Anhidrosis: a clue to an underlying autonomic disorder.

We describe a patient with Ross syndrome who had the classic triad of segmental anhidrosis, tonic pupils and hyporeflexia. Dilute pilocarpine (0.1%) instillation in both eyes revealed parasympathetic denervation hypersensitivity. There was evidence of cardiac dysautonomia in the form of a decrease in heart rate variability with deep breathing and an abnormal Valsalva response. A thermoregulatory sweat test showed the presence of sweating in the right cheek, neck and upper one-third of the left arm and shoulder only. Sympathetic skin responses were absent in the affected segments of the upper limb. Ross syndrome is a degenerative disorder that progressively involves different fibre populations, starting with autonomic fibres and then involving the unmyelinated and myelinated sensory fibres. A careful clinical examination and simple bedside autonomic tests can confirm the diagnosis.

Visual Function and Ocular Status in Children with Disabilities in Special Schools of Northern India.

INTRODUCTION: Children with disabilities (other than visual impairment) are at a higher risk of visual impairment as compared to normal population. Majority of the ocular disorders, like refractive errors and strabismus, are easily treatable. As these children depend on their visual inputs for social and academic activities, an early detection and prompt treatment of even a minor visual problem is of utmost importance for them. AIM: To assess the visual function and ocular status of children with disabilities other than visual impairment and to identify the preventable and treatable causes of visual impairment. MATERIALS AND METHODS: The study was conducted on children aged 3-16 years who were studying in special schools/ rehabilitation centers in Ludhiana. After prior permission, detailed ocular examination of all the children was done using standard examination techniques. Cycloplegic retinoscopy and refraction was also done and spectacles were prescribed. Children requiring further evaluation were referred to base hospital. RESULTS: A total of 404 children with disabilities (other than visual disabilities) studying in 7 rehabilitation centers/ special schools were enrolled. These included children with Cerebral palsy (12.1%), with Hearing impairment (35.3%), with Attention Deficit Hyperactive Disorder (ADHD) (3.7%), with Autism (8.6%), with Down syndrome (12.8%) and with Mental retardation (27.2%). Ocular disorders were seen in 174(43%) children. The most common ocular disorders seen in these children were refractive errors (23%) and strabismus (18.1%). A total of 93(23%) children were prescribed spectacles and 37(9.2%) children were referred for further evaluation. CONCLUSION: Ocular problems are common in children with other disabilities. Delay in the detection and treatment of these disorders compounds the already existing disability in these children. Lack of awareness and sensitization among the parents and teachers is a matter of great concern. Therefore, strategies regarding increasing awareness, mandatory ocular examination in these children and early detection and treatment of the ocular disorders is the need of the hour.

Risk assessment of vegetables irrigated with arsenic-contaminated water.

Arsenic (As) contaminated water is used in South Asian countries to irrigate food crops, but the subsequent uptake of As by vegetables and associated human health risk is poorly understood. We used a pot trial to determine the As uptake of four vegetable species (carrot, radish, spinach and tomato) with As irrigation levels ranging from 50 to 1000 µg L(-1) and two irrigation techniques, non-flooded (70% field capacity for all studied vegetables), and flooded (110% field capacity initially followed by aerobic till next irrigation) for carrot and spinach only. Only the 1000 µg As L(-1) treatment showed a significant increase of As concentration in the vegetables over all other treatments (P < 0.05). The distribution of As in vegetable tissues was species dependent; As was mainly found in the roots of tomato and spinach, but accumulated in the leaves and skin of root crops. There was a higher concentration of As in the vegetables grown under flood irrigation relative to non-flood irrigation. The trend of As bioaccumulation was spinach > tomato > radish > carrot. The As concentration in spinach leaves exceeded the Chinese maximum permissible concentration for inorganic As (0.05 µg g(-1) fresh weight) by a factor of 1.6 to 6.4 times. No other vegetables recorded an As concentration that exceeded this threshold. The USEPA parameters hazard quotient and cancer risk were calculated for adults and adolescents. A hazard quotient value greater than 1 and a cancer risk value above the highest target value of 10(-4) confirms potential risk to humans from ingestion of spinach leaves. In our study, spinach presents a direct risk to human health where flood irrigated with water containing an arsenic concentration greater than 50 µg As L(-1).

Pterygium removal: knife excision versus modified evulsion technique.

Seventy-four pterygia were removed by knife excision (KE), and 85 using a modified evulsion technique (MET); follow up ranged from 6 months to 5 years (mean, 14 months). The recurrence rate with MET was 5.88%; with KE, 20.27%. This difference is statistically significant (p = .05).

Single-nucleotide polymorphism alleles in the insulin receptor gene are associated with typical migraine.

We have identified a migraine locus on chromosome 19p13.3/2 using linkage and association analysis. We isolated 48 single-nucleotide polymorphisms within the locus, of which we genotyped 24 in a Caucasian population comprising 827 unrelated cases and 765 controls. Five single-nucleotide polymorphisms within the insulin receptor gene showed significant association with migraine. This association was independently replicated in a case-control population collected separately. We used experiments with insulin receptor RNA and protein to investigate functionality for the migraine-associated single-nucleotide polymorphisms. We suggest possible functions for the insulin receptor in migraine pathogenesis.