An inadvertent usage of the deep stromal lenticule in anterior lamellar keratoplasty – An emancipator technique

Anterior lamellar keratoplasty (ALK), of late, has gained popularity because of its prolonged graft survivability as a result of reduced endothelial cell loss. A 56-year-old female with bilateral granular corneal dystrophy was taken up for ALK in the left eye. Because of unforeseen errors during the procedure, the surgeon was obliged to customize a novel technique by using a deep stromal lenticule after removal of Descemet’s membrane. Post-op visual recovery was equivalent to conventional ALK with complete epithelization of the graft. This new or adapted technique has an added advantage for surgeons to prevent forfeiture of the valuable donor tissue. In the developing world, manual dissection is still the primary technique of lamellar keratoplasty and many precious corneas get wasted because of intra-operative unintended errors of dissection and trephination. Therefore, this novel technique holds its importance in saving the precious corneal tissue, especially in developing countries, and opens a new area for exploration.

Post-corneal transplant Candida keratitis – Incidence and outcome

Purpose: To report the risk factors, clinical characteristics, and outcomes of Candida keratitis following corneal transplantation in India. Methods: On retrospective review of medical records of 789 patients, 31 eyes developed a graft infection following corneal transplantation or keratoprosthesis and we could identify the Candida infection in only five. These cases were operated at two tertiary care centers in India. These five records were reviewed for demographics, risk factors (local and systemic) for graft infection, characteristics of infective lesion, corneal scraping results, treatment plan, and the final outcome following management. Results: The median age of the subjects with the Candida graft infection was 62.4 ± 10.33 years (range, 62–71 years). All patients were males. The predominant risk factors included repeat corneal transplantation (5/5), prolonged usage of topical steroids (5/5), and epithelial defects (4/5). The clinical characteristics included infiltrates of variable configuration like powdery deposits, white plaque, fluffy white infiltrate, and crystalline keratopathy. The smear showed budding yeasts in all five cases whereas culture was positive in four out of five cases. The final outcome with antifungals (systemic [4/5] and topical [5/5]) is variable. Two eyes underwent evisceration, two eyes had scar formation in the failed grafts, and one patient succumbed to the systemic disease 1?month post?corneal infection. Conclusion: Candida keratitis, in India, seems to be an emerging pathology following corneal transplantation and has a varied presentation. Though the outcomes following management seem to be grim, however, such infection can easily be avoided by a timely reduction of the risk factors.

Effect of sitagliptin on depression in male wistar rats

Background: Growing evidence supports relationship between depression and inflammation. The hypothesis of involvement of inflammatory pathways in depression is supported by the findings of increased levels of proinflammatory cytokines. So, we decided to evaluate the effect of sitagliptin on depression using forced swim test (FST) and possible effects of sitagliptin on serum oxidative stress markers and cytokine gene expression in rat hippocampus.Methods: FST model was used to evaluate antidepressant effect in male wistar rats. Rats in group I (control group) were given normal saline, group II (standard group) were given fluoxetine, group III and IV (test groups) were given sitagliptin 5 mg/kg and sitagliptin 9 mg/kg respectively. All the drugs in all groups were given per orally. At the end, animals were sacrificed and blood was collected. Hippocampus of rat brain was dissected out. Serum oxidative stress markers and hippocampal pro inflammatory cytokine gene expression analysis was carried out.Results: Sitagliptin 5 mg/kg and 9 mg/kg showed reduction in depressive symptoms and hippocampal cytokine gene expression in comparison to control. In case of serum oxidative stress markers, there was statistically significant reduction in nitric oxide levels with stagliptin 9 mg/kg. Although there was a decrease in the levels of catalase and increase in the levels of glutathione with standard and test groups, the results were not statistically significant.Conclusions: The present study showed significant antidepressant effect activity of standard and test groups. Hence, further research should be carried out to substantiate above results.

Survey on Pesticides Used by Farmers in Belagavi Taluka and Analysis of Pesticide Residues in Commonly Used Vegetables

Background: Fruits and vegetables are important components of the human diet since they provide essential nutrients that are required for most of the reactions occurring in the body. However, indiscriminate and overuse of pesticides damage agriculture and environment, but the pesticide residues on food products affect the health. Aim and Objective: The present study aimed to assess the Knowledge, Attitude and Practices (KAP) among the farmers of Belagavi taluka, regarding the pesticide use and to determine pesticide residues in commonly used vegetables. Materials and Methods: The present cross-sectional study included a total of 200 farmers selected randomly from 4 divisions of Belagavi taluka. Questionnaire was developed to assess the KAP. Fresh tomatoes and chilies were used as samples, fine homogenized sample (200 g) was extracted with ethyl acetate and analyzed using gas chromatography-mass spectrometry. Results: Most of them were aware of the precautions to be taken during pesticide use. However, not all armers followed the measures. Maximum of them used pesticides (n=150), followed recommended method (n=130) and concentration (n=152). Pesticide residues found in chili and tomato samples exceeded the maximum residue limit. Conclusion: Chlorpyrifos and ethion in tomato sample, and chlorpyrifos and cypermethrin in chillies sample were the pesticide residues. Protective measures followed by the farmers was poor. Therefore, the knowledge of the farmers should be upgraded and, camps should be conducted periodically to monitor pesticide residues and health of the farmers.

Clinical profiling of subclinical hypothyroidism at presentation at tertiary care center

Background: Subclinical hypothyroidism (SCH) is defined as serum thyroid-stimulating hormone (TSH) level above upper limit of normal despite normal levels of serum free thyroxine, stable over a period of one month in the absence of any non thyroidal illness. Present study is aimed at evaluating prevalence of SCH in developing countries and evaluating the clinical spectrum of these patients highlighting the importance of treatment of SCH.Methods: Total number of 120 patients with established SCH was enrolled for the study over 3 years. The values were measured by third generation non-isotopic immunochemiluminiscence method using the standard protocol as indicated in the kit.Results: Patients were aged 15-50 years old. The most common manifestation was generalized weakness, lethargy and tiredness (60%) followed by generalized body ache (52.5%). 46.7% % of the patients had complaints of weight gain. Triglyceride levels and serum cholesterol levels were deranged in 28.3% of all cases. Body mass index was increased in 28.3% of all patients with obesity in only 2 patients. 15 patients (11.7%) were found to be anaemic with increased MCV and MCH/MCHC, attributable to hypothyroidism.Conclusions: These symptoms caused significant debilitated life style and poor outcome in SCH patients. Treatment of these patients can help in improving their lifestyle and perform better on daily basis.

Scanning laser polarimetry in glaucoma.

Glaucoma is an acquired progressive optic neuropathy which is characterized by changes in the optic nerve head and retinal nerve fiber layer (RNFL). White‑on‑white perimetry is the gold standard for the diagnosis of glaucoma. However, it can detect defects in the visual field only after the loss of as many as 40% of the ganglion cells. Hence, the measurement of RNFL thickness has come up. Optical coherence tomography and scanning laser polarimetry (SLP) are the techniques that utilize the evaluation of RNFL for the evaluation of glaucoma. SLP provides RNFL thickness measurements based upon the birefringence of the retinal ganglion cell axons. We have reviewed the published literature on the use of SLP in glaucoma. This review elucidates the technological principles, recent developments and the role of SLP in the diagnosis and monitoring of glaucomatous optic neuropathy, in the light of scientific evidence so far.

The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractory glaucoma in Indian eyes.

Aim: To evaluate the efficacy of Ahmed glaucoma valve (AGV) drainage devices in cases of adult refractory glaucoma in Indian eyes. Settings and Design: Retrospective interventional case series study. Materials and Methods: Fifty two eyes of 32 patients of refractory glaucoma in the age group of 35 to 60 years who underwent AGV implantation with or without concomitant procedures from January 2003 to Jan 2007 were studied. Of these, 46 eyes (88%) had undergone filtering surgery earlier whereas remaining eyes underwent primary AGV implantation following failure of maximal medical therapy. The follow up ranged between 12 months to 48 months Results: Eighteen eyes (35%) had undergone phacoemulsification with AGV implantation, penetrating keratoplasty (PK) with AGV and intraocular lens (IOL) implantation in 13 eyes (25%), AGV over preexisting IOL in eight eyes (15%). AGV implantation alone was done in six (11%) eyes. Anterior chamber (AC) reconstruction with secondary IOL and AGV was performed in the remaining eyes. The mean intra ocular pressure (IOP) decreased from 36.3 ± 15.7 mm Hg to 19.6 ± 9.2 mm Hg. Complete success as per criteria was achieved in 46 eyes (88%). None of the eyes had failure to maintain IOP control following AGV. Conclusion: The AGV resulted in effective and sustained control of IOP in cases of adult refractory glaucoma in intermediate follow up.

Aetiology and clinical profile of spontaneous pneumothorax in adults.

BACKGROUND: Limited information is available on epidemiology of spontaneous pneumothorax (SP) from India. The present study was aimed at studying aetiology and clinical profile of patients with SP. METHODS: All patients admitted at a tertiary care hospital with the diagnosis of SP between January 2001 and March 2002 were prospectively studied. Detailed demographic and clinical data were recorded. Patients were divided into two groups-primary spontaneous pneumothorax (PSP), if no underlying aetiology for pneumothorax was found, and secondary spontaneous pneumothorax (SSP), when an underlying respiratory disorder could be identified. The clinical features were compared between the two groups. RESULTS: Sixty patients (12 with PSP and 48 with SSP) were included in the study. Annual incidence of SP was calculated as 99.9 per 100,000 hospital admissions. Annual incidence figures for PSP and SSP were 20.0 and 80.0 per 100,000 hospital admissions respectively. Age distribution showed a biphasic pattern and the overall male to female ratio was 5 : 1. The most common cause of SSP was found to be pulmonary tuberculosis (41.7%). CONCLUSIONS: Pneumothorax is more common among men. In India, SSP is far more common than PSP, and the predominant underlying cause is pulmonary tuberculosis.

Efficacy of splinting and oral steroids in the treatment of carpal tunnel syndrome: a prospective randomized clinical and electrophysiological study.

OBJECTIVE: To study the efficacy of splinting and oral steroids in the management of carpal tunnel syndrome (CTS). DESIGN: Prospective, randomized, open-label, clinical and electrophysiological study with 3-month follow-up. MATERIALS AND METHODS: Forty patients with CTS were randomly divided into splint group (N-20), wearing splint in neutral position for 4 weeks; and steroid group (N-20), who received oral prednisolone 20 mg/day for 2 weeks followed by 10 mg/day for 2 weeks. Clinical and electrophysiological evaluations were done at baseline and at 1-month and 3-month follow-up. Independent 't' test and paired 't' test were used for statistical analysis. OUTCOME MEASURES: Primary outcome measure was the symptom severity score and functional status score. Secondary outcome measures were median nerve sensory and motor distal latency and conduction velocity. RESULTS: At the end of 3 months, statistically significant improvement was seen in symptom severity score and functional status score in both groups (P<0.001). Median nerve sensory distal latency and conduction velocity also improved significantly in both the groups at 3 months. Improvement in motor distal latency was significant (P=0.001) at 3 months in steroid group, while insignificant improvement (P=0.139) was observed in splint group. On comparing the clinical and electrophysiological improvement between the two groups, except for the functional status score, there was no significant difference at 3-month follow-up. Improvement in functional status score was significantly more in steroid group (P=0.03). CONCLUSION: There was significant improvement in both groups, clinically as well as electrophysiologically, at 3 months. On comparing the efficacy of the two treatment methods, except for the functional status score, there was no significant difference between the two groups.

Adrenoleukodystrophy manifesting as spinocerebellar degeneration.

X-linked adrenoleukodystrophy (XALD) is an inherited disorder of peroxisomal metabolism. Atypical presentations have been occasionally reported in literature. However, extrapyramidal and cerebellar manifestations are distinctly rare. We report a patient of X-linked adrenoleukodystrophy with cranial and cervical dystonia and neurological presentation resembling spinocerebellar degeneration followed by a brief review of relevant literature.

Isolation and characterization of plasma membrane from Acanthamoeba culbertsoni.

A rapid method for preparation of plasma membrane from Acanthamoeba culbertsoni involving toluene treatment followed by lithium bromide extraction is described. In the plasma membrane preparation, 5'-nucleotidase, Na+ + K+ -ATPase, Mg2+ -ATPase and glucose-6-phosphatase activities were enriched. The membrane preparation was free from nucleic acid, cytochrome P-450 and cytochrome b5. Amino acid (14C-Ieucine) was not incorporated in the plasma membrane in 2 min. Succinic dehydrogenase was not detectable in the plasma membrane preparation. The molar ratio of cholesterol and phospholipids was 0·95 which is characteristics for plasma membranes. Under electronmicroscopy the preparation was homogenous without any other component of the cell. Plasma membrane proteins and glycoproteins were separated on acrylamide gel electrophoresis.