Cataract surgery in juvenile xanthogranuloma: case report and a brief review of literature

There is limited literature on the management of cataracts in juvenile xanthogranuloma (JXG). A 2-month-old girl presented to us with hyphema, secondary glaucoma OU and skin nodules suggestive of JXG. She developed bilateral cataracts during her follow-up and was treated successfully with cataract surgery and aphakic rehabilitation.

Attitudes of undergraduates towards mental illness: A comparison between nursing and business management students in India

<p><strong>Background.</strong> Mental illness is an important public health issue worldwide; stigmatisation and negative attitudes towards people with mental illness are widespread among the general public. However, little is known about the attitudes of undergraduates to mental illness. </p><p><strong>Purpose.</strong> To compare the attitudes towards mental illness among undergraduates enrolled in nursing courses v. those enrolled in Bachelor of Business Management (BBM) courses. </p><p><strong>Methods.</strong> A cross-sectional descriptive design was adopted for the present study. A total of 268 undergraduates were selected to complete the<em> </em>Attitude Scale for Mental Illness (ASMI) and the Opinions about Mental Illness in the Chinese Community (OMICC) questionnaires. </p><p><span><strong>Results. </strong>We found significant differences between the number of nursing and BBM students who agreed with statements posed by the questionnaires, e.g., that they would move out of their community if a mental health facility was established there (χ²=16.503, <em>p</em>&lt;0.002), that they were not afraid of treated mentally ill people (χ²=15.279, <em>p</em>&lt;0.004), and that people with mental illness tend to be violent (χ²=14.215, <em>p</em>&lt;0.007) and dangerous (χ²=17.808, <em>p</em>&lt;0.001). Nursing students disagreed that people with mental illness are easily identified (χ²=30.094, <em>p</em>&lt;0.000), have a lower IQ (χ²=70.689, <em>p</em>&lt;0.000) and should not have children (χ²=24.531, <em>p</em>&lt;0.000). Nursing students were more benevolent than BBM students, as they agreed that people with mental illness can hold a job (χ²=49.992, <em>p</em>&lt;0.000) and can return to their former position (χ²=11.596, p&lt;0.021), that everyone faces the possibility of becoming mentally ill (χ²=38.726, <em>p</em>&lt;0.000), and that one should not laugh at the mentally ill (χ²=17.407, <em>p</em>&lt;0.002). Nursing students held less pessimistic attitudes, as they felt that the mentally ill should receive the same pay for the same job (χ²=10.669, <em>p</em>&lt;0.031) and that the public are prejudiced towards people with mental illness (χ²=17.604, <em>p</em>&lt;0.001).</span></p><p><strong>Conclusion.</strong> College students’ attitudes towards people with mental illness vary based on the course that they are enrolled in. Attitudes may be positively improved by revising curriculum design to incorporate educational sessions about mental illness. These are essential steps to combat discrimination, and potentially enhance the promotion of human rights for the mentally ill.</p>

9-(2-Chloro-benzyl-idene)anthracen-10(9H)-one

In the title compound, C₂₁H₁₃ClO, the central anthracene system is distorted towards a boat conformation and the outer rings are not coplanar with the central ring [dihedral angles = 7.79 (1) and 11.90 (1)°]. The crystal structure features inversion dimers with graph-set motif R₂²(18) formed by C—H⋯O inter­actions.

Targeting Multidrug Resistant Mycobacterium tuberculosis HtrA2 with Identical Chemical Entities of Fluoroquinolones

Tuberculosis is a highly communicable and chronic respiratory disease caused by pathogenic bacterium Mycobacterium tuberculosis. The drug - resistant species of Mycobacterium tuberculosis are tough to cure due to its resistant activity toward potential drugs. Available inhibitors of tuberculosis include few antimicrobial fluoroquinolone agents like ciprofloxacin, ofloxacin, and moxifloxacin to treat resistant Mycobacterium strains. Literature study elucidates that macromolecular target namely, HtrA2 of Mycobacterium tuberculosis play a dual role of protease and chaperone. These two activities are dependent on temperature, with low temperatures promoting the chaperone function and high temperatures promoting serine protease activity. Under normal physiological conditions HtrA2 acts as a quality control factor and promotes cell survival. In the present investigation, we screened fluoroquinolone such as ciprofloxacin, moxifloxacin and ofloxacin and their analogues based on better Docking score, absorption, distribution, metabolism and excretion screening and Lipinski's rule of 5, to find out their efficiency on resistant strain through in silico study. From the results observed, the analogues are suggested to be potent inhibitors of HtrA2 with sufficient scope for further exploration.

Completion rates of anterior and posterior continuous curvilinear capsulorrhexis in pediatric cataract surgery for surgery performed by trainee surgeons with the use of a low-cost viscoelastic

Context:

Pediatric cataract surgery is traditionally done with the aid of high-molecular-weight viscoelastics which are expensive. It needs to be determined if low-cost substitutes are just as successful.

Aims:

The study aims to determine the success rates for anterior and posterior capsulorrhexis and intraocular lens (IOL) implantation in the bag for pediatric cataract surgery performed with the aid of a low-molecular-weight viscoelastic.

Settings and Design:

Nonrandomized observational study.

Materials and Methods:

Children less than 6 years of age who underwent cataract surgery with IOL implantation in the period May 2008–May 2009 were included. The surgeries were done by pediatric ophthalmology fellows. A standard procedure of anterior capsulorrhexis, lens aspiration with primary posterior capsulorrhexis, anterior vitrectomy, and IOL implantation was followed. Three parameters were studied: successful completion of anterior and posterior capsulorrhexis and IOL implantation in the bag.

Results:

33 eyes of 28 children were studied. The success rate for completion was 66.7% and 88.2 % for anterior and posterior capsulorrhexis, respectively. IOL implantation in the bag was successful in 87.9%.

Conclusions:

2% hydroxypropylmethylcellulose is a viable low-cost alternative to more expensive options similar to high-molecular-weight viscoelastics. This is of great relevance to hospitals in developing countries.

Assessment of oxidative stress and chromosomal aberration inducing potential of three medical grade silicone polymer materials

Medical expenditures for devices are increasing along with the ageing of human population and the synthesis of materials such as silicone polymers is on upsurge for manufacturing these devices. The International Organization for Standardization (ISO) emphasizes a battery of tests for preclinical assessment of biocompatibility of medical devices. Genotoxicity assays have become an integral component of these test procedures and it employs a set of in vitro and in vivo experiments to detect mutagens. Hence, this study was performed with an intention to investigate the genotoxic potential of the physiological saline extracts of three medical grade silicone polymer materials by the in vitro chromosomal aberration assay using human peripheral blood lymphocytes. Further, the oxidative stress inducing potential of the material extracts was investigated in vivo in mice liver homogenates using cyclophosphamide as positive control. The investigation revealed that none of the three materials were able to produce marked human lymphocyte chromosomal aberration, suggesting the absence of mutagens. The materials also showed negative results in their oxidative stress inducing potential, which was revealed by the normal levels of lipid peroxidation and unaltered levels of glutathione and its metabolizing enzymes in the mice liver tissue homogenates. It was interesting to observe a significant correlation between the genotoxic and antioxidant parameters investigated. Hence, it is suggested that the estimation of antioxidant status would serve as a better preliminary testing procedure prior to evaluating the genetic and molecular toxicity mechanisms of medical devices and/or materials intended for manufacture of such devices.

Improvement in visual acuity following surgery for correction of head posture in infantile nystagmus syndrome

PURPOSE

To report the effect of the abnormal head posture (AHP) correcting procedures on the visual acuity improvement in patients with infantile nystagmus syndrome (INS) and the visual acuity improvement outcomes in different AHP correcting surgeries in INS.

METHODS

This was a prospective, non-randomized, interventional study. Twenty-eight patients underwent the Anderson-Kestenbaum procedure or the modified Anderson procedure with or without tenotomy of at least one horizontal recti for correction of AHP. Best-corrected binocular null zone acuity and degree of AHP was recorded preoperatively and compared with those done 1 month postoperatively.

RESULTS

The average null zone logarithm of the minimum angle of resolution acuity was 0.42 preoperatively, which improved significantly to 0.33 postoperatively (P = .002). The AHP ranged from 10° to 40° (mean: 20.89°), which improved significantly to a mean of 3.21° (P = .000). No significant difference (P = .65) was found in the visual acuity improvement among patients who underwent the Anderson-Kestenbaum procedure or the modified Anderson procedure with or without tenotomy. No significant difference in the visual acuity improvement was seen in patients who underwent tenotomy of at least one horizontal rectus muscle along with the modified Anderson procedure compared to those who underwent the modified Anderson procedure alone (P = .28).

CONCLUSION

The procedures used mainly for correction of AHP in INS do yield significant improvement in the visual acuity. This improvement is seen in patients undergoing surgery for both horizontal and vertical AHP.

Transient Reversal of a Face Turn (an Abnormal Head Posture, AHP) due to Manifest Latent Nystagmus, after Eye Muscle Strabismus Surgery for the Associated Infantile Esotropia

Patients with infantile esotropia and manifest latent nystagmus adopt a face turn towards the fixing eye as a nystagmus dampening mechanism. The surgical plan should aim to correct both the face turn and the strabismus. Reversal of the face turn after surgery for the strabismus can be (i.e. was) distressing for both the surgeon and the patient and has not been reported previously to the best of our knowledge. We report our patient with a transient reversal of face turn after surgery.

Wildervanck syndrome associated with cleft palate and short stature

We report a case of Wildervanck syndrome exhibiting Klippel-Feil anomaly, Duane retraction syndrome and deafness. Since the first case was reported in 1952, there have been more reports describing this triad, either complete or incomplete. Our patient had the complete triad of the syndrome along with cleft palate and short stature. Also, a review of the literature regarding this syndrome is presented here.

Bilateral persistent fetal vasculature: a study of 11 cases

PURPOSE

To describe the clinical and radiologic features of patients with bilateral persistent fetal vasculature (PFV).

METHODS

All patients diagnosed with symmetric, bilateral PFV over a 3.5-year period were included in this representative, observational case series. Only patients with more or less symmetrical disease in both eyes were included. Examination under anesthesia was performed in all but 1 case. B-scan ultrasonography of the eye was performed in all cases. A computed tomographic or magnetic resonance imaging scan was done if the ocular ultrasonography was inconclusive. A systemic workup was performed to rule out associated systemic anomalies.

RESULTS

The study group included 11 patients. Of the 22 eyes studied, 20 (91%) showed features of both the anterior and the posterior forms of PFV. Two children tested positive for IgM rubella antibodies. Ten eyes (45.5%) had a horizontal corneal diameter of less than 10 mm. Fifteen eyes (68.2%) had cataract at presentation. Intraocular pressure was >21 mm Hg in 17 eyes (77.3%).

CONCLUSIONS

Microcornea and cataract were common findings. Bilateral PFV cases were more commonly associated with combined anterior and posterior PFV. Bilateral PFV, although infrequent, should be considered in the differential diagnosis of bilateral leukocoria.

Bilateral Duane retraction syndrome with optic nerve hypoplasia

The authors report a unique case of a child with the infrequent association of bilateral Duane retraction syndrome with underdevelopment of the anterior visual pathway. Both conditions were caused presumably due to a common disturbance of neuronal development during the second month of embryogenesis.

Inferior rectus paresis and medial rectus overaction following retrobulbar anesthesia for cataract surgery

Strabismus is a well recognized complication of retrobulbar anesthesia for cataract surgery. This may manifest as either paresis or sometimes contracture (overaction) in the late stage. Management of the patient is tailored to the individual case. Herein, we report a patient with inferior rectus paresis and medial rectus overaction after retrobulbar anesthesia. The presenting symptom was diplopia increasing on downgaze, which improved with medial rectus recession and plication of the inferior rectus.

Assessment of laryngeal dysfunctions of dysarthric speakers

Dysarthria is a neuromotor impairment of speech that affects one or more of the speech sub-systems. It is reflected in the acoustic characteristics of the phonemes as deviations from their healthy counterparts. In the current work, the deviations associated with laryngeal dysfunctions are analysed in order to assess and quantify parameters that will help evaluate dysarthria. Perturbation measures, pitch period statistics and Pitch Variation Index (PVI) are computed for the assessment of laryngeal dysfunctions of dysarthric speakers. The assessments were performed on the Nemours database of dysarthric speech and compared with normal speakers available in the TIMIT speech corpus. The results were correlated with Frenchay Dysarthria Assessment (FDA) scores. The analysis resulted in a technique to predict the degree of severity of dysarthria and illustrate the multi-causal nature of the disorder.

Mutations that are a common cause of Leber congenital amaurosis in northern America are rare in southern India

PURPOSE

To test patients from southern India for the presence of mutations that most commonly cause Leber congenital amaurosis (LCA) in northern America.

METHODS

A review of the literature identified 177 unique LCA causing mutations in eight different genes: aryl hydrocarbon receptor interacting protein-like 1 (AIPL1), crumbs homolog 1 (CRB1), cone-rod homeobox (CRX), guanylate cyclase 2D (GUCY2D), nephronophthisis 6 (NPHP6), retinol dehydrogenase 12 (RDH12), retinal pigment epithelium-specific protein 65 kDa (RPE65), and retinitis pigmentosa GTPase regulator interacting protein 1 (RPGRIP1). Allele-specific ligation assay and bidirectional sequencing were used to test 38 unrelated LCA patients from southern India for 104 of these mutations, which contribute to more than 30% of the LCA cases in a northern American population.

RESULTS

Only one participant was found to harbor one of the 104 mutations in the allele-specific assay (homozygous RPE65 Tyr368His). A mutation that was not part of the assay (homozygous RPE65 Tyr143Asp) was incidentally detected in a second patient when an equivocal signal from one allele on the assay was followed up with automated DNA sequencing.

CONCLUSIONS

Mutations that contribute to 30% of the LCA cases in northern America were detected in only 2.6% of LCA cases in our cohort from southern India. There were no instances of IVS26 c.2991+1655 A>G in NPHP6, the most commonly detected mutation in LCA. These data suggest that LCA in India is caused primarily by a different set of mutations in the same genes associated with disease in northern America, or by mutations in other genes that have not yet been discovered. Therefore, mutation-specific assays developed for European and northern American cohorts may not be suited for testing LCA patients from India or other ethnically distinct populations.

Genotype/phenotype association in Indian congenital aniridia

The developmental birth eye disorder of iris is known as aniridia. Heterozygous PAX6 gene, which causes human aniridia and small eye in mice, is located on chromosome 11p13. The variability had been documented between the affected individuals within the families, is due to genotypic variation. Haploinsufficiency renders PAX6 allele non-functional or amorphic, however it presents hypomorphic or neomorphic alleles. India is not a well-studied ethnic group, hence the focus on congenital aniridia gene analysis supports the literature and the phenotypic association were analysed both in sporadic as well as familial. The consistent association of truncating PAX6 mutations with the phenotype is owing to non-sense-mediated decay (NMD). It is presumed that the genetic impact of increased homozygosity and heterozygocity in Indian counter part arises as the consequence of consanguineous marriages. The real fact involved in congenital aniridia with other related phenotypes with PAX6 mutations are still controversial.

Incomplete penetrance and phenotypic variability characterize Gdf6-attributable oculo-skeletal phenotypes

Proteins of the bone morphogenetic protein (BMP) family are known to have a role in ocular and skeletal development; however, because of their widespread expression and functional redundancy, less progress has been made identifying the roles of individual BMPs in human disease. We identified seven heterozygous mutations in growth differentiation factor 6 (GDF6), a member of the BMP family, in patients with both ocular and vertebral anomalies, characterized their effects with a SOX9-reporter assay and western analysis, and demonstrated comparable phenotypes in model organisms with reduced Gdf6 function. We observed a spectrum of ocular and skeletal anomalies in morphant zebrafish, the latter encompassing defective tail formation and altered expression of somite markers noggin1 and noggin2. Gdf6(+/-) mice exhibited variable ocular phenotypes compatible with phenotypes observed in patients and zebrafish. Key differences evident between patients and animal models included pleiotropic effects, variable expressivity and incomplete penetrance. These data establish the important role of this determinant in ocular and vertebral development, demonstrate the complex genetic inheritance of these phenotypes, and further understanding of BMP function and its contributions to human disease.

Anterior plagiocephaly with contralateral superior oblique overaction

Anterior plagiocephaly is a craniofacial anomaly related to premature unilateral synostosis. We present three cases of anterior plagiocephaly with contralateral superior oblique dysfunction. A detailed ophthalmic examination, including orthoptic assessment for the extraocular muscle misalignment, with appropriate radio-imaging was done in all the three cases. All of them showed a right-sided plagiocephaly, with overaction of the left superior oblique muscle, alternating exotropia and a dissociated vertical deviation. Two underwent surgical correction of squint. Both were well aligned after squint surgery. Plagiocephaly has been reported to simulate superior oblique muscle paresis. We report a rare occurrence of contralateral superior oblique muscle overaction in three children with anterior plagiocephaly.