Study of Amblyopia Recurrence in Eastern Uttar Pradesh

Background: To evaluate the various factors associated with recurrence of Amblyopia. Methods:In this prospective observational study, 100 patient’s diagonised anisometropic and strabismic amblyopia. All patients were undergone squint workup and were treated with optical correction, occulusion therapy or penalization. Patients were divided three groups - group 1 age (4-7 year) , group 2 age(8-12 year), group 3 age(13-17 year) . Patients were followed upto 12 month and various factors assessed which could be responsible for amblyopia and compared between three group. Results:Recurrence of amblyopia was seen in 24% of patients which was more in group 1 & mixed amblyopia type (statically significant p < 0.05). Recurrence of amblyopia was found to be patients independent of binocular vision and mode of treatment. Recurrence and its relation with length and dose of occlusion therapy were significant those who were weaned off 6 hrs patching as compared 2 hrs patching. Recurrence of amblyopia was found to be more in those who improved five lines as compared to two lines with statistically significant p < 0.05. Recurrence was more in first 6 month as compared to last six month during follow up. Conclusion: Recurrence is more commonly seen between the ages of 4-7 yrs and those who with mixed amblyopia should be closely monitored during follow up. Occlusion therapy should be prescribed weaning off, it should not be abruptly stop. Since recurrence may occur even beyond 1 year hence, a longer follow up period would be advisable.

Ewing’s Sarcoma of Zygomatic Bone.

Ewing’s sarcoma is an uncommon malignancy usually arising from the skeletal system particularly pelvic bones and long bones of lower extremities and mostly affecting children and young adults. Its occurrence in the maxillofacial region with soft tissue involvement is struck with rarity. It carries a poor prognosis due to its uncontrolled potential for metastatic spread; therefore an early and integrated treatment approach must be adopted to improve patient’s long term survival.

Dress Syndrome: Time to Define Treatment Guidelines.

Background: DRESS (Drug rash with eosinophilia and systemic Symptoms) syndrome is a drug hypersensitivity syndrome which begins around 2- 6 weeks after exposure to a drug. If treated early, can recover completely and much of morbidity can be avoided. Case: A patient with history of taking carbamazepine for epilepsy, presented with typical features of maculopapular erythematous rash, exfoliative dermatitis and edema over upper and lower extremities, face, and trunk. He had eosinophilia, lymphadenopathy and elevated liver enzymes. His condition rapidly improved after withdrawing carbamazepine and starting steroids. Discussion: The rapid recovery with steroids in this case and in a few cases reported previously also suggests a need of RCT to assess steroids as an established modality for management of this severe but curable entity.

Ectopic Thyroid Tissue Co-Existing with a Eutopic Thyroid.

Ectopic thyroid tissue, a developmental defect of thyroid gland, is met with rarity in day to day clinical practice. The diagnosis of ectopic thyroid demands a meticulous clinical examination and use of different imaging modalities. We are here reporting a case which presented as an anterior neck swelling, moving with deglutition, and also on and off dysphagia. After necessary investigations she underwent surgery and then the diagnosis of ectopic thyroid was made which was later confirmed with biopsy report which was suggestive of lymphocytic thyroiditis.

Prevalence of archaea in chronic periodontitis patients in an Indian population.

Aim: The aim of this study was to investigate the prevalence of archaea in the subgingival crevices of patients with chronic periodontitis in an Indian population. Materials and Methods: Thirty four chronic periodontitis patients and 16 healthy subjects were included in the study. Thirty four subgingival plaque samples were collected from chronic periodontitis patients, of which 17 samples were from deep pockets and 17 were from shallow pockets. Sixteen subgingival plaque samples were collected from healthy subjects. The presence of archaea in plaque samples was detected by polymerase chain reaction. Results: Prevalence of archaea in chronic periodontitis patients was 29.4% and in healthy subjects was 11.8%, which was not a statistically significant difference. However, prevalence of archaea, in deep periodontal pockets was 47.1%, in shallow periodontal pockets was 11.8% and in healthy sulcus was 12.5%, respectively. Thus, showing a statistically significant difference between prevalence of archaea in deep periodontal pockets (47.1%) and healthy sulcus (12.5%) and also between deep periodontal pockets (47.1%) and shallow pockets (11.8%), respectively. Conclusion: Archaea were detected commonly in severe periodontitis suggesting that these microorganisms might be involved in the pathogenesis of periodontal diseases.

Multiple Idiopathic Cervical Resorption: A Case Report.

Multiple idiopathic cervical resorption (MICR) is a disease of the tooth in which there is progressive cervical resorption of multiple teeth leading to exfoliation of crown. The etiological factors for such a resorption are various but the lack of definitive single etiological factor/disease process makes management of such processes extremely difficult. A flap surgery followed by restoration with glass ionomer cement was carried out for the cessation of resorption process, finally a cast partial denture was delivered for prosthetic rehabilitation.

EDTA and citric acid mediated phytoextraction of Zn, Cu, Pb and Cd through marigold (Tagetes erecta).

Phytoextraction is an emerging cost-effective solution for remediation of contaminated soils which involves the removal of toxins, especially heavy metals and metalloids, by the roots of the plants with subsequent transport to aerial plant organs. The aim of the present investigation is to study the effects of EDTA and citric acid on accumulation potential of marigold (Tagetes erecta) to Zn, Cu, Pb, and Cd and also to evaluate the impacts of these chelators (EDTA and citric acid) in combination with all the four heavy metals on the growth of marigold. The plants were grown in pots and treated with Zn (7.3 mg l-1), Cu (7.5 mg l-1), Pb (3.7 mg l-1) and Cd (0.2 mg l-1) alone and in combination with different doses of EDTA i.e., 10, 20 and 30 mg l-1. All the three doses of EDTA i.e., 10, 20 and 30 mg l-1 significantly increased the accumulation of Zn, Cu, Pb and Cd by roots, stems and leaves as compared to control treatments. The 30 mg l-1 concentration of citric acid showed reduced accumulation of these metals by root, stem and leaves as compared to lower doses i.e., 10 and 20 mg l-1. Among the four heavy metals, Zn accumulated in the great amount (526.34 mg kg-1 DW) followed by Cu (443.14 mg kg-1 DW), Pb (393.16 mg kg-1 DW) and Cd (333.62 mg kg-1 DW) in leaves with 30 mg l-1 EDTA treatment. The highest concentration of EDTA and citric acid (30 mg l-1) caused significant reduction in growth of marigold in terms of plant height, fresh weight of plant, total chlorophyll, carbohydrate content and protein content. Thus EDTA and citric acid efficiently increased the phytoextractability of marigold which can be used to remediate the soil contaminated with these metals.

A report on the indoor residual spraying (IRS) in the control of Phlebotomus argentipes, the vector of visceral leishmaniasis in Bihar (India): an initiative towards total elimination targeting 2015 (Series-1).

Background & objectives: Visceral leishmaniasis, commonly known as kala-azar is endemic in Bihar state, India. Current vector control programme in Bihar focuses mainly on spraying the sandfly infested dwellings with DDT. The Government of India in collaboration with WHO has fixed the target 2015 for total elimination of kala-azar. The present study was carried out to see the impact of DDT and improved IEC in the containment of vector density vis-à-vis disease transmission. Methods: Before the start of the spraying operations training was imparted to all the medical and paramedical personnel regarding the methods of spraying operations. Pre- and post-sandfly density was monitored in four selected districts. Incidences of kala-azar cases were compared for pre- and post-spray periods. Social acceptability and perceptions of households was collected through questionnaires from 500 randomly selected households in the study districts. Results: House index in three study districts reduced considerably during post-spray when compared to pre-spray. Kala-azar incidence in many districts was reduced after the DDT spray. Either partial or complete refusal was reported in 14.4%, while 35% were not satisfied with the suspension concentration and coverage; and 46.6% were found satisfied with the spraying procedure. Interpretation & conclusion: Strengthening the IEC activities to sensitise the community, proper training of health personnel, monitoring of spray, good surveillance, proper treatment of cases and two rounds of DDT spray with good coverage in the endemic districts up to three years are essential to achieve the desired total elimination of kala-azar in Bihar state.

Long segment ileal duplication with extensive gastric heterotopia.

Duplications of the alimentary tract are rare congenital anomalies which can be found at all levels of the alimentary tract. Majority of the duplications present as spherical cysts and usually range from a few millimeters to less than ten centimeters in size. Duplications produce complications such as intestinal obstruction or hemorrhage. A two-month-old infant presented with recurrent episodes of bleeding per rectum. Laparotomy revealed a giant ileal duplicated bowel segment which exhibited extensive gastric heterotopia with focal ulceration.

Clinical and Laboratory Comparison of Different Brands of Amphotericin B Used for the Treatment of Kala-Azar: An Observational Study.

The communication presents clinical response of cases of visceral leishmaniasis to treatment by two different brands of Amphotericin B. FungizoneTM was found to be slightly better than Amphotericin BTM, however, the difference is not statistically significant.

EDTA enhances lead uptake and facilitates phytoremediation by vetiver grass.

Vetiver grass (Vetiveria zizanioides) has strong and dense root system and is a potential phytoremediator plant since it can tolerate a wide range of climatic conditions and grow well in soils contaminated with heavy metals. Soil was artificially contaminated by lead (20 mgl(-1)) during field trials. Four concentration of EDTA (Ethylene diamine tetra acetic acid-disodium salt) solution i.e. 0, 3, 5 and 10 mmol kg(-1) were added to soil prior to harvesting, to study the influence of EDTA solution on phytostabilization by vetiver grass. Results showed that the concentration of lead in roots of vetiver is significantly increased after EDTA solution (5 mmol kg(-1)) application. However, high concentration of EDTA (10 mmol kg(-1)) does not show such significant increase. The toxicity of highly contaminating metal did not affect the growth of vetiver grass significantly but a slight decrease in parameters studied was noticed. No stress symptoms were observed in vetiver plants. Results of present study reveal that vetiver could be considered as a potential phytoremediator for lead contamninated site.

Surgical outcome of cortical dysplasias presenting with chronic intractable epilepsy: A 10-year experience.

Background: There has been sparse description of cortical dysplasias (CDs) causing intractable epilepsy from India. Aim: Clinical retrospective study of CDs causing intractable epilepsy that underwent surgery. Materials and Methods: Fifty-seven cases of CDs reviewed (1995 till July 2006) are presented. All patients had intractable epilepsy, and underwent a complete epilepsy surgery workup (inter ictal electroencephalography (EEG), video EEG, MRI as per epilepsy protocol, SPECT {interictal, ictal with subtraction and co-registration when required}, and PET when necessary). Surgical treatment included a wide exposure of the pathology with a detailed electrocorticography under optimal anesthetic conditions. Mapping of the sensori-motor area was performed where indicated. Procedures included resection either alone or combined with multiple subpial transactions when extending into the eloquent areas. Results: Our study had 28 (49.12%) cases of isolated focal CDs, and 29 (50.67%) with dual pathology. Average age at the time of onset of seizures in our series was 7.04 years (three months to 24 years), and average age at the time of surgery was 10.97 years (eight months to 45 years). Among coexistent pathologies, one had associated MTS, 16 had coexistent gangliogliomas and 12 (dysembryonic neuroepithelial tumor) DNTs. At an average follow-up of 3.035 years (range 5-10 years), three patients were lost to follow-up. Fifty-one per cent (29/57) patients had a good outcome (Engel Grade I) and 26%(15/57) had a Grade II outcome. Conclusion: Cortical dysplasias have a good outcome if evaluated and managed with concordant electrical and imaging modalities.

Hepatocellular carcinoma presenting as neutrophilic leukaemoid reaction--a rare entity.

Leukaemoid reaction is a rare, growth factor-driven, paraneoplastic manifestation of hepatocellular carcinoma. It may masquerade as the neutrophilic chronic myeloid leukaemia or as chronic neutrophilic leukaemia. A 52-year-old male presented with hepatosplenomegaly and severe leucocytosis. He had progressive leucocytosis, neutrophil alkaline phosphatase score elevated, liver function tests altered. FNAC from the mass in the liver revealed features of moderately differentiated hepatocellular carcinoma. The patient deteriorated within two weeks and died thereafter.

Malignant myelomatous pleural effusion with good response to combination chemotherapy.

Malignant pleural effusion in myeloma is a rare terminal event with 91 cases reported so far. Majority of the patients survive less than 4 months. We are presenting a short series of four such cases, who had a good clinical response to combination chemotherapy.

Neuropathological spectrum of lesions associated with intractable epilepsies: a 10-year experience with a series of 153 resections.

BACKGROUND: Surgical management of intractable epilepsies is currently an established mode of therapy in various clinical settings. AIMS: To retrospectively evaluate the neuropathological findings in both temporal and extratemporal lobe resections in such patients. MATERIALS AND METHODS: The study included resected specimens from patients with intractable epilepsy managed at a tertiary care hospital of India, during a 10-year period (1995-2004). RESULTS: A total of 153 patients, with mean age of 19.4 years and male predominance (73.2%) were included in the study. Overall, there was a predilection for the temporal lobe (73.2%), while 41cases were extratemporal in location. On histopathology, mesial temporal sclerosis (MTS) (24.8%) was the commonest lesion, followed by tumors (19.6%) and isolated focal cortical dysplasia (FCD - 15.11%). Other less common findings included Rasmussen encephalitis, non-specific gliosis and vascular malformations. In addition, 20.9% (32 cases) had dual lesions, majority of which included FCD with ganglioglioma (15 cases) or with dysembryoplastic neuroepithelial tumor (12 cases). In the temporal lobe, neoplasms and dual lesions formed the majority (apart from MTS), unlike dual lesions followed by neoplasms and FCD, in the extratemporal location. CONCLUSION: This series demonstrates that most patients with chronic intractable epilepsy have significant histopathological findings and highlights the neuropathological spectrum of such lesions, in the Indian context. This was similar to that reported from the West, but different from the single Indian series available in the literature. Further, the overall profile of temporal lobe lesions was not different from the extratemporal ones.

Spinal Intramedullary Tubercular abscess.

Spinal intramedullary tubercular abscess is an extremely rare entity. Only few cases are reported in literature. A Nine-year-old girl presented with pain in gluteal region and progressive paraparesis. Her chest-X-ray revealed a primary focus suggesting pulmonary Koch’s & MRI lumbosacral spine showed a ring enhancing hypointese lesion in T1w and hyperintense in T2w at L2 to L3 suggestive of epidermoid or tubercular abscess, which was confirmed at operation and subsequently by AFB staining and culture. Mycobacterium tuberculosis was seen in both staining and culture of pus. Patient improved after 2 months of ATT.

Magnitude of unresponsiveness to sodium stibogluconate in the treatment of visceral leishmaniasis in Bihar.

BACKGROUND: The Indian government proposes to eliminate kala-azar, which has been a serious public health problem in Bihar. This study aimed to assess the magnitude of unresponsiveness to sodium stibogluconate in the treatment of new cases of visceral leishmaniasis and to identify the associated factors. METHODS: Patients with clinically and parasitologically confirmed visceral leishmaniasis (n = 182) who had received no prior treatment, were enrolled for the study. The patients were treated with sodium stibogluconate (20 mg/kg body weight; upper limit 850 mg), intramuscularly for 30 days. The vital parameters and side-effects, if any, were monitored. Patients who developed toxicity during treatment were excluded from the study but were given rescue treatment with liposomal amphotericin B. All patients who completed the treatment were followed up for 6 months. RESULTS: Unresponsiveness to sodium stibogluconate at the end of treatment was 43%. It was higher in women (48%) compared to men (40%). A significant association was observed between unresponsiveness and level of endemicity (p = 0.0002), large spleen size (p = 0.04) and immune response (migration inhibition factor) (p = 0.00002). At the end of 6 months' follow up, 27% of patients relapsed, giving a total unresponsiveness rate of 58%. CONCLUSION: Unresponsiveness to sodium stibogluconate is a serious problem in the management of patients with visceral leishmaniasis. In patients with factors associated with nonresponse to sodium stibogluconate, alternative drugs such as miltefosine or amphotericin B should be considered as first-line drugs.