Patient motivation for laser in situ keratomileusis in the State of Bihar.

PURPOSE: To evaluate the main reasons for seeking laser in situ keratomileusis (LASIK) and patient satisfaction after surgery in the socioeconomically underdeveloped eastern state of Bihar, India. METHODS: This retrospective study evaluated results of the first 100 consecutive patients (169 eyes) who had LASIK at our center from July 2002 to September 2003. RESULTS: Of the 100 patients, 65% were male and 35% were female. Ninety percent of male patients were between 18 and 24 years old; they sought LASIK to achieve an uncorrected visual acuity of 6/6 to 6/9-the basic qualifying criterion for jobs in the railway and defense services. Eighty-six percent of female patients were of marrying age. At 1 month after LASIK, 93% of patients achieved an UCVA of 6/6, 4% had UCVA between 6/9 to 6/12, and only 1% had <6/60. CONCLUSION: In the socioeconomically poor state of Bihar, the main reason for males in our study to seek LASIK was to enhance their job prospects. In females, the main reason was to improve facial appearance in order to enhance marriage prospects.

Hypoparathyroidism with extensive intracranial calcification: a case report.

We present a case of hypoparathyroidism, demonstrating extensive intracranial calcification, not only in basal ganglia, but also outside the extrapyramidal system. The patient presented with an unexplained epileptifors disorder, accompanied by extrapyramidal dysfunction in the form of choreoathetosis and hemiballismus. Hemiballismus is reported for the first time to our knowledge in association with hypoparathyroidism.

Microalbuminuria in non insulin dependent diabetes and essential hypertension: a marker of severe disease.

Sixty five (65) hypertensive, 91 non-insulin dependent diabetes and 50 matched, healthy controls were examined for the presence of microalbuminuria, using the Micral strip test. Microalbuminuria was observed in 25 per cent of diabetics and 21.54 per cent of hypertensive subjects. None of the controls demonstrated microalbuminuria. Diabetics with microalbuminuria were poorly controlled and demonstrated significantly higher systolic pressure. In hypertensive subjects, microalbuminuria was seen more in patients with severe disease. In both diabetics and hypertensives, presence of microalbuminuria was significantly influenced by the disease duration.

A study of hyperinsulinaemia in Indian hypertensive subjects.

Fasting and 2 hours post-prandial serum insulin levels were estimated in 100 hypertensive subjects and 25 matched, healthy controls, by radio-immuno assay (RIA). Seventy four of the 100 hypertensives exhibited fasting hyperinsulinaemia. Post-prandial hyperinsulinaemia was present in 85 hypertensives. None of the healthy individuals demonstrated hyperinsulinaemia. Although, most hyperinsulinaemic patients exhibited an abnormal lipo-protein profile, there was no statistical correlation between absolute values of lipo-protein and insulin.

Differential but infrequent alterations of hepatic enzyme levels and thyroid hormone levels by anticonvulsant drugs.

OBJECTIVE: To assess the differential effects of antiepileptic drugs (AEDs) on hepatic enzyme and thyroid hormone levels and to assess the frequency and degree of these alterations. STUDY DESIGN: Retrospective analysis of hepatic enzyme (serum aspartate aminotransferase and alanine aminotransferase) and thyroid hormone (thyroxine, T uptake; and free thyroxine index) levels obtained during a 10-year period in a large unselected outpatient population of patients with epilepsy. PATIENTS: Unselected (for age, sex, race, type of epilepsy, or degree of control) epileptic subjects (n = 642 for determination of hepatic enzyme levels and n = 317 for determination of thyroid hormone levels) attending the largest outpatient epilepsy center in the Midwest. Infants (younger than 1 year) and those receiving more than two AEDs were excluded. OUTCOME MEASURE: Hepatic enzyme and thyroid hormone level alterations vis-à-vis the type of AED, serum AED levels, and monotherapy vs bitherapy. RESULTS: Aspartate aminotransferase level alterations were mainly due to valproate or phenobarbital, and alanine aminotransferase alterations were due to phenytoin. Significant enzyme level elevations were infrequent (2% [14/642] of patients), mild, usually associated with bitherapy, transient, and confined to aspartate aminotransferase level. Persistent elevations of both aspartate aminotransferase and alanine aminotransferase levels occurred in only one patient, and he had underlying liver disease. Phenytoin was most and phenobarbital least likely to influence the thyroid indexes. Although bitherapy was more likely to produce biochemical alterations of thyroid hormone levels compared with monotherapy, clinically significant thyroid hormone level alterations were seen in only one of 317 patients, and this patient was known to have hypothyroidism. CONCLUSIONS: Antiepileptic drugs affect hepatic enzyme and thyroid hormone levels differentially, and bitherapy alters them more than monotherapy does. However, alterations are mostly mild and clinically insignificant and do not justify routine testing, except in those known to have a coexisting hepatic or thyroid abnormality, those who develop symptoms of hepatic or thyroid involvement while receiving AEDs, and perhaps those receiving bitherapy with high serum AED levels.

Lateralizing value of transient hypofrontality during Wada's test.

Five of 22 subjects who underwent Wada's test in our institution over last year developed transient hypofrontality, always following the injection of the side contralateral to seizure focus (as defined by prior ictal recordings). This event may have lateralizing value and could well be because of pharmacological ablation of contralateral frontal-lobe combined with compromised ipsilateral frontal-lobe causing transient hypofrontality.

Carbamazepine offers no psychotropic advantage over phenytoin in adult epileptic subjects.

We compared 19 men on carbamazepine (CBZ) monotherapy with 19 men on phenytoin (PHT) monotherapy, all of whom had standard therapeutic levels. The two groups were matched for age, sex, education, premorbid predicted IQ, seizure frequency, duration, number, type and aetiology, weekly ethanol consumption and psychiatric history. The two groups did not differ statistically on self- and reliable-informant rated personality inventories, word recognition, face recognition, confrontation naming, finger oscillation or trailmaking series completion times. These data fail to support a behavioural and cognitive advantage of CBZ over PHT in adult epileptics.

Event-related potentials in complex partial seizures.

Both early (N1 and P2) and late (N2 and P3) event-related potentials (ERP) were obtained in 16 patients with complex partial seizures, 12 with left hemispheric ictal focus and 4 with right, to see if they help in lateralizing the seizure focus, and also to determine if they correlate with behavioral (MMPI, Bear-Fedio), attentional (Trails A and B), cognitive (WAIS-R, Boston Naming, Warrington Word and Face recognition) and mental speed (Stroop color naming and reading) tasks. Early waves were more often lateralized than late waves but both were often falsely lateralizing. Early waves were better correlated with behavioral tasks whereas late waves were better with those measuring mental speed, attention and cognition. These data tentatively discourage the utility of ERP in preoperative lateralization of seizure focus but argue for their potential value in psychophysiological correlations.

Prior head injury accounts for the heterogeneity of the alcohol-epilepsy relationship.

Fifty-five adult male patients with alcoholism and seizures were divided into three groups. In group I, all seizures were consistently produced by alcohol withdrawal (N = 16); in group II, some seizures were clearly precipitated by alcohol withdrawal and others were not (n = 18); and in group III none of the seizures had a consistent relationship with drinking (N = 21). The three groups were compared for age, frequency of seizures, compliance, Bear-Fedio and Boston-Naming scores, those for memory of words and faces, and finger-tapping scores, and neuropsychological impairment ratings as well as EEG background frequencies. The incidence of severe head injury preceding the onset of seizure disorder was significantly higher in groups II and III. This was further supported by a greater prevalence of asymmetric alpha rhythm, abnormal CT scans and multiple seizure types in those two groups. These data indicate that a prior head injury is a major variable accounting for the heterogeneity of the alcohol-epilepsy relationship.

Enalapril monotherapy in essential hypertension.

Thirty adults with essential hypertension (systolic BP greater than 150 mmHg or diastolic BP greater than 100 mmHg) were treated with 5-20 mg of enalapril to study its anti-hypertensive efficacy and safety. Ten patients had mild hypertension (diastolic BP greater than 90 mmHg and less than 105 mmHg), 10 had moderate hypertension (diastolic BP greater than 105 mmHg and less than 115 mmHg) and 6 had severe hypertension (diastolic BP greater than 115 mmHg). Of the 20 patients who completed the trial, 9 (45%) showed optimum reduction of BP to less than 130/90 mmHg) and a further 7 (35%) showed significant reduction. The mean fall in systolic BP was 32.5 mmHg (0-80 mmHg) and in diastolic BP was 18.5 mmHg (0-50 mmHg). The peak fall in BP was achieved in 3.5 weeks (1-6 weeks) with a mean dose of 7.2 mg of enalapril daily (5-15 mg/day). Mild side effects not needing drug withdrawal were seen in 8/20 patients (40%). Monotherapy with enalapril appears to be effective and safe as step one therapy for patients with essential hypertension.

Plasma renin activity in diabetics with and without microangiopathy.

Plasma renin activity was measured in ten diabetics with nephropathy, 10 uncomplicated diabetics and 10 normal healthy controls. All the groups were comparable for age, sex, and duration of diabetes. Plasma renin activity was found to be significantly lower in patients with nephropathy in comparison to uncomplicated diabetics and normal healthy controls. There was no correlation between plasma renin activity and mean blood pressure or degrees of renal failure. These findings raise the possibility that microangiopathic changes occurring in the glomeruli and juxta-glomerular apparatus may alter the renin-angiotensin system. Also the finding of low renin in diabetics with nephropathy may modify management policies.

Brain electrical activity mapping of monocular P100 reveals another type of uncrossed asymmetry.

Reference-independent analysis of monocular full-field P100 reveals another type of uncrossed asymmetry, not hitherto appreciated, and perhaps dependent on skull-impedance characteristics.

Blood histaminase in phlyctenulosis.

Blood Histaminase estimations were done in 42 cases of phlyctenulosis and 25 normal subjects. Significantly higher level of blood Histaminase was found in patients of phlyctenulosis, which may be a consequence of its induction secondary to increased release of histamine in the early phase of disease.