The study of simultaneous bilateral ocular trauma in Northern India: clinical presentation, epidemiology and patterns of injury.

PURPOSE: This study is aimed to determine the frequency, sociodemographic profile, clinical presentation, patterns of injury, treatment and outcomes of cases of simultaneous bilateral ocular trauma treated in a teaching hospital of Northern India. METHODS: This retrospective study was conducted from May 2015 to April 2019. The medical records of patients presenting with bilateral ocular injuries were reviewed. RESULTS: Among the 402 patients presenting with ocular injuries, 34 (8.5%) had simultaneous bilateral ocular trauma. The majority were male (70.6%), and the mean age was 26.82 ± 15.86 years (range: 2-70 years). The most frequently affected age group has been 16-25 years (35.3%). Most injuries occurred away from home (64.7%), mainly on roads (32.4%) or playgrounds (14.7%), and the vast majority (91.2%) were non-occupational in nature. Mechanical injuries were most frequent (47.1%), followed by cracker (17.7%), chemical (17.7%) and thermal (11.8%) injuries. Most cases occurred due to assault (26.5%), road traffic injury (20.6%) or sports/recreational activities (17.7%). The majority of victims were not using protective devices at the time of injury (82.4%) and had associated polytrauma (58.8%). Closed and open globe injuries accounted for 29.4% and 14.7% of cases, respectively, mostly involving zones I (55.0%) and II (40.0%). Orbital fractures occurred in 27.9% of eyes. Category I and II ocular trauma scores were noted in 5.9% and 7.4% of eyes, respectively. Overall, 13.2% were blinded as a result of the trauma. CONCLUSION: Simultaneous bilateral ocular trauma is rare and occurs mostly following road traffic accidents, assault or recreational activities. In particular, young-adult males are more prone to bilateral ocular injuries, the majority of which are severe and associated with poor outcomes. The study also highlights that poor initial visual acuity, multiple ocular structure involvement, large open globe injury, presence of intraocular hemorrhage, posterior segment injury, multiple orbital fractures and lower OTS were the poor prognostic factors.

Tragal Perichondrium and Composite Cartilage Graft Complimenting Endoscopic Tympanoplasty in True Sense: A Comparison.

INTRODUCTION: In days of scar less surgeries it has become necessary for otologists to concentrate on tympanoplasties without external incisions. This study compares the anatomical and functional results of tragal perichondrium graft and perichondrium-cartilage composite graft for transcanal endoscopic tympanoplasties in Himalayan region. METHODS AND MATERIALS: This prospective study included 60 subjects of chronic otitis media (mucosal type), who underwent transcanal endoscopic underlay type I tympanoplasty and were divided into two groups. In 30 cases tragal perichondrium graft and in rest of 30 cases Tragal perichondrium Cartilage composite graft was used. Anatomical and functional outcomes were evaluated at 6 months time. RESULTS: Hearing gain comparing Audiometric data between the tragal perichondrial graft group and tragal perichondrial cartilage composite graft group at 6 months showed no statistically significant differences (P= 0.9533). Assessment of anatomical outcome indicated a greater number of complications in the tragal perichondrial graft group although it was not statistically significant (P=0.6360 in anterior graft failure group, P =0.1322 in reperforation group and P= 0.1056 in retraction group). CONCLUSION: Functional results validated both the grafting material while anatomical results are slightly better in tragal perichondrial cartilage composite graft group in term of re perforation and retraction. Moreover use of tragal grafts endoscopic tympanoplasty fulfils its true meaning as no visible scar and post operative patient morbidity is prevented.

Serum Malondialdehyde as a Biomarker of Oxidative Stress in Patients with Primary Ocular Carcinoma: Impact on Response to Chemotherapy.

PURPOSE: To study the level of serum malondialdehyde (MDA), a biomarker of oxidative stress before and after chemotherapy in various ocular malignancies and to correlate its significance with clinicopathological parameters. METHODS: Thirty two histopathologically confirmed cases of primary ocular malignancies were included in this longitudinal cohort study. Detailed clinicopathological assessment was done. Analysis of serum MDA level in the patient before and after chemotherapy was measured and its prognostic significance was analyzed. RESULTS: Maximum cases were of eyelid malignancy (n=18, 56.2%) followed by retinoblastoma (18.8%) and OSSN (6, 18.8%). About 43.75% patients were in the advanced-stage. The tumor was histopathologically well-differentiated in 20 (62.5%) cases. Most common malignancy was sebaceous gland carcinoma of the eyelid (n=10,31.25%). Serum MDA level in patients were significantly higher than controls [5.5712±0.32779 vs 2.5531±0.08056 nmol/mL, p<0.001]. Level was significantly reduced after chemotherapy (4.5146±0.23209 nmol/mL). Serum MDA was maximum in cases of rhabdomyosarcoma (5.9450±0.23335 nmol/mL) and retinoblastoma (5.7433±0.14334 nmol/mL). It was minimum in basal cell carcinoma (5.3775±0.17746 nmol/mL). Pre chemotherapy serum MDA level was significantly higher in patients having larger tumor (>20mm, p< 0.001) and having lymph node metastasis than those without lymph node metastasis [5.8350±0.17113 vs 5.4833± 0.32193 nmol/mL, p<0.006]. No significant difference was observed in post chemotherapy serum MDA level as for as size of tumor (p=0.947) and histopathological differentiation (p=0.109) was concerned. CONCLUSION: The serum MDA level is a potential biomarker in primary ocular carcinoma to assess oxidative stress and its impact on response to chemotherapy.

Clinicopathological Analysis and Demographic Features of Ocular Malignancies.

OBJECTIVE: This study aimed to evaluate the epidemiological and clinicopathological spectrum of ocular malignancies among patients presenting to a teaching hospital in Northern India. METHODS: A total of 246 histopathologically diagnosed patients with ocular malignancies were included in the study. Tumor type and size, primary origin and location of tumor, clinical staging, radiological findings, histopathological type, and treatment outcomes were assessed. RESULTS: Overall, males over 55 years of age were most commonly affected and the majority of cases were primary ocular or adnexal malignancies (n = 226; 91.87%). The eyelids and periocular structures (n = 92; 37.40%) were the most commonly involved site, followed by the orbit (n = 72; 29.27%), ocular surface (n = 46; 18.70%) and intraocular region (n = 36; 14.63%). The majority of the patients (n = 68; 27.64%) were managed by primary surgical excision and reconstruction. However, 46 patients (18.70%) with advanced lesions underwent neoadjuvant chemotherapy followed by surgical excision and more extensive orbital lesions were treated by exenteration followed by adjuvant chemotherapy (n=48; 19.51%), while patients with metastatic tumor were given palliative chemotherapy/external beam radiation therapy (n= 46; 18.70%). Overall, 45.12% of patients were cured completely, 15.45% showed a partial response to the treatment, 13.04% had progressive disease and 16.67% demonstrated disease recurrence. CONCLUSION: A clinicopathological analysis of ocular malignancies at a teaching hospital in Northern India indicated the preponderance of primary ocular malignancies, with eyelid sebaceous gland carcinomas being the most common pathological diagnosis. Most of our patients had advanced and extensive disease among them majority belonged to the rural background and poor socio-economic status.

The epidemiology of ocular trauma in Northern India: A teaching hospital study.

AIM: The aim was to determine the epidemiology of ocular trauma in a large teaching hospital in northern India over 4 years from 2010 to 2014. MATERIALS AND METHODS: This prospective, hospital-based, observational study was conducted at the Ophthalmology and Emergency Outpatient Departments of S. S. Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from March 2012 to February 2016. Detailed history was taken with special consideration to time, place and session of trauma, mode of injury, and type and nature of traumatic agent. All patients were thoroughly examined as per the standard clinical procedures to identify the type, extent, and severity of injury and impact on ocular structure and vision. Follow-up period was 6 months. Statistical analysis was based on age, sex, residence, marital status, occupation, per capita income, type of trauma and nature of damage, etc. RESULTS: Out of 402 patients, 293 (72.9%) were male and 109 (27.1%) were female. Overall male-to-female sex ratio was 2.7:1. Patients were aged between 2 and 70 years (mean: 26.48 ± 15.88, median: 23 years). The most vulnerable age group was 6-15 years (24.38%) followed by 16-25 years (23.88%). Maximum patients belonged to rural background (61.94%). The extent of ocular trauma was 3.93% (95% confidence interval: 3.23-4.63). Majority of participants were single (78.11%) and rest were married. About 112 (27.9%) participants were illiterate and 24.4% had primary education only. One hundred and eighty-eight (46.8%) participants belonged to lower and lower middle socioeconomic status. The cases were clustered in Rs. 1000-5000 per capita income. Most of the injuries occurred in summer season (46.18%) and in afternoon between 12.00 and 17.59 h (48.8%). Majority of trauma occurred away from home (66.20%) mainly on street (28.6%) and playground (9.2%). The most common injury was nonoccupational (82.3%) including sports related (23.9%) and road traffic accident (23.6%). Mechanical injuries were accounted for 89.3% of all eye injuries, and most common source was wooden object (24.9%) followed by metallic objects (20.9%). Traumatic agents were blunt and sharp in 56% and 17% of cases, respectively. Majority of traumatic agents were solid (82.1%). Seven percent of victims were drowsy during trauma and 98.4% of participants were not using any protective device at the time of injury. In 60.7% of cases, time elapsed between injury and treatment was between 1 and 24 h. Around 44.5% had isolated ocular trauma and rest 55.5% were polytrauma cases. Three hundred and sixty-eight (91.5%) participants had unilateral involvement and 8.5% had bilateral involvement. Almost 52.8% had injuries of adnexa and 32.8% had globe injuries. More than half of the study participants had ≥3 ocular structure involvement. After 6 months, 14.8% of the right eyes and 25.5% of the left eyes showed poor outcome. CONCLUSION: This study highlights epidemiology of ocular trauma in northern India. Mass health education and awareness about risk of ocular trauma, morbidity caused by delayed presentation, and need to adopt safety or preventive strategies should be focused, especially during travel, playground, and at workplace.

Optical Coherence Tomography and Subclinical Optical Neuritis in Longitudinally Extensive Transverse Myelitis.

OBJECTIVE: The aim is to compare the retinal nerve fiber layer (RNFL) thickness of longitudinally extensive transverse myelitis (LETM) eyes without previous optic neuritis with that of healthy control subjects. METHODS: Over 20 LETM eyes and 20 normal control eyes were included in the study and subjected to optical coherence tomography to evaluate and compare the RNFL thickness. RESULT: Significant RNFL thinning was observed at 8 o'clock position in LETM eyes as compared to the control eyes (P = 0.038). No significant differences were seen in other RNFL measurements. CONCLUSION: Even in the absence of previous optic neuritis LETM can lead to subclinical axonal damage leading to focal RNFL thinning.

Anticancer activity of the roots of Ichnocarpus frutescens R. Br. and isolated triterpenes.

The roots of Ichnocarpus frutescens along with roots of Cissampelos pareira, Bauhinia vahlii and Ardisia solanacea are processed together and given orally to cure stomach cancer by the tribes of Chotanagpur and Santhal parganas of Bihar, India. In vitro anticancer activity of the residue from methanolic extract of roots of I. frutescens (MIF) and isolated triterpenes were evaluated by 3-(4, 5-dimethyl thiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay using MCF-7, BEL-7402, SPC-A-1 and SGC-7901 cancer cell lines. MIF showed significant anticancer activity on four cancer cell lines with IC50 values 163.5±3.58, 156.3±2.95, 142.6±2.60 and 112.4±1.85 respectively as compared to vehicle treated control. Ursolic acid showed anticancer activity on four cancer cell lines with IC50 values 8.5±0.29, 9.9±0.12, 8.1±0.40 and 6.2±0.23 respectively, while IC50 values for α-amyrin on four cancer cell lines was found to be 7.2±0.12, 8.2±0.29, 7.6±0.06 and 5.0±0.12 respectively.

Ichnocarpus frutescens Ameliorates Experimentally Induced Convulsion in Rats.

The present study was carried out to evaluate the anticonvulsant activity and probable mechanism of action of the methanol root extract from I. frutescens (MEIF) using different experimental animal models. Anticonvulsant activity of the single dose of MEIF (100, 200, and 400 mg/kg, p.o.) was evaluated in maximal electroshock- (MES-), pentylenetetrazole- (PTZ-), and isoniazid- (INH-) induced convulsions models in rats. The levels of γ-amino butyric acid (GABA), glutamate, GABA-transaminase (GABA-T) activity and oxidative stress markers were measured in pretreated rat's brain homogenate to corroborate the mechanism of observed anticonvulsant activity. MEIF (200-400 mg/kg, p.o.) protected the animals in all the behavioral models used. Pretreatment of MEIF (200-400 mg/kg, p.o.) and diazepam (1.0 mg/kg, i.p.) to the animals in INH-induced convulsion model showed 100% and 80% protection, respectively, as well as significant restoration of GABA and glutamate level in the rat's brain. MEIF and vigabatrin (50 mg/kg, i.p.) reduced the PTZ-induced increase in the activity of GABA-T (46%) in the brain. Further, MEIF reversed the PTZ-induced increase in lipid peroxidase (LPO) and decrease in reduced glutathione (GSH), catalase (CAT), and superoxide dismutase (SOD) activities. The findings of this study validate the anticonvulsant activity of I. frutescens.

Quaternary alkaloids of Argemone mexicana.

Four quaternary isoquinoline alkaloids, dehydrocorydalmine, jatrorrhizine, columbamine, and oxyberberine, have been isolated from the whole plant of Argemone mexicana Linn. (Papaveraceae) and their structures established by spectral evidence. This is the first report of these alkaloids (dehydrocorydalmine, jatrorrhizine, columbamine, and oxyberberine) from Argemone mexicana and the Argemone genus.

Cyclopeptide alkaloids from Zizyphus sativa bark.

A new cyclopeptide alkaloid, sativanine-M (1), together with known alkaloid nummularine-P have been isolated from the stem bark of Zizyphus sativa and identified by spectral analysis.

Xylopyrine-A and xylopyrine-B, two new peptide alkaloids from Zizyphus xylopyra.

Two new 13-membered cyclopeptide alkaloids, xylopyrine-A and xylopyrine-B have been isolated from Zizyphus xylopyra, and their structures established by spectral and chemical evidences.

A live cysticercosis in anterior chamber leading to glaucoma secondary to pupilary block.

A 28-year-old woman presented with pain and redness in her left eye. On examination, a free-floating cyst of size 4 mm with prominent scolex was observed in the anterior chamber. Scolex was occasionally moving in and out of its bag. To prevent the cyst migrating to the posterior chamber, pilocarpine eye drops were instilled. After 2 hours, the patient developed total pupilary block with iris bombe. The intraocular tension was 48 mm Hg. The diagnosis of cysticercosis leading to glaucoma secondary to pupilary block was made. The cyst was removed surgically by viscoexpression. The histopathology proved to be a cysticercosis.