Reversible blindness in cryptococcal meningitis with human immunodeficiency virus infection

Ocular complications in cryptococcal meningitis (CM) are commonly attributed to elevated intracranial pressure (ICP). We report a case of reversible vision loss complicating acquired immunodeficiency syndrome (AIDS) related to CM with a normal ICP. The patient had sudden onset painless blindness during the anti-retroviral therapy (ART) and anti-fungal therapy. On evaluation, clinical and radiological findings of optic neuritis were present. While reviewing the literature for causes of blindness in CM, we concluded the cause was optic neuritis due to immune reconstitution inflammatory syndrome (IRIS) because of concomitant ART intake by the patient. We witnessed dramatic visual improvement after the use of systemic corticosteroids. The potential significance of this case report is to highlight the possible role of corticosteroids in the prevention of blindness due to CM.

Class - III malocclusion: Genetics or environment? A twins study.

Etiology of class-III malocclusion is generally believed to be genetic. A wide range of environmental factors have been suggested as contributing factors for the development of class-III malocclusion. Twin study is one of the most effective methods available for investigating genetically determined variables of malocclusion. Discordancy for class-III malocclusion is a frequent finding in dizygotic twins. However, class-III malocclusion discordancy in monozygotic twins is a rare finding. The purpose of this study of monozygotic twins is to assess the genetic and environmental components of variation within the cranio-dento-facial complex.

Improvized pneumatic dilator for achalasia cardia.

The indigenous pneumatic dilator for achalasia cardia reported previously by the authors was being placed alongside the endoscope to perform dilatation under direct vision. It has now been improvised to make the procedure wire-guided and fluoroscopy-assisted as well. The improvization includes insertion of a central Teflon tube for passage of a guidewire and presence of three radio-opaque markers, which define the proximal, central and distal ends of the dilator and help in precise positioning under fluoroscopy. Dilatation for achalasia cardia using the improvized pneumatic dilator with fluoroscopic guidance was performed successfully on 10 patients at our center. All patients had clinical response with greater than 50% improvement in total symptom score. Barium swallow examination after dilatation showed improvement in esophageal transit in all patients. None of the patients developed any complication. Cost of the dilator is approximately 50 times less than that of commercially available dilators. The dilator can be re-used by sterilizing it, which further reduces the cost.

Pitfalls in diagnosis of epilepsy of Janz and its implications.

84 patients of juvenile myoclonic epilepsy (JME) of Janz were studied. Diagnosis was confirmed using clinical and electro-encephalographic (EEG) criterias. 58 (78%) patients of JME were referred as 'refractory or uncontrolled seizures'. Ignoring myoclonic episodes and non-use of activation procedures in EEG were important reasons for diagnostic delay. Sodium valproate (VPA) or clonazepam are the drugs of choice while phenobarbitone (PB), carbamazepine (CZ), and phenytoin (PHT) are ineffective. Clinical spectrum of JME is slightly different in India. Family history of epilepsy or JME is not forthcoming and there is gross delay in the diagnosis. Other differences include age of presentation and mild cognitive impairment. All juvenile patients of generalized epilepsy, not responding to more commonly used CZ, PB and PHT should be strongly suspected for JME by carefully searching for myoclonus.

Extent of use of immediate-release formulations of calcium channel blockers as antihypertensive monotherapy by primary care physicians: multicentric study from Bahrain.

BACKGROUND: The issue of cardiovascular safety of calcium channel blockers (CCBs) has been widely debated in view of reflex increase in sympathetic activity induced by immediate release (IR) / short acting formulations. It is generally agreed that such CCBs should not be used alone in the management of hypertension. AIMS: We have determined the extent to which primary care physicians prescribe CCBs as monotherapy, especially the immediate release formulations, in the management of uncomplicated hypertension and diabetic hypertension - with an emphasis upon the age of the patients. SETTING, DESIGN AND METHODS: A retrospective prescription-based study was carried out in seven out of 18 Health Centres in Bahrain. The study involved a registered population of 229,300 representing 46% of registered individuals, and 35 physicians representing 43% of all primary care physicians. The data was collected between November 1998 and January 1999 using chronic dispensing cards. RESULTS: In all categories CCBs were the third commonly prescribed antihypertensive as monotherapy, with a prescription rate of 11.1% in uncomplicated hypertension, 18% in diabetic hypertension and 20.1% in elderly patients above 65 years of age. Nifedipine formulations were the most extensively prescribed CCBs. Almost half of the CCB-treated patients were on IR-nifedipine, whereas IR-diltiazem and IR-verapamil, and amlodipine were infrequently prescribed. CONCLUSION: Prescription of IR-formulations of CCBs as monotherapy by primary care physicians does not conform with recommended guidelines. In view of concerns about the safety of such practice, measures to change the prescribing pattern are required.

Herpes simplex encephalitis in North West India.

All patients admitted with provisional diagnosis of an encephalitic illness over a period of 30 months, were studied. Special investigations included CSF analysis, EEG, CT scan and MRI. Herpes simplex virus (HSV) antibody estimation in CSF and blood was done simultaneously using ELISA. Patients with diagnosis of cerebral venous thrombosis, cerebral malaria, tubercular meningitis etc, who resembled herpes simplex encephalitis (HSE), were excluded systematically with relevant investigations. 28 patients showed electroencephalographic, serologic and/or neuroradiological evidence of herpes simplex encephalitis. Males were affected more than females. Age ranged from 4 years to 65 years. Main clinical features included altered sensorium (100%) and seizures (89%). Serological test for HSV antibody in CSF and blood was positive in 14 patients. Fronto-temporal localisation was seen in EEG of 18 patients. CT and MRI were fairly characteristic with bilateral asymmetric fronto-temporal lesions. Patients with mild disease and who reported earlier responded well to treatment with acyclovir. Mortality was higher if treatment was delayed or if the disease was severe. Delayed treatment even in less severe cases produced neurological deficit in many survivors. Despite limitations of non-availability of CSF-PCR and serial estimation of HSV antibodies, the study is an attempt to highlight the value of high index of suspicion of HSE on clinical grounds, systematically excluding cases with different aetiologies resembling HSE and planning early antiviral therapy to reduce both mortality and morbidity associated with this fatal disease.

A mixture of Ca(OH)2 paste and ZnO powder as a root canal filling material for primary teeth: a preliminary study.

The present pilot study was conducted on five primary mandibular second molars requiring endodontic treatment to evaluate the clinical and radiographic success of root canal filling material which was a mixture of calcium hydroxide paste (1 cm), Zinc oxide powder (15 gms) and distilled water using hand operated lentulo spirals. All the five cases on clinical evaluation after 2,4,6,9, and 12 months were found to be asymptomatic with no history of pain, tenderness or abnormal mobility. Immediate post-operative radiographic evaluation revealed adequate root canal filling in all cases. The obturated material remained upto the apex of root canals till the beginning of physiologic root resorption. The roots of the primary teeth as well as the filling material mentioned above were seen to resorb at the same rate in one case.

Sequential MTX-5 FU chemotherapy in pallination of advanced cancer cervix.

Twenty four patients with advanced cancer of cervix were submitted to sequential chemotherapy 5FU and MTX. The response rate was 85% in stage III and 50% in stage IV. Overall response rate was 75%. Patients who had not received radiotherapy earlier responded better than those who had received it earlier. This easy and economical modality has importance in view of late reporting and advanced stage of disease encountered in our set up.

Taste deficiency for phenylthiocarbamide in Mathur Kayasths community of Hyderabad, A.P.

The ability to taste phenylthiocarbamide (PTC) has been investigated in 422 individuals representing both sexes among the Mathur Kayastha community of Hyderabad, A.P. There is a great excess of non-tasters with a high 't' gene frequency (0.76). There is no significant difference between the males and females for the t-gene. It is suggested that the high incidence of non-tasters in Mathurs is possibly due to their Aryan origin or even endogamdus customs.