Biomedical subjects
Publications and source records attributed to P Vijayalakshmi.
This report describes a rare occurrence of bilateral, spontaneous, nontraumatic hyphema in a 6 weeks old infant, associated with a small, multiple skin lesions. The diagnosis of juvenile xanthogranuloma was confirmed by histopathological examination of the cutaneous lesions. The hyphaema cleared gradually in 2 weeks time with conservative management.
Congenital unilateral fibrosis, blepharoptosis and enophthalmos syndrome is one of the rare forms of congenital fibrosis of extraocular muscles. The nature and cause of such unilateral inflammation leading to fibrosis is unknown. Prenatal orbital penetration has been proposed as a cause of this syndrome. We report a case of this rare syndrome associated with an adjacent sinus tumor.
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BACKGROUND: Astigmatism is commonly reported in children with and without nystagmus. In children less than 4 years of age the astigmatism changes from against the rule (ATR) to with the rule (WTR) astigmatism in children without nystagmus. However, little is known about children with congenital nystagmus. We compared astigmatism in children with congenital nystagmus below 4 years and above 4 years of age. MATERIAL AND METHODS: Three hundred and fifty-six eyes in 178 children who satisfied the study criteria were included. The children were divided into those below 4 years of age (n of eyes = 192) and those above (n of eyes = 164). Cycloplegic refraction (with manual retinoscopy) carried out at presentation and at the last follow-up were recorded and compared. Cycloplegia was achieved using cyclopentolate eye drops. Outcome of eyes with no astigmatism at initial presentation was compared with the final refraction in both the age groups. The visual acuity at the first presentation was compared with the visual acuity at the last presentation. RESULTS: Average follow-up duration was 3.36+/-1.59 years. On presentation, 176 (49.44%) eyes did not have any astigmatism. We found that 26 (25.2%) out of the 103 children below 4 years of age who did not have any astigmatism on presentation developed WTR astigmatism after a mean follow-up of 3.5+/-1.5 years. (p= 0.042). In children >or=4 years of age only 7 (9.6%) children out of 73 developed WTR after a mean follow-up of 3.4+/-1.4 years. The visual acuity change was not found to be significant in the two groups. The majority (90.3%) improved or had same visual acuity in group A and 88.9% improved or had the same visual acuity in group B at the last follow-up (p= 0.77). DISCUSSION: Our incidence of WTR astigmatism in children with congenital nystagmus is similar to those previously reported series. Our data suggest that there is a significant chance that children under 4 years with congenital nystagmus may develop WTR astigmatism compared with children above 4 years of age. CONCLUSION: With the rule (WTR) astigmatism is common in children with nystagmus. Children under 4 years of age presenting with no astigmatism may acquire WTR astigmatism as they grow. The amount of astigmatism increases with age in children with nystagmus. Visual acuity, however, remains stable as the age advances.
BACKGROUND: Butyrylcholinesterase is an enzyme that may serve as a marker of metabolic syndrome. We (a) measured its level in persons with diabetes mellitus, (b) constructed a family tree of the enzyme using nucleotide sequences downloaded from NCBI. Butyrylcholinesterase was estimated colorimetrically using a commercially available kit (Randox Lab, UK). Phylogenetic trees were constructed by distance method (Fitch and Margoliash method) and by maximum parsimony method. RESULTS: There was a negative correlation between serum total cholesterol and butyrylcholinesterase (-0.407; p < 0.05) and between serum LDL cholesterol and butyrylcholinesterase (-0.435; p < 0.05). There was no statistically significant correlation among the other biochemical parameters. In the evolutionary tree construction both methods gave similar trees, except for an inversion in the position of Sus scrofa (M62778) and Oryctolagus cuniculus (M62779) between Fitch and Margoliash, and maximum parsimony methods. CONCLUSION: The level of butyrylcholinesterase enzyme was inversely related to serum cholesterol; dendrogram showed that the structures from evolutionarily close species were placed near each other.
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13 essential hypertensive patients aged 41 to 60 years were given yoga training for 60 min daily, Monday through Saturday, for a total duration of 4 weeks. Blood pressure and heart rate (HR) were measured with non-invasive semi-automatic blood pressure monitor. Measurements were recorded before the training and at weekly intervals during the 4 week training period. Results of our study show a significant (P<0.001) reduction in resting HR and rate-pressure-product (RPP) after 2 weeks of yoga training. Systolic pressure (SP), diastolic pressure (DP) (P<0.001) and mean pressure (MP) (P<0.05) showed a significant reduction at 3 weeks of training period. After 4 weeks of training, there was further fall in SP, DP, pulse pressure (PP) (P<0.05), MP (P<0.001), HR and RPP. Isometric handgrip test before yoga training produced a significant rise in SP and MP and insignificant rise in DP, HR and RPP. After yoga training, there was a significant rise in all these parameters. Our results show that yoga training optimises the sympathetic response to stressful stimuli like isometric handgrip test and restores the autonomic regulatory reflex mechanisms in hypertensive patients.
Systolic time intervals (STI) are non-invasive and sensitive tests for measuring the ventricular performance. It has been reported that practice of pranayam modulates cardiac autonomic status and improves cardio-respiratory functions. Keeping this in view, the present study was designed to determine whether pranayam training has any effect on ventricular performance as measured by STI and cardiac autonomic function tests (AFT). Twenty four school children were randomly divided into two groups of twelve each. Group I (pranayam group) subjects were given training in nadishuddhi, mukh-bhastrika, pranav and savitri pranayams and practiced the same for 20 minutes daily for a duration of 3 months. Group II (control group) subjects were not given any pranayam training. STI (QS2, LVET and PEP) and AFT (RRIV and QT/QS2) were measured in both the groups at the beginning and again at the end of three months study period. Pranayam training produced an increase in RRIV and a decrease in QT/QS2, suggesting an enhanced parasympathetic and blunted sympathetic activity respectively. QS2, PEP and PEP/LVET increased significantly, whereas LVET was reduced significantly in pranayam group. In contrast, the changes in STI and AFT were much less marked in the control group. Our study shows that three months of pranayam training modulates ventricular performance by increasing parasympathetic activity and decreasing sympathetic activity. Further studies on a larger sample size may illustrate the underlying mechanism(s) involved in this alteration.
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Time course of systolic time interval (STI) variations during 60 degrees head-up tilt (HUT) was studied in 21 patients with essential hypertension and equal number of age-matched control subjects. ECG, Phonocardiogram and carotid pulse were recorded simultaneously on polygraph. Electromechanical systole (QS2), left ventricular ejection time (LVET), pre ejection period (PEP), PEP/LVET ratio and ejection fraction (EF) were determined immediately after and at 1, 2, 3, 4 and 5 min after the tilt. In hypertensive patients, basal values of PEP and PEP/LVET ratio were insignificantly higher whereas LVET and EF were insignificantly lower as compared to the control subjects. 60 degrees HUT produced significant decrease in LVET (P < 0.001) and EF (P < 0.001) and a significant increase in PEP/LVET ratio (P < 0.001) in control subjects. The changes in hypertensive subjects were similar in pattern but statistically insignificant. It is concluded that tilt-induced changes in STIs are blunted in hypertensive patients.
PURPOSE: To describe the ocular manifestations of congenital rubella syndrome (CRS), a common cause of congenital cataracts in developing countries. METHODS: Retrospective analysis of case records of 46 sero-positive infants under 12 months of age who presented at Aravind Eye Hospital, Madurai between July 1993 and February 2001. The ocular and systemic examination details were recorded. RESULTS: Both eyes were affected in 41 (89%) patients. Cataract was present in 81 (93.1%) eyes; most of them were nuclear cataract (79, 97.5%). Other common ocular presentations included microphthalmos in 74 (85.1%) eyes, iris abnormalities in 51 (58.6%) eyes, and pigmentary retinopathy in 33 (37.9%) eyes. Cataract, microphthalmos and iris hypoplasia was a common combination present in 49 (56.3%) eyes. Systemic manifestations included cardiac anomalies in 23 (50%) and neurological anomalies in 16 (34%) children. Multi-system involvement was present in 32 (70%) children. Low birth weight (below 2 kg) was seen in 30% infants. CONCLUSION: CRS may present with a wide spectrum of ocular and systemic findings and requires a high index of suspicion for diagnosis. Any sick infant with unilateral or bilateral congenital cataract should be investigated thoroughly for CRS.
We report herein the design, synthesis, and transfection biology of a novel series of non-glycerol-based cationic lipids with lactic acid-derived head groups The synthetic procedure adopted herein for preparing 1-hydroxy-prop-2-yl head-group-based monocationic transfection lipids 1-7 is fairly straightforward and potentially applicable in designing other cationic lipids with lactic acid-derived head groups. A striking anchor-length dependency was observed in NIH3T3 cells in the sense that except lipid 4, all the other lipids were essentially transfection-inefficient. Ethidium bromide assay for the lipid:DNA interactions is consistent with the general observation that significant lipid:DNA interactions do not guarantee on improved transfection efficiency cationic lipid mediated gene delivery. Given its remarkable transfection properties and low cellular toxicity, lipid 4 is likely to find future use in the area of liposomal gene delivery.
PURPOSE: To describe the epidemiologic, clinical, and histopathologic features of trematode granulomas of the conjunctiva, eyelid, and anterior chamber in pediatric patients. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Forty-one children from a southern Indian village with conjunctival granulomas. METHODS: The village of Sellananthal was selected for a field visit after analysis of earlier hospital-based allergic conjunctival granuloma cases. Children with ocular diseases were examined, and histories of exposure to assumed risk factors and clinical findings were evaluated. Selected patients were brought to the base hospital for excisional biopsy. Serial sections obtained from the excised nodules were examined for the presence of a parasite. MAIN OUTCOME MEASURES: Histopathologic examination of excised conjunctival lesions or response of lesions to local medical therapy. RESULTS: In this year-long prospective study, 41 children (16 years or younger; 38 boys and 3 girls) with clinical features of allergic conjunctival granulomas were examined. Thirty-four patients were from a single village located in the southern Indian state of Tamil Nadu; the remaining 7 were from various parts of the same state. All children swam in their village's freshwater pond. Twenty patients with nodules less than 5 mm in diameter received medical treatment; 13 with larger nodules underwent surgical excision of the lesions. Nine of these 13 cases revealed a zonal granulomatous inflammation admixed with eosinophilic leukocytes; 4 of these 9 displayed fragments of the tegument and internal structures of a trematode and Splendore-Hoeppli phenomenon. The remaining 4 of the 13 cases revealed nongranulomatous inflammation made up of lymphocytes, histiocytes, and eosinophils. Eight patients refused surgical treatment. CONCLUSIONS: In southern India, one cause of allergic conjunctival granulomas in children seems to be trematode infection. The clustering of cases in a single village and exposure to a village freshwater pond indicate the need for an epidemiologic investigation and study of the parasite's life cycle. Sporadic cases from other parts of the state with similar histories of exposure to their local pond or river water suggest a widespread distribution of the etiologic agent.
PURPOSE: Discussion of four cases of congenital corneal anesthesia with varied systemic associations and modes of presentation. Classification and systemic associations of congenital corneal anesthesia along with the importance of multi-specialty evaluation of such patients. METHODS: Clinical examination of all four cases and corneal sensation assessment with Cochet-Bonnet esthesiometer. Thorough systemic examination and investigations including serum bio-chemical analysis, roentgenography, ultrasonography, nerve conduction studies, and CT scan of the patients to identify systemic associations. RESULTS: All four patients proved to have bilateral congenital corneal anesthesia with Cochet-Bonnet esthesiometry confirming corneal anesthesia. Systemic examination revealed associated congenital mesenchymal anomalies in the first case. The second case had generalized reduction in pain sensitivity confirmed by nerve conduction studies. The third case was an isolated bilateral congenital corneal anesthesia, while the fourth was a case of congenital trigeminal nerve anesthesia involving all three divisions of both trigeminal nerves. Other causes of corneal anesthesia and self-inflicted corneal injuries were ruled out by clinical multi-specialty evaluation and appropriate investigations. Correct diagnosis and symptomatic treatment aided speedy relief of symptoms of all the patients. CONCLUSION: Congenital corneal anesthesia is a rare condition and is often a diagnostic dilemma. Although more common conditions that cause corneal anesthesia can mislead the clinician, the congenital variant should be kept in mind in any case of intractable corneal ulceration in children. Early diagnosis, symptomatic treatment and measures to prevent further corneal damage will immensely help in retaining useful vision for the affected children.
Since the cardiovascular effects of tilting are influenced by degree as well as duration of the tilt, we planned to study the time course of blood pressure and heart rate (HR) responses during 30 degrees, 60 degrees, 80 degrees head up tilt (HUT). The study was conducted on 20 volunteers aged 18-20 y who were tilted on a tilting table. Blood pressure was determined by sphygmomanometer and HR was calculated from R-R interval of ECG. 30 degrees HUT produced an insignificant decrease in systolic pressure (SP) and pulse pressure (PP) while diastolic pressure (DP), mean pressure (MP) and rate-pressure-product (RPP) registered an insignificant rise. The changes produced by 60 degrees and 80 degrees HUT were more marked than those produced by 30 degrees HUT. While SP and PP decreased significantly, HR and RPP increased significantly. In conclusion, 30 degrees HUT produces insignificant changes while 60 degrees and 80 degrees HUT produce significant changes in SP, PP and RPP.
Electromyographic (EMG) and electrodiagnostic studies were made on sciatic nerve-anterior tibialis muscle in vivo in rats administered with a sublethal dose of Parthenium hysterophorus dry leaf powder 100 mg/100 g body weight of rat. Nerve-evoked and muscle-evoked compound muscle action potentials were recorded at different frequencies of stimulations and at different time intervals. The EMG studies revealed depolarizing neuromuscular junctional (NMJ) blocking effects of the leaf extract. The decrement-increment (D-I) phenomena and the EMG pattern in general showed a resemblance to an established anticholinesterase agent like neostigmine. The studies confirm that the leaf extract contains a proven and promising new depolarizing NMJ blocker.
AIMS: The primary objective was to determine which surgical technique gave the best long term visual outcome for infants and young children with bilateral symmetrical cataract in south India. Secondary objectives were to assess complications and the need for further surgical intervention. METHODS: A randomised controlled clinical trial was undertaken. 65 children under 10 years old with bilateral cataract had one eye treated by lensectomy and the other by aspiration with primary capsulotomy. RESULTS: 56 children (86%) with a mean age at surgery of 53 months were reviewed 3 years after surgery. The overall binocular acuity was 6/18 or better in 57.1% and 6/60 or better in 94.6%. There was no difference in visual acuity between the matched pairs of eyes undergoing aspiration or lensectomy at the third year of follow up (p=0.57). Aspiration eyes were more likely to require a secondary procedure to restore vision than lensectomy eyes (66.1% v 1.8%). CONCLUSION: Aspiration with primary capsulotomy gives an acceptable visual outcome in this part of India providing that there is good follow up to manage capsule opacification. If secondary intervention is not possible owing to poor compliance with follow up, then lensectomy is likely to give better long term visual rehabilitation providing there is good maintenance and technical support for the lensectomy equipment.
PURPOSE: To describe the clinical presentation and natural history of Vogt-Koyanagi-Harada (VKH) syndrome in children, an often unrecognized cause of pediatric uveitis. METHODS: We performed a clinic-based cross-sectional survey and retrospective review of pediatric patients with VHK seen in the uveitis clinic at the Aravind Eye Hospital, Madurai, India, between January 1993 and December 1995. RESULTS: A total of 98 patients with VKH syndrome were seen in the uveitis clinic at the Aravind Eye Hospital during the three years covered by the survey, of whom three (about 3%, with an approximate incidence of 1 case/year) were children 16 years of age or younger. Initial symptoms included eye pain, redness, and blurred vision in all three patients. Headache and dysacusis accompanied the onset of visual symptoms in one patient. Each patient eventually developed areas of vitiligo and poliosis, although these signs were not present at the time of presentation in any of our patients. Signs of active uveitis included anterior chamber and vitreous inflammation, optic disc edema, exudative retinal detachments, and Dalen-Fuchs'-like nodules. All three patients developed cataracts, two developed retinal pigment epithelium atrophy, and one developed glaucoma. Each patient responded well, with good visual recovery, to topical and/or systemic corticosteroids. CONCLUSIONS: Although frequently unrecognized, VKH syndrome may affect children. As with adults, visual loss occurs most typically as the result of cataract, glaucoma, or retinal pigment epithelium atrophy.