COVID-19 infection in a child following liver transplantation.

COVID-19 infection immediately after liver transplantation presents a unique and challenging situation. In this report, we present the case of an 11-year-old girl who underwent emergency living donor liver transplantation for acute liver failure. After an uneventful intra-operative course, the patient was transferred to the intensive care unit. On the second postoperative day, the patient developed unexplained severe hypoxia. A polymerase chain reaction test was positive for SARS-CoV-2 virus and a hypercoagulable state was indicated by laboratory investigations. Despite therapies such as mechanical ventilation and therapeutic anticoagulation, further clinical deterioration occurred. On the seventh postoperative day, the patient's pupils were fully dilated bilaterally and unreactive to light, and brain death was later confirmed. This report highlights unique challenges pertaining to oxygenation, coagulation and immunosuppression after liver transplantation in a child with COVID-19. Hypoxia of unknown origin in the postoperative period should prompt consideration of COVID-19 as a possible cause.

Ocular disability--WHO grade 2 in persons affected with leprosy.

Leprosy remains to be a leading cause of peripheral neuropathy and disability. In recent years under Leprosy control programme more stress is being laid on disability assessment. This study was aimed to find prevalence of grade of Ocular disability among persons affected with leprosy (PAL) according to WHO disability grading scale and to find Ocular contributors to grade 2 disability in PAL. A cross sectional study was carried out in tertiary care hospital in Lucknow, Uttar Pradesh. About 302 PAL were interviewed and their eyes clinically examined during 2 years. Data was analysed in percentages, x2 test, Anova. Ocular disability was found in 39.40% persons affected with leprosy (PAL). Of 604 eyes, 13.07% had grade 1 disability and 19.86% had grade 2 disabilities. Bilateral disability was more common than unilateral disability. Ocular disability was more common in PAL with more than one year of leprosy and even higher in those staying in leprasoria (p = 0.012). The most common cause of ocular grade 2 disabilities was corneal involvement (14.23% PAL). Cataract was found to be the most common cause of visual disability (although it is not caused by leprosy). Screening for ocular disability should be incorporated as a routine protocol in PAL to reduce the severity of Ocular disability. Early diagnosis and prompt preventive measure is essential to reduce the burden of visual impairment and blindness in PALthus bringing down the load of grade 2 disability due to leprosy in the society which in itself is an indicator of leprosy control.

Retinal profile: a clinical indicator of severity in dengue fever in a suburban Indian environment.

PURPOSE: To study the retinal changes in subjects suffering from dengue fever and check if these changes can be taken as sufficient indicator of severity and progression of the disease. PATIENTS/METHODS: A detailed history was recorded of 118 patients on whom ocular examination, including direct ophthalmoscopy, indirect ophthalmoscopy and coloured fundus photography, was performed. RESULTS: Forty-seven percent of patients were found to have posterior segment abnormalities. Retinal vein dilatation or tortuosity was the most common finding followed by changes in the optic disc (8.4% of patients) and background haemorrhage (6.7% of patients). With increasing severity of thrombocytopenia, the proportion of patients with retinal abnormalities increased. In patients with grade I thrombocytopenia, no fundal abnormality was found. In those with grade II thrombocytopenia, fundal abnormality was found in 13.63% patients, whereas in the grade III category it was 27.90%. CONCLUSIONS: Severity of thrombocytopenia had a significant association with retinal abnormalities. Occurrence of fundus changes increases with an increase in severity of thrombocytopenia. Fundus changes were found in all patients with grade IV thrombocytopenia.

Clinical profile of herpes zoster ophthalmicus.

Herpes zoster ophthalmicus was seen in 22 cases out of 195 cases of herpes zoster (11.3% incidence). It was affecting mainly adults (90.9%). Oedema over the lids (81.8%) was invariably present and lead to ptosis. Mucopurulent conjunctivitis, predominantly mucoid (72.7%) was the commonest manifestation associated with vesicles over the lid margins. Sectorial (22.7%) and diffuse (9.1%) episcleritis appeared in later part of first week, while nodular episcleritis was observed in one case only on 12th day of the disease. Nummular keratitis was seen in 31.8% of cases between 8-10 days. Iritis and iridocyclitis was seen in 45.4% of cases out of which 36.3% had secondary ocular hypertension (glaucoma). Neuroparalytic keratitis and internal ophthalmoplegia were detected in one patient each. Postherpetic neuralgia occurred in 22.7% of cases and was uncommon in younger age group (below 40 years, 4.5%). Carbamazepine was effective in relieving the herpetic pain.

Cutaneous leishmaniasis in India. Clinical experience with itraconazole (R51 211 Janssen).

Fifteen patients with cutaneous leishmaniasis were randomly selected for clinical trials with itraconazole. A single daily itraconazole dose of approximately 4 mg per 1 kg of body weight was administered to each patient with breakfast for 6 weeks. Five patients served as controls. On completion of therapy, ten cases in the study group (66.6%) were considered to be cured. No major adverse effects were reported. No significant changes were seen in the controls at the end of the study. The possibility of spontaneous recovery will be discussed in this report even though it is considered to be unlikely. Itraconazole has promising potential in cutaneous leishmaniasis therapy.

Mechanism of haloperidol-induced miosis.

Haloperidol administration (iv) has been shown to produce miosis in dogs. In the present study on rabbits, haloperidol administration (iv) produced dose-related miosis but when administered intracerebroventricularly, it failed to produce any change in pupillary size. Higher degree of miosis was observed when haloperidol was administered directly into the anterior chamber of eye. Haloperidol pretreatment failed to significantly modify the mydriasis produced by phenylephrine or atropine. These observations suggest that the miosis produced by haloperidol is a peripheral effect, and also that the miosis is not mediated through the blockade of alpha adrenoceptors of radial muscles or stimulation of cholinoceptors of circular muscles of iris.

Dapsone in the treatment of cutaneous leishmaniasis.

Fifty patients with cutaneous leishmaniasis were treated with dapsone (DDS) approximately 2 mg per kilogram body weight per day for 21 days. Forty patients (80%) were declared cured on the basis of clinical and pathologic criteria. Follow-up examination after 6 months revealed no recurrences. No major side effects were noted. In the control group of 15 patients not receiving the drug, no significant change was seen in the lesions. Dapsone thus was used successfully for the first time.

Laser selected fluorescence of human cataractous lenses at liquid helium temperatures.

Laser excitation of an inhomogeneous distribution of chromophors at temperatures near 0 K is known to result in sharp fluorescence spectra in numerous systems. When this technique was applied to human cataractous lenses at 4 K, broad fluorescence resulted. The wavelengths of maximum fluorescence were different from those previously reported, thus demonstrating the observation of new fluorophors. The broad fluorescence appears to result from internal conversion and energy transfer processes and not from low frequency vibrational motions or strong vibronic coupling. Consequently, other site selection techniques, such as spectral hole burning, may produce sharp spectra with vibronic structure that can be used to identify the molecular species involved.

Effect of vitamins on growth and sporulation of Alternaria alternata (Fr.) Keissler.

Alternaria alternata, a leaf spot pathogen of beet (Beta vulgaris), was found to be auxoautotrophic for thiamine. On the other hand, riboflavin, biotin, inositol, and pyridoxine were heterotrophically needed for its growth. Vigorous sporulation was prominent in response to the additions of riboflavin, d-biotin, and inositol. A curiously depressent effect on both the growth and sporulation of the pathogen was noticed in presence of 1-ascorbic acid, folic acid, and nicotinic acid. These substances also lowered the pH of the medium towards acidity. Separate additions of thiamine, riboflavin, pyridoxine, biotin, and inositol, however, increased the pH towards the neutral and alkaline range.

Perforation of the Palate in Scleroma.

A case of sclerotma with perforation of the palate is described. The patient presented a picture suggestive of syphilitic granuloma with perforation of the nasal septum and the palate. The diagnosis of scleroma was made on the basis of histopathology. The case was treated by surgical resection of the nasal mass and with antibiotics for a period of 3 months. The aetiopathogenesis of the clinical of the features in this case is discussed briefly in the light of available literature.

Amino acid content in relation to growth of Helminthosporium maydis Nishikado and Miyake.

During the growth period of thirty days, altogether thirteen amino acids showed their presence and activity in the developing culture of Helminthosporium maydis Nishikado and Miyake. Initiation of growth by the 5th day coincided with the appearance of profuse amounts of dl-alanine and serine, and moderate amounts of valine, threonine, and aspartic acid. The thirteen amino acids, which appeared in full complement by the 15th day, were actively engaged in accelerating mycelial accumulation. Beyond this growth period, there was a decline in the amino acids.

Varying spectrum of amino acids in relation to growth in Helminthosporium oryzae Breda de Haan.

Fifteen amino acids were detected in the developing mycelium of Helminthosporium oryzae Breda de Haan. During the first fortnight of mat accumulation, which was more rapid, a marked influence of amino acids on the growth pattern was discernible. A high level maintenance of dl-alanine l-cysteine, l-leucine/isoleucine, threonine, tyrosine, glutamic, and aspartic acids, as well as an increase in the amount of gamma-aminobutyric acid and proline during the first fortnight of culture development were effective in initiating growth and keeping it at a more rapid pace. Glutamine and methionine appeared in the latter half of fungal growth. During this slow pace of mycelial accumulation in the latter half period, there was a general and overall decline in the amount of most of the amino acids. The amino acids started disappearing from the mycelial extract from the 20th day onwards till the end of the 30th day. In the culture filtrate, aspartic acid and proline appeared during the rapid growth phase and dl-alanine and methionine during the slower phase.

Fluctuation in amino-acid constituents of a developing culture of Sclerotium rolfsii Sacc. and its relation to growth.

Altogether eleven amino acids were detected in the mycelial extract of Sclerotium rolfsii Sacc. Here, with the appearance of aspartic acid and homoserine on the 5th day, growth was initiated. The maximum mycelial output, achieved by the 15th day, coincided with the detection of leucine/isoleucine and valine in the mycelial extract and of methionine in the culture filtrate. Lysine and gamma-amino-butyric acid which appeared late in the mycelium did not contribute to its growth. Tyrosine, an aromatic amino acid, was present only in the culture filtrate and not in the fungal extract. Aspartic acid, homoserine, and methionine were profusely produced in the culture filtrate during the decline of mycelial growth, suggesting that these amino acids could be fungal autolysis products as well.

An Unusual -large Sized Rhinophyma.

A case of rhinopttyma of dzfobulated type iated with is presented. The growth was big (I 5 x TO cm,) and showed dilated follicles andpits. Itwas surgically. The, relevant literature is reviewed.