Endogenous endophthalmitis in post-COVID-19 patients: a case report

Ocular involvement in coronavirus disease 2019 (COVID-19) can be due to direct viral invasion or indirectly due to an immunosuppressed state. Prolonged hospitalization also makes them susceptible to various secondary infections. The purpose of this case report is to report two rare cases of endogenous endophthalmitis (EE) in COVID-19 recovered patients.

CASE PRESENTATION

Two patients who were hospitalized and received treatment for COVID-19 pneumonia with remdesivir and systemic steroids presented with decreased vision. The first case had a severe anterior chamber reaction with a hypopyon and dense exudates in the vitreous. The second case had cells and flare in the anterior chamber and exudates in the vitreous. They were diagnosed with EE and underwent a diagnostic vitreous tap followed by pars plana vitrectomy and intravitreal antibiotic and steroid. The culture of vitreous fluid was negative for any bacteria and fungus in both cases. However, the first case demonstrated Escherichia coli in urine culture. The follow-up visual acuity was no perception of light and only perception of light in the first and second case, respectively.

CLINICAL DISCUSSION

Severe COVID-19 patients who are hospitalized, receive systemic steroid and have associated comorbidities like diabetes mellitus are at high risk of EE.

CONCLUSION

Delay in diagnosis and appropriate treatment in these patients leads to poor visual outcome.

Role of multimodal imaging in differentiating unilateral APMPPE from unilateral Harada disease - a case report

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is classified as a part of the spectrum of the white dot syndromes affecting the inner choroid and the outer retina. It is usually bilateral and affects young patients between the second and fourth decades. The authors report an unusual case of unilateral APMPPE mimicking Vogt-Koyanagi-Harada (VKH) disease where the fundus fluorescein angiography was instrumental in confirming the diagnosis.

Case presentation

A 35-year-old male presented with decreased visual acuity in the right eye for 3 days. Fundus examination revealed minimal vitritis, disc edema, and multifocal yellowish placoid lesions. Optical coherence tomography (OCT) showed the accumulation of subretinal fluid with subretinal septations closely mimicking VKH. Fundus fluorescein angiography depicted features of early hypofluorescence and late staining of the placoid lesions, suggesting APMPPE. Subretinal fluid partly resolved within a week, and visual acuity improved to 6/9(20/30) in the affected eye after the use of oral NSAIDS. Complete resolution of subretinal fluid was seen after 6 weeks.

Clinical discussion

The most distinguishing feature in this case is the unilateral presentation and macular serous retinal detachment with subretinal septa on OCT imaging, which are not the typical features in APMPPE but quite similar to the characteristic features in acute VKH disease.

Conclusion

APMPPE and acute VKH disease may share some overlapping clinical manifestations and imaging findings on OCT. APMPPE is a self-resolving disease, unlike VKH, and early diagnosis can avoid unnecessary administration of steroids and related side effects.

Moth hair in cornea in a case of seasonal hyperacute panuveitis

Seasonal Hyperacute Panuveitis (SHAPU) is a seasonal and cyclic uveitic disease reported only from Nepal occurring every odd year. Untreated eyes go blind and phthisis within a week. Circumstantial evidence for the role of moths has been reported earlier. Herein for the first time, we describe a SHAPU case in a healthy young Nepalese patient where the exposure to white moth was followed by the development of the uveitis and the moth hair particles was detected in the corneal and presence was confirmed with anterior segment optical coherence topography.

The multiple effects of aspirin in prostate cancer patients

Aspirin is a commonly used medication with anti-inflammatory and analgesic properties, and it is widely used to reduce the risk of ischaemic heart disease-related events and/or cerebrovascular accidents. However, there is also evidence from epidemiological and interventional studies to suggest that regular aspirin use can reduce the risk of prostate cancer development and progression, and can reduce the risk of disease recurrence following anti-prostate cancer therapy. Aspirin use in African-American men is associated with a reduced incidence of advanced PCa and reduced disease recurrence, and there is evidence from other studies of an association between regular aspirin use and decreased PCa-related mortality. The cyclooxygenase-2 enzyme inhibited by Aspirin and other NSAIDs, and which catalyses prostaglandin synthesis and mediates inflammation, is overexpressed in prostate cancer, therefore inhibition of cyclooxygenase-2 may have direct, and indirect, therapeutic effects. This review explores the evidence suggesting that aspirin use can modify prostate cancer biology and disease characteristics, and explores the potential mechanisms underpinning the observed associations between aspirin use and modification of prostate cancer risk. It also summarises the potential for adjuvant aspirin use to combine with other therapeutic approaches such as radical surgery and radiotherapy.

Unilateral retinitis pigmentosa

OBJECTIVE

To report a rare case of unilateral retinitis pigmentosa and to present the clinical features, and findings of multifocal ERG and visual field of this case.

CASE

A 70-year-old-female diagnosed as Retinitis Pigmentosa in right eye 7 years back, presented with further gradual painless diminution of vision in the very eye and without any similar symptoms in left eye. On examination, the findings (including multifocal ERG and visual field) suggested the features of retinitis pigmentosa in her right eye, while the other eye being unaffected.

CONCLUSION

In this rare case, the distinct features of retinitis pigmentosa are seen only in one eye, and this can be further confirmed from multifocal ERG and visual field.

Idiopathic Chylothorax in Infants - Is Octreotide Alone Enough?

Five month old female baby presented to us for evaluation of asymptomatic right sided pleural effusion. Pleural fluid analysis revealed it as chylous effusion. Radiological investigations revealed gross right side pleural effusion with partial collapse of right lung. After investigations, diagnosis of asymptomatic idiopathic chylothorax was made. Baby was treated with Inj. Octreotide alone. Pleural drain was not placed. After three doses of Octreotide, there was complete clearance of pleural effusion.J Nepal Paediatr Soc 2015;35(1):64-66

Outcome of the patients with post-operative cluster endophthalmitis referred to a tertiary level eye care center in Nepal

INTRODUCTION

The causative organism and treatment outcomes of post operative endophthalmitis may vary depending on several factors.

OBJECTIVE

To find out the causative organisms and visual outcome after an outbreak of post-operative endophthalmitis.

MATERIALS AND METHODS

An interventional prospective series of cases of clinically suspected endophthalmitis was studied. Eleven patients who presented within 48 hours after manual cataract surgery on the same day, by a one surgeon in a single center were enrolled in the study. They underwent both anterior chamber and vitreous aspiration and all of them received intravitreal Vancomycin, Amikacin and Dexamethasone. Samples were subjected to microbiological evaluation. All patients were followed up till 8 weeks for clinical and visual outcome.

RESULTS

Of the 11 eyes of suspected endopthalmitis, only one vitreous aspiration showed Gram negative bacilli on Gram stain and 3 vitreous aspirates showed Gram positive cocci. Of the 11 eyes, 3(42.85%) had culture positive on vitreous aspirate. In 2 cases E Coli was isolated and in 1 Staphylococcus aureus was isolated. After 48 hours of intravitreal injection, 10 out of 11 eyes improved and in one, intravitreal injection of vancomycin, amikacin and dexamethasone was repeated. The best corrected visual acuity of 6/9 was achieved in 2 patients, 5 had 6/18, 2 had 6/60 and 2 had 5/60 at the end of eight weeks.

CONCLUSION

Staphylococcus aureus and E coli can cause endophthalmitis immediately on the first day post-operatively. Clinically suspected endophthalmitis treated with antibiotics and steroid intravitreal injection can result in better visual outcome.

Anatomical and functional outcomes of surgery of rhegmatogenous retinal detachment

INTRODUCTION

Rhegmatogenous retinal detachment (RRD) is a potentially blinding condition.

OBJECTIVE

To evaluate the anatomical and functional outcome of surgery of RRD.

MATERIALS AND METHODS

A prospective study of interventional case series was designed including 50 consecutive patients with RRD in a tertiary level eye center in Kathmandu. The patients underwent scleral buckling (SB) or pars plana vitrectomy (PPV) according to the proliferative vitreo-retinopathy (PVR) changes. All the patients had at least 3 months of follow-up. The anatomical and physiological outcome measures were primary retinal reattachment and improvement in visual acuity respectively. The surgery was considered successful when there was attachment of retina after the first surgery.

RESULTS

The mean age of these patients at the time of presentation was 46.24 ± 19.82 years. Of 50, sixty-six percent of the patients underwent SB and 34 % underwent PPV. Primary surgical success rate was 88 %. While comparing the initial best corrected visual acuity (BCVA) with the final, 72% had an improvement, 12 % unchanged and 16 % had a deteriorated visual acuity.

CONCLUSION

The visual acuity improves and the anatomical success rate is high in the majority of the patients after surgery for rhegmatogenous retinal detachment.

Changing trends in idiopathic retinal vasculitis in a tertiary eye care centre of Nepal over a ten-year period

OBJECTIVES

To study the demographic profile, clinical presentations, management and visual outcome of retinal vasculitis in a tertiary eye care center of Nepal

MATERIALS AND METHODS

A retrospective, record based study of retinal vasculitis cases in the retina clinic of a tertiary care centre in Nepal from January 2009 to January 2011 was carried out. Results of the study were compared to those from the study conducted in a similar set- up between 1998 and 2000.

RESULTS

Sixty-nine eyes of 51 affected patients were evaluated in the study. The male/female ratio was 2.64:1 vs 19:1 a decade ago (p=0.0027). The mean age of the patients was 33.53 ± 12.29 years in the present study. Bilateral ocular involvement was present in 18 cases (35.3%) vs 56.14% in the past decade (p=0044).The common symptoms were dimness of vision (29.4%), floaters (25.5 %) and flashes of light (3.92%). Seventy-one eyes (69.6%) had the best corrected visual acuity of 6/18 or better. Four eyes (3.92 %) had no light perception. Vascular sheathing was the most common finding (32.35%), followed by vitritis (30.39%). Corticosteroids were primarily used to manage retinal vasculitis (39.21%). No association of retinal vasculitis with tuberculosis was found.

CONCLUSION

The demographic pattern and clinical presentation of idiopathic retinal vasculitis has changed over a decade period in Nepal.

The factors associated with age related macular degeneration and quality of life of the patients in a tertiary-level ophthalmic center in Kathmandu

INTRODUCTION

age-related macular degeneration (ARMD) is a leading cause of blindness in the elderly population.

OBJECTIVE

to frame a profile of patients withARMD and find out the factors associated with it

MATERIALS AND METHODS

a cross-sectional study was carried out including a total of 75 patients with ARMD presenting to the out-patient department of a tertiary level ophthalmic center in Kathmandu. The data pertaining to their demography, ocular and systemic history and the findings of clinical examination and laboratory investigations were analyzed. The quality of life was assessed based on their dependability on the others for daily activity.

RESULTS

mean age of presentation of ARMD was 73 years +/- 7.93. Of the total, 44 were male and 31 female. Smoking was significantly associated with ARMD (p<0.01). 47 of the subjects had a sedentary lifestyle and 28 a non-sedentary lifestyle. Sedentary life style was significantly associated with ARMD (p=0.028). 48 subjects were hypertensive. Systemic hypertension was significantly associated with ARMD (p = 0.015). 45 had dry ARMD, 21 had wet ARMD and 9 ofthemhad a mixed variety. Thirteen out of the 75 study subjects were leading a normal life while 45 of them had some limitation (self-care only) and 17 of them were dependent on the others for their daily activity. The quality of life was not significantly different between dry and wet ARMD (p = 0.40).

CONCLUSION

sedentary life style, smoking and hypertension are the modifiable factors that are associated with ARMD. A significant number of people with the ARMD have a compromised quality of life.

Etiology of vitreous hemorrhage in a tertiary eye care center in Nepal

INTRODUCTION

Vitreous hemorrhage is one of the most common differential diagnoses of sudden painless decrease in vision.

OBJECTIVE

To find out the etiology of vitreous hemorrhage in cases of vitreous hemorrhage at a tertiary eye centre in Nepal.

MATERIALS AND METHODS

This was a hospital-based cross-sectional study done over a period of one-and-a-half years. One hundred and one subjects with vitreous hemorrhage were evaluated in detail to establish the etiology.

STATISTICS

The mean value and standard deviation were calculated. The data were analyzed using microsoft excel and SPSS 11.5 program.

RESULTS

A total of 122 eyes of 101 patients were evaluated. The mean age was 41.90 (± 21.50) years with a range of 2 months to 84 years. Male were 73 %. Bilateral involvement was found in 20.8 %. Proliferative diabetic retinopathy, retinal vasculitis, branch retinal vein occlusion, rhegmatogenous retinal detachment together with ocular trauma constituted the etilogoy of vitreous hemorrhage in more than 75 % of patients.

CONCLUSION

Proliferative diabetic retinopathy, retinal vasculitis and branch retinal vein occlusion are the most common causes of vitreous hemorrhage in adults whereas in children trauma is the commonest cause.

Synthesis of Sterically Hindered Polychlorinated Biphenyl Derivatives

A series of sterically hindered (methoxylated) polychlorinated biphenyl derivatives was synthesized using the Suzuki and the Ullmann coupling reaction. The Suzuki coupling with Pd(dba)(2)/2-dicyclohexylphosphino-2',6'-dimethoxybiphenyl (DPDB) gave better yields (65-98%) compared to the classic Ullmann coupling reaction (20-38%). Despite the reactive catalyst system, no significant coupling with aromatic chlorine substituents was observed. Crystal structure analysis of four PCB derivatives revealed solid state dihedral angles ranging from 69.7° to 81.0°, which indicates that these highly ortho substituted PCB derivatives have some conformational flexibility.

Alport's syndrome

Alport's syndrome (Haemorrhagic Familial Nephritis) is a rare syndrome. It encompasses a group of heterogeneously inherited disorders involving the basement membrane of the kidney frequently involving the cochlea and the eye. We describe here the detailed ocular findings and the systemic problems of a case of Alport's syndrome in a 30 years male from Nepal. The current understanding of the clinical features and aetiopathogenesis are also discussed.

Tearfilm immunoglobulin E (IgE) level in vernal keratoconjunctivitis by ELISA

BACKGROUND

Vernal keratoconjunctivitis (VKC) is recurrent chronic allergic conjunctivitis occurring in the prepubertal age-group with secondary involvement of the cornea and is self-limiting in character. The disease is prevalent worldwide but it shows predominance in the areas with dry and warm climate including the South Asia. VKC represents about 3% of the serious ophthalmic disease in some parts of the world where the prevalence is rate is high.Type I hypersensitivity reaction which is IgE-dependent and type IV hypersensitivity reaction have been implicated for the pathogenesis VKC.

OBJECTIVE

To determine level of immunoglobulin E (IgE) in the tear fi lm of patients with Vernal Keratoconjunctivitis (VKC) attending outpatient department of BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS).

MATERIALS AND METHODS

Thirty-four VKC patients and thirty-four controls were included in this study. Tear samples were collected using micro- capillary glass tube method and tear IgE levels were measured using an enzyme - linked immunosorbent assay (ELISA).

RESULTS

There was high concentration of tear IgE level in VKC (95.09IU/ml) than in controls (1.63IU/ml) though the difference was not statistically significant (p=0.16). No statistically significant difference was observed in male and female gender within VKC group and when compared with control group (in male group, p=0.21 and in female group, p=0.26). There was no statistically significant difference observed in tear IgE level in different age groups within VKC group and when compared with control group (p=0.30). The result did not show any significant difference in tear IgE level with respect to the duration of the disease (p=0.23).There was no statistically significant difference in tear IgE level with different episodes of VKC (p=0.69). No statistically significant difference of IgE concentration in tear was seen among different types of VKC (p=0.53) and grades of tarsal and limbal papillae (p=0.72).

CONCLUSION

There was high concentration of tear IgE level observed in VKC.

A Pattern of Age-related Macular Degeneration

Introduction: Age related macular degeneration is a disorder of the macula most often clinicallyapparent affecting central vision and is one of the leading causes of blindness in the populationabove 50 years. The aim of this study is to determine clinical profi le of AMD in Nepalese presentingto a Teaching Hospital in Kathmandu.Methods: It was a hospital-based cross-sectional study. The subjects included in the study were thosepresenting to the Ophthalmology department of Kathmandu Medical College Teaching Hospitalfrom July 2007- Dec 2007.The total number of individuals included in the study were 402 and totalnumber of eyes were 804.Results: AMD was observed in 5.2% out of 402 subjects of 40 years and above age group withprevalence increasing with age. The prevalence of AMD was 0.7% within 40-50 years of age-groupindividuals increasing to 2.6% in 51-60 years, 6.5% in 61-70 years and to 19.3% among subjectsabove 71 years. This study revealed that the prevalence of AMD in females was higher with femalepreponderance in ratio of 2.5:1. 52.5 % AMD subjects in our study had visual impairment with 6/24-6/60 vision and 15% had vision <3/60-PL. Our study revealed statistically signifi cant increased riskfor AMD with aging (p=0.00). Increased risk was observed in female gender and diabetics though theOdds ratio (OR) was statistically insignifi cant (p=>0.01).Conclusions: Prevalence of AMD in Nepalese presenting to Kathmandu Medical College TeachingHospital was 5% with female preponderance in ratio of 2.5:1. Aging showed statistically signifi cantincreased risk for AMD development in this study.Key Words: Age-related macular degeneration, blindness, Nepalese, prevalence

A pattern of age-related macular degeneration

INTRODUCTION

Age related macular degeneration is a disorder of the macula most often clinically apparent affecting central vision and is one of the leading causes of blindness in the population above 50 years. The aim of this study is to determine clinical profile of AMD in Nepalese presenting to a Teaching Hospital in Kathmandu.

METHODS

It was a hospital-based cross-sectional study. The subjects included in the study were those presenting to the Ophthalmology department of Kathmandu Medical College Teaching Hospital from July 2007- Dec 2007.The total number of individuals included in the study were 402 and total number of eyes were 804.

RESULTS

AMD was observed in 5.2% out of 402 subjects of 40 years and above age group with prevalence increasing with age. The prevalence of AMD was 0.7% within 40-50 years of age-group individuals increasing to 2.6% in 51-60 years, 6.5% in 61-70 years and to 19.3% among subjects above 71 years. This study revealed that the prevalence of AMD in females was higher with female preponderance in ratio of 2.5:1. 52.5 % AMD subjects in our study had visual impairment with 6/246/60 vision and 15% had vision <3/60-PL. Our study revealed statistically significant increased risk for AMD with aging (p=0.00). Increased risk was observed in female gender and diabetics though the Odds ratio (OR) was statistically insignificant (p=>0.01).

CONCLUSIONS

Prevalence of AMD in Nepalese presenting to Kathmandu Medical College Teaching Hospital was 5% with female preponderance in ratio of 2.5:1. Aging showed statistically significant increased risk for AMD development in this study.

Acceptability of Praneem polyherbal vaginal tablet among HIV uninfected women & their male partners in Pune, India--Phase I study

BACKGROUND & OBJECTIVE

The number of HIV infected women is steadily increasing worldwide and women controlled methods to prevent HIV are urgently needed. Vaginal microbicides are products for vaginal administration that can be used to prevent HIV infection and other sexually transmitted diseases (STDs). We conducted a Phase I safety and acceptability study of Praneem polyherbal tablet, a candidate microbicide, among HIV uninfected women in Pune, India.

METHODS

Twenty eligible women were requested to use the product intravaginally once daily for 14 consecutive days between menses. Safety was assessed by clinical examination, laboratory monitoring and colposcopy. Acceptability was assessed after 14 days of product use through structured questionnaires, focus group discussions among participating women, and in-depth interviews with a subset of 5 randomly selected male partners.

RESULTS

Praneem polyherbal tablet was found acceptable by the study participants with 90 per cent of the participants showing 80 per cent and more acceptability score. Discharge of the product residue was reported as a concern by 6 (30%) of participants. Nineteen (95%) female participants liked the smell and the same number reported that the product was easy to use and did not affect the usual sexual pleasure. However, men reported lack of sexual satisfaction.

INTERPRETATION & CONCLUSION

Product characteristics received good acceptability score in women. However, studies of long-term safety and acceptability among at-risk population would provide more detailed information about its long term acceptability.

High rates of syphilis among STI patients are contributing to the spread of HIV-1 in India

BACKGROUND

Recent syphilis outbreaks have raised concern regarding the potential enhancement of HIV transmission. The incidence of syphilis and its association with HIV-1 infection rates among a cohort of sexually transmitted infection (STI) clinic attendees was investigated.

METHODS

2732 HIV-1 seronegative patients attending three STI and one gynaecology clinic, were enrolled from 1993-2000 in an ongoing prospective cohort study of acute HIV-1 infection in Pune, India. At screening and quarterly follow up visits, participants underwent HIV-1 risk reduction counselling, risk behaviour assessment and HIV/STI screening that included testing for serological evidence of syphilis by RPR with TPHA confirmation. Patients with genital ulcers were screened with dark field microscopy.

RESULTS

Among 2324 participants who were HIV-1 and RPR seronegative at baseline, 172 participants were found to have clinical or laboratory evidence of syphilis during follow up (5.4 per 100 person years, 95% CI 4.8 to 6.5 per 100 person years). Independent predictors of syphilis acquisition based on a Cox proportional hazards model included age less than 20 years, lack of formal education, earlier calendar year of follow up, and recent HIV-1 infection. Based on a median follow up time of 11 months, the incidence of HIV-1 was 5.8 per 100 person years (95% CI 5.0 to 6.6 per 100 person years). Using a Cox proportional hazards model to adjust for known HIV risk factors, the adjusted hazard ratio of HIV-1 infection associated with incident syphilis was 4.44 (95% CI 2.96 to 6.65; p<0.001).

CONCLUSIONS

A high incidence rate of syphilis was observed among STI clinic attendees. The elevated risk of HIV-1 infection that was observed among participants with incident syphilis supports the hypothesis that syphilis enhances the sexual transmission of HIV-1 and highlights the importance of early diagnosis and treatment of syphilis.

Experience with NTBC therapy in hereditary tyrosinaemia type I: an alternative to liver transplantation

We present the clinical data of five infants with type I (hepato-renal) tyrosinaemia on NTBC therapy. All presented initially at the local hospital in the 1st year of life with progressive abdominal distension owing to hepato-splenomegaly and with radiological evidence of liver cirrhosis, except for one child who was diagnosed during screening because of an affected sibling. Age at commencement of NTBC therapy ranged from 6 to 30 months. All infants showed remarkable improvement within 2-6 months of starting NTBC treatment, except one who died 2 months after commencement of therapy from uncontrolled liver failure, severe coagulopathy and Streptococcus pneumoniae septicaemia. NTBC treatment along with a phenylalanine- and tyrosine-restricted diet has effectively reversed most clinical manifestations of this disease. To date, none of our patients has developed hepatic carcinoma and NTBC was well tolerated without side-effects. NTBC is costly but life-saving and is an obvious alternative to more hazardous liver transplantation.

Evaluation of radiographic predictors to assess the rate of mandibular residual ridge resorption

Sixty healthy clinical edentulous patients (thirty male and thirty female) were chosen for the study. Panoramic and lateral cephalometric radiographs were taken of each patient. The amount of bone loss was estimated from the panoramic radiographs as per the formula proposed by Wical and Scoop. The rate of mandibular residual resorbed ridge (RRR) expressed as percentage of bone loss per year was then computed. The correlation between the mandibular RRR and gonial cortical thickness and the percentage of cortical bone at the symphysis was tested. These parameters were also compared between the male and female patients. The rate of mandibular RRR, expressed as percentage of bone loss per year, was found to be indirectly correlated with the cortical thickness at gonion as measured from the panaromic and the lateral cephalometric radiographs. The values of students 't' test for mean differences between the female and the male patients with respect to the rate of mandibular RRR and the cortical thickness at the gonion were found to be statistically significant.

46,XY,der(3)t(1;3)(q23;p22): double aneuploidy at a new breakpoint

A 12-month-old Omani boy is described with double aneuploidy involving chromosomes 1 and 3. In this case the aberration involved segment (q23;p22) which has not been reported previously.

Pattern of inborn errors of metabolism in an Omani population of the Arabian Peninsula

We analysed all patients < 18 years of age diagnosed with inborn errors of metabolism (IEM) in the Metabolic Division, Sultan Qaboos University Hospital, Muscat, Oman from June 1998 to December 2000. A total of 82 patients from 76 families were studied, of whom 33 (40%) were aged < 1 week at presentation. Disorders identified included different lysosomal storage disorders (22), organic acidurias (9), carbohydrate metabolic disorders (9), congenital lactic acidosis (9), urea cycle disorders (8), amino acidopathies (8), fatty acid oxidation defects (7/82) and various other miscellaneous disorders (10). Tandem mass spectrometry helped in the diagnosis of 26 (32%) cases. Parental consanguinity was twice as frequent in the study patients as in the general population. Duration of follow-up ranged from 1 to 30 months (median 15) during which time 46/56 (82%) patients with disorders amenable to specific dietary and drug therapy available in Oman were free from frequent exacerbation. Our study shows the relevance of identifying patients with IEM in Oman and the need to establish screening for the conditions identified and provide effective management protocols.

Cardiac involvement in infantile Sandhoff disease

An 18-month-old boy with enzyme assay-confirmed infantile Sandhoff disease (MIM 268800) is reported. Besides the classical neurological features, this patient exhibited severe mitral regurgitation secondary to mitral valve prolapse and mild aortic regurgitation from aortic valve prolapse. He also had asymmetric hypertrophy of the interventricular septum without left ventricular outflow tract obstruction.

Rat microglia exhibit increased density on Alzheimer's plaques in vitro

The relationship of microglia to senile plaques was investigated by culturing glial cells derived from neonatal rat brain on cryostat sections of Alzheimer's disease (AD) or control brain. Rat microglia were identified by their uptake of DiI-acetylated LDL. Plaques were colocalized using Thioflavin-S staining. Although the number of microglia attached to AD tissue sections did not differ significantly from the number on control brain tissue, the density of microglia on senile plaques was significantly greater than on nonsenile plaque areas of the same sections. These results suggest that microglia may have a higher affinity for senile plaques than for nonsenile plaque regions of AD brain tissue and are consistent with the hypothesis that microglia respond to plaques.

Gastrin and colon cancer: a unifying hypothesis

Recently, a variety of studies in vivo as well as in vitro have demonstrated that gastrointestinal hormones can influence the rate of proliferation of neoplastic cells. The widespread use of omeprazole, which increases serum gastrin, coupled with the findings that omeprazole causes gastric carcinoid tumors in rats and that a significant number of patients with adenocarcinoma of the colon have increased serum gastrin have focussed attention on the relationship between gastrin and colon cancer. In the present paper, we have reviewed the experimental findings in humans, experimental animals, and colon cancer cells in tissue culture that bear on the possible relationships between gastrin and colon cancer. Based on these findings, we have proposed two hypotheses that can account for the increased serum gastrin that occurs in some patients with colon cancer.

Effect of indomethacin on increases in leukotriene B4 and pulmonary edema in response to phorbol ester administration in dogs

The administration of leukotrienes (LTs) into the pulmonary circulation results in edema formation and increased vascular permeability. We reported previously that the administration of phorbol myristate acetate (PMA, 20 micrograms/kg) to intact anesthetized dogs results in a reduction in circulating white blood cells as well as the development of pulmonary edema concomitant with the appearance of LTs in the lungs. In contrast, when a smaller dose of PMA (10 micrograms/kg) was administered, neither extravascular lung water nor LTs increased, although there was a similar reduction in circulating white blood cells. In the present study, we used a property of indomethacin, namely, its capacity to augment the formation of LTs, to examine further the relationship between LT generation and pulmonary edema formation in response to PMA administration. In intact pentobarbital-anesthetized dogs pretreated with saline (N = 9), the administration of PMA at a dose of 10 micrograms/kg, i.v., did not result in any change in extravascular lung water or in LTB4 present in bronchoalveolar lavage fluid (BALF). In contrast, in six animals pretreated with indomethacin (5 mg/kg), the administration of this dose of PMA resulted in increases in both extravascular lung water (P < 0.05) and LTB4 (P < 0.05) in BALF. These results provide support for the hypothesis that leukotrienes are requisite for PMA-induced increases in extravascular lung water.

Relaxation of porcine coronary artery to bradykinin. Role of arachidonic acid

Bradykinin-induced relaxation of precontracted, porcine coronary artery (PCA) rings is mediated by distinctly different endothelium-derived relaxing factors depending on the contractile agent used. Thus when contracted with KCl, bradykinin-induced relaxation of PCA rings is mediated solely by nitric oxide (NO), whereas when contracted with the thromboxane mimetic U46619, a small component of the relaxation is attributable to NO and a large component is attributable to a non-NO mechanism that is independent of cyclooxygenase activity. We hypothesized that the non-NO component was mediated by arachidonic acid (AA) or by a non-cyclooxygenase product of AA metabolism. Bradykinin-induced relaxations of PCA rings precontracted with U46619 in the presence of indomethacin (10 mumol/L) were moderately attenuated by the NO synthase inhibitor N omega-nitro-L-arginine methyl ester (L-NAME, 100 mumol/L), whereas when precontracted with KCl, L-NAME abolished the relaxations. AA produced endothelium-dependent relaxations of rings precontracted with U46619 that were unaffected by L-NAME, whereas AA did not relax rings precontracted with KCl. In rings precontracted with U46619, in the presence of L-NAME and indomethacin the phospholipase inhibitors quinacrine (50 mumol/L) and 4-bromophenacyl bromide (10 mumol/L) attenuated bradykinin- but not AA-induced relaxations. Inhibitors of both lipoxygenase (BW 755c [100 mumol/L] and nafazatrom [20 mumol/L]) and cytochrome P-450 (proadifen [10 mumol/L] and clotrimazole [10 mumol/L]) pathways did not eliminate bradykinin- or AA-induced relaxations, although clotrimazole partially attenuated AA-induced relaxations. These findings suggest that bradykinin-induced relaxation of PCA rings is mediated by AA through a mechanism that is not dependent on cyclooxygenase, lipoxygenase, or cytochrome P-450 pathways.

Enteral pancreatic enzyme feedback inhibition of the exocrine secretion of the human transplanted pancreas

The mechanism of regulation of negative feedback inhibition of the exocrine pancreas and its possible role in decreasing the exocrine secretion of the grafted human pancreas is unknown. To evaluate this we studied the effect of oral pancreatic enzymes on the stimulated transplanted pancreatic exocrine secretion in eight patients with allograft pancreaticocystostomies. After an 8-hr fast, all graft exocrine secretions via graft stent, fistula, and urinary anastomosis were collected for a 1-hr basal period. A standard 300-ml Lundh test meal was then ingested, and all exocrine secretions were collected in 30-min intervals for 3 hr. This test was repeated with 6 capsules of pancrelipase (24,000 units of lipase, 120,000 units of amylase, and 150,000 units of protease) given with the Lundh test meal. Stent, urine and fistula volume, amylase, and pH were measured for each collection period. The total 3-hr amylase secreted after the test meal and the test meal plus pancrelipase were compared. The period of peak amylase secretion after the test meal alone was compared with the same period after the test meal plus pancrelipase and the premeal basal period. The total amylase decreased 34% from 5550 +/- 1000 to 3680 +/- 740 IU/3 hr (P < .03) with pancrelipase. The peak amylase secretion decreased 63% from 1520 +/- 271 to 567 +/- 185 IU/30 min (P < .02) with the addition of pancrelipase to the test meal. Pancrelipase eliminated all meal-stimulated amylase secretion with the mean secretion 16% below the basal secretion of 674 +/- 117 IU/30 min. We conclude that pancreatic negative feedback inhibition significantly decreases meal-stimulated and basal exocrine secretion in the transplanted human pancreas.

Role of endothelium in responses of isolated hepatic vessels to vasoactive agents

The role of the endothelium as a participant in the responses to vasoactive agents was evaluated in isolated canine hepatic artery (HA) and portal vein (PV) rings. Endothelial and smooth muscle integrity was determined by pharmacologic responses as well as by histologic examination. Smooth muscle relaxation was expressed as the percent of decrease of norepinephrine-induced isometric contraction. Acetylcholine (ACh)-induced relaxation of the HA was abolished by removing the endothelium or by the addition of either hemoglobin, methylene blue (MB) or Ng-mono-methyl-L-arginine. In addition, relaxation induced by nitroglycerin, but not that induced by prostaglandin E1, was attenuated by MB. These data suggest endothelium-dependency of the relaxation to ACh and mediation of the response by endothelium-derived relaxing factor through activation of guanylate cyclase. In contrast, ACh produced contraction of the PV which was unaffected by removing the endothelium. The calcium ionophore, A23187, on the other hand, produced relaxation of the PV, which was significantly decreased by removing the endothelium. Relaxation of both HA and PV, produced by 2-chloroadenosine (2-C-Ado) was partially attenuated by removing the endothelium. With the endothelium intact, neither hemoglobin, MB, Ng-monomethyl-L-arginine nor indomethacin affected the responses to 2-C-Ado in the HA and PV, suggesting that the responses were not mediated by endothelium-derived relaxing factor or products of guanylate cyclase or cyclooxygenase activity. Nitroglycerin relaxed both vessels in the presence or absence of endothelium, indicating that removal of the endothelium had not affected smooth muscle function.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of hydrocortisone acetate on the maturity of male Labeo gonius (ham.)

The effect of hydrocortisone acetate on the maturity of male Labeo gonius was studied during spawning season. Maturation was inhibited and spermiation arrested. Reduction in the lobes of the testes, volume of the testes and gonadosomatic index were observed. The length of the testes was also reduced. The clumping of spermatozoa occurred in the middle part of the seminiferous lobules. The control group remained unchanged.

Quantitative temporal analysis of 99mTechnetium p-isopropyl-iminodiacetic acid (PIPIDA) as a measure of hepatic function in health and disease

Excretory liver function was analyzed in 10 healthy volunteers and 28 subjects with acute or chronic liver injury following intravenous administration of 99mtechnetium p-isopropyl iminodiacetic acid. Hepatobiliary transit of this agent was quantitated at 5-min intervals for a total of 60 min. Indices of total liver activity, liver cell uptake, liver parenchymal clearance, and bile duct clearance of 99mtechnetium p-isopropyl iminodiacetic acid were calculated from time--activity curves over heart, liver, extrahepatic bile ducts, and gallbladder. Seven subjects with acute viral hepatitis, 15 with extrahepatic biliary obstruction, and 6 with intrahepatic cholestasis were evaluated. Compared with healthy volunteers, a significant (p less than 0.0001) reduction in total liver activity and liver parenchymal clearance was demonstrated in all patient groups. Major resolution in all liver-derived indices, particularly total liver activity, occurred during convalescence from hepatitis and after biliary drainage. Nonmeasurable bile duct clearance always indicated a diagnosis of extrahepatic obstruction in cholestatic subjects, and this index normalized in subjects following biliary drainage. Whereas visual assessment of 99mtechnetium p-isopropyl iminodiacetic acid scans provided limited, useful information about the functional status of the liver, quantitative temporal analysis proved to be a much more effective technique.

Candidiasis of the duodenum and jejunum

Infection of the small bowel with Candida species has previously been noted to occur in as many as 20% of autopsy cases with histologically demonstrated gastrointestinal candidiasis. Antemortem diagnosis, however, has been difficult and not previously reported. A renal transplant recipient presented with esophageal, duodenal, and jejunal candidiasis, and the correct antemortem diagnosis of small bowel involvement was suggested by radiologic and endoscopic findings. Antifungal therapy resulted in complete resolution of these findings.

Complementary use of computerized tomography and technetium scanning in the diagnosis of accessory spleen

A patient with a previous splenectomy presented with acute gastrointestinal bleeding. He was found to have a benign gastric ulcer, esophagogastric varices, and a mass indenting the gastric fundus. Abdominal computerized tomography and technetium liver-spleen scanning established the diagnosis of an accessory spleen as cause for the mass effect. This diagnostic approach obviated the need for arteriography and exploratory laparotomy.

Heartburn of pregnancy

Lower esophageal sphincter pressure, basal gastric pH, fasting plasma gastrin, and plasma concentrations of estrone, estradiol, and progesterone were measured in pregnant volunteers at 12, 24, and 36 weeks of gestation, and again at 1 to 4 weeks postpartum. In addition, basal and pentagastrin-stimulated acid secretory responses at each time were measured. No differences in basal gastric pH, basal, and peak acid outputs were observed during pregnancy when compared to the postpartum values. In contrast, lower esophageal sphincter pressure was reduced at all times during pregnancy, reaching a nadir at 36 weeks. Postpartum lower esophageal pressures were normal. As expected, plasma concentrations of progesterone and both estrogens increased progressively during pregnancy. These data are consistent with earlier studies in women ingesting oral contraceptives. Moreover, they provide support for the thesis that the progressive increase in plasma progesterone alone or in combination with estrogens that occurs during pregnancy is responsible for the reduction of lower esophageal sphincter pressure which allows esophageal reflux to occur with the resultant development of symptomatic heartburn.

Association between diabetic retinopathy and serum lipoproteins level

Introduction: Diabetic retinopathy is the leading cause of blindness of working-age patients in the urban areas. Objective: To find out the association between diabetic retinopathy and serum lipoproteins in patients with diabetes mellitus Materials and methods: A community-based cross-sectional study involving 100 subjects with type II diabetes living in the cities of Kathmandu, Bhaktapur and Lalitpur of Nepal was carried out using a purposive sampling method. The retinopathy was classified according to the modified Airlie House classification of diabetic retinopathy. The patients with systolic hypertension were excluded. The blood sugar level was assessed by using glycosylated hemoglobin. The fasting serum lipoproteins were assessed by photometric enzymatic methods. Statistics: The SPSS version 10.0 software was used. The p value of <0.05 was considered significant. Results: The majority (n=91) of the patients were in the age group 31-60 years with the mean of 48.2 ± 9.5. The mean duration of diabetes mellitus in the patients with no-diabetic-retinopathy was 4 ±3.4 years and that in those with the retinopathy was 6.4 ± 4years, (p =0.006). The mean glycosylated hemoglobin level for no-diabetic-retinopathy group was 6.9 ±1.1 %, whereas for the diabetic retinopathy group, it was 7.7 ± 1.5% (p = 0.004). The mean values of serum lipoproteins when taken together were slightly higher in the diabetic retinopathy group than in the group with no-diabetic-retinopathy. The serum triglyceride value was higher in the group with diabetic retinopathy than in the group with no retinopathy. Serum triglyceride had a low degree of positive correlation with HbA1c value. Conclusion: There is no significant association between the serum lipoprotein levels and diabetic retinopathy in patients with type II diabetes mellitus. Serum triglyceride level has a low degree of positive correlation with HbA1c value. Keywords: diabetic retinopathy; lipoproteins; glycosylated hemoglobin DOI: 10.3126/nepjoph.v1i2.3684 Nep J Oph 2009;1(2):107-113