Changing patterns of early childhood blinding conditions presenting to a tertiary eye center: The epidemic of retinopathy of prematurity in India

Purpose: Retinopathy of prematurity (ROP) is now emerging as one of the major causes of preventable childhood blindness. The proportion of preterm babies has increased dramatically over the past decade. Our study aims to emphasize the need for ROP screening and management services in these preterm infants. Methods: ICD-coded medical records of children less than 10 years of age presenting to a subspecialty eye hospital from 2000 to 2017 were reviewed. ROP, congenital cataract, congenital glaucoma, and vitamin A deficiency were the most common diagnoses. We evaluated the trend of these diseases from 2000 to 2017. Results: Our data suggested a 20-fold increase in the attendance of children with a diagnosis of ROP who now make over 2% of outpatient children. Vitamin A deficiency has declined over time whereas cataract and glaucoma have remained stable. Conclusion: Our data indicate a need to scale up ROP screening integrated with neonatal care, as well as to build capacity for the treatment of acute and late-stage ROP in India.

Expression of breast cancer type 1 and its relation with expression of estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2/neu in breast carcinoma on trucut biopsy specimens

Objective: (1) The objective is to study the immunohistochemical expression of Breast cancer type 1 (BRCA1) in breast carcinoma on trucut biopsy specimens and (2) To relate its expression with that of estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER-2)/neu and the clinicopathological parameters. Settings and Design: A cross-sectional hospital-based study was performed in Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, with collaboration of the Departments of Pathology and Surgery from the period of November 2008 to March 2010. Materials and Methods: The study group included 54 cytologically proven cases of breast carcinoma. The immunohistochemical expression of BRCA1 was studied and related with expression of ER, PR, and HER-2/neu on their trucut biopsies. Results: The altered expression of BRCA1 (i.e., reduced or absent expression) was seen in 44.4% cases of breast carcinoma while 55.6% had positive expression. About 83% of breast carcinomas with altered BRCA1 expression were larger than 3 cm in size. The breast carcinomas showing altered expression were found to be mostly high grade (63.6%). This was statistically significant. The ER and PR negativity were seen in 62.5% and 79.2% breast carcinomas with altered BRCA1 expression, respectively. The score 3 positivity of HER-2/neu was more common among carcinomas with altered BRCA1 expression (21% vs. 16.7%). The triple negativity was found in 41.7% breast carcinomas having altered BRCA1 expression. This was statistically significant. Conclusion: The combination of immunohistochemical expression of BRCA1, ER, PR, and HER-2/neu and clinicopathological details may be helpful in predicting the individuals more likely to carry BRCA1 mutations and thus selecting the candidate and family members for genetic screening for BRCA1 mutations.

Echocardiographic evaluation of left ventricular function after acute myocardial infarction

Background: The study was taken up to evaluate the left ventricular systolic and diastolic function after acute myocardial infarction [AMI] in male patients

Method: A hospital based study was conducted at tertiary care centre in UP, India with 60 male healthy controls and 125 confirmed cases of AMI admitted to the coronary care unit who fulfilled the inclusion criteria. After a clinical examination/history taking, left ventricular [LV] functional parameters were assessed by echocardiography in M-mode. The data obtained was analyzed using Microsoft Excel2010 software

Results: The predominant sites of myocardial infarction [MI] were antero-septal MI [57.6%], with inferior wall MI [28%], and lateral wall MI [4.8%]. Body mass index [BMI] was in overweight category in both study groups. A statistically significant difference was noted in haemodynamic parameters with lower values noted in AMI cases. Statistically significant differences with lower values in AMI cases were noted in Stroke volume [p<0.001], cardiac output [p<0.001], Ejection fraction [p<0.001] and Fractional fibre shortening [p<0.001] when compared with healthy subjects. A statistically significant decrease in E [p=0.015], increase in A [p<0.001] and decrease in E/A ratio [p=0.015] was noted in AMI cases when compared with healthy controls

Conclusion: The overall LV function was decreased among acute myocardial infarction patients. Echocardiographic assessment provides prognostic information which helps to stratify risks and initiate rationale therapeutic measures to reduce morbidity and mortality associated with it

Development and validation of microbial bioassay for quantification of Levofloxacin in pharmaceutical preparations / 药物分析学报

The aim of this study was to develop and validate a simple, sensitive, precise and cost-effective one-level agar diffusion (5t1) bioassay for estimation of potency and bioactivity of Levofloxacin in pharmaceutical preparation which has not yet been reported in any pharmacopoeia. Among 16 microbial strains, Bacillus pumilus ATCC-14884 was selected as the most significant strain against Levofloxacin. Bioassay was optimized by investigating several factors such as buffer pH, inoculums concentration and reference standard concentration. Identification of Levofloxacin in commercial sample Levoflox tablet was done by FTIR spectroscopy. Mean potency recovery value for Levofloxacin in Levoflox tablet was estimated as 100.90%. A validated bioassay method showed linearity (r2 ? 0.988), precision (Interday RSD ? 1.05%, between analyst RSD ? 1.02%) and accuracy (101.23%, RSD ? 0.72%). Bioassay was correlated with HPLC using same sample and estimated potencies were 100.90%and 99.37%, respectively. Results show that bioassay is a suitable method for estimation of potency and bioactivity of Levofloxacin pharmaceutical preparations.

Effect of neoadjuvant chemotherapy on stromal CD10 antigens in breast cancer - A preliminary study.

Introduction: CD10 is a zinc-dependent peptidase (metalloproteinase). Stromal CD10 expression in breast cancer correlates with poor prognosis, oestrogen receptor negativity and higher grade. CD10 may be a potential target of new cancer therapies as it is involved in cleavage of doxorubicin. Aim: To evaluate the effect of neo-adjuvant anthracycline-based chemotherapy on status of stromal CD10 antigens in breast cancer. Materials and Methods: Patients with invasive breast cancer scheduled for anthracycline-based neo-adjuvant chemotherapy were included in the study. Tumor stromal CD10 expression was estimated before and after 3 cycles of chemotherapy, and change in its status was correlated with clinical response to chemotherapy. Results: 16 out of the 29 patients had strong CD10 expression; in these 16 patients, 14 (87.5%) were hormone receptor negative, and 14 (87.5%) had HER-2/neu overexpression. Stromal CD10 expression remained same in 13 out of 29 cases (44.83%) after chemotherapy. There was a change in CD10 expression in the remaining 16 cases (55.17%); in 13 cases (44.83%) it decreased from its pre-chemotherapy status, while its expression increased in 3 cases (10.34%). In cases of complete and partial clinical response, there was no increase in CD10 expression. Where CD10 expression had increased after chemotherapy, there was either a minor response or no response to chemotherapy. In 13 cases where CD10 expression had decreased, 12 cases had a clinical response to chemotherapy. Conclusions: Strong CD10 expression correlates with hormone receptor negativity and HER-2/neu overexpression. Stromal CD10 expression in breast cancer is not static and changes with neo-adjuvant anthracycline-based chemotherapy. A stable or decrease in CD10 expression correlates with complete or partial clinical response, while an increase in CD10 expression appears to correlate with poor clinical response. A larger series is required to determine the clinical significance of these changes. As stromal CD10 expression and its change with chemotherapy may have a prognostic significance, they should be documented in breast cancer patients before and after chemotherapy.

An unusual combination of primordial dwarfism with isolated cleft palate.

Primordial dwarfism is a rare anomaly with over 200 sub-types, which results in a relatively small body size in all stages of life, beginning at the intrauterine period. The life expectancy for these patients is around 30 years but very few survive their intra-uterine phase. Other features associated with primary dwarfism reported till date includes pigmentation of skin, cleft lip and palate, and semilobar holoprosencephaly. We report an unusual combination of primordial dwarfism associated with isolated cleft palate.

Cytokine response to dietary rehabilitation with curd (Indian dahi) & leaf protein concentrate in malnourished children.

Background & objectives: Protein energy malnutrition (PEM), an important cause of secondary immune deficiency, is associated with several abnormalities in the immune system including cytokine production. In the present study cytokine levels (both pro- and anti-inflammatory) were evaluated in protein energy malnourished children following nutritional rehabilitation with curd (Indian dahi) and leaf protein concentrate (LPC). Methods: Eighty moderately and severely malnourished children, 1-5 yr of age, received the WHO recommended diet for severe malnutrition, modified according to local dietary habits, containing in addition either curd or micronutrient-rich leaf protein concentrate, for a period of 15 days. Cytokine levels [tumour necrosis factor α (TNFα), interferon γ (IFNγ), interleukin-10 (IL-10), interleukin-4 (IL-4)] were measured before and after dietary rehabilitation. Results: The baseline cytokine levels (TNFα, IFNγ, IL-10 and IL-4) were high in malnourished children. Both the diets caused an increase in serum pro-inflammatory (TNFα, IFNγ), and anti-inflammatory (IL-10) cytokine levels after nutritional rehabilitation. The increase in IL-10 was significant in children receiving curd. There was an insignificant fall in IL-4 levels with both the diets. The cytokine response was comparable in children with moderate and severe malnutrition, as also in children < 2 yr to those between 2-5 yr. Interpretation & conclusions: The study suggests that cytokines (TNFα, IFNγ, IL-10 and IL-4) may serve as biological markers to assess the effect of functional foods like curd or LPC on immunity in malnutrition. Curd may help to maintain the balance in cytokine production by increasing the production of IL-10, and may be considered in place of milk in the nutritional rehabilitation of malnourished children.

A pilot study on the effects of curd (dahi) & leaf protein concentrate in children with protein energy malnutrition (PEM).

BACKGROUND & OBJECTIVE: In protein-energy malnutrition (PEM) there is a significant impairment of immunity, both cell-mediated and humoral, which may be reversed with nutritional rehabilitation. With the use of probiotics like curd (dahi) and micronutrient-rich leaf protein concentrate (LPC), this immune recovery may be hastened. This study was conducted to assess the impact of supplementation of curd and LPC on nutritional status, and immunity as assessed by anthropometry, haemoglobin, ferritin levels, T- cell subpopulation and C-reactive protein (CRP), in children suffering from PEM. METHODS: Eighty moderate to severely malnourished children (1-5 yr) were randomized to receive either curd or LPC in addition to WHO recommended two-step diet over 15 days. Nutritional, immunological and haematological parameters were measured before and after supplementation and compared within the groups. RESULTS: The change in weight, haemoglobin level and CD4:CD8 T-cell subpopulation was significant in both the groups after supplementation. Response of CRP was blunted in PEM. Serum ferritin decreased significantly after supplementation in both groups. INTERPRETATION & CONCLUSION: Curd and LPC when added to diet of malnourished children, may have therapeutic value by accelerating immune recovery. More studies need to be done on a larger sample to confirm these findings.

Prevalence of anaemia in pregnant & lactating women in India.

BACKGROUND & OBJECTIVES: The prevalence of anaemia during pregnancy and lactation was significantly lower in the National Family Health Survey 1998-1999 (NFHS-2), using the hemocue method for haemoglobin estimation compared to earlier surveys. The present study selected seven States and used the same districts and villages studied in the NFHS-2, to see if the reported reduction in prevalence of anaemia was due to health and nutrition inputs and/or due to a different method for haemoglobin estimation. METHODS: A total of 1,751 women (1,148 pregnant and 603 lactating- exclusively breastfeeding up to 3 months of age), from seven States- Himachal Pradesh and Haryana in north; Assam and Orissa in east; Kerala and Tamil Nadu in south and Madhya Pradesh in central India, were selected. Haemoglobin was estimated by the cyanmethaemoglobin method, so that comparison was possible with earlier studies. Data on socio-demographic characteristics, pregnancy, nutritional status and dietary intakes were collected. RESULTS: Prevalence as well as severity of anaemia was significantly higher in the present study as compared to the NFHS-2 study data. The difference could be due to haemocue method, which gives higher haemoglobin values. The contributing factors found on multiple regression analysis for anaemia in pregnancy and lactation were: literacy, occupation and standard living index of the study women; their awareness about anaemia, its prevention by regular consumption of ironfolate tablets and increase in food intake. Maternal height, age of marriage, parity and foetal loss also contributed to haemoglobin level. There were interstate differences; lower fertility, higher literacy and better diet was observed in Himachal Pradesh as compared to Haryana. The literacy and nutritional status of women in Tamil Nadu was lower than Kerala. The remaining 3 states had poor fertility, lower social living index and nutritional status with >90 per cent women being anaemic in pregnancy and lactation. Low prevalence of severe anaemia in Orissa as compared to Assam was due to availability and consumption of iron folate tablets. The antenatal services in the first trimester and checkup by a doctor, along with availability and consumption of iron folate tablets over 3 months in all the States influenced haemoglobin levels. INTERPRETATION & CONCLUSION: Despite the measures taken to control anaemia in pregnancy and lactation in the last two decades, the severity of nutritional anaemia continues to remain a public health issue of great magnitude, suggesting that these measures have been largely ineffective. The present findings also showed interstate differences particularly in fertility, women education, nutrition status and occupation; availability of antenatal services and iron folate tablets as possible factors responsible for differences in prevalence of anaemia.

Permanent dentition in Delhi boys of age 5-14 years.

Eruption pattern of permanent teeth in Delhi boys was studied in 1800 well nourished children age 5-14 years. Relationship of height, weight and sexual maturity with eruption of teeth was calculated. Earliest teeth to appear were lower first molar (5.64 years) followed by lower central incisors (6.02 years), The sequence of eruption in maxilla was first molar, incisors-central then lateral, first premolar, canine, second premolar and second molar. In mandible eruption pattern canine preceded first premolar. Eruption of teeth was significantly positively related to height, weight and sexual maturity.

Cytological diagnosis of cholangiocarcinoma with rib metastasis in a young female--a case report.

Intrahepatic cholangiocarcinomas are second most common primary tumors of the liver. They are usually seen in 6th to 7th decades of life and at an advanced stage leading to poor prognosis. Their occurrence in the young age group is rare. Histopathological features of this tumor are well documented but literature regarding cytomorphological features on FNA is limited. We describe the cytological features of this tumor in a young woman presenting primarily with a rib metastasis. FNA smears from hard lump in the right chest wall and liver mass showed small round tumor cells arranged in the form of sheets, clusters and occasional tubules. The cells showed mild pleomorphism and bland nuclear morphology. Intimately admixed with tumor cells were spindle shaped fibroblastic cells. Serum alpha-fetoprotein level was within normal limit. Special stain for bile and immunocytochemical staining for NSE, chromogranin and CALLA were all negative. Cholangiocarcinoma was diagnosed based on cytological findings and special stains and this diagnosis was histologically confirmed on biopsy.

Demonstration of sperm head shape abnormality and clastogenic potential of cypermethrin.

Adult male Swiss albino mice were administered ip. suspension solution of cypermethrin in 0.15% DMSO at the doses of 30 mg, 60 mg and 90 mg/kg b. wt. daily for 5 days. Another group of animals was injected cyclophosphamide ip. (60 mg/kg b. wt.) in similar manner which served as positive control. Effect of cypermethrin on body and testes weight and sperm head morphology was studied. Clastogenic potential of cypermethrin was studied by using modified Allium test. The cytological changes were studied in the root tip cells of Allium cepa after 3 days treatment with three different concentration of cypermethrin (0.1, 1.0 and 10.0 microg/ml). The results revealed that body weight gain was considerably reduced in higher dose groups, but the testicular weight did not change significantly in any of the cypermethrin treated groups. However, a significant elevation in the number of abnormal shape of sperm head was noticed in higher dose groups as compared to control. It was observed that the abnormality in the shape of sperm head was dose-dependent. The cytological changes in the root tip cells of Allium cepa indicated that cypermethrin is having toxic effects on the root tip cells in the form of stickiness of chromosomes and also affect the mitotic activity. This study suggest that cypermethrin may have the potential to induce adverse effects on sperm head shape morphology of mouse as well as clastogenic effects on root tip cells of Allium cepa.

Effectiveness of nutrition education, iron supplementation or both on iron status in children.

OBJECTIVE: A community-based, randomized trial was designed to compare the effect of nutrition education and/or iron supplementation (weekly) on iron status of children in an urban slum in Delhi. METHODS: Four hundred and fifty one children, 9-36 months of age and their caretakers (mothers), assigned to one of the following groups were included in the cohort. Group 1, nutrition education. Group 2, supplementation (with 20 mg elemental iron). Group 3, nutrition education with supplementation (with 20 mg elemental iron) and Group 4, control given placebo. The intervention program was of four months duration, with a treatment phase of 8 wk followed by 8 wk of no treatment. RESULTS: Post intervention, at 8 wk and at 16 wk, the hemoglobin change in the nutrition education, supplementation, nutrition education with supplementation and control groups was 2.9, 1.9, 3.8 and -5.9%, respectively and 2.1, -1.9, 0 and -9.3%, respectively (as compared to initial values). There was no significant effect of any of the intervention at 8 weeks. At 16 wk, there was significant positive effect of nutrition education group (p less than 0.05). The percent change in serum ferritin value at 16 wk in the nutrition education, supplementation, nutrition education with supplementation and control groups was 5.7, -2.3, -3.4 and -40%, respectively. Serum ferritin values were significantly higher for the nutrition education group (p < 0.001) as compared to the control. At 16 wk, the nutrition education group mothers showed significantly higher nutrition knowledge and the dietary iron intake of children was significantly higher than their control group counterparts (p < 0.0001). CONCLUSION: The study suggests that nutrition education did have a positive effect on the iron status possibly by improving the dietary iron intake.

Anemia prophylaxis in adolescent school girls by weekly or daily iron-folate supplementation.

OBJECTIVE: To examine the benefits of anemia prophylaxis in adolescent school.girls by weekly or daily iron-folate supplementation. DESIGN: Prospective study. SETTING: Government girl schools of northeast Delhi. SUBJECTS: 2088 subjects (with hemoglobin greater than 7.9 g/dL), including 702 on daily and 695 on weekly iron-folate administration; 691 girls served as controls. RESULTS: About 85% girls were iron deficient out of which 49.3% were anemic. Weekly administration took longer time to raise hemoglobin but was effective as well as practical. Plasma ferritin estimation in girls showed rise in level in both the treated groups. CONCLUSION: Weekly administration of iron-folate was a practical and effective strategy for anemia prophylaxis in adolescent school girls.

Deciduous dentition and enamel defects.

Two hundred eighty children including wellnourished, malnourished and infants with intrauterine growth retardation (IUGR) were examined for dental eruption and enamel hypoplasia. In malnourished and IUGR children eruption of teeth was delayed. The prevalence of enamel hypoplsia in wellnourished children was 20% being significantly higher in females as compared to males in age group 1-2 years. Enamel hypoplasia was seen in 36.6% malnourished subjects. Breast-feeding was protective against enamel hypoplasia.

BCG vaccination reaction in low birth weight infants.

BACKGROUND & OBJECTIVES: About 30 per cent newborns (preterm and term) weigh < 2500 g at birth. The immunological system is less mature in low birth weight (LBW) babies compared to term and normal birth weight (NBW) babies. Bacille Calmettee Guerin (BCG) vaccine is given at birth under the national immunization programme. There is a paucity of information on the immunogenicity of BCG vaccine in preterm and LBW babies. It was, therefore, proposed to study the reaction of BCG vaccination in LBW, preterm and normal birth weight newborns. METHODS: A total of 143 newborns (90 term and 53 preterm; of these 78 were LBW) received during March to September 1998, 0.1 ml of BCG vaccine (Danish 1331 strain) intradermally on the left arm just above the insertion of the deltoid muscle within 7 days of life. At the same time trivalent oral polio vaccine was administered as per the national immunization programme. These babies were followed up in the immunization clinic at 4, 6, 8, 10 and 12 +/- 1 wk to observe reactions at the BCG vaccination site. RESULTS: After 4 wk reaction at the vaccination site was significantly (P < 0.001) delayed in preterm babies as compared to term infants, and in the LBW babies (P < 0.05) as compared to NBW babies. The reaction at the site of vaccination was not found to be different at 6, 8, 10, 12 wk. BCG scar was seen in 47.5 per cent infants (45.4% in < 2500 g birth weight and 50% in > or = 2500 g birth weight infants) at 12 wk. But 33 (42.3%) LBW and 24 (36.9%) NBW infants also showed papule, pustule, ulceration or scab at the BCG vaccination site. INTERPRETATION & CONCLUSION: The BCG reaction was seen in the sequential order from papule to scar formation. No significant difference was seen in the scar formation in infants studied with varying gestation and birth weights after 12 wk of BCG vaccination. Fifty seven (40.4%) babies still showed different stages of BCG reaction at 12 wk. BCG vaccine along with OPV administered in early neonatal life showed successful BCG reaction in 95.5 per cent infants.