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Purpose: This study aims to renew the management of viral epidemic conjunctivitis by introducing a one-time, low-concentration ocular surface povidone-iodine (LOS-pI) wash. Methods: Among the 3,002 patients screened, 1,328 with acute conjunctivitis were categorized into two groups. Group A (664 patients) underwent a 1% betadine wash in addition to the standard treatment protocol (Eye Lubricant + Moxifloxacin 0.5% eyedrops), while Group B (664 patients) followed the standard protocol alone. In cases of membranous conjunctivitis, manual membrane removal was performed. Treatment responses were observed daily for three days, followed by weekly assessments for two additional weeks. Results: Co-infection of adenovirus with enterovirus was found to be the main cause, often accompanied by staphylococcal superinfection. Group A showed complete resolution of conjunctival inflammation, with a remarkable 76.05% of patients experiencing improvement within an average of 2.6±0.51 days, in contrast to Group B's average of 7.5±1.1 days (p <0.05). Additionally, 13% of Group B patients with recalcitrant conjunctivitis significantly recovered following the 1% betadine wash. Complications (subconjunctival hemorrhage: 34.04%, superficial punctate keratitis: 6.02%) were more prevalent in Group B. Discussion: The authors hypothesized that a single wash with betadine is sufficient to reduce disease duration and prevent secondary infections and complications. The core strength of our study lies in its substantial sample size. To our knowledge, no similar previous research has been conducted, on such a larger scale. Conclusion: Viral conjunctivitis brings discomfort, work absenteeism, and financial burden. A single low-concentration betadine wash expedites recovery and reduces complications in acute infective conjunctivitis. This approach significantly enhances patient outcomes and alleviates the socioeconomic impact of the condition.
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Anti-Infecciosos Locais , Conjuntivite Viral , Soluções Oftálmicas , Povidona-Iodo , Humanos , Povidona-Iodo/administração & dosagem , Povidona-Iodo/uso terapêutico , Conjuntivite Viral/tratamento farmacológico , Conjuntivite Viral/diagnóstico , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Anti-Infecciosos Locais/uso terapêutico , Anti-Infecciosos Locais/administração & dosagem , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/virologia , Adulto Jovem , Adolescente , COVID-19/epidemiologia , Resultado do Tratamento , Idoso , SARS-CoV-2 , CriançaRESUMO
Objective: To investigate the clinical characteristics, associated systemic features, and management outcomes of patients with limbal dermoids diagnosed with Goldenhar syndrome. Methods: This case series included patients from the eye outpatient department, diagnosed with Goldenhar syndrome based on systemic evaluation. Demographic data, ophthalmological assessments, and systemic evaluations were recorded. Various surgical interventions were employed based on the extent of limbal dermoids, and postoperative follow-up spanned one year. Results: Seven patients (nine eyes) were included, with a mean age of 7.71±4.15 years. Limbal dermoids were bilateral in two patients and unilateral in five. Grade 1 and grade 2 limbal dermoids were observed. The mean BCVA was 0.50±0.11 (logMAR), and astigmatism was present in six patients. Systemic features of Goldenhar syndrome included vertebral anomalies, ear abnormalities, facial anomalies, and lower limb deformity. Surgical interventions varied, with simple excision, lamellar keratoplasty, and amniotic membrane transplantation utilized. Postoperatively, corneal scar formation occurred in all simple excision cases. Conclusion: This case series underscores the rarity of limbal dermoids in the context of Goldenhar syndrome and the importance of early surgical intervention in managing these cases. By sharing our experiences and outcomes, we hope to contribute to the broader understanding of this condition and its optimal treatment.
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Doenças da Córnea , Cisto Dermoide , Neoplasias Oculares , Síndrome de Goldenhar , Humanos , Síndrome de Goldenhar/cirurgia , Síndrome de Goldenhar/diagnóstico , Masculino , Feminino , Criança , Cisto Dermoide/cirurgia , Cisto Dermoide/diagnóstico , Pré-Escolar , Doenças da Córnea/cirurgia , Doenças da Córnea/diagnóstico , Adolescente , Neoplasias Oculares/cirurgia , Neoplasias Oculares/diagnóstico , Limbo da Córnea/cirurgia , Limbo da Córnea/patologia , Estudos Retrospectivos , Lactente , Acuidade Visual , Seguimentos , Transplante de Córnea/métodosRESUMO
Aspirin is one of the most frequently detected non-steroidal anti-inflammatory drugs in aquatic environments. Despite its prevalence, toxicity possessed by aspirin to non-target organisms like fish is poorly explored. In the present study, cell death induced by different concentrations of aspirin (1, 10, and 100 µg/L) has been investigated in the liver of fish, Labeo rohita exposed for 28 days. A significant increase (p < 0.05) in the density of caspase-3 positive cells in a dose and duration-dependent manner assessed through immunofluorescent staining indicates caspase-dependent pathway of cell death which may be either through intrinsic or extrinsic pathway. The flow cytometric analysis, in addition, revealed a significant (p < 0.05) decline in the live cells and an increase in apoptotic cells in the liver of fish exposed to aspirin. Cell death due to apoptosis is further indicated by a significant increase (p < 0.05) in the Kupffer cells and tumor necrosis factor-α. The decrease in the activity of cyclooxygenase (COX) enzyme significantly (p < 0.05) in all three exposure concentrations of aspirin suggests COX-dependent pathway of cell death. The present study provides in-depth insights into aspirin-induced cell death in the liver of fish at environmentally realistic concentrations.
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Gunpowder-related ocular injuries are rare and can present significant diagnostic and management challenges. This case report describes a 27-year-old male who was discovered to have subconjunctival gunpowder foreign bodies during a routine annual medical examination. The patient presented with best-corrected visual acuity (BCVA) of 20/20 in both eyes and was asymptomatic, with no complaints of pain, visual disturbances, or other ocular symptoms. Biomicroscopic examination revealed three gunpowder spherules embedded in the inferotemporal bulbar conjunctiva of the right eye, the largest measuring approximately 1.5 × 0.5 × 0.5 mm. When questioned, the patient recalled a firearm injury from 3 years prior but had never experienced any ocular discomfort or required treatment. Bilateral fundus examination and ultrasound B-scan confirmed the absence of intraocular foreign bodies and an intact scleral wall. Given the patient's asymptomatic presentation, no immediate treatment was recommended. Instead, the patient was advised to return for follow-up if symptoms developed. The case underscores the importance of thorough examination and patient history in determining the appropriate course of action for ocular foreign bodies, especially those related to gunpowder. Despite their high-velocity impact, gunpowder-related foreign bodies are generally well tolerated, suggesting that observation can be a safe approach for asymptomatic cases. Nonetheless, a critical and patient-centered management strategy is essential, with interventions like phototherapeutic keratectomy (PTK) reserved for cases where foreign bodies cause visual impairment or other complications. This case report highlights the need for individualized treatment plans and suggests that observation can be a viable approach when dealing with asymptomatic ocular foreign bodies.
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Triclosan (TCS), an antimicrobial additive in various personal and health care products, has been widely detected in aquatic environment around the world. The present study investigated the impacts of TCS in the gills of the fish, Cyprinus carpio employing histopathological, biochemical, molecular docking and simulation analysis. The 96 h LC50 value of TCS in C. carpio was found to be 0.968 mg/L. Fish were exposed to 1/1000th (1 µg/L), 1/100th (10 µg/L), and 1/10th (100 µg/L) of 96 h LC50 value for a period of 28 days. The histopathological alterations observed in the gills were hypertrophy, hyperplasia, edematous swellings, and fusion of secondary lamellae in TCS exposed groups. The severity of these alterations increased with both the concentration as well as the duration of exposure. The present study revealed that the activity of antioxidant enzymes such as superoxide dismutase, catalase, glutathione-S-transferase, glutathione reductase, glutathione peroxidase, and reduced glutathione content decreased significantly (p < 0.05) in both concentration and duration dependent manner. However, a significant (p < 0.05) increase in the activity of the metabolic enzymes such as acid phosphatase and alkaline phosphatase was observed in all three exposure concentrations of TCS from 7 to 28 days. The activity of acetylcholinesterase declined significantly (p < 0.05) from 7 to 28 days whereas the content of acetylcholine increased significantly at the end of 28 day. The experimental results were further confirmed by molecular docking and simulation analysis that showed strong binding of TCS with acetylcholinesterase enzyme. The study revealed that long-term exposure to sublethal concentrations of TCS can lead to severe physiological and histopathological alterations in the fish.
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Acetilcolinesterase , Carpas , Brânquias , Simulação de Acoplamento Molecular , Triclosan , Animais , Triclosan/toxicidade , Brânquias/efeitos dos fármacos , Brânquias/patologia , Acetilcolinesterase/metabolismo , Poluentes Químicos da Água/toxicidade , Glutationa Transferase/metabolismoRESUMO
Purpose: To compare the efficacy of Brinzolamide-Brimonidine (BB) (1%+0.2%) with the gold standard Latanoprost-Timolol (LT) (0.005%+0.5%) in treating primary open-angle glaucoma (POAG) and ocular hypertension (OHT). Methods: A 1-year prospective study, spanning from May 2022 to May 2023, conducted at a tertiary eye-care hospital. Participants, aged 40-60, with a baseline intraocular pressure (IOP) >21 mm Hg, requiring a >30% reduction, were enrolled. Group A (n = 100) received BB, and Group B (n = 100) received LT. Outcomes were assessed at 1 month (IOP difference from baseline), 3 and 6 months (mean diurnal variations). Results: The mean age at presentation was 55.5 ± 4.5 years in Group A and 54.7 ± 4.2 years in Group B. At 1 month, Group A exhibited a mean IOP of 18.7 mm Hg, while Group B had 17.6 mm Hg, with no statistically significant difference (P = 0.53). No significant diurnal variation was observed in either group (P = 0.07). Target pressure was achieved in 88% of patients in Group A and slightly higher at 92% in Group B. Moreover, no serious side effects were reported, and compliance was higher in Group B (98%) compared to Group A (96%). Conclusion: Although LT showed slightly better and sustained IOP reduction, the difference was not statistically significant. Both BB and LT demonstrated comparable outcomes for managing POAG and OHT.
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Anti-Hipertensivos , Tartarato de Brimonidina , Glaucoma de Ângulo Aberto , Pressão Intraocular , Latanoprosta , Hipertensão Ocular , Sulfonamidas , Timolol , Humanos , Glaucoma de Ângulo Aberto/tratamento farmacológico , Pessoa de Meia-Idade , Pressão Intraocular/efeitos dos fármacos , Hipertensão Ocular/tratamento farmacológico , Latanoprosta/administração & dosagem , Latanoprosta/uso terapêutico , Latanoprosta/farmacologia , Tartarato de Brimonidina/administração & dosagem , Tartarato de Brimonidina/uso terapêutico , Tartarato de Brimonidina/farmacologia , Tartarato de Brimonidina/efeitos adversos , Masculino , Feminino , Estudos Prospectivos , Timolol/administração & dosagem , Timolol/uso terapêutico , Timolol/efeitos adversos , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/farmacologia , Adulto , Sulfonamidas/administração & dosagem , Sulfonamidas/uso terapêutico , Sulfonamidas/efeitos adversos , Sulfonamidas/farmacologia , Tiazinas/administração & dosagem , Tiazinas/uso terapêutico , Tiazinas/efeitos adversos , Combinação de Medicamentos , Resultado do Tratamento , Soluções Oftálmicas/administração & dosagemRESUMO
In the field of ophthalmology, slit-lamp gonioscopy has long been a cornerstone for examining anterior chamber angles and diagnosing conditions such as angle closure, secondary causes of raised intraocular pressure, neovascularization of angle, angle recession, angle tumors, and foreign bodies. However, the conventional approach for goniophotography is a demanding procedure requiring juggling a gonioscopy lens in one hand and a smartphone in the other. Balancing a gonioscopy lens with one hand makes it difficult to adjust and focus the image in busy clinical settings. This article introduces a groundbreaking solution to this problem - a universal slit-lamp-mounted gonioscope ingeniously repurposed from discarded materials, that is, indirect goniophotography (IndiGo). This novel system simplifies the process of both gonioscopy and goniophotography, allowing ophthalmologists to easily assess anterior chamber angles and capture high-quality images. These images can be swiftly shared with glaucoma specialists worldwide for digital analysis. Not only does this approach enhance examination efficiency, but also it fosters sustainability in ophthalmic diagnostics.
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Desenho de Equipamento , Glaucoma de Ângulo Fechado , Gonioscopia , Pressão Intraocular , Gonioscopia/métodos , Humanos , Pressão Intraocular/fisiologia , Glaucoma de Ângulo Fechado/diagnóstico , Câmara Anterior/diagnóstico por imagem , Lâmpada de Fenda , Microscopia com Lâmpada de FendaRESUMO
Purpose: To report patients who first presented with various ocular manifestations and eventually ascertained to have underlying dengue. Methods: A prospective study was conducted at multiple tertiary eye-care centers in India from 2012 to 2022. Cases reporting initially with ocular features along with fever/past history of fever over the last two weeks or with clinical features of dengue were selected. After an ophthalmological examination, patients underwent complete serological and biochemical analysis and those with reduced platelet counts were evaluated for dengue. Results: Out of 564 cases, 15 patients were verified to be afflicted with dengue eventually. A rising trend of cases was seen every year and out of 15 cases, eight cases were reported during the Covid-19 pandemic (from 2020 to 2022), but were COVID-negative. 9 cases presented with acute redness followed by diminished vision. Seven cases presented a history of fever over the last few days and one had traveled from dengue endemic area. The various ocular presentations included subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth-nerve palsy, and vitreous hemorrhage. On serological examination, all 15 patients were detected to have low platelets. All cases responded well with supportive treatment and the ocular features subsided in all within a couple of weeks with good visual recovery. Conclusion: In a tropical nation, such as India, with endemic dengue zones and increasing figures of dengue lately, ophthalmologists must include dengue fever among the differential diagnoses in various ocular presentations like subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth nerve palsy, and vitreous hemorrhage. Abbreviations: DHF = dengue hemorrhagic fever, PCR = polymerase chain reaction, RT-PCR = real-time automated reverse transcriptase (RT-PCR), SD = standard deviation, MAC-ELIS = IgM antibodies capture enzyme-linked immunosorbent assay, RE = right eye, LE = left eye, CECT = Contrast-enhanced computed tomography.
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Doenças do Nervo Abducente , Dengue , Infecções Oculares Virais , Ceratite , Uveíte Anterior , Humanos , Hemorragia Vítrea , Pandemias , Estudos Prospectivos , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/epidemiologia , Dengue/complicações , Dengue/diagnóstico , Dengue/epidemiologiaRESUMO
PURPOSE: The aim of this study was to improve cosmesis in patients with corneal opacity (CO) using newer organic micronized pigments. METHODS: Settings: Tertiary Care eye center, Design: Retrospective study. INCLUSION CRITERIA: Patients with unsightly corneal scars not suitable for keratoplasty, eccentric corneal opacity not requiring keratoplasty, or lenticular opacity/anterior or posterior capsular opacities in non-seeing eyes. Micronized organic pigment was used for keratopigmentation by the intrastromal pocket technique (ISPT) in deep corneal opacities and lenticular opacities, whereas the intrastromal needle puncture technique (ISNT) was used in superficial opacities or corneoiridic scars. The records of 463 patients were reviewed and analyzed for the duration of the past 7 years. RESULTS: Two hundred and ninety-three (63.2%) patients underwent ISNT, eight underwent combined technique, and the rest underwent ISPT. The postoperative follow-up period showed more watering and redness in the needle puncture technique (p > 0.001), which resolved in 70.4% of patients by the end of 4 weeks. Repeat procedures were required in 5.3% of the patients with ISNT. The patient's satisfaction grading showed excellent levels in 375 (80.9%) patients, 45 (9.7%) had good satisfaction levels, and the rest had average satisfaction levels. CONCLUSION: Intrastromal keratopigmentation is a boon for unsightly corneal scars and gives respite to the patients from the social stigma.
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Catarata , Lesões da Córnea , Opacidade da Córnea , Transplante de Córnea , Tatuagem , Humanos , Substância Própria/cirurgia , Tatuagem/métodos , Estudos Retrospectivos , Opacidade da Córnea/diagnóstico , Opacidade da Córnea/cirurgia , Corantes , Lesões da Córnea/cirurgiaRESUMO
Aspirin is one of the emerging pharmaceutical contaminants in the aquatic environment and thus it could impart toxicity to non-target organisms including fish. The present study aims to investigate the biochemical and histopathological alterations in the liver of the fish, Labeo rohita exposed to environmentally relevant concentrations of aspirin (1, 10, and 100 µg/L) for 7, 14, 21, and 28 days. The biochemical investigation revealed a significant (p < 0.05) decrease in the activity of antioxidant enzymes such as catalase, glutathione peroxidase, glutathione reductase; and reduced glutathione content in a concentration and duration dependent manner. Further, the decrease in the activity of superoxide dismutase was in a dose dependent manner. The activity of glutathione-s-transferase, however, increased significantly (p < 0.05) in a dose dependent manner. The lipid peroxidation and total nitrate content showed a significant (p < 0.05) increase in a dose and duration dependent manner. The metabolic enzymes such as acid phosphatase, alkaline phosphatase, and lactate dehydrogenase showed a significant (p < 0.05) increase in all three exposure concentrations and durations. The histopathological alterations in the liver such as vacuolization, hypertrophy of the hepatocytes, nuclear degenerative changes, and bile stagnosis increased in a dose and duration dependent manner. Hence, the present study concludes aspirin has a toxic impact on fish, which is evidenced by its profound effect on biochemical parameters and histopathological analysis. These can be employed as potential indicators of pharmaceutical toxicity in the field of environmental biomonitoring.
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Cyprinidae , Estresse Oxidativo , Animais , Aspirina/toxicidade , Aspirina/metabolismo , Antioxidantes/metabolismo , Cyprinidae/metabolismo , Catalase/metabolismo , Fígado/metabolismo , Glutationa/metabolismo , Peroxidação de Lipídeos , Superóxido Dismutase/metabolismo , Preparações Farmacêuticas/metabolismoRESUMO
INTRODUCTION: Multisystem inflammatory syndrome (MIS-C) is a rare paediatric hyper-inflammatory disorder that occurs following SARS-CoV-2 infection. Acute kidney injury (AKI) occurs in approximately one-quarter to one-third of the patients with MIS-C and is associated with poor prognosis in critically ill children. This systematic review is aimed to evaluate the incidence of AKI, mortality, and the need for kidney replacement therapy (KRT) in patients with MIS-C. METHODS: We searched databases from Medline, EMBASE, Cochrane Register, and Google Scholar from December 2019 to December 2021 with our search strategy. Studies meeting the following criteria were included in this systematic review: (1) articles on AKI in MIS-C; (2) studies providing AKI in MIS-C and COVID-19 infection separately; (3) studies reporting outcomes such as mortality, KRT, serum creatinine; length of hospital/ICU stay. QUALITY ASSESSMENT: The quality of the included studies was independently assessed by using the National Heart Lung and Blood Institute (NHLBI) quality assessment tool for cohort studies and case series. STATISTICAL ANALYSIS: Outcomes and their 95% confidence intervals (CI) were reported if a meta-analysis of these outcomes was conducted. Heterogeneity was reported using I2 statistics, and heterogeneity ≥ 50% was considered high. We used Baujat's plot for the contribution of each study toward overall heterogeneity. In sensitivity analysis, the summary estimates were assessed by repeating meta-analysis after omitting one study at a time. Forest plots were used for reporting outcomes in each study and with their 95% CI. All statistical tests were performed using R software version 4.0.3. RESULTS: A total of 24 studies were included in this systematic review and of these, 11 were included in the meta-analysis. The pooled proportion of patients with MIS-C developing AKI was 20% (95% CI: 14-28%, I2 = 80%). Pooled proportion of death in children with MIS-C was 4% (95% CI: 1-14%; I2 = 93%). The odds of death in patients with AKI were 4.68 times higher than in patients without AKI (95% CI: 1.06-20.7%; I2 = 17%). The overall pooled proportion of MIS-C-induced AKI patients requiring KRT was 15% (95% CI: 4-42%; I2 = 91%). CONCLUSION: Approximately one-fifth of children with MIS-C develop AKI which is associated with higher odds of death. PROSPERO registration: CRD42022306170 A higher resolution version of the Graphical abstract is available as Supplementary information.
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Injúria Renal Aguda , COVID-19 , Humanos , Criança , COVID-19/complicações , SARS-CoV-2 , Injúria Renal Aguda/etiologia , Terapia de Substituição Renal/efeitos adversosRESUMO
Studies show nearly half to two-thirds of the children in India to be deficient in vitamin B12. Meningitis is a major disease in Indian children with studies attributing up to 22% of under-five deaths to meningitis and pneumonia. India is one of the countries with the highest mortality in absolute numbers due to meningitis. Usually, the diagnosis of each of these entities is straightforward. The presence of meningeal signs, papilledema, seizures, and altered sensorium often suggests meningitis. And vitamin B12 deficiency has a myriad of clinical presentations. At times, encephalopathy secondary to cobalamin deficiency may be confused with infection. Here, we present a case that presented with signs and symptoms suggestive of central nervous system infection but turned out to be cobalamin deficiency eventually. To our knowledge, this is the first presentation of cobalamin deficiency presented with features suggestive of meningitis.
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INTRODUCTION: Diastrophic dysplasia (DTD) results from SCN26A2 gene mutation, with autosomal recessive inheritance and widely variable phenotype. The gene has been mapped to chromosome 5q32-q33.1. CASE REPORT: We present a case of a 4-year-old female with short stature, bilateral feet and knee deformity, and dysplastic facies. SCN26A2 mutations were seen in patient as well as parents. She underwent multiple orthopedic procedures involving metatarsals, gastrosoleus, and distal femur. Based on typical clinical features, DTD was suspected. Genetic studies of patient and parents provided the exact diagnosis in this case. CONCLUSION: Genetic diagnosis and family counseling are important caveat of management. Key features like ear abnormalities help to suspect diagnosis which requires a high index of suspicion. Associated bony and soft-tissue abnormalities of lower limb may require surgical intervention for improvement of gait, functions, and cosmesis.