Comparison of topical steroids versus adjunctive intracameral triamcinolone versus posterior subtenon triamcinolone in pediatric cataract surgery

Purpose: Prolonged postoperative topical corticosteroids are commonly given after pediatric cataract surgery to control inflammation. This study was undertaken to compare the efficacy, safety, and compliance of postoperative topical steroids and adjunctive intracameral (I/C) triamcinolone acetonide (tricort) and posterior subtenon (PST) triamcinolone in modulating postoperative inflammation after surgery. Methods: Forty?eight eyes of children with pediatric cataract between the ages of 5 and 10 years were randomized into three equal groups (T, I, S) before surgery. Group T received postoperative topical 1% prednisolone tapered over 4 weeks; Group I received adjunctive intraoperative I/C 1.2 mg/0.03 ml tricort and topical 1% prednisolone for 2 weeks postoperatively, and Group S received a single 0.5 ml (40 mg/ ml) PST tricort without topical steroids. Signs of inflammation, intraocular pressure (IOP), and central corneal thickness were assessed at day 1, week 1, week 3, week 6, and week 12 postoperatively with optical coherence tomography (OCT) macula to rule out cystoid macular edema at the sixth and 12th weeks postoperatively. Results: Posterior synechiae were present in two eyes out of 16 in groups T and I, which resolved. Severe anterior chamber cells were present in four eyes out of 16 in group T, in two eyes in group I, and in one eye in group S, which resolved. All groups had comparable pre? and postoperative IOP. Conclusion: In pediatric cataracts, outcomes were better with PST tricort and the adjunctive I/C tricort compared to postoperative topical prednisolone, for modulating postoperative inflammation

Orbital varix presenting with enophthalmos and intermittent proptosis: a case report

We report the case of a 22-year-old male, presenting with right enophthalmos and intermittent exophthalmos observed after valsalva maneuver. Orbital imaging revealed a retrobulbar vascular lesion with multiple phleboliths suggestive of orbital varices. On magnetic resonance angiography, no obvious feeder vessel could be delineated. We decided to manage the patient conservatively, in the absence of complications such as proptosis with corneal exposure, optic nerve compression, orbital hemorrhage. Orbital varix is a low flow vascular anomaly which generally presents with an intermittent exophthalmos. Development of enophthalmos associated with orbital varices as in our case, is very rare.

A case of nevirapine-induced exfoliative dermatitis in an immunocompromised patient: a case report.

Nevirapine is a non-nucleoside reverse transcriptase inhibitor used as one of the first-line drugs for the highly active antiretroviral therapy (HAART) in human immunodeficiency virus positive patients. The side effects range from skin rashes to fulminant hepatotoxicity. The most of the side effects are manifested in the first 6-10 weeks indicating a need for close monitoring and follow-up of the patient in first few weeks. We hereby are presenting a case of a 41-year-old female who developed exfoliative dermatitis after 4 weeks of therapy. Keywords: Highly active antiretroviral therapy, Human immunodeficiency virus, Exfoliative dermatitis, Non-nucleoside reverse transcriptase inhibitors, Nucleoside reverse transcriptase inhibitor.

Bilateral optic disc pit with maculopathy in a patient with cleft lip and cleft palate.

Optic disc pit (ODP) is small, gray‑white, oval depression found at the optic nerve head. It is a congenital defect that occurs due to imperfect closure of superior edge of the embryonic fissure. Cleft lip and palate are also congenital midline abnormalities occurring due to defect in the fusion of frontonasal prominence, maxillary prominence and mandibular prominence. There is only one case report describing the occurrence of ODP in a young patient with cleft lip and palate who also had basal encephalocele. We describe a 52‑year‑old patient with congenital cleft lip and palate with bilateral ODP with maculopathy but without any other midline abnormality.

Clinical and Immunohaematological Course of 64 Cases Of Antenatal Rh D Alloimmunisation At A Tertiary Care Centre In India.

Background and Objectives: Incidence and outcome of Hemolytic disease of Fetus and New-born due to RhD alloimmunisation has changed in last few decades after the advent of RhIG and other diagnostic and therapeutic tools. But reports from different centres vary. In this study Rh D sensitised antenatal women were followed up at Medical college, Trivandrum and clinical &laboratory profile analysed. Objectives of the study are to describe the clinical &laboratory profile of Rh D alloimmunised pregnant ladies and to describe severity and treatment of Hemolytic Disease in their off springs. Materials and Methods: Cross sectional study done on 64 antenatal cases, positive for anti Rh D antibodies by ICT and followed up with serial titres and ultrasound. Cord blood values and Direct Coombs test were used to diagnose HDFN at birth. Data was analyzed in SPSS ver.17.catagorical data was expressed in percentages and continuous data was expressed with mean and standard deviation. Results: Out of 2,496 Rh D negative women tested with ICT, 78 (3.12%) were positive.54 RhD positive new-borns were DCT positive (93.1%).50.9% cases were unaffected or mild. Severe cases accounted for 10% only. Majority (50%) received no treatment and phototherapy was the major modality of treatment. Overall survival rate of affected new-borns was 92.18%. Out of 6 hydropic babies, 4 died in utero. Interpretations and Conclusions: Rh alloimmunisation is still prevalent among antenatal women, but majority of cases produces only mild disease in new-born. Survival rate in newborns is >90%. Hydropic babies have a higher death rate. Better strategies to prevent Rh D alloimmunization and introduction of interventions like IUT are warranted.

Ocular findings in a case of periorbital giant congenital melanocytic nevus

Giant congenital melanocytic nevus [GCMN] is a large melanocytic nevus that rarely occurs in the periorbital region. Various systemic, as well as ophthalmic associations, have been reported with GCMN. However, there is only one case report describing ophthalmic findings in periorbital GCMN. We describe the ocular findings in a case of periorbital GCMN

Temporal changes of Japanese encephalitits virus in different brain regions of rat.

Background & objectives: Japanese encephalitis virus (JEV) infection results in acute encephalitic illness. The affinity of JEV to different regions of brain and temporal changes in viral load have not been studied. This study was conducted to describe localization of JEV to different regions of the brain at different stages of disease in a rat model of Japanese encephalitis (JE). Methods: Twelve days old Wistar rats were inoculated intracerebrally with a dose of 3 x 106 pfu/ml of JEV. After 3, 6, 10 and 20 days post-inoculation, brains were dissected out and different regions of brain (cortex, striatum, thalamus and mid brain) were taken. Motor deficit was assessed by the rota rod and JEV RNA copies were evaluated using real-time PCR assay. Results: There was a significant increase in motor deficit in rats inoculated with JEV compared to the controls. JEV RNA copies were present in all studied regions of the brain on days 3, 6 and 10 post-inoculation. Maximum number of JEV RNA copies were present in the mid brain on days 3 and 10 post-inoculation. JEV RNA copies were not detected in any of the brain regions on day 20. Interpretation & conclusions: This study reports JEV RNA load in different brain regions of rat with higher affinity of JEV virus to thalamus and mid brain compared to other regions.

Inflammatory glaucoma

Glaucoma is seen in about 20% of the patients with uveitis. Anterior uveitis may be acute, subacute, or chronic. The mechanisms by which iridocyclitis leads to obstruction of aqueous outflow include acute, usually reversible forms [e.g., accumulation of inflammatory elements in the intertrabecular spaces, edema of the trabecular lamellae, or angle closure due to ciliary body swelling] and chronic forms [e.g., scar formation or membrane overgrowth in the anterior chamber angle]. Careful history and follow-up helps distinguish steroid-induced glaucoma from uveitic glaucoma. Treatment of combined iridocyclitis and glaucoma involves steroidal and nonsteroidal anti-inflammatory agents and antiglaucoma drugs. However, glaucoma drugs can often have an unpredictable effect on intraocular pressure [IOP] in the setting of uveitis. Surgical intervention is required in case of medical failure. Literature on the Medline database was searched using the PubMed interface

D-dimer is useful in the diagnosis of cortical venous sinus thrombosis.

BACKGROUND: Estimations of D-dimer correlate with deep vein thrombosis and pulmonary thromboembolism and may serve as a marker of cortical venous sinus thrombosis (CVST). AIM: To study the usefulness of D-dimer in the diagnosis of CVST. MATERIALS AND METHODS: A total of 26 patients with CVST were subjected to a detailed medical history and neurological evaluation. A cranial MRI was carried out on a 1.5T scanner using T1, T2, and DWI sequences and two-dimensional time of flight MR venography. D-dimer was estimated using a rapid latex agglutination slide test using monoclonal antibodies. RESULTS: The age of patients ranged between 16 and 70 years old (median 31 years old); 8 were males and were examined after a mean duration of 22 days of symptoms. Cortical venous thrombosis was attributed to puerperium in 4 patients, infection in 5 patients, and pregnancy, dehydration, insect bite, and migraine in 1 patient each. Superior sagittal sinus was involved in 15 patients, transverse sinus in 16 patients, straight sinus in 3 patients, sigmoid sinus in 7 patients, and cavernous and deep system in 1 patient each. A total of 12 patients had more than one sinus involvement. D-dimer was positive in 20 patients and correlated with the duration of symptoms but not with the extent of sinus thrombosis and the outcome. CONCLUSION: D-dimer is useful in patients suspected of CVST and patients with positive test results should be urgently sent for MR imaging.

Pattern of cerebellar perfusion on single photon emission computed tomography in subcortical hematoma: A clinical and computed tomography correlation.

Background: There is paucity of studies evaluating the role of asymmetry index (AI) on single photon emission computed tomography (SPECT) studies in patients with intracerebral hemorrhage (ICH). Aim: To evaluate cerebellar perfusion in ICH employing SPECT study and correlate with clinical and CT scan findings. Setting and Design: Tertiary care teaching hospital. Materials and Methods: A total of 29 patients with ICH were subjected to neurological examination including Glasgow Coma Scale (GCS) and Canadian Neurological Stroke Scale (CNS). Clinical features of raised intracranial pressure and herniation were noted. On CT scan, ICH location, volume, ventricular extension and midline (ML) shift were noted. On SPECT, cerebral and cerebellar perfusion was measured semiquantitatively and AI calculated. Outcome was defined at 3 months into poor and good. Results: Fourteen patients had putaminal and 15 thalamic hemorrhages. Their mean age was 59 years. The mean GCS score was 10 and CNS score 2.8. Hematoma was large in five, medium in 16 and small in eight patients. ML shift was present in 15 and hematoma extended to ventricule in 16 patients. On SPECT, cerebellar AI significantly related to ML shift but not with size of hematoma. AI was low in patients with ML shift. Outcome was related to GCS score, ML shift, size of hematoma and cerebellar AI. Conclusion: In acute stage of ICH, cerebellar AI is lower in patients with more severe stroke having ML shift.

Cullin4B/E3-ubiquitin ligase negatively regulates beta-catenin.

Beta-catenin is the key transducer of Wingless-type MMTV integration site family member (Wnt) signalling, upregulation of which is the cause of cancer of the colon and other tissues. In the absence of Wnt signals, beta-catenin is targeted to ubiquitin-proteasome-mediated degradation. Here we present the functional characterization of E3-ubiquitin ligase encoded by cul4B. RNAi-mediated knock-down of Cul4B in a mouse cell line C3H T10 (1/2) results in an increase in beta-catenin levels. Loss-of-function mutation in Drosophila cul4 also shows increased beta-catenin/Armadillo levels in developing embryos and displays a characteristic naked-cuticle phenotype. Immunoprecipitation experiments suggest that Cul4B and beta-catenin are part of a signal complex in Drosophila, mouse and human. These preliminary results suggest a conserved role for Cul4B in the regulation of beta-catenin levels.

Prospective evaluation of contracted sockets.

AIMS: To establish a correct method of evaluation and management of contracted sockets RESULTS: Anopthalmic socket were frequently seen in orbit and Oculoplasty clinic of Aravind Eye Hospital, Madurai, South India. Prospective evaluation of Anophthalmic Sockets was done in this study. Anophthalmic Socket which can not support prosthetic eye is called contracted socket.4,5,14. These sockets were graded as congenital and acquired, which were managed using single, combined and multiple procedures. Surgical outcome of each case were analyzed.

Heat shock transcription factors regulate heat induced cell death in a rat histiocytoma.

Heat shock response is associated with the synthesis of heat shock proteins (Hsps) which is strictly regulated by different members of heat shock transcription factors (HSFs). We previously reported that a rat histiocytoma, BC-8 failed to synthesize Hsps when subjected to typical heat shock conditions (42 degrees C, 60 min). The lack of Hsp synthesis in these cells was due to a failure in HSF1 DNA binding activity. In the present study we report that BC-8 tumor cells when subjected to heat shock at higher temperature (43 degrees C, 60 min) or incubation for longer time at 42 degrees C, exhibited necrosis characteristics; however,under mild heat shock (42 degrees C, 30 min) conditions cells showed activation of autophagy. Mild heat shock treatment induced proteolysis of HSF1, and under similar conditions we observed an increase in HSF2 expression followed by its enhanced DNA binding activity. Inhibiting HSF1 proteolysis by reversible proteasome inhibition failed to inhibit heat shock induced autophagy. Compromising HSF2 expression but not HSF1 resulted in the inhibition of autophagy, suggesting HSF2 dependent activation of autophagy. We are reporting for the first time that HSF2 is heat inducible and functions in heat shock induced autophagic cell death in BC-8 tumor cells.

Risk factors of herpes simplex virus type 2 among STD clinic attenders in Delhi, India.

The present study was conducted to determine the seroprevalence and risk factors associated with HSV-2 infection among sexually transmitted diseases (STD) clinic attenders of Delhi in India. Out of 128 patients included, 76 were males and 52 were females. Antibodies to HSV 1 and 2 and HIV infection were determined by ELISA. Syphilis seropositivity was determined by VDRL test and confirm by TPHA test. Ulcer scrapping were stained by Giemsa for Herpes progenitalis and Donovan bodies and Grams for Haemophilus decreyi infection. The HSV-2 and HSV-I seroprevalence was found to be 85.2% and 77.3% respectively. 87.3% of HSV-2 seropositive patients were asymptomic. 10.7% of patients had coinfection of HSV-2 and HIV. STDs like syphilis, chancroid, gonococcal and non-gonococcal urethritis were significantly associated in HSV-2 infection. Thus the study demonstrates high prevalence of HSV-2 infection in Delhi city. Significant association of HSV-2 infection with previous history of STD (p < 0.02) and multiple sexual partners in males was found (p < 0.002).