Clinical features and visual outcomes of pediatric optic neuritis in the Indian population: A prospective study

Purpose: Optic neuritis, defined as inflammation of the optic nerve, is the most common optic neuropathy affecting adults. Various studies in Southeast Asia have shown that the clinical profile of optic neuritis might differ in these regions from that reported in the western literature. Through this study, we evaluate the clinical profile of pediatric optic neuritis (PON) in the Indian population. Methods: This was a hospital?based prospective observational study. Patients with optic neuritis younger than 16 years who attended the neuro?ophthalmology clinic from May 2016 to April 2017 were included in the study. Results: This study included 54 eyes of 38 patients. The mean age of presentation was 10.6 years. Unilateral disease (58%) was found to be more common, and a slight female preponderance (58%) was noted. The most common feature was visual loss (96.3%). Pupillary light reflex abnormality was seen in most patients. Fundus examination revealed disk edema (77.7%) to be the most common feature. Neuroimaging was performed in 34 patients, and multiple sclerosis was diagnosed in four patients. At 3 months follow?up after treatment, 89% of eyes had best correct visual acuity of 6/9 or better (P < 0.001). Conclusion: In our study, we found the clinical profile of PON to be similar to that seen in western studies as well as those done previously in the Indian population, although with a few differences

Erythropoietin as a treatment option for indirect traumatic optic neuropathy: A pilot study

Purpose: Our study aims to evaluate the effectiveness of intravenous erythropoietin (EPO) in patients with indirect traumatic optic neuropathy (TON), assess the side effects, and compare the visual function results among three groups of patients who had received different treatment options – EPO, steroids, and observation. Methods: Patients with indirect TON presenting to the neuro?ophthalmology clinic from August 2019 to March 2020, were assigned to three groups, with six patients in each group. In group 1, patients were recruited prospectively and received recombinant human erythropoietin, whereas, in groups 2 and 3, patients were recruited retrospectively and received intravenous methylprednisolone followed by oral steroids and multivitamins, respectively. Groups 1 and 2 included patients presenting within 2 weeks of trauma, whereas group 3 included those presenting beyond that. Best?corrected visual acuity, pupillary reaction, color vision, and visual fields following treatment were measured. Results: Initial visual acuity in the EPO group ranged from 20/80 to no perception of light (No PL). The mean initial BCVA (1.82 logMAR, standard deviation [SD] = 0.847) improved to 1.32, SD = 0.93 logMAR after treatment recorded at the third month (P = 0.0375), with no significant adverse effects. The initial BCVA of group 2 ranged from 20/120 to No PL. The mean initial BCVA (1.95, SD = 0.77 logMAR) improved to 1.45 logMAR, SD = 0.97 after treatment (P = 0.0435) but three patients had side effects of steroids. Initial visual acuity in Group 3 ranged from 20/40 to no PL. The mean initial BCVA (1.09 logMAR, SD = 1.10) worsened to 1.19 logMAR, SD = 1.06 after treatment after treatment (P = 0.0193). The improvement in BCVA when compared between the three groups was not significant. Conclusion: Both erythropoietin and steroids are effective in the management of traumatic optic neuropathy. However, erythropoietin shows lesser or no side effects when compared to steroids

Diagnostic accuracy and clinical utility of bed side tests versus laboratory tests in the diagnosis of ocular myasthenia

Purpose: To assess the diagnostic accuracy of forced eyelid closure test (FECT), ice pack test (IPT), repetitive nerve stimulation test (RNS), and acetylcholine receptor (AchR) antibody test in patients with suspected ocular myasthenia. To assess the clinical utility of AchR antibody test in predicting disease progression. Methods: Retrospective cohort study of patients diagnosed with ocular myasthenia at a South?Indian neuro?ophthalmology tertiary eye clinic. Baseline characteristics; ocular myasthenia symptoms; results of FECT, IPT, RNS, and AchR antibody test; and progression time to generalized myasthenia (GM) over 36 months from the time of diagnosis were recorded and analyzed using receiver operator curve analysis, multiple logistic regression, and Kaplan朚eier survival analysis. Results: FECT had a sensitivity of 96.7% (95% CI: 88.5�.6) and a specificity of 75% (95% CI: 34.9�.8). Combination of FECT and IPT, using the positivity of at least one test, increased the sensitivity to 98.3% (95% CI: 91�0), reducing the specificity to 50% (95% CI: 15.7�.3), whereas using the positivity of both tests, we obtained a sensitivity of 71.7% (95% CI: 58.6�.5) and a specificity of 100% (95% CI: 63.1�0). In the subset of patients with double negative RNS and AchR antibodies, the positive predictive value of combined FECT and IPT (double positive) was 100%. Patients who developed GM were more likely to have a positive AchR antibody test result (P = 0.001). Conclusion: Combined FECT and IPT (double positive) has high diagnostic accuracy even among patients with normal RNS and negative AchR antibodies. Despite low sensitivity, AchR?antibody test has a significant predictive value in disease progression.

Ameliorating Effect of Melatonin on L- Arginine Induced Acute Pancreatitis in Rats

The present study was aimed to evaluate the ameliorative potential of melatonin against L-arginine induced acute pancreatitis in rats. Male Sprague Dawley rats (150–240 g) were divided into 3 groups, viz. group I (control group), group II (acute pancreatitis control group) and group III (treatment control) which were further subdivided into 3 subgroups according to time points of 24 hours, 3 days and 7 days. Rats from groups II and III received two injections of L-arginine (2 g/kg i.p.) at 1 h intervals for induction of acute pancreatitis. Melatonin was administered to group III daily at a single dose of 10 mg/kg i.p. On 6 hours, 24 hours, 3 days and 7 days, blood samples were obtained from each group and subjected for the assays of oxidative stress and serum biochemical parameters. Erythrocytic lipid peroxides contents in acute pancreatitis group were significantly higher, while reduced glutathione contents were significantly lower in comparison with the normal controls. The activities of other antioxidant enzymes were also significantly low in these rats. Moreover, significantly increased activities of serum amylase and serum lipase were found in these rats. Administration of melatonin significantly reduced the over production of malonaldialdehyde levels. Other antioxidant enzymes viz. reduced glutathione, superoxide dismutase and catalase activities were improved significantly in melatonin treated rats. Melatonin had also considerably ameliorated the altered serum amylase and serum lipase levels towards normalcy. Thus, it can be concluded that melatonin may possess therapeutic efficacy against L-arginine induced acute pancreatitis in rats

Coronary Artery Disease in Young Indians: A Different Entity

Objective: To study the angiographic profile, treatment andoutcome of Coronary Artery Disease (CAD) in young (< 45years) individuals in India.Methods: Consecutive 132 young adults with CAD reporting totwo tertiary care centres over a period of 1 ½ years wereenrolled as a case control observational study. Subjects whopresented with acute coronary syndrome (ACS), chronic stableangina (CSA), Heart failure or AsymptomaticElectrocardiogram (ECG) abnormalities but confirmed CAD onCoronary Angiogram (CAG) were included. Angiographicprofile, treatment and outcome were analysed with a follow upof one year.Results: Risk factors of abdominal obesity, lipoprotein (a)[Lp(a)] and tobacco consumption were significantly higher instudy group. ST elevation Myocardial Infarction (STEMI) wasthe commonest presentation (71.21%). Single vessel disease(56.06 %) was the commonest angiographic profile with LeftAnterior Descending Artery (LAD) involvement (40.91%).Primary Angioplasty in Myocardial Infarction (PAMI) was donein 42.5% of STEMI and Thrombolysis in 48.9%. Three types ofcoronary involvement were noticed with Type I having discretelesions/thrombus and Type III having multiple segment/arteryinvolvement with differing risk factor profile and outcome.Diffuse and more severe CAD was associated with tobaccouse, abdominal obesity and elevated Lp (a). Late presentation,diffuse disease and persistence of smoking predicted pooreroutcome.Conclusions: CAD in Young commonly presents with AcuteMI and single vessel LAD involvement. Less than half haveaccess to PAMI. Most require stenting although selectedpatients do well with intracoronary thrombolysis. Delayedtreatment and failure to modify risk factors portend badprognosis.

Microscopic Agglutination Test (MAT) for Leptospirosis in Association with Acute Renal Failure in Dogs

The present investigation was carried out in the Department of Veterinary Medicine, College of Veterinary and Animal Sciences, GBPUA&T, Pantnagar, Uttarakhand, India. Total of 100 sera samples from azotemic dogs were subjected to Microscopic Agglutination Test (MAT) using Leptospira culture in Leptospira lab, Department of Veterinary Bacteriology and Mycology, IVRI, Izatnagar, Bareilly (U.P.) All the sera samples were tested against L. interrogans: Serovars icterohaemorrhagiae, pomona, canicola, autumnalis, grippotyphosa and javanica. Out of 100 sera samples, 20 (20%) were found positive (+) for different serovars of Leptospira interogans and 3 (3%) were doubtful (±) at an antibody titre ≥1:100. The serovars identified were L. autumnalis (17/100), L. icterohaemorrhagiae (8/100), L. gryppotyphosa (4/100), L. canicola (2/100), L. javanica (2/100) and L. Pomona (1/100). The highest prevalence of Leptospira was observed for serovars L. autumnalis (17%), followed by L. icterohaemorrhagiae (8%) and least for L. Pomona (1%)

Correlation between Central Corneal Thickness and Refractive Error: A Pilot Study in Rural Population of Haryana

Central corneal thickness (CCT) is an essential tool in the assessment and management of corneal disease. CCT has thus become very important for the interpretation of intraocular pressure and prerefractive procedure assessment; however little is known about its distribution within a population with wide range of refractive errors. Therefore the objective is to study the correlation of CCT with a broad range of refractive errors in rural population of Haryana. Methods: Prospective analysis of patients with refractive error presenting to the Ophthalmology outpatient services were included as cases. Age and sex matched emmetropic subjects were included as controls. Both cases and controls were undertaken for CCT measurements by ultrasonic pachymetry. Results: A total of 187 eyes as cases, 101 as controls. Among cases, 122 eyes myopic (Group- 1) (Mean CCT= 531.80±37.83 μ) and 65 hypermetropic (Group- 2) (Mean CCT=549.66±45.66 μ). The results shows that the central corneal thickness was decreased in the myopic eyes in comparison to the normal eyes which was statistically significantly (p=0.001). However in the hypermetropic group, no correlation was found between central corneal thickness and degree of hypermetropia. Conclusion: This study provides pilot data of CCT in different types of refractive errors in our set of rural population which helps us in understanding the variation of CCT with refractive errors.

Genetic Variations in Asparagus racemosus, an Endangered Medicinal Herb Endemic to India Using RAPD Markers.

Aim: To study the genetic diversity in Asparagus racemosus germplasm using RAPD molecular markers for its better conservation and utilization. Study Design: RAPD markers used to check genetic diversity in Asparagus racemosus using different softwares. Place and Duration of Study: Department of Bio & Nano Technology, Guru Jambheshwar University of Science & Technology, Hisar-125001 between May 2013 to June 2014. Methodology: A total of 60 RAPD markers used to check polymorphism at genetic level among 60 asparagus genotypes. PCR amplified bands were scored as 0 and 1 for absence and presence. The binary data so obtained used to reveal genetic polymorphism via NTSYS, POPGENE and AMOVA analysis. Results: A significant level of genetic diversity (81.48%) among all genotypes was assessed by using RAPD molecular markers. Out of 60, 49 RAPD primers produced 425 polymorphic loci. The value of Jaccard’s coefficient varied from 0.48 to 0.97 for RAPD. OPB-15 primer proved to be the most polymorphic marker among all used. The POPGENE analysis revealed 44.44, 79.01 and 64.20% polymorphism for RAPD analysis in groups with low, intermediate and high saponin content. The overall value of Shannon’s index and Nei’s genetic diversity was 0.3402 & 0.2169 for RAPD marker system. Conclusion: These results showed RAPD marker system useful in detecting significant genetic polymorphism among genotypes which can be used for production and conservation of improved genotypes.

Evaluation of corneal biomechanical properties following penetrating keratoplasty using ocular response analyzer.

Purpose: To evaluate corneal biomechanical properties in eyes that has undergone penetrating keratoplasty (PK). Materials and Methods: Retrospective observational study in a tertiary care centre. Data recorded included ocular response analyzer (ORA) values of normal and post‑keratoplasty eyes [corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann‑correlated intraocular pressure (IOPg), and cornea‑compensated intraocular pressure (IOPcc)], corneal topography, and central corneal thickness (CCT). Wilcoxon signed rank test was used to analyze the difference in ORA parameter between post‑PK eyes and normal eyes. Correlation between parameters was evaluated with Spearman’s rho correlation. Results: The ORA study of 100 eyes of 50 normal subjects and 54 post-keratoplasty eyes of 51 patients showed CH of 8.340 ± 1.85 and 9.923 ± 1.558, CRF of 8.846 ± 2.39 and 9.577 ± 1.631 in post-PK eyes and normal eyes, respectively. CH and CRF did not correlate with post‑keratoplasty astigmatism (P = 0.311 and 0.276, respectively) while a significant correlation was observed with IOPg (P = 0.004) and IOPcc (P < 0.001). Conclusion: Biomechanical profiles were significantly decreased in post‑keratoplasty eyes with significant correlation with higher IOP as compared with that in normal eyes.

Cytological diagnosis of mucoepidermoid carcinoma of parotid - A diagnostic dilemma.

Mucoepidermoid carcinoma (MEC) of parotid, a rare disease, was diagnosed by fine needle aspiration in a young child and later confirmed on histopathology. Of all salivary gland tumors, mucoepidermoid carcinoma is the most difficult to diagnose by fine needle aspiration cytology due to overlapping cytomorphology with benign lesions. So, fine needle aspiration cytology helps in early diagnosis and management

Clinical profile of cerebral venous sinus thrombosis and the role of imaging in its diagnosis in patients with presumed idiopathic intracranial hypertension.

Retrospective descriptive study reporting the rate of occurrence of cerebral venous sinus thrombosis (CVST), highlighting the role of magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) in patients with presumed idiopathic intracranial hypertension (IIH). Study was conducted in the department of neuro-ophthalmology at a tertiary eye care center in South India. Data from 331 patients diagnosed with IIH from June 2005 to September 2007 was included. Inclusion criteria were: Elevated opening cerebrospinal fluid (CSF) pressure of more than 200 mm of water on lumbar puncture, normal CSF biochemistry and microbiology, and normal neuroimaging as depicted by computed tomography(CT) scan. Exclusion criteria were: Space-occupying lesions, hydrocephalus, meningitis, intracranial pressure within normal range, abnormal CSF biochemistry and microbiology. The remaining patients were evaluated with MRI and MRV. CVST was present in 11.4% of patients who were presumed to have IIH (35/308). MRI alone identified 24 cases (68%) of CVST, while MRI used in combination with MRV revealed an additional 11 cases (32%). Risk factors associated with CVST were identified in nine out of 35 patients (26%). CVST may be misdiagnosed as IIH if prompt neuroimaging by MRI and MRV is not undertaken. Risk factors of CVST may not be apparent in all the cases and these patients are liable to be missed if CT scan alone is used for neuroimaging, hence MRI, combined with MRV should be undertaken to rule out CVST.

Listeria monocytogenes meningitis: an uncommon opportunistic infection in HIV/AIDS.

OBJECTIVE: To report an interesting case of meningitis caused by Listeria monocytogenes meningitis in an HIV seropositive individual. MATERIALS & METHODS: A previously healthy 45 years old HIV seropositive man, presented with atypical clinical features of meningitis. Blood and Cerebrospinal fluid (CSF) were obtained for biochemical and microbiological investigations. RESULTS: CSF analysis showed pleocytosis with lymphocytic predominance. Gram stain of CSF was negative; however culture yielded growth of gram positive bacilli with tumbling motility. Based on relevant biochemical tests the isolate was identified as Listeria monocytogenes. Patient was treated with i.v. ampicillin and recovered completely. CONCLUSION: Listeriosis is relatively rare in HIV/AIDS among the immunodeficient populations. Atypical clinical and laboratory findings make the diagnosis difficult and these infections may go undiagnosed. Since it is easily treated with readily available antibiotics, it is important to diagnose them at the earliest and thereby prevent treatment failure.

Combined central retinal artery and vein occlusion secondary to systemic non-Hodgkin's lymphoma.

We report a rare case of low-grade systemic B-cell non-Hodgkin's lymphoma (NHL) causing central retinal artery and vein occlusion, which was the only manifestation of disease recurrence. A young man with resolved systemic NHL underwent fluorescein angiography, magnetic resonance imaging and computed tomography to investigate a severe unilateral visual loss. A combined vascular occlusion was observed in the right eye. Neuroimaging detected optic nerve infiltration; but no systemic/ central nervous system involvement was observed. The patient was treated with high-doses of corticosteroids and optic nerve irradiation. The optic neuropathy and vascular occlusion were resistant to treatment. The subsequent neovascular glaucoma was treated by panretinal photocoagulation, which relieved the pain, but vision was not recovered. No further recurrence was observed over the following year.