Prevalence of incidental and total human immunodeficiency virus, hepatitis B and hepatitis C seropositivity among patients posted for cataract surgery at a tertiary care center in India

Purpose: To study the prevalence of human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV) viral seropositive among the patients posted for cataract surgery at a tertiary care center in north India. Methods: It was a cross?sectional study done for 30 months duration. All the patients posted for cataract surgery underwent comprehensive ophthalmic evaluation followed by routine hematological workup, including viral markers for HIV, Hepatitis B surface antigen (HBsAg), and anti?HCV. Data were analyzed by the Statistical Package for Social Science (SPSS Version 20). Results: A total of 7,316 individuals underwent cataract surgery from Jan 2016 to August 2018, 4,073/7,316 (55.7%) were males. The prevalence for HIV was 58/7,316 (0.8%), HBsAg was 151/7,316 (2.1%), and HCV was 11/7,316 (0.1%); 28/58 (48.3%) HIV positives were unaware of their seropositivity till testing, as were 37/151 (24.5%) of HBsAg positives, and 4/11 (36.4%) HCV positives. There was a significant relationship between the mean age in the patients with HIV (P = 0.002) and anti?HCV (P = 0.045). A majority of the seropositive patients were found to be illiterate (45.6%), followed by educated up to high school level (29.1%), and graduate (25.0%). Conclusion: Viral seropositivity was significant among the patients posted for cataract surgery. The eye care providers could refer these patients for counseling and further management for the patient’s and their caretaker’s benefit

Organ Weights and Intestinal Morphology of Broiler Chickens Fed Diets Containing Different Supplements

The present study was evaluated the effect of dietary inclusion of various feed supplements and their combination on the performance index, glucose and serum cholesterol for 6 weeks. Day-old broiler chicks (n=252) were randomly assigned to seven treatment groups, each with 3 replicates. The first treatment was designated as control (T0) in which no supplement was added to the feed, while in treatments T1; organic mineral mixture (Organomin forte), T2; organic mineral mixture (Vannamin), T3; probiotics (Microguard), T4; enzyme (Brozyme -XPR) and probiotics, T5; emulsifier (Lipigon) were provided through feed. In the T6 group, 3 percent less energy was given through feed. The weight of vital organs viz. heart, liver, gizzard, and spleen were significantly (P<0.05) increased by the feed supplements of which were in the normal range. The gut morphology was also favorably altered due to feed supplementations. This indicates that the organic mineral mixtures, probiotics, enzymes and emulsifiers, and their combinations can be used as a growth promoter in broiler diets and can improve gut health. These products show promising effects as alternatives for antibiotics as pressure to eliminate growth-promoting antibiotic use increases

Incidence of Pterygium in Teenagers -A Clinical Study

Aim: The aim of our study was to evaluate increasing occurrence of pterygium in young individuals and to suggest methods for its prevention. Methods: This was a hospital based prospective observational study carried out for a period of one year. A total of 30 eyes of 25 patients were taken who were diagnosed to have pterygium on slit lamp examination. All patients were less than 20 years of age. Patients who presented with complaints of irritation, redness and mass in the eyes were included in our study. Patients with history of trauma and chemical injuries were excluded in this study. All selected patients underwent detailed ophthalmic examination including visual acuity, refraction, slit lamp examination and fundus evaluation. The side, progression, position, autorefractometry and keratometry were noted in each and every patient. Results: A total of 30 eyes of 25 patients were included in our study among which 21 (84.0%) were males and rest 4 (16.0%) females. All of our patients belonged to age group 11-20 yrs. The complaint of pterygium was found more in patients who belonged to rural background (18, 72.0%). 5 (20.0%) patients had bilateral pterygium and rest 20 (80.0%) had complaint in only one eye. Majority of our patients had pterygium on nasal side (21, 84.0%), 3 of them on temporal side (12.0%) and one on both sides (4.0%). Majority of them had concern with cosmesis followed by diminution in vision and irritation in the eyes. Almost all of them (24, 96.0%) spent their time outdoors while work and play. Pterygium was graded as grade 1 when it just touched the limbus, grade 2 when pterygium was at half the distance between the limbus and pupillary margin, grade 3 when pterygium reached the pupillary margin and grade 4 when it crossed the visual axis to the other side. All of our patients had grade 1 and 2 pterygium. Conclusion: The prevalence of pterygium has been on a rise in these recent years in young individuals. Hence, adequate precautions like wearing protective glasses, hooded caps, brimmed hats etc. should be advised to young individuals in order to prevent them from pterygium. All of them should be educated for safety measures in order to prevent pterygium and hence to lead a good quality of life.

Changes in the Central Corneal Thickness in Diabetes Mellitus Patients with age and Gender Matched Healthy Controls in North Indian Population

Background: Since diabetes mellitus affects the all part of body including ocular structures so we planned a study to compare the central corneal thickness in diabetes mellitus patients with age and sex matched healthy controls in North Indian population. The aim of our study was to compare the central corneal thickness in diabetes mellitus patients with age and sex matched healthy controls in North Indian population. Methods: It was a prospective clinical study done at tertiary care centre on two hundred patients. Out of them 100 were diabetic and 100 were healthy subjects. The CCT measurement was done in enrolled patient using a non contact ultrasonic pachymeter probe gently placed in the mid pupillary axis of the cornea in undilated eye. All CCT and IOP recordings were done between 12- 2 pm keeping in mind the diurnal fluctuations. Data was analysed by SPSS Software version16. Results: CCT was higher in diabetics having duration > 10 years than those having duration < 10 years.Central corneal thickness values increased from patients with no diabetic retinopathy to those with proliferative retinopathy. Conclusion: The cornea of diabetics is significantly (P≤0.001) thicker than normal healthy subjects.

Clinical and Biochemical Profile of Acute Liver Failure with Hepatic Encephalopathy in Children from Eastern Nepal.

Introduction: Hepatic encephalopathy is a potentially reversible neurophyschiatric abnormality in the setting of liver failure. Acute liver failure (ALF) is a potentially life-threatening disorder in children. Objectives: The present study evaluated the clinical profile, outcome and factors influencing the outcome of children presenting with acute liver failure and hepatic encephalopathy presenting to a referral hospital of Eastern Nepal. Methodology: Thirty children (17 males and 13 females) were admitted with this diagnosis during two year period.Prospective study. Results: The most common cause of acute liver failure was mushroom poisoning seen in 30% of cases. Only 37% (11 out of 30) children survived, most of them in early stages (Stage I and II) of encephalopathy. Bleeding manifestations were significantly more common (P=0.002) in deaths as compared to survivors. Conclusion: As liver failure is associated with high mortality rates especially in absence of facilities for liver transplantation, efforts should be directed in favor of implementing preventive measures such as vaccination and community education to prevent toxin ingestion.

Mixed gonadal dysgenesis with normal karyotype : A rare case report.

Mixed gonadal dysgenesis (MGD) presents as a unilateral testis, usually intraabdominal, a streak gonad on contralateral side, and persistent mullerian structures. 45X/45XY karyotype is most frequent in such cases with predominance of 45X cells in both peripheral lymphocytes and gonads. We present a rare case of a left undescended testis, normally descended right testis, with penoscrotal hypospadias, who had a normal karyotype and whose histopathological findings were endometrial tissue and fallopian tube in left testicular biopsy. Gonadal dysgenesis should always be kept a possibility in patient with undescended testis and proximal hypospadias. If karyotype reveals a 46XY gonadal dysgenesis, these patients need all the more careful follow-up to screen for gonadoblastoma in remaining normal testis. Subjecting the patients to prophylactic orchidectomy with hormone replacement can be an additional option in such patients.

Primary cutaneous aspergillosis due to Aspergillus niger in an immunocompetent patient.

Primary cutaneous aspergillosis is a rare entity, usually caused by A. fumigatus and A. flavus . Here, we present such a case, manifested by ulceration due to A. niger, which remained undiagnosed for a prolonged period. The immunological status was intact, although the patient had associated severe fungal infection. Recurrence of the lesion occurred despite repeated anti-fungal therapies. Anti fungal testing was done based on the broth dilution (M-38A, NCCLS, USA) method. The culture isolate was found to be sensitive to fluconazole and amphotericin B. Continuation of antifungal therapy improved the symptoms, reducing the size of the lesion.

Brain tumours in children.

A 10 years old, female patient presented with symptoms of abnormal movement of the body for 5 years, deviation of mouth to left side for 12 days and difficulty in walking for 12 days. We report a very rare case of Brain Stem gliomas. Clinical and imaging findings were suggestive of brain stem gliomas.

Incidence of congenital heart disease in tertiary care hospital.

AIMS AND OBJECTIVES: The present study was under taken to determine the spectrum, clinical profile and outcome of patients with congenital heart disease (CHD) admitted to a tertiary care hospital. MATERIALS AND METHODS: This is a retrospective, observational hospital based study conducted during January 2006 to December 2006. Out of 14461 admissions, 84 were cases of CHD. Only patients with echocardiographic proof of CHD were included in the study. Detailed clinical and laboratory findings and outcome of all cases were noted in pre-structured formats. Data were entered in MS-excel. Data was analyzed by software SPSS version 10. RESULTS: The incidence of CHD was 5.8 per 1000 hospitalized patients. Out of 84 CHD cases, 51 were males and 33 females; with a male to female ratio of 1.5:1. CHD presented more frequently during infancy (46 %). Acyanotic heart disease was detected in 58 (69 %) cases while cyanotic heart disease was detected in 26 (31%) cases. Among acyanotic heart disease, ventricular septal defect (VSD) was found in 49 (58.3%), atrial septal defect (ASD) in 4 patients (4.8%), endocardial cushion defect (ECD) in 2 patients (2.4%) and dextrocardia was found in 3 patients (3.6%). Among cyanotic heart disease, Tetralogy of Fallot (TOF) accounted for 13.1%, total anomalous pulmonary venous connection (TAPVC) 3.6%, transposition of great arteries (TGA) with VSD 1.2% and unspecified cases of heart disease was found in 13.1%. VSD and TOF were the most common lesions while other CHD like ASD, dextrocardia, TAPVC, ECD, TGA with VSD were encountered less frequently. The most common clinical presentations were failure to thrive (FTT) and developmental delay (86.9%), breathlessness (69%), lower respiratory tract infection (LRTI) (52%), congestive cardiac failure (CCF) (46%), cyanosis (20.2%), cyanotic spell (9.5%) and infective endocarditis (9.5%). The mortality rate was 20 %. CONCLUSION: The incidence of CHD was 5.8 per thousand hospitalized children. VSD, TOF were the most common congenital cardiac lesion. VSD was observed either isolated or associated with other lesions like TGA. The mortality rate was 20 %. The mortality usually occurred in those patients complicated with congestive cardiac failure, lower respiratory tract infection and infective endocarditis.

Clinico- Biochemical Profile of Neonatal Seizure.

Objectives: The present study was undertaken to study the incidence, etiological factor, and days of onset, clinical types and biochemical abnormalities in babies having neonatal seizures. Materials and Methods: This is a retrospective, observational hospital based study. Ninety neonates, who developed seizures before 28 days of life and admitted to neonatal intensive care unit and nursery with neonatal seizure, were evaluated for incidence, etiological factor, clinical types and biochemical abnormalities found in neonatal seizure. The variables were analysed using Chi- Square and student t- test. Results: The incidence of neonatal seizure was 10.3/ 1000 live births. The seizures were common in male babies. 65 (72.2%) neonates were born to multiparous women while 35 (38%) were born to primigravidas. In birth asphyxia (n= 40), the most common type of seizure observed was subtle seizure 20 (50%), followed by focal clonic 10 (25%) and multifocal clonic 5 (12.5%). Tonic type of seizure was observed in 3 (7.5%) and myoclonic in 2 (5%). Meningitis and septicaemia was the second most common cause of neonatal seizure observed in our study. Among metabolic abnormalities hypoglycaemia was found in 20 (22%) and hypocalcaemia in 10 (11%). Conclusion: The commonest cause of seizure was birth asphyxia presenting within 72 hours of life. Among infection septicaemia and meningitis was the most common cause leading to neonatal seizure. Among biochemical abnormalities the most common cause of seizure observed in our study was hypoglycaemia and hypocalcaemia. Subtle seizures were the commonest type of seizure observed in this study.

A modified two-step treatment for actinomycetoma.

BACKGROUND: Combination antibiotic regimens are effective in the treatment of actinomycetoma but many treatment schedules require supervised parenteral therapy for prolonged periods. We describe a schedule that includes parenteral medication in an initial, short phase followed by a longer phase of oral medication. METHODS: Sixteen patients with clinically diagnosed mycetoma, who did not show any evidence of a fungal etiology, were treated presumptively for actinomycetoma. Evidence of actinomycotic infection was found on microscopy of granules / discharge and / or histopathological examination in eight (50%) patients. The treatment consisted of an intensive phase (Step 1) with gentamicin, 80 mg twice daily, intravenously and cotrimoxazole, 320/1600 mg twice daily orally for four weeks. This was followed by a maintenance phase with cotrimoxazole and doxycycline, 100 mg twice daily till all sinuses healed completely. The treatment was continued for 5-6 months. RESULTS: Treatment response was assessed monthly. At the end of the intensive phase, there was a significant improvement in all 16 patients. Nine patients who continued the maintenance phase of the regimen had complete healing of sinuses with marked reductions in swelling and induration in 2.4 +/- 1.7 months. Maintenance treatment was continued for a mean of 9.1 +/- 4.3 months in these patients. Six patients have remained free of disease activity during a follow-up period of 11.1 +/- 4.2 months after treatment was stopped. Two patients developed leucopenia and thrombocytopenia necessitating withdrawal of cotrimoxazole. CONCLUSION: This regimen was effective in treating actinomycetoma. The short duration of the phase requiring parenteral therapy makes it convenient to administer.

Acid base and electrolyte disturbance in diarrhoea.

OBJECTIVE: The present study was undertaken to study the frequency of electrolyte imbalance in children with diarrhoea and the relationship between electrolyte abnormalities and mortality. MATERIALS AND METHODS: This is a retrospective, observational hospital based study. Fifty seven children admitted to paediatric ward with diarrhoea and dehydration was evaluated for electrolyte and acid base status at presentation. The variables were analyzed using chi-square and student t- test. RESULTS: Majority (70%) of patients were below 2 years of age. There were 37 (65%) males and 20(35%) females. Electrolyte disturbance was observed in 46 (80%) patients while acid base disturbance was observed in all (100%) where the estimations were done. The major electrolyte disturbances noted were hyponatremia (56%), which was either isolated (26%) or associated with hypokalemia (26%). The second common abnormality was hypokalemia (46%) which was again either isolated (14%) or associated with hyponatremia (26%). About 10% patient had hypernatremia and about 3% had hyperkalemia. Twenty one (37 %) patients had mixed electrolyte imbalance. ABG analysis was performed only in 16 patients. Arterial blood gas analysis could be performed only in 16 patients. Metabolic acidosis was present in 15 (94%) while one (6%) had metabolic alkalosis. Out of 57, five patients (8.7%) expired. All of them had electrolyte abnormalities. Out of five patients who died one had isolated hyponatremia, 2 had hyponatremia + hypokalemia, while one each had hypernatremia + hypokalemia and hypernatremia+ hyperkalemia. Statistically significant mortality was observed in patients presenting with either hyponatremia or hypokalemia as compared to the group with normal electrolytes. CONCLUSION: Hyponatremia, hypokalemia and metabolic acidosis are common electrolyte and acid-base abnormalities in children with diarrhoea and dehydration and often responsible for mortality.

Evaluation of a new fixed duration (12 weeks) multi-drug regimen of bactericidal drugs in multibacillary leprosy.

Leprosy still remains a public health problem mainly in Asia, Africa and South America. The WHO Expert Committee on Leprosy recommended, in 1997, the simplified treatment of leprosy for multibacillary (MB) cases, by reducing the duration of treatment from 24 to 12 months. From the operational point of view even this reduced duration is still long and monthly supervised drug administration may not always be practical in those areas where the accessibility is difficult and health infrastructure weak. The present study was carried out to compare the safety and efficacy of a new fixed duration regimen consisting of four bactericidal drugs with WHO/MDT (MB). METHODS: Thirty adult patients were randomly allocated to two groups. Group 1 (18 patients) received a new regimen of daily rifampicin 600 mg, sparfloxacin 200 mg, clarithromycin 500 mg and minocycline 100 mg for 12 weeks. Group 2 (12 patients) received WHO/MDT (MB) for 12 months. A detailed clinical evaluation and laboratory investigations, BI and MI were done at the baseline, every 4 weeks for 12 weeks, and thereafter every 8 weeks till 48 weeks. Skin biopsies were taken and chest X-rays were done at 0, 12 and 48 weeks. RESULTS: At 48 weeks, the net percentage clinical improvement in group 1 was 73.92% and in group 2 it was 66.66%. The net percentage reduction (NPR) in BI in group 1 was 19.17% and in group 2 it was 18.87% (p = 0.09). NPR in MI in both groups was 100% by 8 weeks, and somewhat faster in group 1. In group 1, 8 patients had mild gastrointestinal side-effect, and 16 had minocycline-induced hyperpigmentation. Three patients in group 1 developed type I reversal reactions. CONCLUSION: The regimen containing daily doses of rifampicin 600 mg, sparfloxacin 200 mg, minocycline 100 mg and clarithromycin 500 mg for 12 weeks was found to be an acceptable, effective and safe alternative regimen for MB leprosy with an additional operational advantage of shorter duration of treatment.

Penile fracture presenting as eggplant deformity.

Penile fracture is caused by sudden trauma to erect penis leading to tear of corpora cavernosa. Although penile fracture is a rare condition, it can lead to crippling penile deformity and erectile impotence, if intervention is delayed. We describe a case of penile fracture caused by masturbation and satisfactory outcome after early surgical intervention. Usually only clinical assessment is sufficient for diagnosis.

Host range nodulation and adaptation in frenchbean rhizobia.

The host range nodulation efficiency of four genetically marked frenchbean rhizobial strains (HURR-3, Raj-2, Raj-5 and Raj-6) was studied with five legume hosts namely, frenchbean (Phageolus vulgaris L.), pigeonpea [Cajanus cajan (L.) Millsp.], mungbean [Vigna radiata (L.) Wilezek.], urdbean [Vigna mungo (L.) Hepper.] and soybean [Glycine max (L.) Merril.]. Except soybean and pigeonpea, all other legume hosts were nodulated by two or more frenchbean rhizobial strains tested. Rhizobia were isolated from nodules produced by strains, HURR-3 and Raj-5, on main (frenchbean) and different (mungbean and urdbean) hosts. There was marked improvement in host range nodulation and nitrogen fixation efficiency of rhizobial strains, HURR-3 and Raj-5. after their isolation from chance nodules on different hosts. This is clearly evident from the ability of such isolates to form nodules on pigeonpea besides mungbean and urdbean, and higher nodulation in all the above three different hosts. The phage-susceptibility pattern and intrinsic antibiotic resistance (used as markers) of the two strains did not change after their passage through different hosts. The results indicate that frenchbean rhizobia had undergone some modification in symbiotic behaviour to adapt to wide host range during their passage through different (alternate?) hosts.

Chilblain lupus erythematosus mimicking acrofacial vitiligo.

Chilblain lupus erythematosus with depigmentation is a rare presentation of lupus erythematosus that may simulate vitiligo. A 52-year-old lady with such a manifestation is being reported.

Cardiac myxoma with glandular elements: a histologic, histochemical, and immunohistochemical evaluation.

Epithelial differentiation in cardiac myxoma is a rare phenomenon. Out of 104 surgically excised specimens, we studied 3 cases of cardiac myxoma with glandular differentiation. All the cases had well formed glands in addition to the myxoma cells lying in a myxoid background. Detailed histochemical and immunohistochemical studies suggest that the epithelial islands in cardiac myxoma show an enteric phenotype.