Eyelid Molluscum Contagiosum Presenting as a Giant Nodule With Chronic Refractory Conjunctivitis

Molluscum contagiosum is a benign cutaneous viral infection caused by a poxvirus, commonly seen in children and adolescents. It typically produces benign, self-limiting eruptions on the skin and mucous membranes, usually on the face, trunks, limbs, and genital areas. The eyelid is the most common site of ocular lesions, less commonly conjunctiva.Eyelid Lesions are typically small papules (two to six mm) with central depressions, or maybe non-umbilicated. Patients with immunodeficiency may have an atypical giant lesion or widely disseminated lesions. We present a case of eyelid molluscum contagiosum presenting with an unusually large nodule with two depressions associated with chronic follicular conjunctivitis in a three-year-old otherwise healthy child. Eyelid lesions were removed surgically. The conjunctival follicular reaction was completely resolved after one month of surgical excision. A histopathological examination confirmed the diagnosis.

Reactive Hypoglycemia in Patients Prior to Cataract Surgery: A Case Series

Cataract surgery is one of the most frequently performed surgical procedures and is often performed under topical anesthesia in conscious patients. Sweating, palpitations, and anxiety may be seen in patients about to undergo surgery. However, these are typical adrenergic symptoms of hypoglycemia and should be further investigated if occurring before surgery. Here, we report five cases of postprandial or reactive hypoglycemia observed in hospital settings just before conducting cataract surgeries in non-diabetic 52-78-year-old patients from 2019 to 2023.

Ganglion cell complex and retinal nerve fiber layer thickness in gestational diabetes mellitus

PURPOSE

The purpose of this study was to compare ganglion cell complex and peripapillary retinal nerve fiber layer (RNFL) thickness between pregnant females with gestational diabetes mellitus (GDM) and healthy pregnant females.

MATERIALS AND METHODS

This was a single-center, prospective, analytical cross-sectional study including pregnant females with a gestational age of 24 weeks or more in the GDM and control groups. The GDM group included 162 pregnant females with GDM, and the control group included 162 healthy pregnant females. Peripapillary RNFL (pRNFL), macular RNFL (mRNFL), GCL+ (ganglion cell layer [GCL] + inner plexiform layer [IPL]), and GCL++ (mRNFL + GCL + IPL) thickness were analyzed using spectral-domain optical coherence tomography (OCT), and comparisons were made between the groups.

RESULTS

Both the groups had similar mean age (P = 0.219), intraocular pressure (P = 0.186), central corneal thickness (P = 0.689), Schirmer test value (P = 0.931), and tear breakup time (P = 0.651). The mean pRNFL thickness of the GDM and control groups was 100.75 ± 8.36 μm and 106.77 ± 8.44 μm (P < 0.0001). pRNFL was significantly thinner in all four quadrants (P < 0.05) in the GDM compared to the control group. We observed that the mean mRNFL, GCL+, and GCL++ thickness were significantly reduced in GDM in comparison to the control group (P < 0.05).

CONCLUSION

Our study showed that OCT plays an indispensable role in determining initial retinal changes caused by GDM before the development of diabetic retinopathy.

A study of retinal changes in women with polycystic ovarian syndrome

Purpose

To compare the optical coherence tomography (OCT)-based retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness at the posterior pole, and total macular thickness of women with the polycystic ovarian syndrome (PCOS) versus healthy reproductive age group females.

Methods

The study included 110 eyes of 55 diagnosed cases of PCOS (study group) and 110 eyes of 55 healthy reproductive age group (15-49 years) females (control group). All patients underwent a detailed ophthalmological evaluation followed by an OCT to measure their retinal thicknesses. The body mass index (BMI) of patients was noted and compared with the retinal thickness. Also, the lipid profile and serum testosterone levels of PCOS patients were recorded.

Results

The retinal thicknesses in the two study were similar and there was no statistically significant difference. However, on stratification with BMI, it was seen that in patients with BMI>30 kg/m², the superior Retinal Nerve Fibre Layer (RNFL) was significantly thicker in the PCOS group as compared with the control group (P = 0.0006). The mean serum testosterone level in patients with PCOS was 141.3 ± 23.2. Also, 65.45% of patients had a serum testosterone level of more than 70 ng/dL. The mean HDL cholesterol in patients with PCOS was 38.1 ± 15.6. The mean LDL cholesterol in PCOS patients was 98.4 ± 21.7, and the mean total cholesterol in PCOS patients was 153.6 ± 27.3.

Conclusion

Androgens have a trophic action on nerves, which could explain the increased RNFL thickness in these patients.

Lobular capillary hemangioma of the conjunctiva

We report a case of lobular capillary hemangioma of the conjunctiva in a 32‐year‐old man, who had no history of eye surgery or trauma, and did not respond to topical corticosteroid therapy. He was treated successfully by surgical excision. Excisional biopsy confirms the diagnosis and rules out any malignant lesion in medically uncontrolled cases.

Subconjunctival foreign body with suspected scleral penetration

Ocular foreign bodies may be threat to vision loss. Superficial foreign body present on the conjunctiva or cornea can be easily detected and removed, and may not cause much harm if treated appropriately without delay. Subconjunctival foreign bodies are relatively rare, commonly missed and present as foreign body granuloma, even if they are visible their extent in deeper tissue is difficult to assess. Foreign bodies penetrating the ocular coat can result in partial or full thickness penetration of cornea and sclera with or without involvement of posterior segment. Here we present a case of subconjunctival metallic foreign body embedded in deeper sclera in a 22-year male working in factory. Foreign body was removed carefully under local anaesthesia avoiding further damage to the eye.

Bilateral severe microphthalmos with bilateral colobomatus orbitopalpebral cyst: accessibility of speciality eye-care and rehabilitation services in low and middle-income countries

A 12-year-old girl presented with an unusually large mass under the right lower eyelid and a smaller mass under the left lower lid since the last 6 months. The parents had noticed the absence of the right eyeball and a very small left eyeball and no vision in both eyes since birth but did not approach the healthcare system. The patient was diagnosed as a case of bilateral severe microphthalmos with colobomatous cyst with late presentation and was treated surgically. The parents were counselled for education and training of the child in schools for visually impaired. Early treatment and rehabilitation help patients lead a normal life in these cases. In rural areas, patients face challenges in getting access to the specialty eye-care services due to several barriers, including lack of availability and affordability. This case highlights the disparities in essential health services in low and middle-income countries.

AB1231 2019 LUPUS CLASSIFICATION CRITERIA SCORE PREDICTS FUTURE LUPUS HOSPITAL ADMISSION

Background:

There are several validated tools to quantitate lupus disease activity, end-organ damage and overall fragility. An algorithm to predict the hospitalization risk in lupus patients was proposed by Li et al1. That algorithm was able to effectively screen patients at increased risk of hospitalization using EHR information only. Recently, the new 2019 Lupus classification criteria score has been noted to accurately predict 10 year mortality2.

Objectives:

To test the above 2 algorithms with potential to predict lupus related hospital admissions.

First, we attempted to validate the existing algorithm from the index study of Li et al to predict lupus hospitalization.

Second, we tested the 2019 lupus clinical classification score for its ability to predict hospitalizations.

Methods:

A retrospective chart review was performed using EHR data collected from 2013 to 2018 at University of Kentucky (UK) Medical Center. Inclusion criteria were 18 years or older at first outpatient rheumatology appointment at UK, at least 3 outpatient rheumatology visits at UK, and ICD 9/10 code for Lupus. A total of 217 patients met inclusion criteria. Variables similar to the index study were extracted from patients’ first outpatient rheumatology visit at UK. Additionally, 2019 Lupus Classification Criteria score was calculated. Patients who were subsequently hospitalized, manual chart review was done to determine if the hospitalization was attributable to lupus or not.

Results:

Table 1 shows differences between the variables predicting hospitalization in patients in this study (UK) and the Ohio State University (OSU) cohort from whom the admission predicting algorithm was derived1. All the risk factors that were found to predict lupus hospitalization in the index study, failed to achieve a statistical significance in our validation study.

Table 1.

Differences in the variables predicting hospitalization between Index and Validation Cohort

Variables predicting Lupus HospitalizationIndex Study (Ohio State),% of patients(n=226)Validation Study(University of Kentucky)% of patients; (n=217)African American33%18%Creatinine > 1.217%7%Hemoglobin < 11g/dl79%18%Platelets < 180 / uL75%22%High Risk immunosuppression35%9. 2%Missed appointment27%25%

There was more success predicting lupus hospitalization using the 2019 lupus classification criteria score (CCS) (Figure 1). A CCS >=19 predicted higher risk of lupus related hospitalization vs CCS < 19 over the ensuing 2 years (p-0.05).

Figure 1.

Kaplan- Meier Survival Analysis comparing the risk of hospitalization between the groups with 2019 Lupus classification criteria score (CCS) of less than 19 (red) and more/equal to 19 (blue). A time-dependent effect, with the admission free survival curves crossing at two years (Figure 1), indicated a 1 out of 3 chance of lupus related admission during the first 6 months for a high CCS score > =19.

Conclusion:

We failed to validate the EHR algorithm identifying patients at high risk for lupus hospitalization in our less severely affected cohort with fewer admission events to analyze. Nonetheless, “criteria counting” using the weightings of the 2019 lupus classification criteria was granular enough to make these case finding criteria themselves prognostic for future hospitalization risk. It is likely that existing EHRs, using protocols based upon classification criteria scores, are now capable of predicting survival, costs, and admissions automatically.

References:

[1]D Li et al. Determining risk factors that increase hospitalizations in patients with systemic lupus erythematosus, Lupus (2018) 27, 1321–1328

[2]Carneiro et al. A comparison of three classification criteria sets for Systemic Lupus Erythematosus – a study looking at links to outcome and mortality; Arthritis Care Res (Hoboken). 2019 Sep 10. doi: 10.1002/acr.24061

Disclosure of Interests:

Saurav Suman: None declared, Mervat Eissa: None declared, Heidi Rogers: None declared, Aleksander Lenert: None declared, Arnold Stromberg: None declared, william roberts Shareholder of: Own Stocks of Pfizer and Novartis

Intraoperative mitomycin C and cryotherapy as adjunct therapy for recurrent lobular capillary haemangioma of conjunctiva

Recurrence of lobular capillary haemangioma of conjunctiva after surgical excision is rare but sometimes it may be difficult to manage multiple recurrences. A 31-year-old female patient presented with recurrent polypoid conjunctival lobular capillary haemangioma. Excisional biopsy was performed, followed by eye drop mitomycin C 0.04% four times a day for 1 week postoperatively. She reported again after 3 months with recurrence of vascular elongated nodular lesion. Excision of the mass with application of mitomycin C 0.02% intraoperatively for 1 min and cryotherapy using double thaw technique of the peripheral conjunctival margin was done. The histopathological examination confirmed the recurrence of lobular capillary haemangioma. On review, 1 year after treatment there was no evidence of recurrence. A combined use of cryotherapy and intraoperative mitomycin C as adjunctive therapy after surgical excision can successfully prevent further recurrence without any adverse effect.

Possible Role of Myoglobin in Regulating Calpain-1 Activity in Postmortem Beef Muscle

ObjectivesPrevious research revealed a relationship between meat color and beef tenderness and indicated that myoglobin can inhibit calpain-1 in solution. The objective of this study was to determine the extent to which myoglobin and beef color are associated with calpain activity and beef tenderness.Materials and MethodsBeef Longissimus dorsi samples from the left side of Holstein beef carcasses (n = 21) were collected immediately post exsanguination on the processing floor for 0 h analyses. Muscle temperature and pH was measured at 0, 24, and 48 h postmortem. After USDA quality and yield grade determination, steaks (n = 6) were removed from the right side of each carcass (n = 21) at 48 h for analyses at 48 and 336 h postmortem. Color (L*, a*, and b* values), surface myoglobin redox forms, metmyoglobin reducing activity (MRA), total myoglobin concentrations, slice shear force (SSF), Warner-Bratzler shear force (WBSF) were measured. Calpain-1 concentrations and autolysis were determined via Western blot at 0, 48, and 336 h.ResultsDecline in muscle pH was 6.4, 5.8, and 5.6 at 0, 24, and 48 h, respectively. Shear force values at 48 h were 73.19 N for WBSF and 384.21 N for SSF and at 336 h were 48.75 N for WBSF and 260.47 N for SSF. Myoglobin reducing activity at 336 h was positively correlated to WBSF at 48 h and negatively correlated to calpain-1 concentration at 0 h (P < 0.05; Table 9). Color measurements of L* and b* at 48 h were moderately correlated with WBSF at 336 h (P < 0.05; Table 9). The b* measurement at 336 h showed a moderate relationship to calpain-1 concentration at 0 h (P < 0.05; Table 9).ConclusionModerate correlations between color and tenderness measurements taken at 48 h with those taken at 336 h were discovered indicating that myoglobin may impact calpain-1 in vivo.Table 9Correlations (P-values) between selected color and tenderness measurements (n = 21)

Comparison of Lipid and Protein Oxidation Products and their Impact on Colour Stability in Bison Longissimus Lumborum and Psoas Major Muscles

ObjectivesTo compare lipid (malondialdehyde [MDA], 4-hydroxy-2-nonenal [HNE]) and protein (carbonyl content [CAR]) oxidation products and determine their influence on color stability in two bison muscles (longissimus lumborum [LL; color stable] and psoas major [PM; color labile]).Materials and MethodsA total of 10 longissimus lumborun (LL) and 10 psoas major (PM) from five A1 grade bison carcasses were obtained from a commercial slaughter plant within 48 h post-mortem. From each muscle, a 10-cm thick piece was removed and subsampled for evaluation of pH, MDA (by thiobarbituric acid assay), HNE (by ELISA) and CAR (by 2,4-dinitrophenylhydrazine). These measurements allowed the establishment of a baseline for the different oxidation products. The remainder of the muscles were cut into two equal portions, and each portion was vacuum-packaged and assigned to an ageing period of 7 and 14 d at 2°C. At the end of each ageing period, each muscle portion was removed from their packages, pH measured, and steaks obtained for sensory (muscle and discoloration scores) and instrumental color measurements (L*, a* and b*) over 5 d of retail display, and for estimation of MDA, HNE and CAR. After 5 d in retail display and following color and pH measurements the steaks were removed and collected for MDA, HNE and CAR determination. Data were analyzed as a completely randomized design with a split-split plot arrangement. Additionally, correlation and regression analysis were performed to identify the influence of the measured attributes on color.ResultsRegardless of the ageing time, LL showed greater redness and lower surface discoloration by instrumental (a* value; P = 0.04) and sensory (P < 0.01) color evaluation than PM at the end of the retail display. Furthermore, LL exhibited lower MDA, HNE and CAR content compared to PM (P < 0.05). A three-way interaction (muscle × ageing time × retail day display) was detected on MDA content, where PM presented a higher level of MDA with increasing ageing time and retail display than LL (P = 0.02). The pH was not different between LL and PM (P > 0.05) steaks.In both muscles, Pearson (r) and Spearman (rs) correlation coefficients indicated that MDA was the oxidation compound showing the highest correlation to a* (r = –0.78; P < 0.01) and discoloration (rs = 0.81; P < 0.01) scores, followed by a moderate correlation with HNE and CAR (r or rs < 0.7; P < 0.01). The pH did not exhibit correlation with color traits, except for lightness, in both muscles. For the stepwise regression analysis, the main variable entered into the equation for predicting a*, color and discoloration score in PM muscle was MDA with an R2 of 0.72, 0.75 and 0.78, respectively, while for LL muscle, MDA presented an R2 of 0.62, 0.68 and 0.66;, respectively. The pH, HNE and CAR only explained an additional 2% of the variation in those attributes.ConclusionThe results of color attributes corroborated that bison LL is a color-stable muscle due to the lower level of protein and lipid oxidation products developed during storage and retail display compared to PM muscle, which is considered color-labile muscle. The MDA seemed to have remarkable importance in the color deterioration than HNE and CAR, particularly in bison PM muscle.

Myoglobin Modeling to Study Species-Specific Differences in the Distance Between Heme Iron and Proximal and Distal Histidines

ObjectivesSpecies-specific differences in amino acid sequence influence myoglobin redox properties. Previous studies reported that the number and location of histidine residues can influence myoglobin redox stability. However, limited knowledge is currently available on the species-specific differences in the distances between the proximal (His 93) and distal (His 64) histidines and the heme iron in myoglobin. The objective of the current research was to utilize homology-based modeling to determine the distances between the proximal and distal histidines and the heme iron in the myoglobins from beef, pork, goat, bison, sheep, water-buffalo, venison, and emu.Materials and MethodsThe homology-based modeling was conducted using the Iterative Threading Assembly Refinement server (I-TASSER), which identifies the homologous structure models of myoglobins (beef, pork, goat, bison, sheep, water-buffalo, venison, and emu) from Protein Data Bank (PDB) using an algorithm named Local Meta-Threading-Server. The secondary structure of the target protein was predicted based on sequence information from the Protein Secondary Structure PREDiction algorithm. The lowest free energy conformations of the proteins were determined by SPICKER (a clustering approach to identify near-native protein folds). Refinement of the low free energy conformations were done by using Fragment Guided Molecular Dynamics simulations and ModRefiner. Prediction of the ligand-binding site of the target proteins were made by COACH algorithm. The distances between histidines (His 64 and His 93) and the iron in the heme group in the predicted structure of eight different species were determined using PyMOL, a computer software used for molecular visualization.ResultsThe homology-based modeling has shown that despite having 80% sequence similarity and conserved histidine residues (His 64 and His 93), the distance between the distal histidine (His 64) and heme iron varied between 4.3–5.5 Angstrom. Pork myoglobin has the shortest distance, and beef myoglobin has the longest distance. The distance between the proximal histidine (His 93) to the heme varied between 1.9 to 3 Angstrom; sheep myoglobin had the shortest and bison had the longest.ConclusionThe results suggest that in addition to the inherent differences in muscle biochemistry, variations in myoglobin structure also contributes to species-specific differences in meat color.

The pro-apoptotic role of autophagy in breast cancer

BACKGROUND

Autophagy is a catabolic process that has a vital role in cancer progression and treatment. Current chemotherapeutic agents, which target autophagy, result in growth inhibition in many cancer types. In this study, we examined the role of autophagy in breast cancer (BCa) patients as well as BCa cell lines.

METHODS

Tissue microarray was used to detect the expression of an autophagy marker, LC3B in BCa patients (normal/hyperplasia=8; grade-I=15, grade-II=84, and grade-III=27) and BCa cell lines. To modulate the activation of autophagy, we used novel herbal compound nimocinol acetate (NA) in BCa cell lines and the anticancer activity was measured by phenotypic and molecular analysis.

RESULTS

LC3B is highly expressed in tumours as compared with normal tissues. Activation of LC3B in NA-treated BCa (MCF-7 and MDA-MB-231) cells was evident as compared with other autophagy makers. Further, our results confirmed that NA-transcriptionally regulates LC3B (as confirmed by mRNA levels and reporter assay), which resulted in the formation of acidic autophagy vesicles and autolysosomes in BCa cells. Nimocinol acetate inhibited mTOR-mediated pro-survival signalling that resulted in inhibition of growth in BCa cells without affecting normal breast epithelial cells. Downregulation of LC3B expression by siRNA significantly inhibited the anticancer effects of NA in BCa cells.

CONCLUSIONS

Together, our results suggest that LC3B is highly expressed in BCa tissues and increasing the threshold of LC3B activation dictates the pro-apoptotic function, which in turn, suppresses the growth of BCa cells. Nimocinol acetate could be a potential agent for treatment of BCa.

Long-term change in intraocular pressure after extracapsular cataract extraction with posterior chamber intraocular lens implantation versus phacoemulsification with posterior chamber intraocular lens implantation in Indians

Purpose:

The purpose of the study is to evaluate the long-term changes in intraocular pressure (IOP) after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation versus phacoemulsification with PCIOL implantation in otherwise normal cataract patients in India.

Materials and Methods:

The study was conducted in the Department of Ophthalmology, King George's Medical College, Lucknow between August 2000 and August 2001. One hundred and seventeen eyes of 115 patients were included in the study. 84 patients were randomly selected for ECCE with PCIOL implantation (ECCE group) and 31 patients were selected for phacoemulsification with PCIOL implantation (Phaco group). IOP was measured pre-operatively and post-operatively, from the 1^st month to the 12^th month. Statistical significance was indicated by P > 0.05.

Results:

There was a mean fall in IOP of 2.70 mm Hg (19.74%) in the ECCE group and 2.74 mm Hg (20.57%) in the phaco group. The decrease in the mean post-operative IOP from baseline was statistically significant (P > 0.01) at the end of 2 months in both groups. There was no statistically significant difference in post-operative IOP at any visit between groups (P < 0.05, all post-operative visits). After 4^th monthpost-operatively, the IOP was mostly stable, but it was significantly lower than the pre-operative IOP.

Conclusion:

Significant IOP reduction may be expected after cataract surgery with either ECCE or phacoemulsification with IOL implantation. The lowering of IOP became statistically significant at about 2 months post-operatively, but became almost stable after the 4^th month.

Transcanalicular endoscope combined laser-assisted dacryocystorhinostomy

Aims:

In this study, we have tried to assess the success rate and difficulties that we came across while performing the transcanalicular endoscope combined laser-assisted dacryocystorhinostomy (T-ECLAD).

Materials and Methods:

A prospective study of 60 patients suffering from nasolacrimal duct obstruction confirmed by preoperative syringing was carried out at the Regional Institute of Ophthalmology. T-ECLAD is a new minimally invasive dacryocystorhinostomy procedure, which is performed by diode laser (980 nm diode laser with power of 10 watts) through lacrimal canaliculi with the help of a cannula and fiber optic cable. The interior of the nasal cavity was visualized with the help of the nasal endoscope on a monitor. Success of procedure was assessed by patency of the lacrimal drainage system on irrigation.

Results:

We performed 56 successive T-ECLAD. The average procedure time was 10 min, and on an average 235 Joules of laser energy was needed. We observed a patent nasolacrimal duct on irrigation in 39 out of 56 treated eyes. 1 patient had partial, 5 patients had blocked irrigation, and 10 patients did not return for follow up. This yields a success rate of 69.6% (if we exclude patients who did not return for follow up) with an average follow-up period of 6 months.

Conclusions:

The 980-nm T-ECLAD is a new contribution to the field of lacrimal surgery. It is a minimally invasive and quick procedure.

Corneal stromal pseudohypopyon in a pseudophakic patient

BACKGROUND

Corneal stromal pseudohypopyon is a rare entity.

CASE

A 65-year-old female developed a suture abscess in her pseudophakic right eye, three years after conventional extra-capsular cataract extraction with posterior chamber intraocular lens implantation. Pusfrom the suture abscess tracked down the corneal stromal layers and formed a pus level leading to the appearance of a corneal intra-stromal pseudo-hypopyon.

CONCLUSION

This case is unique due to its unusual clinical presentation and highlights the fact that corneal pseudo hypopyon may occur without any associated anterior chamber hypopyon or Descemet's detachment.

Use of the pro-seal laryngeal mask airway facilitates percutaneous dilatational tracheostomy in an intensive care unit

Purpose:

To study the feasibility of using the pro-seal laryngeal mask airway (LMA) for airway maintenance during bronchoscopic-guided percutaneous tracheostomy.

Materials and Methods:

Observational study of 60 patients in a 16-bed intensive care unit. The patient’s tracheal tube was exchanged for a pro-seal LMA before undertaking percutaneous tracheostomy.

Results:

Inspiratory pressure and tidal volumes achieved during the procedure were recorded. The median peak inspiratory pressure was 25 (standard deviation 4.4) cm H2O. There was no loss of tidal volume in 30 patients, a loss of less than 100 mL/breath in 27, and loss of more than 100 mL in 3 patients. A pro-seal LMA successfully maintained the airway and allowed adequate ventilation during per-cutaneous tracheostomy in all 60 patients. In all patients, fiber optic bronchoscopy through the pro-seal LMA provided a clear view of the cords and trachea and there was no laryngeal or tracheal soiling at any stage of the procedure.

Conclusion:

The pro-seal LMA provides a reliable airway and allows effective ventilation during percutaneous tracheostomy. The passage of a fiberscope through the pro-seal LMA and glottis is easy and provides a clear view of the upper trachea.

Primary pericardial mesothelioma presenting as pericardial constriction: a case report

A 19 year old man presented with a six month history of chest pain, dyspnoea, and lethargy and was found on an echocardiogram to have a dilated left ventricle with a small pericardial effusion. Ramipril and a course of steroids were tried but serial echocardiograms showed a persistently thickened pericardium and slowly developing features of constriction. On computed tomography, a large mediastinal mass encasing the heart, along with para-aortic and paratracheal lymphadenopathy, was found. Right heart catheter studies showed equal pressures in all four chambers. His deteriorating clinical condition led to a pericardiectomy. Histology confirmed primary pericardial mesothelioma. The patient died soon after surgery.

Successful management of infantile hypertrophic pyloric stenosis with atropine sulfate

OBJECTIVE

To evaluate the effectiveness of atropine sulfate in management of infantile hypertrophic pyloric stenosis (IHPS).

DESIGN

Prospective observational.

SUBJECT

Patients attending the hospital with complaints of persistent vomiting and later clinically and sonographically diagnosed as cases of IHPS were selected for the trial.

METHODS

Atropine was initially administered intravenously in a dose of 0.06 mg/kg/day in eight divided doses, increased by 0.15 mg/kg/day till vomiting ceased and remained so for a period of 24 hours at a stretch and ultrasonography showed a transit time (of gastric contents through pyloric canal) of less than 1 minute. Intravenous atropine was then substituted by oral atropine at double the effective IV dose for 3 weeks. Ultrasonographic evaluation of pyloric muscle thickness and length was done at the commencement of IV treatment, after completion of oral treatment and at 3,6,9,12 and 15 months follows up. Transit time of gastric contents was measured at the commencement of intravenous treatment and then daily after the vomiting stopped for more than 24 h at a stretch.

RESULTS

Medical treatment of IHPS with atropine was successful in 50/52 (96.2%) cases. Vomiting ceased in 1-3 days in all patients with mild hypertrophy and in 4-7 days in all the cases with moderate hypertrophy. In all except 2 patients with severe hypertrophy, vomiting ceased in 8-12 days. These two cases continued to vomit at least once daily even after 2 weeks of IV treatment and ultimately opted out for pyloromyotomy. All the 50 medically treated children made uneventful recovery during oral therapy except 3 cases (6%) in whom vomiting recurred during the follow-up. These 3 children later responded by increasing the dose of oral atropine. All of them began to gain weight by the time oral therapy was commenced and ultrasonographic evidence of normalization of pylorus was observed in all these children 3-15 months after completion of oral therapy.

CONCLUSION

Atropine sulfate proved to be an effective and safe treatment option for IHPS.

C-reactive protein as an indicator of complications in bacterial meningitis

OBJECTIVE

To determine the value of serum C-reactive protein (CRP) estimation in the follow-up of bacterial meningitis (BM).

DESIGN

Longitudinal follow-up.

SETTING

Urban hospital.

METHODS

Sequential serum CRP estimation was done in 50 healthy children and in 100 children with BM. Serial serum CRP value was correlated with the clinical picture in BM.

RESULTS

Serial serum CRP in 14 patients with complicated BM was significantly different than the 72 uncomplicated BM cases.

CONCLUSIONS

Serial determination of serum CRP may be a cheap, simple and reliable prognostic indicator in BM.

A comparison between rebound and Goldmann’s tonometers in screening of patients for glaucoma

DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5880 NEPJOPH 2012; 4(1): 201-202