Comparison of the safety and efficacy of topical Tacrolimus (0.03%) versus dexamethasone (0.05%) for subepithelial infiltrates after adenoviral conjunctivitis

Purpose: To compare the safety and efficacy of tacrolimus 0.03% ointment with dexamethasone 0.05% ointment for subepithelial infiltrates (SEIs) following adenoviral keratoconjunctivitis (AK). Methods: A randomized, double blind trial was done. Eligibility criteria was corrected distance visual acuity of 6/9 Snellen or worse for at least 4 weeks with corneal SEIs following AK. The grading of SEIs was done on a scale of 0 to 3; 0, no infiltrates, 1 mild infiltration, 2 moderate infiltration and 3, severe infiltration. Consecutive patients with SEIs following AK were randomized to receive either topical tacrolimus 0.03% or dexamethasone 0.05% ointment twice daily for 6 months. Treatment was successful if there was reduction of SEIs and improvement in vision. Results: A total of 45 patients each were assigned to the Tacro and Dexa groups, respectively. Baseline characteristics of patients did not differ significantly (P > 0.001). There was a significant change in symptoms, vision and SEIs in both the groups. However, the magnitude was greater in tacro group. Treatment was successful in 37 (92.5%) patients in Tacro and 34 (85%) patients in dexa group. In dexa group, after a period of 1.24 ± 0.24 months, 7 (15.6%) patients developed a significant rise in intraocular pressure (IOP). Three (7.5%) eyes in tacro and 6 (15%) eyes in dexa group had recurrence of SEIs after cessation of therapy. Conclusion: Tacrolimus 0.03% is an effective alternative to dexamethasone 0.05% with low recurrence rate, no significant rise in IOP but may cause burning and foreign body sensation in some patients.

Problematic internet use among students in South-East Asia: Current state of evidence

Problematic Internet use (PIU) among students has become a significant mental health concern. Our goals were to review the existing studies on problematic Internet from Southeast Asian Region and examine: the prevalence for PIU among students; explore for sociodemographic and clinical correlates; and assess the physical, mental, and psychosocial impact of PIU in this population. All studies conducted among population of the Southeast Asia, involving students (school students to postgraduate students) of any age which explored etiological factors and/or the prevalence or any other factor associated with PIU/Internet addiction were considered eligible for the present review. The electronic databases of PubMed and Google Scholar were systematically searched for the relevant published studies up to and including October 2016. Our search strategy yielded 549 articles, 295 of which were eligible for screening based on their publication in English language in a peer-reviewed journal. Of these, a total of 38 studies met the inclusion criteria and were included in the review. The prevalence of severe PIU/Internet addiction ranged from 0 to 47.4%, whereas the prevalence of Internet overuse/possible Internet addiction ranged from 7.4% to 46.4% among students from Southeast Asia. Physical impairments in the form of insomnia (26.8%), daytime sleepiness (20%), and eye strain (19%) were also reported among problem users. There is a need to conduct further research in this area to explore the protective and risk factors associated with it and also longitudinally assess the trajectories of the outcome.

Endocrine mucin-producing sweat gland carcinoma of the eyelid: A clinical and histological conundrum

A 60-year-old male presented with a 6-month-old history of a left upper lid mass. The mass was excised, and histopathological evaluation showed a well-circumscribed, multinodular, intradermal tumor consisting of round-to-oval cells with round nuclei and mucin filled cysts. On immunohistochemical analysis, the tumor cells stained positively for cytokeratin (CK)-7, CK-8, estrogen receptor (ER), progesterone receptor (PR), mucicarmine, synaptophysin, gross cystic disease fluid protein-15 (GCDFP-15), and neuron-specific enolase (NSE). A diagnosis of endocrine mucin-producing sweat gland carcinoma (EMPSGC) of the eyelid was made and at 6-month follow-up, no recurrence was noted. In this communication, we discuss the pathology and treatment options of EMPSGC of the eyelid. Although an uncommon entity, EMPSGC may be considered as a differential when encountered with a suspicious, potentially malignant eyelid mass.

The spectrum of perforation peritonitis - central India experience.

Introduction: Peritonitis secondary to gut perforation is one of the most common surgical emergencies in India and is associated with high morbidity and mortality. The aim of this study was to recognize the spectrum of perforation peritonitis as managed at Govt. Chhattisgarh Institute of Medical Sciences hospital Bilaspur Chhattisgarh, in central India. Method: A retrospective analysis of 618 patients was done,in terms of clinical presentation, duration, seasonal variation, operative findings and post operative morbidity and mortality, admitted at Chhattisgarh Institute of Medical Sciences hospital Bilaspur. Chhattisgarh, over a period of 03 years. All the patients had undergone emergency laprotomy and the site of perforation was identified. Results: The most common site of perforation was prepyloric (393 cases. 63.6%).In 22.16% of the cases the perforation was associated with typhoid fever and in 2.7% cases with abdominal Koch’s. Trauma however showed perforation in only 5.6% cases, mainly jejunal. The overall mortality was 12.13%. Conclusion: Non traumatic upper gastrointestinal perforation peritonitis is common in our place. In contrast to the west, where lower gastrointestinal tract perforations predominate, in India upper gastrointestinal tract perforations constitute the majority of cases.

Bilateral lower zone shadows on chest radiograph - A clinicopathological profile.

Background: The initial suspected diagnosis in bilateral lower zone lung involvement made clinically can be compared and correlated with the final diagnosis obtained after percutaneous FNA cytology, BAL fluid examination and transbronchial biopsy. Aim: To study diseases presenting with bilateral lower zone shadow on chest radiograph and compare the initial clinical diagnosis to the final diagnosis. Methods: Fifty six patients were studied by routine hematological, sputum and pleural fluid examination along with PCNA and TBNA cytology, bronchial aspirate/ BAL fluid examination and transbronchial biopsy after a detailed clinical history and thorough physical examination. Results: Initially suspected diagnosis included tuberculosis in 32.1% cases, pneumonia in 30.4%, malignancy in 10.7%, pulmonary oedema in 5.4%, bronchiectasis in 8.9%, ILD in 7.1%, TPE in 3.6% and bilateral hydatid disease of lung in 1.7% of cases. The final diagnosis revealed tuberculosis in 25.0% cases, pneumonia in 23.2%, malignancy in 16.1%, bronchiectasis in 8.9%, pulmonary oedema and ILD in 7.1% each, sarcoidosis and TPE in 3.6% each, while pulmonary candidiasis, pulmonary alveolar proteinosis and bilateral hydatid disease of the lung in 1.7% case each respectively. Conclusion: Majority of cases can be diagnosed by a detailed clinical profile along with a chest radiograph. However, FNAC and fibreoptic bronchoscopy are of high value for pathological and microbiological confirmation of the diagnosis and provides a significant yield.

Prevalence of aspergillosis in bronchogenic carcinoma.

Bronchoalveolar lavage of 42 patients of bronchogenic carcinoma was studied to find out the prevalence of aspergillosis. Sera of the patients were also analysed for presence of anti-Aspergillus antibodies by Immunodiffusion (ID), Enzyme linked immunosorbent assay (ELISA) and dot blot assay (DBA). Aspergillus was isolated in culture from 6 (14.2%) patients of bronchogenic carcinoma. Aspergillus fumigatus was the predominant species isolated. All the strains of Aspergillus were sensitive to itraconazole, ketoconazole and amphotericin B while resistance (33.3%) was found with fluconazole. Anti-aspergillus antibodies were detected equally by ID, ELISA and DBA in 9 (21.4%) cases. The present study revealed prevalence and seroprevalance of Aspergillus in bronchogenic carcinoma to be 14.2% and 21.4% respectively. Consistent reactivity against 18 kDa Aspergillus fumigatus antigen was noted in serologically positive cases. Antibodies against 18 kDa protein antigen in western blotting may be used as a reference marker for diagnosis of aspergillosis in bronchogenic carcinoma. It is also suggested that the simplest serological technique like ID may be performed along with culture for diagnosing Aspergillosis in patients of bronchogenic carcinoma since ID, ELISA and DBA showed similar sensitivity.

Contact vitiligo: etiology and treatment.

Fifty patients of contact vitiligo were studied. Etiological agents of contact vitiligo were identified by clinical history, distribution of lesions and patch testing with suspected material. All patients were advised to avoid the suspected agent and treated with PUVASOL and topical steroid. Out of 50 patients (Male 8%, Female 92% age 14-60 years)., etiological agent of contact vitiligo was found to be sticking bindi alone in 24 (48%), while bindi along with other etiological agents were found to be purse, foot wear, plastic watch strap, lipstick and tooth paste in 14 (28%) cases. 14 (28%) patients also had disseminated lesions of vitiligo along with contact vitiligo. Positive reaction with patch testing was observed in 18 (36%) while depigmentation was seen in 4 (8%) cases. We observed that response of treatment was better in patients with shorter duration of disease while poor response was seen in patients with longer duration of disease.

Health profile of lock factory workers in Aligarh.

In order to assess the health problems and its relationship to the nature of work of lock factory workers, a field based cross sectional study was carried out in sixty randomly selected lock factories in urban industrial areas of Aligarh city. Nine hundred fifty seven lock factory workers were included in the study out of them 45.7 percent were found to be suffering from one or more than one diseases. Detailed study of the workers showed that 73.05 percent were suffering from respiratory tract diseases, a majority of them having upper respiratory tract infection. Diseases showed a definite trend either increasing (Chronic bronchitis, Emphysema etc) or decreasing (upper respiratory tract infection, Bronchial asthma, Injuries & accidents), according to the age and duration of work. Polishing & filing appeared to be the most hazardous type of the work as shown in the proportion of chest diseases, (56.6%) & (38.3%) in polishing & filling workers respectively.

Prevalence of aspergillosis in chronic lung diseases.

Eighty eight patients of chronic lung diseases (CLD) attending TB and Chest department of J.N. Medical college Hospital were studied to find out the prevalence of Aspergillus in Broncho-alveolar Lavage (BAL) and anti- aspergillus antibodies in their sera. Direct microscopy and fungal culture of BAL was done. Antibodies were studied by immunodiffusion (ID) and Enzyme linked immunosorbent assay (ELISA). Dot blot assay for anti-aspergillus antibodies was also performed in sera of patients which were either positive by ID or by ELISA. Aspergillus was isolated in culture from 13(14.7%) cases of CLD, while, 30.6% cases showed anti-aspergillus antibodies by serological methods. Aspergillus fumigatus was the predominant species isolated. 17(19.3%) cases of CLD showed antibody against Aspergillus by ID, 22(25%) by ELISA, while 19 of 27 seropositive cases also showed positive results by Dot Blot assay. In cases of bronchogenic carcinoma and pulmonary tuberculosis, anti-aspergillus antibodies were detected equally by ID and ELISA in 21.42% and 21.05% cases respectively. In bronchial asthma, the antibodies could be detected in 60% cases by ELISA, while, in only 10% cases by ID. ELISA was found more sensitive than ID for detection of anti-aspergillus antibodies. The sensitivity of Dot Blot lies some what between ID and ELISA. It is concluded that prevalence of Aspergillosis is quite high in chronic lung diseases, culture and serological test should be performed in conjunction and more than one type of serological tests should be performed to establish the diagnosis.

Angiokeratoma of tongue.

An 8-year-old male child who presented with lesions of angiokeratoma on tongue is described.

Comparison of two colorimetric assays to determine viral infectivity in micro culture virus titration.

Efficacy of two colorimetric assays, viz. MTT (3-4,5-dimethylthiazol-2-(yl-2,5-diphenyl tetrazolium bromide) and neutral red (NR) assays, performed by integrating them to micro culture virus titration (MCVT), was compared with the conventional MCVT method in terms of percentages of infectivity and 50% infectivity end points by employing Polio virus type-3 and Dengue virus type 4 as the candidate viruses. The results suggested that MTT assay has an edge over NR assay as well as conventional MCVT method. For the first time, NR assay has been successfully employed for the determination of virus infectivity titre.

WHOQOL-Hindi: a questionnaire for assessing quality of life in health care settings in India. World Health Organization Quality of Life.

BACKGROUND: Quality of life is becoming an important component of overall assessment in health care settings. However, satisfactory instruments are not available for use in India. METHODS: Qualitative and quantitative work was conducted at the Delhi centre as a part of the WHOQOL (World Health Organization Quality of Life) project at 15 centres in developing and developed countries to construct a new quality of life instrument (WHOQOL). The pilot field trial at Delhi was conducted on 304 adult subjects using the 236-item questionnaire. RESULTS: Based on the pilot field trial data, item reduction could be done to develop a 100-item version (WHOQOL-100, Hindi). The items are distributed into 4 domains (physical; psychological, social and environmental health) and 25 facets. Each facet has four items, rated on a five-point scale. The initial psychometric properties of this instrument are satisfactory. A 26-item short version has also been developed (WHOQOL-Bref, Hindi). CONCLUSION: The WHOQOL-100, Hindi appears to be a suitable instrument for comprehensively assessing quality of life in health care settings. WHOQOL-Bref, Hindi can be used for intervention studies including drug trials.

Primary adenocarcinoma of the urinary bladder--a case report with review of literature.

Primary adenocarcinoma of the urinary bladder is a rare neoplasm. We present the clinicopathological and immunohistochemical analysis of a case in a 50 year old male. The histogenesis of the tumour and a review of literature is also discussed.

Alteration in the levels of pyrazinamide in pleural fluid following simultaneous administration of prednisoline in patients of tubercular pleural effusion.

20 Patients of tuberculous pleural effusion were administered a combination of pyrazinamide (30 mg/kg) + isoniazid (300 mg) orally for 7 consecutive days and pyrazinamide was estimated by spectrophotometric method in serum and pleural fluid. Prednisolone was added to the above regimen for next 7 consecutive days and pyrazinamide was again estimated. The level of pyrazinamide in pleural fluid was 23.4 +/- 1.2 (micrograms/ml). Following addition of prednisolone the level increased (27.6 +/- 1.3) significantly (P less than 0.001). The serum pyrazinamide level was not influenced by simultaneous administration of prednisolone. The pleural fluid/serum pyrazinamide ratio was increased from 0.465 to 0.542 by the addition of prednisolone to therapeutic regimen.

Autonomic responses to breath holding and its variations following pranayama.

Autonomic responses to breath holding were studied in twenty healthy young men. Breath was held at different phases of respiration and parameters recorded were Breath holding time, heart rate systolic and diastolic blood pressure and galvanic skin resistance (GSR). After taking initial recordings all the subjects practised Nadi-Shodhana Pranayama for a period of 4 weeks. At the end of 4 weeks same parameters were again recorded and the results compared. Baseline heart rate and blood pressure (systolic and diastolic) showed a rendency to decrease and both these autonomic parameters were significantly decreased at breaking point after pranayamic breathing. Although the GSR was recorded in all subjects the observations made were not conclusive. Thus pranayama breathing exercises appear to alter autonomic responses to breath holding probably by increasing vagal tone and decreasing sympathetic discharges.