalência e de risco. Realizou-se uma busca eletrônica na base de dados PubMedMedIinecom as plavras-chave: "Periodontitis" AND "crosssectional/case control/epidemiology". Os artigos foram selecionados e analisados. Este trabalho de revisão encontrou grande variedade de definição de casos usada em estudos de prevalência e de fatores de risco.A partir dos sistemas de indexação, as definições foram influenciadas pelo então entendimento corrente da patogênese da doença. Há necessidade de uma definição de caso uniforme para inquéritos de prevalência e definições populacionais específicas para estudos de associação.

Smoking as a risk factor for periodontitis: A literature review / Tabagismo como um fator de risco para periodontite: Uma revisão de literatura

Smoking is an important risk factor for periodontitis. The high prevalence of smokers in any population makes smoking a feasible target for intervention in public health. The magnitude of the associated risk between smoking and periodontitis varies among studies, and this variation is the result of the case definition adopted rather than the limitations of the population studies. A MEDLINE search was used to identify previous publications, and a literature review was developed based on the selected articles. Smoking was consistently identified as a risk factor for periodontitis, but the risk estimates varied between studies. The comparison of risk estimates between studies was affected by the lack of uniformity for case definitions of periodontitis and smoking status.

O tabagismo é um importante fator de risco para periodontite. A alta prevalência de fumantes em qualquer população torna o hábito de fumar um alvo possível para intervenção em saúde pública. A magnitude do risco associado entre tabagismo e periodontite varia entre os estudos na literatura e esta variação é o resultado mais de uma definição do caso que de limitações dos estudos populacionais. Uma busca na base MEDLINE foi realizada para identificar publicações anteriores e a revisão de literatura foi desenvolvida baseada em artigos selecionados. O tabagismo foi identificado consistentemente como um fator de risco para periodontite, mas as estimativas de risco variaram entre os estudos. A comparação das estimativas de risco entre estudos foi afetada pela falta de uniformidade das definições de casos de periodontite e de condições de tabagismo.

Periodontitis in India and Bangladesh. Need for a population based approach in epidemiological surveys. A Literature review.

Background: Early surveys showed people of India and its neighbors to be highly susceptible to periodontitis. This was based on the early surveys which estimated a higher prevalence. Aim: This paper reviews the prevalence of periodontitis in India and Bangladesh and attempts to find out why the populations of the Indian subcontinent were considered more susceptible to periodontitis. Settings and design: Review of periodontitis prevalence studies on the Indian and Bangladeshi population. Methods and material: After identifying articles from Pub Med, DAOJ and hand searching, the epidemiology of periodontitis is reviewed. Results and conclusion: This review identifies that very few studies have been done on representative population. Yet it can be certainly concluded that there is a high prevalence of periodontitis in the adults and the economically weak population which can be reduced by adopting preventive public health strategies. Conclusions: Standardized population based studies in a representative population with a robust design to identify the true prevalence of periodontitis is needed.

Association between chronic generalized periodontitis and hyperlipidemia – a case control study.

Introduction: Hyperlipidemia is a major risk factor for cardiovascular disease. Periodontal disease is caused by predominantly anaerobic gram negative bacteria. Microbial substances initiate and perpetuate the inflammation resulting in the production of high levels of proinflammatory cytokines and hyperactivity of white blood cells and of blood platelets, thus promoting the development of hyperlipidemia. Objective: To evaluate the plasma lipids (Total cholesterol, Low Density Lipoproteins and Triglycerides) as well as Fasting blood glucose levels in non diabetic, non-obese periodontal disease patients and controls. Materials and methods: 18 subjects with chronic periodontal disease (aged 38 to 50 years) were matched for age, sex and BMI (Body Mass Index) with 18 healthy subjects. Total cholesterol, low density lipoprotein, triglycerides and fasting blood glucose levels were measured using routine enzymatic biochemical methods. Results: Total cholesterol, LDL cholesterol and triglycerides was significantly higher in chronic periodontitis patients by 12 %( p<0.02), 14 %( p<0.03) and 22 %( p<0.03) respectively as compared to controls. Fasting blood glucose levels was higher by 7% (p<0.04) in chronic periodontitis patients than controls. Conclusion: Hyperlipidemia and prediabetic state may be associated with chronic periodontitis.

Width of attached gingiva in an Indian population: A descriptive study.

Objectives: Attached gingiva is important for maintaining periodontium in a healthy state. The present study tries to find the normal values of width of attached gingiva in a periodontally healthy Indian population. Material and Methods: The width of attached gingiva was measured with a periodontal probe in periodontally healthy patients attending the periodontics department. Descriptive statistical analysis was done to get the mean, which will represent the normal values of width of attached gingiva for the population. Results: Female patients had a greater width than males and the 20 to 30 year old group had the greatest width of attached gingiva. The mean values of attached gingiva varied in different areas of the mouth with greatest width in maxillary central incisors and least in mandibular molars. Conclusion: Width of attached gingiva varies with age, gender and in different areas of the mouth.

Pregnancy in women with epilepsy : preliminary results of Kerala registry of epilepsy and pregnancy.

Eighty-five women with epilepsy were followed up for reproductive functions under the registry of epilepsy and pregnancy. 32 of them had completed the pregnancy. Their mean age was 26 years and mean seizure frequency was 0.7 during current pregnancy. Nineteen of them (59.4%) had generalized epilepsy. Nine of them were not on any anti epileptic drugs (AED), 23 women were on various AEDs, 19 being on monotherapy. Only 40% of the women were taking folic acid during pregnancy. Pregnancy ended as spontaneous abortion in one patient. Nearly one third required cesarean section. Majority (87.5%) had term babies. Three (10.7%) babies had birth asphyxia. Six babies (21.4%) had low birth weight. Congenital malformations were detected in four cases (12.5%). Malformations included neural tube defects, talipes equinovarus and other minor anomalies. These babies were exposed to sodium valproate, carbamazepine or phenobarbitone. The risk of malformation was significantly greater (p<0.05) when the mother had generalized epilepsy. The odds ratio for risk of malformation was much higher with sodium valproate (6) than that with carbamazepine (1.2) or phenobarbitone (0.8). Majority of women with epilepsy had safe pregnancy and childbirth without any aggravation of epilepsy.

Dengue virus and insecticide susceptibility status of Aedes aegypti mosquitoes from Belagola village, Mandya District, Karnataka state: during and post-epidemic investigations.

Aedes aegypti mosquitoes collected during and after dengue virus epidemic season were exposed to diagnostic dosages of insecticides. Mosquitoes collected during the epidemic showed resistance to DDT only, while mosquitoes collected after the control measures showed tolerance to malathion and low resistance to DDT. Since there was no indication of malathion resistance in the mosquitoes collected during the epidemic, the second batch was subjected to malathion selection pressure for 8 generations to find out the mechanism of resistance in this strain. There was 2-4 fold increase in resistance to malathion. Polyacrylamide electrophoresis showed increase in intensity of three esterase bands after selection. Quantitative enzyme assays showed an increase in esterase activity by 3-4 folds. Mosquitoes collected during the epidemic showed higher susceptibility to dengue-2 virus as compared to the laboratory strain, while the mosquitoes collected after malathion fogging showed further increase in the susceptibility to dengue virus. Virus susceptibility of the mosquitoes after eight generations of selection with malathion did not show any further significant increase.

Experimental studies on the vector potential of certain Culex species to West Nile virus.

Experimental studies were carried out to determine the vector potential of four species of mosquitoes to West Nile (WN) virus, viz. Culex tritaeniorhynchus, Cx. vishnui, Cx. bitaeniorhynchus and Cx. univittatus. All the four species of mosquitoes successfully transmitted and supported the growth of WN virus. The study indicated that the four species of mosquitoes could act as potential vectors of WN virus in nature.

Releasable suture technique for trabeculectomy.

A retrospective review of 154 trabeculectomies with releasable sutures was performed to assess the effect of suture release on intraocular pressure (IOP) at various postoperative periods. Release of the suture was necessary in 38% of cases. The immediate reduction in IOP was significant (p < 0.01) when the suture was released during the first three postoperative weeks. Seventy percent of eyes had a reduction in IOP more than 5 mmHg if released within the first week compared to 20% after the third week. With suture release after the third postoperative week, there was no clinically significant decrease in IOP. The decrease in IOP was similar in eyes undergoing trabeculectomy alone or when cataract extraction through a separate corneal incision was undertaken simultaneously. The period during which release of suture was effective was not prolonged by use of antimetabolites. Complications included a typical windshield-wiper keratopathy (18 eyes), failure to release the suture (13 eyes), epithelial abrasion (6 eyes) and a sub-conjunctival bleed (1 eye).

Studies on the mosquito vectors of Japanese encephalitis virus in Mandya District, Karnataka, India.

Entomological investigations were carried out in areas affected by Japanese encephalitis (JE) in Mandya District, Karnataka, India, from 1983 to 1988, to determine species composition and the density of mosquito vectors, in relation to the incidence of JE cases. JE cases occurred in two spells in a year, one during April-June (summer epidemic) and another during October-December (winter epidemic). There was very high incidence of JE cases in extensively irrigated areas and a low incidence in some of the taluks with less or no irrigation systems. Among culicines, Culex tritaeniorhynchus was the most predominant species (20.54%), followed by Cx. fuscocephala (16.94), Cx. vishnui (16.48%), Cx. gelidus (10.70%) and other species. The overall mosquito population showed two peaks in a year, one during the March-April, and another during September, usually preceding the human epidemics. Relative abundance of certain species varied in different years.

Cerebro-spinal fluid cytomorphology in tuberculous meningitis--a preliminary report.

The morphology of cells in centrifuged cerebrospinal fluid (C.S.F.) of 25 patients with tuberculous meningitis (T.B.M.) in different stages of the illness is presented. Blood brain barrier studies were also done in 6 patients. Maximum variability of cells in the initial stages of the illness and persistence of polymorphs in the later stages of the illness is noted. No correlation was established between cerebrospinal fluid cytomorphology and complications of the illness.

Botulinum toxin in the treatment of paralytic strabismus and essential blepharospasm.

As an alternative to conventional medical and surgical modalities that have met little success in the treatment of paralytic strabismus and essential blepharospasm, we explored the use of botulinum toxin as a treatment of choice in these two disorders. We used botulinum toxin in three patients with paralytic strabismus and in nine patients with essential blepharospasm. In three patients with paralytic strabismus, the botulinum toxin was injected into the ipsilateral antagonist of the paralysed muscle. The preinjection deviations ranged from 18 to 60 prism diopters. Two of these three patients achieved orthotropia around the thirtieth day and thereafter maintained it. The third patient became orthotropic on the eighteenth day, but deviation recurred and therefore required another injection of toxin. In nine patients with essential blepharospasm, botulinum toxin was injected into the orbicularis oculi muscles. Both objective and subjective improvement occurred in all nine patients within seven days and the effect lasted 12 to 15 weeks. Further injection of the toxin produced extremely beneficial results. However, the only significant complication that we encountered in both groups of strabismus and blepharospasm was ptosis, which was usually partial and temporary. From our experience, we advocate the use of botulinum toxin in the treatment of essential blepharospasm.