Changing trend in the pattern of ocular diseases in patients attending ophthalmology department of a teaching institute in North India during COVID-19 pandemic.

PURPOSE: The objective of this study is to report the changing trend in ocular diseases during COVID-19 pandemic. METHODS: A retrospective review of patients attending the ophthalmology department of a teaching institute was conducted. We studied the 3 months of the COVID period from April 2020 to June 2020. For comparison, we took the corresponding period of April 2019 to June 2019. Data were collected from the medical record section of the Hospital. RESULTS: Overall, 876 patients presented during the 2020 period compared to 7,242 patients in the 2019 period. Percentage of female patients decreased from 53.1% to 49.1% in the 2020 period (P = 0.0251). There is significant decrease in pediatric group in the 2020 period (P < 0.0001). In the 2019 period, refractive errors was the most common (57.6%) followed by cataract (12.29%), allergic conjunctivitis (3.82%), diabetic retinopathy (3.37%). While in the 2020 period refractive errors, constitute 22.37%, followed by allergic conjunctivitis (8.56%), scleritis/episcleritis (7.19%), dry eyes (7.08%), infective conjunctivitis 6.85%), anterior uveitis (6.74%). In the 2020 period, there was significant decrease (P < 0.00001) in the percentage of refractive errors, cataract and diabetic retinopathy, and significant increase in painful symptomatic conditions. The features of ocular trauma in the two study periods were also quite different. CONCLUSION: There is significant decrease in patients of curable/avoidable blindness. We should be ready for the increase burden of curable/avoidable blindness and should plan various strategies to overcome the potential backlog of blindness.

Pharmacoepidemiological Observational Study of Antimicrobial Use in Outpatients of Ophthalmology Department in North Indian Population.

BACKGROUND: Recognition of drug usage patterns provides the basis for improving safety and plummeting risks associated with their use. Thus, this study was undertaken to explore the drug usage pattern in ophthalmology with an emphasis on antimicrobial use at a tertiary care teaching hospital. MATERIALS AND METHODS: An observational study was conducted in the Department of Ophthalmology, Hakeem Abdul Hameed Centenary Hospital, Jamia Hamdard, New Delhi, India for 9 months. Newly registered patients visiting the Outpatient Department for curative complaints were included. All drugs prescribed were recorded, including dose, route, dosage form, frequency of administration, indications for prescription, and duration of therapy, and the data was audited using the indicators prescribed by the World Health Organization. RESULT: A total of 600 prescriptions were analyzed. The number of drugs prescribed was 1097 with an average drug per prescription being 1.8. The most common disorders diagnosed were infective conjunctivitis (21.5%) followed by stye (5.5%). Drugs were prescribed in different dosage forms with eye drops (72.6%) being the most common. Drugs were predominantly prescribed by brand name (100%). Antimicrobials (44.7%) were the most commonly prescribed drugs followed by lubricants (17.5%). Moxifloxacin (53.5%) was the most commonly prescribed antimicrobial agent. Of the antimicrobials prescribed, 89.6% were prescribed topically. Average total cost per prescription was 113 INR. CONCLUSION: The study concludes with an overall impression of rational prescription in terms of prescribing in consensus with the recommended treatment protocol of ocular diseases. Nevertheless, health-care professionals should be encouraged to prescribe by generic name. Creating awareness regarding selection of drugs from essential drug list to reduce the drug cost is the need of the hour. Last but not least, updating knowledge regarding appropriate antimicrobial use and the development of discreet strategies for their use should be implemented to steer clear of antimicrobial resistance.

Hypobaric hypoxia impairs cued and contextual fear memory in rats.

Fear memory is essential for survival, and its dysregulation leads to disorders. High altitude hypobaric hypoxia (HH) is known to induce cognitive decline. However, its effect on fear memory is still an enigma. We aimed to investigate the temporal effect of HH on fear conditioning and the underlying mechanism. Adult male Sprague-Dawley rats were trained for fear conditioning and exposed to simulated HH equivalent to 25,000 ft for different durations (1, 3, 7, 14 and 21 days). Subsequently, rats were tested for cued and contextual fear conditioning. Neuronal morphology, apoptosis and DNA fragmentation were studied in the medial prefrontal cortex (mPFC), hippocampus and basolateral amygdala (BLA). We observed significant deficit in cued and contextual fear acquisition (at 1, 3 and 7 days) and consolidation (cued at 1 and 3 days and contextual fear at 1, 3 and 7 days) under HH. HH exposure with retraining showed the earlier restoration of contextual fear memory. Further, we found a gradual increase in the number of pyknotic and apoptotic neurons together with the increase in DNA fragmentation in mPFC, hippocampus, and BLA up to 7 days of HH exposure. The present study concludes that HH exposure equivalent to 25,000 ft induced cued and contextual fear memory deficit (acquisition and consolidation) which is found to be correlated with the neurodegenerative changes in the limbic brain regions.

Complete bilateral ophthalmoplegia with unilateral facial palsy in a child with anti-GQ1b syndrome.

The classical phenotype of Miller Fisher syndrome is characterized by ophthalmoplegia, ataxia and areflexia. However, less extensive forms have been described. The authors report a 14-y-old boy with positive anti-GQ1b antibodies with unusual clinical findings. He presented with headache, double vision and vomiting for 7 d. Examination revealed complete opththalmoplegia, right lower-motor-neuron facial palsy, no limb weakness or cerebellar signs and normal fundus. CSF examination and MRI brain were normal. Electrophysiological studies showed normal limb nerve conduction studies, low CMAP amplitude of right facial nerve, abnormal blink reflex and negative repetitive-nerve-stimulation test. Anti-GQ1b antibodies were positive. The child was managed conservatively with gradual complete recovery. The patients with positive anti-GQ1b antibodies who do not demonstrate the full complement of the Miller Fisher syndrome triad have been reported previously. However, unilateral facial palsy has not been reported previously. This report further expands the phenotypic spectrum of anti-GQ1b syndrome.

Ocular side effect of tinidazole: a rare case report.

Ocular side effects in the form of punctate epithelial erosions with the use of tinidazole - a 5-nitroimidazole group of drugs is very rare. A 32-year-old male was prescribed tablet tinidazole for the treatment of amoebiasis but developed adverse effects in the form of blisters on both upper and lower lips with itching and burning sensation, itching and burning on penile and anal area associated with punctate epithelial erosions of cornea of both the eyes. All these are rare manifestations but punctate epithelial erosions of cornea has never been reported in the literature so far. Punctate epithelial erosions of cornea have not previously been reported and should be added to the list of complications of tinidazole. Hence, this case is being reported.

Orbital oculomotor nerve schwannoma extending to the cavernous sinus: a rare cause of proptosis.

PURPOSE: To report a case of orbital oculomotor nerve schwannoma extending to the cavernous sinus through the superior orbital fissure presenting with proptosis, but without any neurological sign. CASE REPORT: A 32-year-old man presented with axial proptosis of his left eye. Visual acuity and other ocular examinations were normal. Orbital magnetic resonance imaging revealed a well-defined fusiform retrobulbar lesion in the left orbit extending into the superior orbital fissure and left cavernous sinus measuring 43 mm × 21 mm × 19 mm and causing superomedial displacement of the optic nerve and axial proptosis. The patient was scheduled for surgery, and gross total excision was done. Postoperatively, the patient developed total third nerve palsy. Pre and postoperative third nerve deficit confirmed the origin of the tumor from the oculomotor nerve. Histopathological examination revealed schwannoma. CONCLUSION: Orbital oculomotor nerve schwannoma, although rare, can be the cause of proptosis. Diagnosis can be confirmed histopathologically. It is a benign tumor; however, it can extend intracranially without any neurological symptoms. Therefore, neuroimaging is essential to rule out intracranial extension. Early surgical removal is mandatory.

Caffeine and modafinil promote adult neuronal cell proliferation during 48 h of total sleep deprivation in rat dentate gyrus.

It has been established that sleep deprivation (SD) reduces the proliferation of neuronal precursors in the adult hippocampus. It has also been reported that psychostimulant drugs modulate adult neurogenesis. We examined the modulatory role of two psychostimulant drugs modafinil and caffeine on adult neuronal cell proliferation (NCP) during 48 h of total SD. A novel automated cage shaking stimulus was used to induce SD based on animal activity. 5-Bromo-2″-deoxyuridine (BrdU; 50mg/kg/day i.p.) was injected at the onset of the light phase for two days. Rats were successfully sleep deprived for 85-94% of total time. Stereological analysis showed that both caffeine and modafinil treatments during SD improved the number of BrdU positive cells as compared to the SD group. Caffeine treatment during SD, significantly increased early proliferative and post-mitotic stages of doublecortin (DCX) positive cells while modafinil treatment during SD, increased intermediate and post-mitotic stages of DCX positive cells compared to SD+Vehicle group. Brain-Derived Neurotrophic Factor (BDNF) expression on BrdU positive cells as well as in the dentate gyrus (DG) region was decreased significantly after sleep deprivation. Both caffeine and modafinil significantly improved BDNF expression in the DG region. Modafinil, but not caffeine, significantly decreased hippocampal adenosine level during SD in comparison to the SD+Vehicle group. It may be concluded that caffeine or modafinil treatment during 48 h of SD prevents the SD induced decline in neuronal proliferation and differentiation. Caffeine and modafinil induced alterations of NCP during SD may involve modulation of BDNF and adenosine levels.

Valeriana wallichii root extract improves sleep quality and modulates brain monoamine level in rats.

The present study was performed to investigate the effects of Valeriana wallichi (VW) aqueous root extract on sleep-wake profile and level of brain monoamines on Sprague-Dawley rats. Electrodes and transmitters were implanted to record EEG and EMG in freely moving condition and the changes were recorded telemetrically after oral administration of VW in the doses of 100, 200 and 300 mg/kg body weight. Sleep latency was decreased and duration of non-rapid eye movement (NREM) sleep was increased in a dose dependent manner. A significant decrease of sleep latency and duration of wakefulness were observed with VW at doses of 200 and 300 mg/kg. Duration of NREM sleep as well as duration of total sleep was increased significantly after treatment with VW at the doses of 200 and 300 mg/kg. VW also increased EEG slow wave activity during NREM sleep at the doses of 200 and 300 mg/kg. Level of norepinephrine (NE), dopamine (DA), dihydroxyphenylacetic acid (DOPAC), serotonin (5-HT) and hydroxy indole acetic acid (HIAA) were measured in frontal cortex and brain stem after VW treatment at the dose of 200mg/kg. NE and 5HT level were decreased significantly in both frontal cortex and brain stem. DA and HIAA level significantly decreased only in cortex. DOPAC level was not changed in any brain region studied. In conclusion it can be said that VW water extract has a sleep quality improving effect which may be dependent upon levels of monoamines in cortex and brainstem.

Low iron diet retards 12-O-tetradecanoyl phorbol-13-acetate-mediated tumor promotion in murine skin.

Recently, we have shown that low iron state reduces benzoyl peroxide-mediated tumor promotion in murine skin. To further test the dependence of iron on skin tumor development, we assessed the effect of a low iron diet on 12- O-tetradecanoyl phorbol-13-acetate (TPA)-mediated tumor promotion in murine skin. Female Swiss albino mice were fed on a low iron diet and initiated with a single dose of 7,12-dimethylbenz[ a]anthracene (DMBA, 40 microg as 150 microl per mouse) and promoted with TPA (2.5 microg as 200 microl per mouse, twice-weekly application for 20 weeks). The appearance of the first papilloma and the number of tumors (papillomas and carcinomas) per mouse were recorded weekly. We observed a decrease in tumor incidence (papillomas and carcinomas) and number of tumors per mouse in TPA-promoted mice fed on low iron diet (0.23 mg Fe/kg diet) compared to normal mice fed on balanced mouse chow (1.70 mg Fe/kg diet). The total iron consumption per day by mice being fed on balanced mouse chow was 340-400 microg Fe/kg body weight, and the total iron consumption per day by mice being fed on low iron diet was 45-55 microg Fe/kg body weight. The number of papillomas per mouse was 45% lower and the conversion of papillomas to carcinomas was about 20% lower in mice fed a low iron diet. The tumor size was also smaller in mice being fed on low iron diet. TPA treatment resulted in decreases in the activities of antioxidant enzymes and depletion in the level of epidermal reduced glutathione (GSH). Feeding mice on low iron diet along with TPA treatment resulted in approximately 50-75% recovery of the depleted levels of GSH and antioxidant enzymes. In addition, TPA-mediated induction of biological markers of tumor promotion, viz. ornithine decarboxylase activity and [(3)H]thymidine incorporation into cutaneous DNA, was about 60% lower in TPA-treated mice fed on low iron diet than in normal mice treated with TPA. Cutaneous iron levels were also lower in mice fed on low iron diet than in mice fed on normal diet. Histopathological sections of the skin portion adjoining tumors showed a lower degree of epidermal hyperplasia and lesser infiltration of inflammatory cells in the dermis, and absence of hyperkeratosis in mice fed on low iron diet. Thus, in this study we observe that the tumor promoting potential of TPA is reduced in mice fed on low iron diet, which is also accompanied by lesser inflammatory changes in the skin of tumor-bearing mice fed on low iron diet.

Free radical generating agents lead to the rapid progression of benign skin tumors to carcinoma in iron-overloaded mice.

Free radical generating compounds have been shown to enhance the malignant conversion of papillomas to carcinomas in mouse skin, and iron has been shown to participate in free radical generating reactions. In the present study, we investigated whether iron can play a role in the malignant conversion of papillomas to carcinomas. Skin tumors were chemically induced in female Swiss albino mice using a standard two-stage initiation-promotion protocol. Topical application of 12- O-tetradecanoyl phorbol 13-acetate (TPA), benzoyl peroxide (BPO), H(2)O(2) and cumene hydroperoxide (COOH) to these tumor-bearing mice increased the rate of malignant conversion. To evaluate the effect of iron-overload on the conversion of benign skin papillomas to carcinomas, the animals were pre-treated with 1.0 mg Fe per mouse for 15 days before they received TPA or free radical generating compounds. The number of carcinomas and the percent incidence of carcinomas were recorded weekly. The rate of malignant conversion was higher in iron-overloaded mice as compared with non-iron-overloaded mice. The ability of iron-overload in enhancing the malignant conversion was in the order TPA

Iron augments stage-I and stage-II tumor promotion in murine skin.

Free radical generating organic peroxides and hydroperoxides are known to promote tumors in mouse skin and iron has been shown to participate in free radical generating reactions. In the present study, we have used various peroxides and hydroperoxides as stage-I and -II tumor promoters and have studied the effect of iron-overload on the two stages of tumor promotion. Swiss albino mice were iron-overloaded by injecting iron-dextran (1.0 mg Fe/mouse per day for 15 days). Twenty-four hours after the last injection of iron-dextran, the animals were initiated with 40 microg 7,12 dimethylbenz[a]anthracene. One week following initiation stage-I tumor promotion was accomplished by applying 12-O-tetradecanoyl phorbol-13-acetate (TPA), benzoyl peroxide (BPO), cumene hydroperoxide (COOH) or H(2)O(2) to mice twice weekly for 2 weeks. Stage-II tumor promotion was accomplished by applying mezerein, BPO, COOH or H(2)O(2) to these mice twice weekly for 40 weeks. The appearance of the first papilloma and the number of tumors/mouse were recorded weekly. When compared to non-iron-overloaded mice, the iron-overloaded mice showed a higher tumor incidence and number of tumors/mouse. The order in which iron-overload was effective in increasing tumor promotion by stage-I tumor promoters was H(2)O(2)>COOH>BPO>TPA and the order in which iron-overload was effective in increasing tumor promotion by stage-II tumor promoters was COOH>mezerein>BPO. Induction in ornithine decarboxylase (ODC) activity, [(3)H]thymidine incorporation in cutaneous DNA and cutaneous lipid peroxidation were also higher in the iron-overloaded mice. TPA was the most effective in inducing epidermal ODC activity and [(3)H]thymidine incorporation followed by mezerein, COOH and BPO. In addition, the level of epidermal reduced glutathione and the activities of antioxidant enzymes were lower in iron-overloaded mice. Besides this, cutaneous iron levels were higher in iron-overloaded mice. Thus, we conclude from this study that iron-overload augments stage-I and stage-II of tumor promotion in murine skin.