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Biomedical subjects

S P Desai

Publications and source records attributed to S P Desai.

At least 19 recordsLinked to original sources

Pediculosis pubis: presentation to ophthalmologist as pthriasis palpebrarum associated with corneal epithelial keratitis.

Pthiriasis palpebrarum caused by infestation with Pthirus pubis (crab louse) draws attention to pediculosis in the pubic and inguinal region. As pthiriasis is usually transmitted by sexual contact, many cases are likely to have other sexually transmitted diseases. A multidisciplinary approach is essential in the management of these cases. In this case report, we highlight the above and report for the first time associated keratitis.

Adult↗

Unintentional inversion of corneal buttons during penetrating keratoplasty: clinico-pathological report of two cases.

AIM: This report describes the clinico-pathological features of unintentionally inverted corneal buttons in two patients. METHODS: A clinico-pathological report. RESULTS: Two patients who underwent repeat keratoplasty for failed grafts were found to have inverted corneal buttons on histopathological examination. A detailed description of the pathological features of the inverse keratoplasty and the clinical outcome after repeat keratoplasty is presented. CONCLUSION: Inadvertent inverse keratoplasty should be considered as a rare cause of corneal graft failure. The serious complication of anterior chamber epithelialization seems to be unlikely and the prognosis following repeat penetrating keratoplasty appears to be very good.

Adult↗

Spectrum, frequency and penetrance of OPA1 mutations in dominant optic atrophy.

Dominant optic atrophy (DOA) is the commonest form of inherited optic neuropathy. Although heterogeneous, a major locus has been mapped to chromosome 3q28 and the gene responsible, OPA1, was recently identified. We therefore screened a panel of 35 DOA patients for mutations in OPA1. This revealed 14 novel mutations and a further three known mutations, which together accounted for 20 of the 35 families (57%) included in this study. This more than doubles the number of OPA1 mutations reported in the literature, bringing the total to 25. These are predominantly null mutations generating truncated proteins, strongly suggesting that the mechanism underlying DOA is haploinsufficiency. The mutations are largely family-specific, although a common 4 bp deletion in exon 27 (eight different families) and missense mutations in exons 8 (two families) and 9 (two families) have been identified. Haplotype analysis of individuals with the exon 27 2708del(TTAG) mutation suggests that this is a mutation hotspot and not an ancient mutation, thus excluding a major founder effect at the OPA1 locus. The mutation screening in this study also identified a number of asymptomatic individuals with OPA1 mutations. A re-calculation of the penetrance of this disorder within two of our families indicates figures as low as 43 and 62% associated with the 2708del(TTAG) mutation. If haploinsufficiency is the mechanism underlying DOA it is unlikely that this figure will be mutation-specific, indicating that the penetrance in DOA is much lower than the 98% reported previously. To investigate whether Leber's hereditary optic neuropathy (LHON) could be caused by mutations in OPA1 we also screened a panel of 28 LHON patients who tested negatively for the three major LHON mutations. No mutations were identified in any LHON patients, indicating that DOA and LHON are genetically distinct.

Alternative Splicing↗

Evaluation of a disposable prism for applanation tonometry.

BACKGROUND: Recently the Medical Devices Agency recommended that 'ophthalmic devices that touch the surface of the eye should be restricted to single use'. AIM: To evaluate one such device: a disposable tonometer prism for routine applanation tonometry. METHODS: The intraocular pressure (IOP) of 100 consecutive patients from a general eye clinic (197 eyes) was measured with both a disposable and the standard Goldmann tonometer (Goldmann). The level of agreement between the two methods of clinical measurement was assessed and the sensitivity and specificity of the disposable prism in detecting clinically significant raised IOP estimated. RESULTS: The mean difference in IOP measured by the two different prisms was 0.44 mmHg with a standard deviation (SD) of 1.54. The mean IOP for the disposable prism was 19.51 mmHg (SD 6.53 mmHg). The mean IOP for the standard Goldmann tonometer prism was 19.07 mmHg (SD 6.64 mmHg). The sensitivity to detect IOP > 21 mmHg was 95.9% (95% confidence interval (CI): 86.0-99.5%) and the specificity of 93.9% (95% CI: 88.8-97.2%). It gave a positive predictive value of 83.9% (95% CI: 71.7-92.4%). CONCLUSION: There was close agreement between the IOP measurements obtained by the disposable tonometer prism and the Goldmann device for high and low pressures. If replicated, the high sensitivity and specificity would justify its use in screening.

Adult↗

Is the first post-operative day review necessary following uncomplicated phacoemulsification surgery?

PURPOSE: To assess the necessity for first post-operative day review in determining the need for post-operative intervention in patients who had uncomplicated phacoemulsification surgery. METHODS: A retrospective study was carried out to review the first post-operative day findings in patients who underwent uncomplicated phacoemulsification surgery by a single surgeon between January 1997 and March 1998. The findings analysed were wound integrity, corneal clarity, anterior chamber activity, intraocular pressure and the intraocular lens status. The need for medical or surgical intervention was also analysed. Those eyes that had coexisting ocular pathology such as glaucoma, ocular hypertension, uveitis, trauma or previous intraocular surgery were excluded from the study. Fisher's exact test was used to compare the difference between the groups. RESULTS: Seventy-one eyes of 71 patients who underwent an uncomplicated phacoemulsification procedure were included in the study. Intraocular pressure of 30 mmHg or greater was found in 7 eyes (10%), all of which also had corneal oedema. These patients received acetazolamide SR 250 mg twice daily for 3 days. Another 21 eyes (30%) had corneal oedema for which no specific treatment was given. The intraocular pressure had returned to baseline and corneal oedema resolved by the first clinic follow-up in 1-2 weeks. None of the 71 patients needed surgical intervention in the post-operative period. CONCLUSION: First post-operative day review is necessary as it gives an opportunity to manage the post-operative rise in intraocular pressure.

Adult↗

Group-C meningococcal conjunctivitis in a neonate.

Meningococcal conjunctivitis, although rare, may be complicated by ocular damage and systemic spread. Identification of the infecting organism is important for appropriate management. Meningococcal infection needs treatment of both the patient and the contacts. We report the use of meningococcal group-C vaccine in the prophylaxis of adult contacts of a neonate with meningococcal conjunctivitis. This measure, we believe, has not been reported before in the management of meningococcal conjunctivitis.

Anti-Bacterial Agents↗

Gabapentin treatment of mood disorders: a preliminary study.

OBJECTIVE: To determine if gabapentin is effective either as adjunctive treatment or as monotherapy for major affective disorders in a naturalistic setting. METHOD: All charts of patients meeting DSM-IV criteria for bipolar disorder or unipolar major depressive disorder treated with gabapentin in a private psychiatric practice were reviewed and clinical response was assessed retrospectively using the Clinical Global Impressions scale for Improvement (CGI-I). RESULTS: Gabapentin was moderately to markedly effective in 30% (15/50) of patients, with statistically nonsignificant differences between patients with bipolar disorder type I, bipolar disorder type II and NOS, and unipolar major depressive disorder. 70% reported side effects, mainly sedation, with 16% of the total sample discontinuing treatment due to adverse events. CONCLUSION: Gabapentin appears to be somewhat effective as add-on treatment in a subgroup of patients with mood disorders in a naturalistic setting. Prospective, controlled studies are required to clarify these pilot data.

Acetates↗

Refinement of the locus for autosomal dominant juvenile optic atrophy to a 2 cM region on 3q28.

Juvenile optic atrophy (Kjer type; OPA1) is an autosomal dominant trait with an insidious onset in the first decade of life. The condition is characterized by a progressive loss of visual acuity that usually occurs with severe defects in color vision and visual fields. Genetic linkage analysis of a number of families has already assigned the OPA1 locus to the 3q28-qter region, within an estimated region of about 8 cM that is flanked by D3S1601 and D3S1265. Our study of a four-generation English family also supported tight linkage between the OPA1 locus and a group of DNA markers from the reported region. Of the 13 markers genotyped in this family, D3S2305 provided the maximum LOD score of 3.91 at theta = 0.00. Inspection of the haplotype transmission in this family identified critical recombinant individuals that refined the location of the OPA1 locus to an estimated region of about 2cM that is flanked by two DNA markers of D3S1601 and D3S2748. This refinement should facilitate the molecular cloning of the OPA1 gene and the determination of its defective product.

Alleles↗

Plasmodium falciparum malaria--a diagnostic dilemma.

A retrospective analysis of fifty cases where falciparum malaria was detected at autopsy, was done. Histopathological sections from all organs were taken. Cerebral malaria was seen in 44 cases on histology. Plugging of cerebral vasculature by parasitised erythrocytes (pRBC) was seen in all cases while Durck granulomas were seen in 5 cases. Multiple organ involvement was seen in form of sequestration of pRBC in all the cases. Positive peripheral smear was obtained in only 20 cases (antemortem). Twenty-nine patients had jaundice of which 18 had altered sensorium. They were clinically diagnosed as hepatic failure with or without hepatic encephalopathy. Fever as a symptom was seen in 19 patients. Age varied from 14 years to 80 years. Twenty-three patients died within 12 hours of admission, 12 other patients expired within a day. Only two cases survived more than a week. Specific antimalarial therapy was administered to 29 patients of which only 11 cases received quinine.

Adolescent↗