A detailed ophthalmic evaluation including slitlamp biomicroscopy, measurement of corneal sensitivity using Cochet and Bonnet aesthesiometer, Schirmer's test and Goldmann applanation tonometry was carried out in 89 patients of Hansen's disease attending the leprosy clinic with or without ocular symptoms and willing to undergo eye evaluation. Thirty-one patients had lepromatous leprosy (8 with erythema nodosum leprosum), 56 patients had borderline disease (13 with reversal reactions) and 2 had tuberculoid disease. In addition to the well documented changes of lagophthalmos (6.7%), uveitis (7.3%) and cataracts (19%), we noted prominent corneal nerves in 133 eyes (74.7%), beaded corneal nerves in 19 eyes (10.7%), corneal scarring in 10 eyes (5.6%), corneal hypoaesthesia in 51 eyes (28%) and dry eye in 18 eyes (13%). Beaded corneal nerves and/or stomal infiltrates occurred mainly in the lepromatous group (75%). Ocular hypotony (IOP less than 12 mm Hg) was not seen more frequently in Hansen's as compared to age and sex matched controls with refractive errors or cataracts (33.7%, vs. 37.8%, p = 0.33). Our study highlights the primary corneal involvement with corneal neuropathy as the predominant feature of Hansen's disease.
Progressive multifocal leukoencephalopathy (PML) is a rare subacute-onset fatal demyelinating disease of the central nervous system caused by the John Cunningham (JC) virus. It usually occurs in impaired cell-mediated immunity settings such as lymphoproliferative disorders, chronic infective or granulomatous conditions on immunosuppressive medications, and human immunodeficiency virus infection. It also appears very rarely with idiopathic CD4 lymphocytopenia. We present a case of PML with visual field defect, progressive motor impairment, behavioral alteration, and dementia. Magnetic resonance imaging had features of asymmetric non-enhancing hyperintense subcortical white matter lesions in the background of chronic active hepatitis B infection. To the best of our knowledge, this is the first case report of CD4 lymphocytopenia associated PML following chronic hepatitis B infection.
INTRODUCTIONConjunctival impression cytology is a recently introduced method for study and diagnosis of eye diseases affecting conjunctiva. A cellulose acetate filter paper is applied on the conjunctival surface to remove the superficial layer of the conjunctiva. The sample is then stained by PAS and Haematoxylin and cytological analysis is done.This method was first used by Egbert PR et al to study conjunctival goblet cells.1 This method can be used to detect dry eye syndrome, vitamin A deficiency and trachoma, metaplastic and dysplastic changes can also be diagnosed.2 Early diagnosis of neoplasm of eye can be done by this method. This technique can also be applied for documenting sequential changes in conjunctiva over the time, monitoring effect of treatment and staging conjunctival squamous metaplasia, as investigational tool for analyzing ocular surface disease with immunostaining and DNA analysis. Aim of our study is to observe the cellular changes in conjunctival superficial layer in various diseases of eye and establishing the diagnosis and helping in management of eye diseases. METHODSCellulose acetate filter paper is used to collect specimen. Cellulose acetate paper is cut in size of 3 x 10mm with diagonal end. Eye is anesthetized by one drop of paracain. Palpabral fissure is widened by retracting eye lid with finger and thumb of one hand, with other hand filter paper applied over the bulbar conjunctiva and left for 4-6 seconds. 4 Then filter paper is removed with forceps in a peeling motion.The specimen is then fixed by dipping in a fixative containing glacial acetic acid, formaldehyde and ethyl alcohol in ratio 1:1:20 for 10 minutes.5 Then it is rinsed in tap water for two minutes. The strip is dipped in 0.05% periodic Schiff reagent for 8 minutes sodium metabisulfite for 2 minutes and in Haematoxylin for 30 seconds. The strip is rinsed for 2 minutes with tap water after each step above. Now 95% ethyl alcohol is applied over strip for 2 minutes. The strip is dehydrated with ABSTRACT Background: Conjunctival impression cytology is a recent method to diagnose various eye diseases. Aim of this study is to observe the cellular changes in conjunctival superficial layer in various diseases of eye and establishing the diagnosis and helping in the management of the disease Methods: Cellulose acetate filter paper is used to take impression from the bulbar conjunctiva. Results: 80 cases were studied for a span of 3 years. Conclusions: Conjunctival impression cytology is a useful method of screening, diagnosing and managing eye disease.
Background: In view of the rapidly growing number of aged population with dementia in India, widespread hypovitaminosis D in the elderly individual, high frequency of dementia of unknown etiology, many studies showing a definite role of Vitamin D in dementia as well as some of the literature showing inconsistent results and reverse causality of hypovitaminosis D in dementia, we planned to investigate the relation between low vitamin D and risk of dementia. Aims and Objective: The aim of the current study was to find out any relationship of Vitamin D with dementia. Materials and Methods: This cross-sectional observational study was performed at a neurology-teaching hospital, Kolkata, India. Ethical clearance was obtained from the hospital ethics committee. A total of fifty adults completed interviews on a semi-structured questionnaire. In addition, general medical and neurological examination and detailed cognitive assessment, including MMSE, were carried out after taking written consent. All individuals with dementia, and age-gender-matched healthy volunteers provided blood samples for routine and relevant biochemical examination, including the estimation of serum 25(OH) Vitamin D by Chemiluminescence Immuno Assay (CLIA). In addition, appropriate statistical methods were applied to analyse the results. Results: Overall, ninety percent of participants had low serum 25(OH)Vitamin D, defined as 25(OH)D < 20mg/ml. Hypovitaminosis D was associated with early and late-stage dementia and was statistically significant. Only five individuals were found to have sufficient 25 (OH) Vitamin D. Conclusion: The mean vitamin D level of demented patients was significantly lower compared to the control population. Our observations provide an association between Vitamin D deficiency and dementia and provides a background of longitudinal prospective study in future to show cause and effect relationship between dementia and hypovitaminosis D.
We report a case of Crohn’s disease (CD) presenting as a thromboembolic middle cerebral artery stroke due to a left ventricular (LV) thrombus in a 50-year-old lady. The proinflammatory and procoagulant state reported in CD seems responsible for this. The patient was managed with conservative treatment, but she died quickly. The findings highlight the rare occurrence of LV thrombus in a patient of CD as well as the need for aggressive control of disease activity with disease-modifying drugs at an earlier phase of treatment.
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