Histopathological spectrum of ocular surface squamous neoplasia: A retrospective study of 776 lesions

Background: Ocular surface squamous neoplasia (OSSN) comprises neoplasm arising from the ocular surface, which includes conjunctiva, cornea, and limbus and ranges from mild dysplasia to invasive squamous cell carcinoma. Purpose: The aim of this work was to study the spectrum of OSSN based on histopathological analysis. Materials and Methods: This was a retrospective cross-sectional study comprising 776 histopathologically diagnosed cases of OSSN from January 2004 to December 2014. Results: The mean age of presentation of OSSN was 45 years (median, 45 years; 2 to 87 years) with male preponderance (74%). The most common age group of presentation was 41–60 years (n = 299; 39%). The most common type of OSSN was invasive squamous cell carcinoma seen in 50% (n = 383) eyes followed by severe dysplasia/carcinoma in situ in 31% (n = 250) eyes. Tumor infiltration at base was seen in 16% (n = 124), positive margins in 32% (n = 248), scleral infiltration in 14% (n = 109), intraocular extension in 3% (n = 23), and orbital extension in 4% (n = 26) eyes. OSSN was associated with actinic keratosis in 21% (n = 165) cases. Conclusion: Based on histopathology, invasive squamous cell carcinoma is the most common form of OSSN in the Asian Indian population.

Implant Supported Overdenture - A Review

Background:Traditional complete dentures were the most common treatment option for patients with edentulous arches. However, the initiation of implant-supported overdentures has substitutedorthodox dentures as animproved standard for restoration. Careful case selection is important criteria for improving success rate of implant supported over denture. Lower arch implant-supported overdentures have a better success percentage than upper arch implant-supported overdentures. Upper arch implant-supported overdentures are simulating a form of “salvage treatment,” rather than being the primary modality of treatment for patients with completely edentulous upper arch.

Beneficial effect of modified egg on serum T3, T4 and dyslipidaemia following dietary Zn-supplementation in Wistar rat.

A fall in serum T3 and T4 along with increase in serum cholesterol, triglycerides, LDL-c and VLDL-c and decrease in HDL-c was observed in albino Wistar rats when fed on semi-synthetic diet containing either 40 or 80mg Zn/kg diet. Zn concentrations were observed to increase with decreased concentration of Cu and Mg in their tissues. On including modified egg (Indian Patent Application No. 2264\Del\2005) in the Zn supplement diet, the levels of T3 and T4, lipid profile in serum and mineral status approached closer to control group-I. The data suggest that hypothyroidism and dyslipidaemia caused by excessive Zn in diet can be ameliorated on consuming these modified eggs due to restoration of mineral status in the body.

Effect of modified egg* on developmental defects in neonates of NIDDM induced Wistar rats.

Maternal Zn deficiency has been suggested as the contributing factor for all congenital malformations during pregnancy particularly in diabetes. Maternal Zn-supplementation, therefore, was suggested as one possible nutrition intervention during pregnancy to improve its outcome. But a number of trials with Zn-supplementation are not consistent and discourage the use of excessive Zn-supplementation during pregnancy. Instead a multivitamin/ mineral supplement to them has been suggested to reduce its complication. Accordingly, the poultry egg was modified for trace elements, vitamin-E and omega-3 fatty acids so as to use it as a dietary supplement for diabetics to reduce their complications during the pregnancy. The results showed that NIDDM induced rats fed either on 40 or 80 mg Zn/kg diet delivered less number of pups/litter and their body weight was higher at birth as compared to control group fed 20 mg Zn/kg diet. During the weaning period, some abnormalities characterized by restricted movements of the hind legs, curl toes of limbs, eye opening problems, less hair on the body and more head to body ratio were observed. Whereas number of pups delivered per litter were more with higher body weights without abnormalities in the pups in NIDDM groups fed egg mixed diet. Further Zn, Cu and Mg concentrations were significantly less in the liver, hair and abdominal muscles in pups in NIDDM groups but their concentrations were restored approaching closer to control in pups in groups fed egg mixed diet estimated on 18th day of weaning period. The excretion of these trace elements increased in the urine of dams fed Zn supplemented diet but decreased in the dams fed egg mixed diet on 15th day of their suckling period. The data suggest that if these modified eggs are included in the regular diet during pregnancy, they may protect the neonates in womb against the damaging effect of imbalances of physiologically important nutrients due to diabetes or environmental contamination.

Long term excessive Zn-supplementation promotes metabolic syndrome-X in Wistar rats fed sucrose and fat rich semisynthetic diet.

During the last two decades Zinc (Zn) as a micronutrient is being used indiscriminately in agricultural and husbandry practices and also in baby foods and multivitamin supplements with a view that Zn is non-toxic and promotes linear growth and body weight in the consumers. The long-term effect of increasing Zn load in the body has not been worked out so far. In this study, three groups of rats were fed on a semi-synthetic diet containing 20 mg (control, group-I), 40 mg (group-II) and 80 mg Zn /kg (group-III) diet respectively for 6 months. The results revealed that the gain in body weight increased in rats in Zn-concentration dependent manner. The urine examined on weekly basis showed glucosuria in group-II on week 10 and in group-III on week 8 and thereafter. The arterial blood pressure was significantly higher in group-II and III than their control counter parts on monthly basis. Histochemical examination of skin revealed an increase in the number of adipocytes filled with triglycerides making a subcutaneous fatty tissue thicker in group-II and group-III than that of control group. The blood profile after 180 days of dietary treatment, displayed a significant rise in glucose, total lipids, cholesterol, triglycerides, LDL-cholesterol, VLDL-cholesterol, insulin, cortisol and aldosterone whereas HDL-cholesterol, T3, T4 and TSH showed a reduction in their levels in the blood serum. The tissue metal status showed an increase of Zn, Cu and Mg in the serum, a rise in Zn in liver, hair and abdominal muscles and fall in Cu and Mg concentrations in liver, hair and abdominal muscles. This data suggest that Zn in excess in diet when fed for longer periods of time induces metabolic syndrome-X.

Influence of low cholesterol eggs enriched with vitamin-E and omega-3 fatty acid on blood lipid profile of Wistar rats.

In the recent past, low cholesterol eggs enriched with vitamin-E and omega-3 fatty acid have been developed and are marketed under different brands claiming them as heart friendly. The influence of these eggs (smart eggs) on lipid profile of rats was evaluated in comparison to that of the standard eggs. Data of 4 week dietary treatment revealed that total plasma cholesterol, low density lipoprotein (LDL) and very low density lipoprotein (VLDL) cholesterol increased only 22% in rats fed on diet containing 4 smart eggs per kg of semi-synthetic diet in contrast to the increase of more than 100 % when fed on diet containing standard eggs. The results suggest that it is not the low cholesterol content alone but also vitamin E and omega-3 fatty acids present in smart eggs that act synergically to prevent a substantial change in blood lipid profile and impose no serious risk to the health of the consumers.

Pharmacokinetics of ciprofloxacin in patients with liver cirrhosis.

BACKGROUND: Bacterial infections are common in patients with cirrhosis of liver and are frequently treated with ciprofloxacin. Literature on pharmacokinetics of ciprofloxacin in patients with cirrhosis of the liver is scanty. The present study compared the pharmacokinetics of ciprofloxacin in cirrhotic patients with that in healthy volunteers. METHODS: In 20 patients with cirrhosis of liver (all Child-Pugh class B) and 10 healthy volunteers, plasma levels of ciprofloxacin were measured using high-performance liquid chromatography at several time points after a 500-mg oral dose. Various pharmacokinetic parameters were calculated. RESULTS: No significant differences were observed in maximum plasma levels reached (mean [SD] 2.6 [0.6] vs 2.6 [1.3] microg/ml), time taken for maximum plasma levels to be reached (1.3 [0.6] vs 1.5 [0.9] h), t1/2a (0.7 [0.3] vs 0.4 [0.9] h), elimination half-life (3.6 [1.2] vs 3.2 [1.8] h), and area under the curve (19.3 [3.8] vs 21.9 [4.5] microg/mL x h) in healthy volunteers and cirrhotic patients, respectively. CONCLUSIONS: Pharmacokinetics of ciprofloxacin is unaltered in patients with liver cirrhosis. Ciprofloxacin can be safely administered in the usual doses in such patients.

Prognostic factors for persistent diarrhoea managed in a community setting.

Two hundred and five cases (mean age 13.4, SD 9.5) of persistent diarrhoea (PD) of 14-28 days duration, attending an urban slum clinic and treated according to standard WHO guidelines, were monitored at weekly intervals to obtain an estimate of treatment failure rates and to identify its clinical predictors. Vitamin and micronutrients (daily 2RDA) were additionally provided. Only 9 (8.2%) of 109 children with criteria for hospital care accepted in-patient care. Weight gain was considered inadequate if the daily increment between enrollment and day 7 of follow up was < 10 g at age 0-3 months, < 5 g at 4-6 months, and any weight loss for those older than 6 months. Recovery was considered delayed if diarrhoea ceased 7 days after enrollment. Overall, 28.3% cases had inadequate weight gain and 25.6% had delayed recovery. The non-breast milk calorie intake was 11.2% during infancy and 40.6% at later ages of the recommended intakes. In a logistic regression model, initial watery stool frequency greater than median (adjusted OR 2.30, p = 0.01), age < or = 6 months (adjusted OR 2.24, p = 0.04) and low consumption of micronutrient mixture (adjusted OR 2.62, p = 0.01) were associated with an increased risk of delayed recovery. In a Cox proportional hazards model for time to recovery from diarrhoea, low consumption of the micronutrient mixture and age < or = 6 months reduced the chances of recovery by 29% and 37% respectively. Low consumption of the prescribed micronutrient mixture (adjusted OR 2.21, p = 0.04), fever (adjusted OR 1.91, p = 0.05) and diarrhoea continuing beyond study day 7 (adjusted OR 2.29, p = 0.03) increased the risk of inadequate weight gain. Breast feeding status and animal milk consumption did not influence weight gain or recovery. Due to the low compliance for advised hospitalisation, approaches for care at community level itself need to be evolved. Focus should be on increasing the overall dietary intake and provision of generous but safe amount of micronutrients; our findings do not support need for routine elimination of animal milk. The efficacy of individual micronutrients needs evaluation in controlled trials.

Clinical profile of trichotillomania.

Twenty-four cases of trichotillomania attending psychiatry outpatient department and child guidance clinic at Kalawati Saran Children's and Smt Sucheta Kriplani Hospitals over a period of 2 years from July, 1985 to November 1987 were studied. Females (66.7%) outnumbered the males (33.3%). Majority of cases belonged to age group 6-10 years (54.2%) and nuclear family (68.5%). Nail-biting (25.0%) was the commonest associated neurotic trait, followed by enuresis (20.9%), temper-tantrum (12.5%), etc. A past history of hysterical fits and neurotic depression was found in 3 cases (12.5%) and 2 cases (8.3%) respectively. Family history of neurosis was seen in mothers and fathers of 20.9% and 12.5% cases respectively. Trichobezoars and trichophytobezoars were found in 6 cases (25.0%) and 3 cases (12.5%) respectively. Majority of patients of trichobezoars presented with vague complaints like heaviness in the stomach (55.6%), inability to gain weight (44.4%), etc, while 22.2% cases were asymptomatic and detected only on screening.

Pathology of ovary, uterus, vagina and gonadotrophs of female mice fed on Zn-deficient diet.

Dietary Zn-deficiency in mature female mice for 6 weeks caused a retardation of ovarian growth characterized by lack of vesicular and Grafian follicles, degenerated corpus luteum, distorted cell membranes of granulosa cells with pycnotic nuclei, poor development of theca interna, inordinate accumulation of sudanophilic granules in theca interna and interstitial cells. The vagina and uterus did not exhibit cyclic changes in their cytoarchitecture as a result of the cessation of estrous cycle after 6 weeks of dietary treatment. They displayed wide spread degenerative changes in their myometrial and endometrial layers. The uterine glands appeared collapsed with little or no secretion. The vagina lacked cornification. Their gonadotrophs reacted positive to PAS, identical to the control group observed at diestrous stage. However, they did not display a negative reaction, characteristic of the gonadotrophs at estrous stage of the control group, examined even at an interval of 1 day for 6 days in succession. These results point towards the suspension of steroidogenesis inspite of intact gonadotrophs under Zn-deficiency condition.

Perforated tubercular enteritis of childhood: a ten year study.

One hundred sixty seven children were operated at the Kalawati Saran Children Hospital for acute peritonitis during last 10 years (1978-88). Bowel perforation was seen in 123 cases. Nineteen cases had underlying tubercular enteritis. Preoperative diagnosis was usually difficult. The terminal ileum was affected in 12 and the jejunum in 5 cases. Multiple perforations were seen in 3 cases. Postoperative mortality was high (12/19) and usually attributable to their poor preoperative status.