Role of visual evoked potential as a window to detect functional changes that occur without signs of diabetic retinopathy in fundoscopy: Case series involving symptomatic overt diabetic pregnant women

Diabetic retinopathy (DR) is a microvascular complication associated with diabetes mellitus. Pregnancy is a major risk factor for DR in diabetic women. Recent evidenced suggests that in course of DR functional changes including damage of pre-ganglionic and ganglionic cells in retina precede structural microvascular changes. A number of studies in the past have highlighted the role of pattern visual evoked potential (VEP) in detecting such functional changes. However, the study of VEP changes in diabetic pregnancies remains unexplored. This case series has the objective of exploring VEP changes in symptomatic OVD cases, who had no signs of DR on fundoscopy. We present two cases of overt diabetic women who complaint of straining of eyes, headache, and difficulty in reading during pregnancy. Complete ophthalmic examination was done in both the cases followed by a VEP test. VEP test was done as a part of a research project. The ethical clearance for the project was obtained from the Institute’s Ethics Committee before the commencement of the study. Fundoscopic examination in both cases revealed that the retina was within normal limits with no signs of retinopathy. In Case 1, P100 latency was increased for the left eye and was normal for the right eye during the first visit. While P100 latency was increased for both left and right eye during the second visit. There was a substantial increase in P100 latency for both eyes in second visit as compared to first visit. In Case 2, P100 latency was increased for both left and right eye and amplitude decreased for the left eye. This is a case series consisting of symptomatic overt diabetic pregnant women who had increased P100 latency despite no signs of retinopathy in fundoscopy. The previous studies have reported that multiple follow-ups with ophthalmoscopy may not be cost-effective in diabetic pregnant women. VEP provides a window for detection of early functional changes that may help identify at risk patients for follow-up and early intervention.

Kisspeptin: new biomarker of pregnancy

Background: The recently identified hormone kisspeptin has been suggested to play an important regulatory role in placentation. The aim and objective of the study is the measurement of serum kisspeptin level in asymptomatic pregnant women and to find out the association of serum kisspeptin with gestational age in women with early pregnancy.Methods: This was a longitudinal study to the evaluation of 178 asymptomatic pregnant women with a gestation of 6 to 16 weeks attending routine antenatal booking visit recruited as study participants from the Antenatal Clinical of Obstetrics and Gynaecology Department, S.M.S. Medical College and Attached Hospitals, Jaipur, Rajasthan, India.Results: After initial clinical examination of every participant, a single blood sample was taken for the measurement of serum kisspeptin. Serum kisspeptin measurement test was performed by ELISA method and results were expressed as ng/ml. Pregnancy outcome was recorded prospectively. Mean serum kisspeptin level of study participants was 2.80±1.87ng/ml and median were 2.41 (Range 0.244-14.06ng/ml). Our result showed the relationship of serum kisspeptin with gestational age (GA) (p<0.000).Conclusions: serum kisspeptin level increases in pregnancy and showed positive relationship with gestational age significantly (p<0.000).

Gas Gangrene after an Intramuscular Injection: A Case Report.

Gas gangrene is a necrotic infection of soft tissue associated with a high mortality, often necessitating amputation to control the infection. It is mainly caused by Clostridium perfringens which is a Gram-positive, anaerobic, spore-bearing bacillus widely found in nature, particularly in soil and feces. Incubation time for gas gangrene is short, usually <24 h, and the physical finding of crepitus is characteristic in the setting of soft tissue infection. Herein, we present a case of gas gangrene of the gluteal region and thigh following an intramuscular injection where the patient was treated with multiple debridements, antibiotics, and hyperbaric oxygen therapy; a review of the literature is presented here.

Cecal Endometriosis: An Unusual Cause of Adult Ileocolic Intussusception.

Endometriosis is defined as the presence of endometrial tissue outside the endometrium and the myometrium. The gastrointestinal tract is the most common site for extrapelvic endometriosis, affecting 5-15% of women in the childbearing age group; the rectum and the sigmoid colon are the most common sites involved. Terminal ileal and cecal involvement is rare and may mimic malignancy of the colon. It is even rarer for endometriosis of the cecum to cause intussusception. The diagnosis of endometriosis in the ileocecal region is seldom made preoperatively in the absence of the previous endometriosis. Ileocolic endometriosis presenting predominantly as a mural mass and causing intussusception is very rare with few reports in world literature. We report a case of ileocolic endometriosis causing intussusceptions in an adult.

Sodium butyrate modulates pRb phosphorylation and induces cell death in human vestibular schwannomas in vitro.

In the present study, effect of Na-Bu on the pRb phosphorylation was analysed in the primary cultures of 12 VS tumors. Primary cultures of VS tumors were established from the fresh tumor tissues removed surgically and were treated with Na-Bu. Na-Bu treatment for 48 h led to morphological changes and apoptotic cell death in VS tumor cells. Na-Bu treatment decreased level of total pRb and phosphorylated form of pRb and caused specific dephosphorylation at Ser 249/Thr 252 and Ser 567. In the untreated and Na-Bu treated cells (when present), pRb was localised in the nucleus. Moreover, in Na-Bu treated cells the nucleus appeared highly condensed as compared to untreated cells. Results of the present study indicated that Na-Bu treatment modulated pRb phosphorylation status and caused apoptotic cell death in VS tumors.

Drug induced diabetes mellitus.

Drug induced diabetes occurs due to a variety of drugs and mechanisms. Considering the vast number of diabetics in this country and also the wide variety of drugs prescribed for diabetic as well as non-diabetic patients especially the elderly, the entity of drug induced diabetes does not appear to be very common. This suggests that an underlying and often unsuspected abnormality probably increases the risk of developing diabetes mellitus. Sulphonylureas which act primarily by enhancing insulin secretion, would not be an effective therapeutic modality for countering drug induced diabetes. In case the drug has to be continued, insulin therapy is the most efficacious approach. The new thiazolidinedione drugs such as troglitazone which increase insulin sensitivity in patients with glucose intolerance and diabetes, may be very useful in cases where insulin resistance has resulted in diabetes.

Peripheral nerve abscess in leprosy: report of twenty cases.

During the year 1994-1995, 20 of the 67 leprosy patients attending the dermatology department with any kind of nerve involvement were found to be having nerve abscess. These abscesses occurred in all types of leprosy (except the Indeterminate) and a variety of nerve trunks and cutaneous nerves. In none of the instances the abscess was associated with reaction. All the patients were surgically treated, without any steroid therapy. All cases showed significant improvement whenever there was nerve function deficit. Similarly, pain was relieved in all cases, when it was present.

Changing phage pattern of Staphylococcus in pyoderma cases.

Staphylococcus aureus is a major pathogen for pyoderma in India. Phage pattern of bacteria gives valuable information in epidemiological studies of infection. Two hundred and two strains of Staphylococcus aureus isolated from pyoderma cases at Gorakhpur, were phage grouped and phage typed. It was found that 43.1 percent strains were not typable. Most common group was mixed phage group (23.8 percent) followed by phage group III (12.4 percent). Predominant phage types in mixed phage group was 84/81/85 and in phage group III was 84/85.

Pattern of leprosy disabilities in Gorakhpur (Uttar Pradesh).

Out of 514 leprosy cases studied, 229(44.56%) had disability. Disability was most commonly seen in lepromatous leprosy. There was an increasing trend in disability with increasing age of patient and duration of disease. Disability rate was higher in males as compared to females. Nerve thickening and reactional states were more common in disabled cases. Dapsone treated group showed a disability rate of 63.8% as compared to 30.0% in untreated group. Hand was the most commonly affected site and mobile claw hand was the single most common disability. The overall disability index-D.I. (2) of Bachelli was 1.25 and lepromatous cases had highest D.I. (1.89). Disability index was higher in males and was found to increase with increasing age of patient and duration of disease.

A study of cutaneous lesions of leprosy on male genitalia.

The cutaneous lesions of leprosy on male genitalia were studied. They were found in 2.9% of cases examined in this series. They were seen most commonly in borderline group. It is emphasised that it is not uncommon to find lesions on male genitalia in leprosy.

A study of palmo-plantar lesions in leprosy: a preliminary report.

Out of 500 leprosy patients screened for palmar and/or plantar lesions, eighteen cases were detected. They were classified according to Ridley-Jopling classification. In majority of cases it was macular lesion. Cases were from TT, BT and BB group. In 50% cases, palmo-plantar involvement was associated with type I reaction. In 66.7% cases, it was extension of patch from surrounding area, 11.1% cases isolated lesions were seen and in 22.2% cases both extension as well as isolated lesions were present.

Calcification of ulnar nerve in leprosy--a case report.

A case of Tuberculoid leprosy who had taken irregular treatment for five years and had thickened ulnar nerve which on radiological examination showed calcification, is reported.

A report on six cases of histoid variety of lepromatous leprosy in children.

Six cases of histoid variety of lepromatous leprosy among children below 12 years of age were detected in over 3 years period. Bacteriological index was high (3 to 5+). None of the patients had received any anti-leprosy treatment. It is a public health problem because of infectious nature of the disease, therefore early detection and management of this entity among children is important.