Role of swept-source anterior segment optical coherence tomography in imaging pediatric cataract

Purpose: To determine the morphology of pediatric cataracts and assess the status of the anterior and posterior capsules preoperatively on swept?source anterior segment optical coherence tomography (ASOCT) and compare the findings to those of intraoperative examination. Secondly, we aimed to obtain biometric measurements on ASOCT and compare them to those obtained on A?scan/optical methods. Methods: This was a prospective and observational study carried out at a tertiary care referral institute. ASOCT scans for anterior segment were obtained preoperatively for all patients, aged <8 years, scheduled for paediatric cataract surgery. The morphology of the lens and capsule and biometry were performed on ASOCT and the same were assessed intraoperatively. The main outcome measures were comparison of ASOCT findings to intraoperative findings. Results: The study included 33 eyes of 29 patients (range 3 months–8 years). The morphological characterization of cataract on ASOCT was accurate in 31/33 (94%) cases. ASOCT accurately identified fibrosis and rupture of the anterior and posterior capsules in 32/33 (97%) cases each. In 30% of eyes, ASOCT gave additional information preoperatively compared to the slit lamp. Intraclass correlation coefficient (ICC) calculation revealed a good agreement between the keratometry values obtained on ASOCT and those obtained preoperatively with a handheld/optical keratometer (ICC = 0.86, P = 0.001). Conclusion: ASOCT is a valuable tool that could provide complete preoperative information of the lens and capsule in pediatric cataract cases. In children as young as 3 months of age, intraoperative risks and surprises could be diminished. The keratometric readings are highly dependent on patient cooperation but show good agreement with the handheld/optical keratometer readings.

Perception of college-going girls towards corneal donation in North India: A latent class analysis study

Purpose: To assess the perception of college?going girls toward corneal donation in Northern India. Methods: An online survey with a pre?structured, pre?validated questionnaire was conducted on 1721 college?going girls in Northern India. The knowledge and attitude scores were regressed, and latent class analysis was carried out. Results: The average of scores for all participants was computed individually for the knowledge questions and the attitude questions, and based on this score, total participants were divided into two groups: Better corneal donation behaviors (BCDB) and poor corneal donation behaviors. The binomial logistic regression model of knowledge domain for predicting BCDB, age of the participant, their awareness about corneal donation, and willingness to discuss eye donation among family members were found significant. Similarly, for the attitude domain, awareness about corneal donation, knowledge about hours within which ideal eye donation needs to be undertaken, and knowledge about eye donation during coronavirus disease 2019 (COVID?19) pandemic were found to be significant. Latent class analysis identified one subset of participants having poorer knowledge and attitude scores and that they were more from a rural background, were having more than first order as birth order, were belonging to SC/ST classes, had illiterate or secondary education of father and mother, and were living in rented houses. Conclusion: The findings of the study significantly contribute to devising a mechanism to improve knowledge and influencing the attitude about eye donation among the youth, especially young women, who can act as counselors and motivators for the masses as well as their own families, in the generations to come.

Disulfiram Induced Mania — A Case Report

Disulfiram has been most widely used in patients suffering from alcohol dependence. When taken along with alcohol it can cause various side effects like flushing, drowsiness, rashes, hyperventilation, palpitations etc. Mania due to Disulfiram is an uncommon side effect and there are only a few reports of it. We hereby report a case of the development of Mania in an individual with alcohol dependence following 2 months of treatment with a therapeutic dose of Disulfiram. Before the onset of mania, the patient was abstinent from alcohol for about 2 months, which made substance-induced mania unlikely. The possible mechanism for this is the dopamine hypothesis which suggests that Disulfiram inhibits dopamine-Beta-hydroxylase which is responsible for the conversion of dopamine to Nor-adrenaline and increases the dopamine level which is responsible for psychotic and mania symptoms. This possibility of Disulfiram induced mania should be assessed whenever clinicians encounter patients with dual diagnosis, as this might change the management as such.

Orbital magnetic resonance imaging profile and clinicoradiological correlation in COVID-19-associated rhino-orbital-cerebral mucormycosis: A single-center study of 270 patients from North India

Purpose: To study the clinical profile and magnetic resonance imaging (MRI) features in patients of COVID?19?associated rhino?orbital?cerebral mucormycosis (CA?ROCM) with orbital involvement and perform a clinicoradiological correlation. Methods: A cross?sectional study was performed at a tertiary care center in north India from May 2021 to June 2021. Consecutive patients with clinical, nasal endoscopic, and/or microbiological evidence of CA?ROCM underwent MRI of paranasal sinuses, orbit, and brain as per the study protocol. Orbital MRI findings were studied in detail and were correlated with clinical signs. Results: Two hundred and seventy patients were studied. The mean age was 48.4 (± 16.82) years. A male predilection was noted (male:female = 1.77). Orbital involvement was seen in 146 (54%) patients on clinical evaluation and in 184 (68%) patients on MRI. Unilateral orbital involvement was more common (134; 92%). The most common presenting symptom was periorbital and/or facial pain (141; 52.2%) and the most common clinical sign was periorbital edema (116; 43%). The most common MRI finding was suggestive of orbital cellulitis (160; 59%). Orbital compartment syndrome was found in 17 (6.3%) patients. The inter?rater agreement between clinical and radiological assessments to detect the involvement of infraorbital nerve and frontal nerve was found to be 85.56%, (? 0.621) and 93.70% (? 0.776), respectively. The diagnostic accuracy, sensitivity, and specificity of MRI to detect medial orbital wall defect were found to be 87.9%, 65%, and 97%, respectively. Conclusion: Orbital imaging features of a cohort of ROCM patients have been presented with clinicoradiological correlation.

Association of screen time, quality of sleep and dry eye in college-going women of Northern India

Purpose: To evaluate the association of daily screen time and quality of sleep with the prevalence of dry eye among college?going women. Methods: This study was a cross?sectional, comparative questionnaire?based study of 547 college?going women in northern India. A 10?item Mini Sleep Questionnaire was used to check the quality of sleep, and the Standard Patient Evaluation of Eye Dryness (SPEED) scale was used to examine the prevalence of dry eye among college?going women. Results: Multinomial logistic regression showed a significant association between dry eye with daily screen time spent (P < 0.05) and the quality of sleep (P < 0.05) among college?going girls. Using Latent Class Analysis, two latent classes were selected based on the Bayesian Information Criteria. It was found that the majority population falls in class two and was having Severe Sleep?Wake difficulty. It was seen that the participants in class two belonged to the age bracket of 18–21 years, were from stream Humanities, education of father and mother equal to graduation, father working only, belonging to the nuclear family, having one sibling, hailing from the urban locality, spending more than 6 h daily on?screen, a majority of them using mobile phones, not using eye lubricants, and reported an increase in screen time during COVID?19. Conclusion: Dry eye and sleep quality are essential global health issues, and coupled with increased screen time, may pose a challenge in the present era. Preventive strategies need to be incorporated in school and college curriculums to promote physical, social, and psychological well?being and quality of life

A comparative study of concomitant boost radiation versus concomitant boost with concurrent chemoradiation versus standard fractionation chemoradiation in locally advanced head-and-neck cancer

Context: As the number of head-and-neck cancer (HNC) patients are high in our subcontinent, the study was designed to reduce the treatment time and increase efficacy. Aims: Comparative evaluation of the efficacy, toxicity, local control, and survival of concomitant boost radiotherapy (CBRT), CBRT with concurrent chemoradiation (CBRT + CCT) and conventionally fractionated radiotherapy with concomitant chemotherapy (CFRT + CCT) in locally advanced HNC (LAHNC). Materials and Methods: Patients with LAHNC were randomly assigned to 3-groups of 30-patients each. Group I (CBRT) received, 45 Gy/25#/5-weeks and 18 Gy/10# concomitant boost in the last 2-week of treatment, receiving a total dose of 63 Gy. Group II (CBRT + CCT) received CBRT with concomitant cisplatin 75 mg/m 2 on day 1, 17, and 34. Group III (CFRT + CCT) received 64 Gy/32#/6.2 weeks, concurrent with injection cisplatin 75 mg/m 2 on day 1, 22, and 42. Statistical Analysis Used: Stata 9.0 SPSS and Chi-square test were used for analysis and disease-free survival (DFS) rates were calculated using the Kaplan–Meier method. Results: The median follow-up period was 8.2 months. At last follow-up, locoregional control was 36%, 57%, and 40% and DFS was seen in 33%, 53%, and 40% of patients in Group I, II, and III, respectively. Grade-3 cutaneous reactions were significantly higher in Group-II as compared to that of Group-III (P = 0.033) and Group-I (P = 0.715). Conclusion: All three groups have similar response rates and DFS with manageable toxicity

A peculiar case of cancer en cuirasse in adenocarcinoma rectum

Cancer en cuirasse in a case of primary adenocarcinoma rectum is an exceedingly rare phenomenon which is scarcely seen in isolated case reports only. It is a specific morphological variant of cutaneous metastasis characterised by diffuse induration and oedema of cutis which is studded with carcinomatous lesions. Cutaneous metastases often occur in elderly individuals in their sixth decade or later. Herein we present a case of carcinoma en cuirasse arising in a young female who was operated for adenocarcinoma rectum.

Tuberculosis Thyroid With Fnac Changes Mimicking Thyroid Tumor

TB in India is extremely common especially in young and adults as compare to other age groups. It is more common in the female population in India where women remain poor and neglected. We present the case of a 35-year-old male who presented with a thyroid lump. On examination, there was a solitary, non-tender, and firm swelling on the left midline neck with no evidence of lymphadenopathy. Ultrasound of thyroid revealed multinodular goiter with the largest nodule (3.5 × 2 cm) in the right lobe of the thyroid. Ultrasound-guided FNAC revealed follicular cells on a background of lymphocytes making a diagnosis of thyroiditis and underwent hemithyroidectomy for the same

Subinhibitory concentration of ciprofloxacin targets quorum sensing system of Pseudomonas aeruginosa causing inhibition of biofilm formation & reduction of virulence.

Background & objectives: Biofilms formed by Pseudomonas aeruginosa lead to persistent infections. Use of antibiotics for the treatment of biofilm induced infection poses a threat towards development of resistance. Therefore, the research is directed towards exploring the property of antibiotics which may alter the virulence of an organism besides altering its growth. The aim of this study was to evaluate the role of subinhibitory concentration of ciprofloxacin (CIP) in inhibiting biofilm formation and virulence of P. aeruginosa. Methods: Antibiofilm potential of subinhibitory concentration of CIP was evaluated in terms of log reduction, biofilm forming capacity and coverslip assay. P. aeruginosa isolates (grown in the presence and absence of sub-MIC of CIP) were also evaluated for inhibition in motility, virulence factor production and quorum sensing (QS) signal production. Results: Sub-minimum inhibitory concentration (sub-MIC) of CIP significantly reduced the motility of P. aeruginosa stand and strain and clinical isolates and affected biofilm forming capacity. Production of protease, elastase, siderophore, alginate, and rhamnolipid was also significantly reduced by CIP. Interpretation & conclusions: Reduction in virulence factors and biofilm formation was due to inhibition of QS mechanism which was indicated by reduced production of QS signal molecules by P. aeruginosa in presence of subinhibitory concentration of CIP.

Expression and clinicopathological significance of antiapoptotis protein survivin in gallbladder cancer.

Background: Clinical significance of survivin (antiapoptosis protein) in gallbladder cancer is not yet established. Aims: This study was performed to assess the expression pattern of survivin in benign and malignant gallbladder lesions using immunohistochemistry (IHC), and to assess its clinicopathological significance. Settings and Design: Prospective study from July 2012 to July 2014 was performed as a part of intramural research project. Materials and Methods: Tissue samples from resected gallbladder for cholelithiasis (n = 27) and carcinoma gallbladder (n = 24) were evaluated for survivin expression by IHC using a scoring system. Their expression was correlated with different clinicopathological parameters. Statistical Analysis: Fisher’s exact test, Student’s t‑test, and Chi‑square test were used as appropriate for data analysis. Kaplan–Meier methods were used to calculate overall and disease‑free survival rates among different groups. Two‑sided P < 0.05 was considered as significant. Results: Benign group (19 females, age [mean ± standard deviation [SD]] 45 ± 14 years) and malignant group (20 females, age [mean ± SD] 48.9 ± 13.4 years) were comparable with respect to menopausal status, presence, size and types of stones. However, survivin expression was significantly higher (66.7%, 95% confidence interval [CI] 24–75) in gallbladder cancer than in cholelithiasis group (33%, CI 46–83), P = 0.025). Its expression did not correlate with gender, age, menopausal status, presence of gallstones or their size, number and type, tumor differentiation, and tumor stage. Conclusions: Significantly higher expression of survivin protein in gallbladder cancer as compared to cholelithiasis group suggests its role in gallbladder carcinogenesis though it may not have prognostic value.

Chondroid Chordoma of the L5S2 Spinous Process Body: A Rare Case Report

Chordoma are slow growing, locally destructive tumors derived from remnants of notochord. They occur mostly along axial skeleton that is basiocciput and sacrococcygeal area. are biphasic malignant neoplasm possessing elements of both chordoma and cartilaginous tissue, an entity which has better prognosis than classical Chordoma. The tumor is likely to recur and hence diagnostically important for appropriate management. Histopathologically, tumor showed chords or nests of cells with partly vacuolated cytoplasm (physaliferous cells) embedded in a myxoid matrix and extensive cartilage formation with degenerative calcification was seen. Immunohistochemically, tumor was positive for Cytokeratin and EMA and negative for S-100 except for Cartilaginous areas which were S-100 positive. We report a case of Chondroid chordoma in a 50 year male presented with intermittent radiating pain in both leg and backache for 1 year. MRI lumbosacral showing the tumor in posterior elements if L S vertebra. Chondroid chordoma is a distinct entity to be 5 2 discriminated from typical type of Chordoma because of its better prognosis. MRI cannot differentiate between Chondroid chordoma and typical chordoma. Awareness of this rare tumor will avoid misdiagnosis and improve the prognosis. Awide surgical excision coupled with adjuvant radiation is the best treatment in the present case.

Walthard Cell Rest Over Fallopian Tube Mimicking? Brenner Tumor- A Curious & Interesting Case Report

Walthard cell rests are benign cluster of epithelial cells found in connective tissue of fallopian tubes and also seen in the mesovarium, mesosalpinx and ovarian hilus. It was proposed that Walthard cell rests may be a source of Brenner's tumor or primary urothelial cell carcinoma because of similar histogenetic origin of their cells. Here we report a case which not only during gross examination showed peculiar peritubal glistening tiny nodules but also demonstrated attention grabbing clusters of cell on histopathology, mimicking ? A tumor. A diagnosis of Walthard cell rest was made. One should always consider a differential diagnosis as Brenner's tumor (primary) or serosal implant from gynaecological, genitourinary or other tumors before making a confirmatory diagnosis of Walthard cell rest.

Usefulness of Serum Prolactin in Differentiating Epileptic and Pseudoseizures in Children.

Transient hyperprolectinemia has been reported to follow unprovoked seizures. This study was conducted in 90 children aged 1-18 years of age. The study comprised of four groups: Group-1 consisted of children with epilepsy which was further subdivided into GTCS, CPS and SPS. Group-2 comprised of children having febrile convulsions. Group-3 comprised of children suffering from non-epileptic paroxysmal events like breath holding spell, syncope and pseudoseizures or conversion reaction. Group-4 consisted of children who served as controls. Blood sample was collected within two hours of the event in all the groups. The exact interval between the event and the collection of blood sample was noted. Serum prolactin level was estimated by ELISA technique. In the present study, significant elevation of serum prolactin level was observed only in the Group-1 (28.77+15.49ng/ml) as compared to controls (9.53+2.45ng/ml) and the highest levels were observed in children with GTCS. Maximum elevation of prolactin was seen within 15 to 30 minutes post ictally. As the prolactin levels become normal after two hours of post ictal period, the test looses its significance.

Morphological findings in bone marrow biopsy and aspirate smears of visceral kala azar: A review.

Context: Visceral leishmaniasis (VL) is endemic in India and may simulate and cause many hematological disorders like pancytopenia, myelofibrosis, myelodysplasia and hemophagocytosis. Aims: The study aims to investigate the hematological manifestation of Visceral Leishmaniasis and associated changes that may be observed in bone marrow aspirate smears and biopsy which may warn a pathologist of possible infections. Settings and Design: This is a retrospective study of 18 VL cases on B (b) one marrow aspirate and biopsy in the department of Pathology in a tertiary care teaching hospital in New Delhi. Methods and Material: Giemsa stained slides of bone marrow aspirates and hematoxylin and Eosin stained biopsy slides were reviewed in detail by two competent pathologists. All the findings were tabulated and discussed and comparisons made with the previous similar studies. Results: Hyper cellular marrow, increased lymphocytes and plasma cells, marrow granulomas, hemophagocytosis, myelofibrosis, myelodysplasia and gelatinous transformation of the marrow were notable features the presence of which together or individually should caution a pathologist to search for Leishman Donovan (LD) bodies in patients especially in a non-endemic zone in a tropical country.