Clinical profile of ocular sarcoidosis in a South Indian patient population.

AIM: To report the ocular and systemic features in patients with definite and presumed sarcoidosis presenting to a tertiary referral eye center in south India. MATERIALS AND METHODS: Retrospective observational case series. Records of 51 patients with diagnosis of sarcoidosis were retrieved. A complete ophthalmic evaluation and systemic examination by a pulmonologist with appropriate laboratory investigations were done in all patients. Results were statistically analyzed using SPSS software. RESULTS: The mean age group was 45.14 ± 10.91 years. Females were more common and 31 cases were biopsy proven. Panuveitis and thoracic involvement was the most common ophthalmic and systemic manifestations of sarcoid respectively. Posterior synechiae, granulomatous keratic precipitates, increased anterior chamber reaction, and cystoid macular edema were significantly more common in those presenting initially to an ophthalmologist. CONCLUSIONS: Sarcoidosis is increasingly recognized in south India as well. A complete review of systems with appropriate investigations is essential to prevent ocular or systemic morbidity.

Apolipoprotein E polymorphism and outcome after mild to moderate traumatic brain injury: a study of patient population in India.

BACKGROUND: The nature and extent of recovery after traumatic brain injury (TBI) is heterogeneous. Apolipoprotein E (APOE) plays a major role in repair of cell membrane and growth of neurites following injury to cells. Studies done on the western population have shown that the APOE e4 genotype is associated with poor survival following neurotrauma. AIM: To explore the association of APOE polymorphism and outcome following TBI in a patient population from a tertiary care hospital exclusive for neurological diseases in south India. PATIENTS AND METHODS: Ninety eight patients who sustained mild to moderate TBI (computed tomography (CT) scan brain showing traumatic parenchymal contusions) were the subjects of the study and the study period was from November 2003 to December 2008. APOE polymorphism status was determined by PCR technique using venous blood. Patients were assessed on follow-up with a battery of four neuropsychological tests as well as Glasgow outcome scale. RESULTS: Of the 98 patients, 20 (20%) patients had at least one APOE e4 allele. A follow-up of minimum six months was available for 73 patients. None of the 12 patients who had at least one APOE e4 allele had a poor outcome at six-month follow-up whereas 11(18%) patients without an APOE e4 allele had a poor outcome (Fisher's Exact test, P=0.192). On the neuropsychological tests, performance of patients with APOE e4 allele did not differ significantly from those without these alleles. CONCLUSION: This study does not support the current contention that the presence of APOE e4 allele should have a significant negative effect on the outcome after TBI.

Utility of QuantiFERON TB gold test in a south Indian patient population of ocular inflammation.

AIM: To study the utility of interferon-g release assays (QuantiFERON TB gold test) in a south Indian patient population of intraocular inflammation. DESIGN: Evaluation of a diagnostic test- a pilot study from January 2007 to October 2008. MATERIALS AND METHODS: QuantiFERON TB gold test was performed on the following groups of patients following an informed consent. Group A included healthy volunteers without any exposure to tuberculosis (TB) or past history of TB (n=22). Group B included patients with active systemic TB diagnosed by the demonstration of acid-fast bacilli or by the histopathology finding of caseation with granuloma formation from the sputum, lymph node, skin or intestinal biopsies (n=26). Group C included patients with uveitis of known etiologies other than intraocular TB without any history of exposure to active TB (n=21). Group D included patients with a diagnosis of presumed intraocular TB, who responded to antitubercular therapy by decreased or no recurrences following treatment and with a minimum of nine months follow-up following initiation of antitubercular therapy (n=39). RESULTS: The sensitivity and specificity of the QuantiFERON TB gold test to pick up active systemic TB was 58% and 77% respectively. The sensitivity and specificity of the QuantiFERON TB gold test to pickup intraocular TB was 82% and 76% respectively. CONCLUSIONS: QuantiFERON TB gold test alone may not be specific for intraocular TB. The significance of this test in a case scenario needs to be interpreted with clinical presentation and other evidences for intraocular TB.