All trans retinoic acid-induced bilateral disc edema in a case of acute promyelocytic leukemia.

An 18-year-old female presented with sudden onset bilateral vision loss. Extensive retinal hemorrhages were seen in both eyes. Systemic examination lead to a diagnosis of acute promyelocytic leukemia. The patient was treated with all trans retinoic acid (ATRA) and other medications in the induction phase. Bilateral disc edema was noted during the second consolidation cycle with ATRA. Complete resolution of bilateral disc edema was attained in three weeks' time after discontinuing ATRA.

An optical coherence study on optic disc parameters and peripapillary retinal nerve fiber layer thickness in patients with optic disc edema.

PURPOSE: This study aimed at evaluation of patients diagnosed with optic disc edema (ODE) in terms of demographics, etiology, clinical presentation, and optical coherence tomography parameters. METHODS: An observational cross-sectional study was conducted from August 2021 to July 2022. Patients diagnosed with ODE underwent comprehensive ophthalmic evaluation. Peripapillary retinal nerve fiber layer (RNFL) thickness and optic nerve head parameters were assessed using optical coherence tomography. Radiologic investigations were done as deemed necessary. RESULTS: One hundred and forty-eight eyes with ODE (134 eyes from 67 patients with bilateral ODE and 14 eyes from 14 patients with unilateral ODE) and 148 eyes of age- and gender-matched control group were included in the study. The mean age of the study population was 31.51 ± 13.33 years, with 44 (54.3%) males and 37 (45.6%) females. Bilateral ODE was seen in 82.7% of patients. Idiopathic intracranial hypertension was the most common cause of bilateral ODE, and nonarteritic anterior ischemic optic neuropathy was the most common cause of unilateral presentation. Decreased vision and headache were the main symptoms reported by a majority of patients. Peripapillary RNFL thickness was significantly increased in the ODE group compared to controls. CONCLUSION: The current study provides the clinical profile and optic disc and RNFL measurements of ODE patients in an Eastern Indian population. Detailed history and careful evaluation are necessary, as the treatment strategy is highly dependent on the underlying etiologies.

Bilateral disc edema: An unusual presentation of renal tuberculosis in a child.

Renal tuberculosis (TB) is a rare clinical disorder in the pediatric population. A 15-year-old female presented with intermittent blurring of vision in both eyes associated with fever, abdominal pain, and weight loss. Fundus examination showed bilateral disc edema. Her blood pressure was 220/110 mmHg. Renal parameters were deranged with bilaterally enlarged kidneys. Renal biopsy was suggestive of epithelioid cell granuloma with Langhans type giant cells. The patient was diagnosed with as a case of refractory hypertension due to tubercular interstitial nephritis with bilateral Grade IV hypertensive retinopathy. She was started on antitubercular therapy and antihypertensives. There was a complete resolution of disc edema 2 months following initiation of therapy. Optic disc edema can be a presenting sign in renal TB. Early diagnosis and prompt referral can be associated with good visual and systemic outcomes.

Assessment of changes in optic disc parameters and peripapillary retinal nerve fiber layer thickness in myopic patients and its correlation with axial length and degree of myopia.

Purpose: The present study aimed to assess the changes in optic disc and peripapillary retinal nerve fiber layer (RNFL) parameters in myopic patients and its correlation with axial length (AL) and spherical equivalent (SE) using optical coherence tomography (OCT). Methods: This was a cross-sectional study carried out from August 2019 to September 2021 in the ophthalmology department of a tertiary care hospital in eastern India. Myopic patients in the age group of 20-40 years and SE between - 0.5 to - 10 Diopters (D) were included in the study. Patients were divided into two groups on the basis of degree of myopia and AL. Appropriate statistical analysis was done at the end of the study period. Results: The study included 307 eyes of 307 myopic patients. There were 181 females (58.96%) and 126 males (41.04%). The mean age of the patients enrolled for the study was 28.78 ± 5.76 years. Statistically significant difference (P < 0.001) was found between SE and AL in between the subgroups of A and B. With every 1 D increase in SE, the average peripapillary RNFL thickness decreased by 0.61 µ while with every 1 mm increase in AL, the average peripapillary RNFL thickness was found to reduce by 1.03 µ. Conclusion: Analysis of optic nerve head parameters and RNFL thickness by OCT for the diagnosis should be compared with a normative control group that has been matched for refractive error and AL instead of comparison with a normative database that has only been age matched.

A comparison of lens parameters in patients with various subtypes of primary angle-closure disease and the normal population: A prospective study.

Purpose: To assess the role of lens parameters in the detection and progression of primary angle-closure disease (PACD) by combining A-scan and A-scan optical coherence tomography (AS-OCT) parameters. Methods: A cross-sectional study was conducted in a tertiary health-care center in eastern India. A total of 91 study subjects including cases and controls were included in the study. The parameters studied were lens thickness (LT), lens axial factor (LAF), relative lens position (RLP), and lens vault (LV). Anterior chamber depth (ACD) and axial length (AL) were also analyzed using A-scan. Results: The LT was significantly more in all subtypes of PACD (from 4.24 ± 0.84 to 5.02 ± 0.18 mm) than in controls (4.04 ± 0.46 mm; P < 0.01). Similarly, LAF was significantly less among all subtypes of PACD compared to controls (P < 0.001). The RLP, calculated using the formula (ACD + 0.5 LT)/AL × 10, showed no significant difference (P > 0.05) between various study groups. The LV in acute angle-closure glaucoma (AcCG) patients was significantly higher compared to the control population (P < 0.01). Ocular parameters like ACD decreased, whereas LT and LAF increased from normal through primary angle closure (PAC) to primary angle-closure glaucoma (PACG). Logistic regression analysis found a significant association between a decrease in ACD and an increased risk of PACG (P-value was 0.0001) and an increase in LT and LAF with increased risk of PACG (P = 0.040 and P = 0.006, respectively). Conclusion: Inclusion of lens parameter assessment in the workup of a patient with PACD helps in detection and close monitoring of the progression from suspected to disease state.

Development of a rapid method for extraction of uranium from uranium bearing materials using ionic liquid as extracting agent from basic media.

The paper presents the development of a rapid method for the direct determination of uranium using liquid scintillation analysis in uranium bearing materials with different uranium concentrations and with different impurity levels (U-ore, Uranium ore concentrate (UOC) and U-metal). Uranium extraction was carried out using hydrophobic ionic liquid Aliquat-336 thiosalicylate, ([A-336][TS]) from diluted samples in basic medium followed by liquid scintillation counting (LSC). Extraction efficiencies for uranium from aqueous medium was studied with very small volumes of ionic liquid under varying volume, pH and uranium concentration of the aqueous medium. Maximum extraction efficiency was achieved near pH 8-11. Uranium was successfully re-extracted from organic medium with nitric acid and electroplated onto stainless steel planchette for alpha spectrometry determination. Maximum re-extraction efficiency with 1 M HNO3 combined with electroplating efficiency observed was 80%. The methodology was applied for real samples. The uranium extraction efficiency using ionic liquid was about 85% for U-metal and UOC samples with comparatively low impurity level; whereas extraction efficiency for U-ore samples was found to be less than 40%. The technique can be applied for nuclear forensic applications as well as nuclear emergency scenarios for a quick initial assessment and isotopic analysis of uranium in the samples.

Mother's Recognition of and Treatment Triggers for Common Childhood Illnesses among Migrant Santal Tribe Living in Bhubaneswar, Odisha, India.

Background: Accelerating reduction in infant and other child mortality rates calls for comprehensive child survival strategies. Early recognition of illness and timely seeking of treatment are critical elements to prevent child deaths, and cultural explanation for these care-seeking behaviours is important. The present article reports (i) mothers' recognition of illness and (ii) triggers of treatment related to some childhood illnesses among a migrant tribal community living in Bhubaneswar city, India. Methods: From the four tribal dominated slums, 175 Santal tribal households were selected based on the criteria, viz. (i) the family should have migrated within the past 12 years and (ii) having a child aged 0-14 years. Semi-structured interviews were conducted with mothers for data related to illnesses occurred to their youngest child during past 1 year. Results: The recognition of illness was made based on multiple symptoms. Triggers of treatment and care-seeking behaviour vary from illness to illness. Usually people wait for 2-3 days after onset of any illness, expecting the symptoms to subside automatically. Late onset symptoms and severity trigger mother to take child for treatment. Conclusion: Mothers were able to recognize the childhood illnesses. There was substantial delay in seeking care. Hence, provision of primary health care and health education-based interventions are needed to improve the mothers' recognition and care-seeking behaviour.

Treatment-seeking and out-of-pocket expenditure on childhood illness in a migrant tribal community in Bhubaneswar, Odisha State, India.

BACKGROUND: In India, migrant status, tribal affiliation and poverty render tribal migrants more vulnerable than any other group which leads to high treatment costs and the risk of low access to health care. OBJECTIVE: To examine treatment-seeking behaviour and out-of-pocket (OOP) expenditure on the treatment of childhood illnesses, with a focus on gender in a migrant tribal community in Bhubaneswar, eastern India. METHODS: A total of 175 households with a child aged 0-14 years and who had migrated within the last 12 years were selected from tribal-dominated slums. Data on health-seeking behaviour and expenditure on a recent illness in the youngest child were collected by interviewing mothers during October 2007 to March 2008. RESULTS: Of the 175 children, 78.8% had at least one episode of illness during the previous year. Of the total number of episodes, 71% had been treated and 61% of them had incurred OOP expenditure. A significantly lower proportion of episodes of illness in girls had been treated than in boys (P = 0.01) and incurred OOP expenditure (P = 0.05). Private health care was preferred and only 16.5% availed themselves of the government sources. About 89 and 87% of households of boys and girls, respectively, incurred OOP expenditure. A child's gender (female) (P = 0.05), mother's education (P = 0.002) and type of illness (P = 0.002) were significantly associated with total OOP expenditure. CONCLUSION: Further studies are warranted to address the low access to government health care and thereby reduce high OOP expenditure by tribal migrants on low incomes. Efforts are required to increase the ability of communities and health providers to identify and address the issues of gender and equity in health care along with a focus on culture-sensitive service provision.

Primary healthcare services among a migrant indigenous population living in an eastern Indian city.

This paper reports the accessibility and utilization of the healthcare services among a migrant indigenous community inhabiting slums of an eastern Indian city. It is based on data collected through semi-structured interviews conducted with heads of the households. The results indicated that the services of health personnel by visiting households are rare and the service provision was very poor. For curative services, the people heavily depend on private practitioners, including unqualified practitioners, by spending large proportions of their earnings. Due to migration, this community becomes more vulnerable to low utilization of healthcare services. This study warrants evolving a system of healthcare to cater the needs of vulnerable migrant groups in urban areas of India.

Marriage, sex, and hydrocele: an ethnographic study on the effect of filarial hydrocele on conjugal life and marriageability from Orissa, India.

BACKGROUND: Lymphatic filariasis (LF), a leading cause of permanent and long-term disability, affects 120 million people globally. Hydrocele, one of the chronic manifestations of LF among 27 million people worldwide, causes economic and psychological burdens on patients and their families. The present study explores and describes the impact of hydrocele on sexual and marital life as well as on marriageability of hydrocele patients from rural areas of Orissa, an eastern state of India. METHODOLOGY/PRINCIPAL FINDINGS: This paper is based on ethnographic data collected through focus group discussions and in-depth interviews with hydrocele patients, wives of hydrocele patients, and other participants from the community. The most worrisome effect of hydrocele for patients and their wives was the inability to have a satisfactory sexual life. The majority of patients (94%) expressed their incapacity during sexual intercourse, and some (87%) reported pain in the scrotum during intercourse. A majority of hydrocele patients' wives (94%) reported dissatisfaction in their sexual life. As a result of sexual dissatisfaction and physical/economic burden, communication has deteriorated between the couples and they are not living happily. This study also highlights the impact on marriageability. The wives of hydrocele patients said that a hydrocele patient is the "last choice" and that girls show reluctance to marry hydrocele patients. In some cases, the patients were persuaded by their wives to remove hydrocele by surgery (hydrocelectomy). CONCLUSIONS/SIGNIFICANCE: The objective of the morbidity management arm of the Global Programme to Eliminate LF should be to increase access to hydrocelectomy, as hydrocelectomy is the recommended intervention. Though the study area is covered by the programme, like in other endemic areas, hydrocelectomy has not been emphasised by the national LF elimination programme. The policy makers and programme managers should be sensitised by utilising this type of research finding.

Mass drug administration under the programme to eliminate lymphatic filariasis in Orissa, India: a mixed-methods study to identify factors associated with compliance and non-compliance.

The present study aimed to identify the factors responsible for compliance and non-compliance of mass drug administration (MDA) under the programme to eliminate lymphatic filariasis (LF) from Orissa, India. It was based on both quantitative (through household MDA coverage survey) and qualitative data (through semi-structured interviews with heads of compliant and non-compliant households) collected during an MDA held in November 2005 in two districts of Orissa. In these districts, 83% of the eligible population received the drug (coverage) and only 49.5% people actually consumed the drug (compliance). Seventeen percent of the population did not even receive the drug. The predominant reason for not receiving the drug at household level was that the drug distributor did not visit the household, while the fear of adverse reactions is the predominant reason for not consuming it. The qualitative data revealed that the major contributor to taking the drug was the awareness that drug protects them from LF. Motivation by health workers was another reason for compliance. In many endemic areas, the issues related to non-compliance were taken casually during implementation. Hence, it is imperative to make the programme more efficient by addressing the issues linked to low compliance.

Sexual risk behaviour among migrant tribals living in urban slums of an eastern Indian city: implications on the spread of HIV.

This paper reports the sexual risk behaviour among migrant tribal community living in an eastern Indian city. The age at marriage is very low in this community and 54% of women had first intercourse before the age of 15 years with the mean of 15.8 years and it is 19.5 years for men. Pre and extramarital relations, including multi-partnered sex is prevalent. Safe sexual practices are not reported and the risk perception is very low. High prevalence of behavioral risk factors leaves a potential risk for rapid spread of human immunodeficiency virus (HIV) both in slums as well as in remote tribal areas.