Aqueous deficiency dry eye in post conjunctivitis cicatrization - Effect of deep thermal punctal cautery

Purpose: To evaluate the effect of deep thermal punctal cautery in eyes with post?conjunctivitis cicatrization. Methods: This retrospective study consisted of patients who underwent deep thermal punctal cautery for post?conjunctivitis dry eye (PCDE). The diagnosis was based on a history suggestive of viral conjunctivitis in past followed by the onset of present clinical features of aqueous deficiency dry eye (ATD). All patients underwent a rheumatological evaluation to rule out underlying systemic collagen vascular disease as a cause for dry eye. The extent of cicatricial changes was noted. Best?corrected visual acuity (BCVA), Schirmer’s test, and fluorescein staining score (FSS; total score of 9) were analyzed pre? and post?cautery. Results: Out of 65 patients (117 eyes), 42 were males. The mean age at presentation was 25.769 ± 12.03 years. Thirteen patients presented with unilateral dry eye. Pre?cautery BCVA (logarithm of the minimum angle of resolution [logMAR]) and Schirmer’s test (mm) improved from 0.5251 ± 0.662 to 0.372 ± 0.595 (P value = 0.000, 95% confidence interval [CI]: 0.09–0.22), and 1.952 ± 2.763 to 4.929 ± 4.338 (P value = 0.000, 95% CI: ?3.79–?2.17); post?cautery, respectively. The pre?cautery FSS of 5.9 ± 2.82 reduced to 1.58 ± 2.38 (P value = 0.000, 95% CI: 3.46–5.17) post?cautery. The mean follow?up was 11.22 ± 13.32 months. No progression in cicatricial changes was noted in any eye during the follow?up. Re?canalization rate was 10.64%, and repeat cautery was performed with successful closure of puncta. Conclusion: Symptoms and clinical signs of ATD in PCDE patients improve with punctal cautery

Dry eye module – An application intelligence platform for diagnosing and monitoring dry eye disease

Dry Eye Module (DEM), a software application, was developed to facilitate the streamlining of dry eye evaluation and documentation, to unify diagnostic jargon, and to analyze data input to generate a dry eye diagnostic report. This diagnostic report generated is based on the current understanding of dry eye diagnostic algorithms (Dry Eye Workshop 2 [DEWS2]/Asia Dry Eye Society [ADES]). Apart from its plausible role in aiding unprecedented multicentric dry eye demographic data collection, the application software can generate a customized referral letter to the rheumatologist, highlighting the salient ophthalmic features to be shared. DEM uses schematic illustrations to depict eyelid, conjunctival, and corneal parameters that impact the ocular surface in dry eyes that can be captured and compared during serial visits. Furthermore, DEM displays a symptom sign trend chart that graphically represents improvement/stability or worsening of the subjective and objective dry eye status. DEM can generate a curated prescription using preloaded advice templates. DEM includes facility for state-of-the-art advanced dry eye diagnostic reporting for super specialty use. The addition of DEM to the dry eye diagnostic armamentarium would help bridge the current unmet needs of dry eye evaluation. These are lack of uniform reporting, lack of multicentric data on a unified platform, the inability to ensure complete evaluation, inability to avoid lacunae during follow-up visits, and the lack of a simple patient-ophthalmologist and an ophthalmologist–rheumatologist interface.

E-PIX: An enhanced grading for acute ocular burns

An enhanced online and manual grading system, based on the I’s and E’s, for acute ocular chemical injuries is being proposed. E-PIX is designed to be an online/manual grading system that includes all the parameters that adversely affect the outcome of acute chemical injuries. The importance of addressing the I’s and E’s in chemical burns cannot be underestimated. These include the need for the documentation and management of epithelial defect (E), intraocular pressure (P) (IOP), ischemia (scleral) (I), and exposure (X) (acronym - E-PIX). Epithelial defect includes that involving the limbus (L), along with conjunctival (C), corneal (K), and tarsal (T). These additional parameters are graded and represented as an annotation along with the limbal grade providing a comprehensive grading for the injury. A manual entry sheet and a freely accessible online grade generator are a part of the system. The proposed enhanced grading offers a final annotation that provides a clear understanding of all factors that can lead to vision-threatening complications ensuring their assessment and hence subsequently their addressal to improve outcomes, if abnormal. The prognostication continues to be based on the grade of limbal involvement. The additional annotations impact prognosis and outcome if not addressed. Including the laterality of injury provides, in addition, a futuristic understanding of available options. The grade generator retains the flexibility to be dynamic with changes reflecting upon the healing process in the acute stage. The proposed system aims to provide primary and tertiary caregivers alike with a uniform grading system.

Role of polymerase chain reaction–based viral detection in pterygia

Purpose: Pterygium is a fibrovascular disease that originates in the conjunctiva and commonly spreads to the corneal surface, thereby posing a threat to eyesight. Despite intensive research, the pathophysiology of this disease remains unclear. Recent research suggests that oncogenic viruses, such as human papillomavirus (HPV), cytomegalovirus, and Epstein–Barr virus (EBV), may play a role in pterygia development. Although there are questions concerning the function of oncogenic viruses in pterygium pathogenesis, existing research shows a lack of consensus on the subject, demonstrating the heterogeneity of pterygium pathophysiology. Therefore, we aimed to simultaneously detect the three common viral pathogens that have been reported in pterygium tissue obtained after excision. Methods: Thirty?five tissue specimens of pterygium from patients undergoing pterygium surgery (as cases) were analyzed for evidence of viral infection with multiplex polymerase chain reaction (PCR), and virus?specific real?time quantitative PCR was used for the samples that were detected positive by multiplex PCR. Results: Of the 35 patients, one sample was positive for EBV and two samples were positive for HPV. Further PCR?based DNA sequencing of the HPV PCR?positive product showed identity with HPV?16. Real?time quantitative PCR on samples that showed EBV or HPV positivity did not yield any detectable copy number. Conclusion: Our study results confirmed that PCR positivity could be due to transient flora, but it was not quantitatively significant to conclude as the causative factor of pterygium pathogenesis. However, additional studies with larger sample populations are warranted to fully determine the role of the virus in pterygium.

Topical corticosteroids in dermatology.

Since their introduction, topical corticosteroids have become indispensable in the treatment of various dermatoses. Hydrocortisone was the fi rst compound. Modifi cations in the basic structure generated in vivo activity and thus different topically active compounds were discovered. Apart from the Stoughton vasoconstrictor assay, various other methods are used for potency assessment of topical corticosteroids. Topical corticosteroides are classifi ed based upon potency and action of these molecules. Mechanism of action at the cellular level and indications of topical corticosteroid use have been discussed. Various adverse effects often occur as an extension of their activity combined with inappropriate usage. Tachyphylaxis and contact allergy are potential problems in clinical practice. Newer compounds with improved risk-benefit ratio are available.

Utility of Papanicolaou test in diagnosis of cervical lesions: a study in a tertiary care centre of western Uttar Pradesh.

Background: Cervical cancer is the most common cancer among females in India. It is also one of the major causes of deaths among them. Papanicolaou (Pap) cytological test helps in detecting the early epithelial abnormalities in cervical cells. The morbidity and mortality due to cervical cancer has come down in countries with well-established screening programmes at national level. This study was conducted to emphasize the value of cervical screening as a tool for early detection of non-neoplastic and neoplastic lesions of cervix. Slide positivity rate was computed and clinico-pathological correlation was done. Methods: This cross-sectional study was conducted from January 2012 to December 2014 (3 years), on 2202 women aged between 20-70 years coming for a Pap smear examination in a tertiary care hospital in Bareilly, India. After staining with conventional Papanicolaou technique, all cases were classified as per Bethesda nomenclature (2001). Results: Out of 2202 cases, 85.16% slides were found to be negative for intraepithelial abnormalities and 14.84% slides were labelled as positive for epithelial lesions. 97.67% of high grade lesions were found in women more than 40 years. Smears with epithelial cell abnormality were found more common in older age groups whereas smears negative for epithelial cell abnormality were found more common in young age groups. Conclusion: Pap test is a cost effective cancer screening and is a simple method to detect various lesions of cervix, non-neoplastic as well as neoplastic. High risk screening programmes should be directed to all women >40 years. Pap test is especially useful to diagnose precancerous lesions of cervix, thereby early detection of these lesions & subsequent proper treatment can be helpful in prevention of cervical cancer.

Does Cord Clamp Affect the Proper Positioning of Breastfeeding.

To determine the appropriateness of breastfeeding position as assessed by 4-point standard objective criteria in the presence of commercial plastic cord clamp. 50 babies each with and without cord clamp were selected randomly in post natal ward. Mean gestational age in both the periods was comparable (39±1.13 and 39±1.34 weeks). On evaluation by the standard 4 points of proper positioning, babies with cord clamp failed to keep their head and body straight (66% vs 94%, P=0.001), keep their baby’s body touching mothers abdomen (16% vs 94% P=0.000), and body well supported (72% vs 96%, P=0.002). However, both groups were appropriately able to turn baby’s body towards mother and nose opposite the nipple (98% vs 88%, P=0.112). On evaluation of mother’s satisfaction score, there was no significant difference except in the mother’s concern about care of cord clamp (P<0.001).

Ovarian fibroma: an unusual morphological presentation with elevated CA-125.

This paper reports a case of a 42 year old female patient who presented with a large multi septate, predominantly cystic ovarian mass with elevated CA-125 levels. A diagnosis of malignant ovarian tumour was made on grounds of pre operative investigations and radical surgery was planned. Histopathological examination however revealed an ovarian fibroma with cystic change reinforcing the non specificity of CA-125 as a marker of ovarian malignancy and establishing the importance of a proper histopathological examination even in the most obvious of cases.

Follicular thyroid carcinoma with metastasis to skin diagnosed by fine needle aspiration cytology.

In April 2006, a 55-year-old female presented with a thyroid mass and multiple skin nodules on scalp, forehead and neck. Fine needle aspiration cytology of thyroid mass and multiple skin nodules show tumor cells clusters in a repetitive microfollicular pattern on May-Grunwald-Giemsa stain suggestive of follicular thyroid carcinoma with metastasis to skin. Although follicular carcinoma have a propensity for vascular invasion and hematogenous dissemination, skin is not commonly involved. Only a few cases of cutaneous metastasis from follicular thyroid carcinoma are reported in the English language literature.