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Background Autonomic neuropathy has been reported in patients with alcoholic liver disease but information on its occurrence in patients with non-alcoholic liver disease is contradictory. Aim To assess autonomic functions in patients with alcoholic and non-alcoholic liver disease. Study design Autonomic function using five standard tests was examined in 20 cirrhotics (10 alcoholics and 10 non-alcoholics) and 20 age and sex matched controls. The extent of autonomic dysfunction was determined in the patients and a comparison between the characteristics of patients with and without autonomic neuropathy was made. Results Sixteen (80%) of the cirrhotic subjects were found to have evidence of autonomic neuropathy. Of these, three (15%) patients had early parasympathetic damage, five (25%) had definite parasympathetic damage, and eight (40%) had combined (that is, both parasympathetic and sympathetic) damage. Nine (90%) of the alcoholics and seven (70%) of the non-alcoholics had autonomic dysfunction. Only one patient belonging to the alcoholic group had clinical evidence of peripheral neuropathy. Moreover, there was no significant association between subjective symptoms of autonomic neuropathy and objective evidence of autonomic damage as assessed by autonomic function tests. Autonomic dysfunction was significantly more frequent in advanced liver disease compared with early liver damage. Nine (75%) out of 12 cirrhotic subjects belonging to Child class B and six (85.7%) of the seven patients belonging to Child class C had autonomic neuropathy. Conclusion This study shows that autonomic neuropathy is common in cirrhotic subjects, that it is found with comparable frequency in alcoholics and non-alcoholics, and that it increases in severity with increase in extent of liver damage, suggesting that liver damage contributes to the neurological deficit.

We herein report a case with multifocal cysticercosis--sub-conjunctival cysticercus cyst, sub-retinal cysticercosis, and neurocysticercosis in a child. The optical coherence tomography (OCT) findings of the sub-retinal cysticercus cyst are reported. He was treated with anti-helminthic drugs and oral prednisolone followed by surgical removal of the sub-retinal cyst. He subsequently underwent silicone oil removal with lens aspiration and intraocular lens implantation maintaining stable vision.

Ophthalmia nodosa with vitreoretinal involvement is rare and may cause permanent loss of eye due to persistent inflammation of the eye. A young female patient having multiple caterpillar hair in the eye including cornea, anterior chamber, sclera, and pars plana presented with recurrent vitritis and pars planitis. Ultrasound biomicroscopy played a vital role and helped in localizing the hair embedded in the pars plana region which were managed by pars plana vitrectomy leading to complete recovery.

Background: A 21-year-old female patient had chorioretinitis in the left eye which relapsed while being on anti-tubercular treatment and oral corticosteroids leading to blindness and the loss of the left eye. Findings: Mycobacterium tuberculosis causing chorioretinitis showed a poor response, and the lung lesions showed a good response to the same anti-tubercular treatment. Conclusions: Mycobacterium tubercle bacilli in the eye may show a poor response to the anti-tubercular drugs due to poor ocular penetration of the drugs secondary to early ocular hypoxia.

The authors describe an atypical presentation of sympathetic ophthalmia in a child caused by multiple surgical interventions in the exciting eye. Optical coherence tomography findings were noted. Early diagnosis and management with intravenous methylprednisolone and immunosuppressants helped in salvaging the only seeing eye of the child.

Fear of dental treatment in children has been recognized as a source of serious health problems and it may persist into adolescence, which may lead to a disruptive behavior, during dental treatment. In order to prevent this psychometric method namely the dental subscale of the children's fear survey schedule (CFSS-DS) is a well-known psychometric scale that was developed by Cuthbert and Melamed in 1982 for assessing dental fear in children. The present study was to evaluate dental fear in children during first dental visit using CFSS-DS between three different age group 4 and 6 years, 7 and 9 years, 10 and 14 years children to select fearful and nonfearful children from a larger reference population and to estimate the dental fear children. Total 600 children show CFSS-DS of 27.17 ± 5.3385, 307 were girls (51.17%) and they showed CFSS-DS of 27.50 ± 5.060 and 293 were boys (48.83%) and they show CFSS-DS 26.84 ± 5.617. This shows that there were no significant difference in fear between boys and girls. In 4 to 6 years show total CFSS-DS 28.78 ± 5.742, 7 to 9 years show that mean and standard deviation of CFSS-DS 27.81 ± 4.783, 10 to 14 years show that mean and standard deviation of CFSS-DS 25.93 ± 5.586. Fear scores were highest for ‘injections', ‘choking', ‘noise of dentist drilling', ‘dentist drilling which was not significant between boy's and girl's but item, ‘having somebody look at you’ showed that significant differences in fear scores between boys and girls in present study. The present study concluded that dental fear decreased as age increased. Total fear scores also exhibited no strong overall sex difference or age by sex interaction. d> Raj S, Agarwal M, Aradhya K, Konde S, Nagakishore V. Evaluation of Dental Fear in Children during Dental Visit using Children's Fear Survey Schedule-Dental Subscale. Int J Clin Pediatr Dent 2013;6(1):12-15.

BACKGROUND The recent recommendation of the U.S. Preventive Services Task Force against PSA-based screening for prostate cancer was based, in part, on the lack of demonstrated diagnostic utility of serum PSA values in the low, but detectable range to successfully predict prostate cancer. Though controversial, this recommendation reinforced the critical need to develop, validate, and determine the utility of other serum and/or urine transcript and protein markers as diagnostic markers for PCa. The studies described here were intended to determine whether inflammatory cytokines might augment serum PSA as a diagnostic marker for prostate cancer. METHODS Multiplex ELISA assays were performed to quantify CCL1, CCL2, CCL5, CCL8, CCL11, CCL17, CXCL1, CXCL5, CXCL8, CXCL10, CXCL12, and IL-6 protein levels in the serum of 272 men demonstrating serum PSA values of

Simulium dermatitis is a common problem in humans and animals in areas where Simulium species occur. It is characterized by chronic eruptions of pruritic papules, vesicles, and erythematous wheals resulting from a hypersensitivity reaction to biting of simuliids or blackflies. It can result in severe skin complications where the man-biting species of Simulium are available.We report two clinical cases of Simulium dermatitis from the North-Eastern region of India. Histopathological study was carried out in one of the cases and the other one was successfully treated with medication.Clinical features like intense itching, which accompanies the eruption, resulting in excoriations, scarring, and permanent hyperpigmentation were reported. Histopathological study revealed the characteristic features of Simulium bite reaction, such as vesicles filled with serous fluid, dermal edema, and perivascular infiltrates rich in eosinophils and lymphocytes.The clinical manifestations and severity of Simulium dermatitis are serious matters of concern in hypersensitive persons.

We present a case of bicornuate uterine horns with complete cervico-vaginal agenesis and associated congenital uterovaginal fistula. The patient presented with cyclical hematuria, amenorrhea, and abdominal lump. The vagina was blind-ending. The cystoscopic examination during cyclical hematuria revealed bloody efflux through a small fistula on the posterior wall of the urinary bladder. The magnetic resonance imaging (MRI) showed bicornuate uterus and cervical agenesis. Hysterectomy and repair of the uterovesical fistula was done. The vagina was reconstructed using an amniotic mould. The report underlies the importance of MRI in diagnosing complexity of such rare anomalies. It also stresses for the need of hysterectomy if cervicovaginal agenesis is present.

Sir, We read with interest the article, “Traumatic central serous chorioretinopathy (CSR)” by Steeples et al.[1] The authors discuss a case of CSR that developed after blunt trauma to the eye, diagnosed with the help of fluorescein angiography and optical coherence tomography (OCT). There are few additional features in this interesting case that we wish to highlight. Figs. 2 and 4 are OCT images of the left eye of the patient pre- and post-resolution of the CSR. Although choroid cannot be seen completely in either, it definitely appears to be much thicker than the retina itself. Hyporeflective areas can be seen just below the retinal pigment epithelium layer in the OCT images, especially beneath the area of pigment epithelial detachment (PED) in Fig. 4b, which are possibly dilated choroidal vessels. These features are suggestive of the recently described entity “pachychoroid pigment epitheliopathy” (PPE) which is believed to be associated with a spectrum of diseases inclusive of CSR and polypoidal choroidal vasculopathy.[2] Furthermore, left eye shows multiple small PEDs which is another feature of PPE. It would be helpful if the choroidal thickness could be objectively determined. OCT images of the right eye may also help in this regard. History of CSR in the right eye of the patient, the presence of PED and possibility of PPE are tempting toward diagnoses of idiopathic CSR rather than traumatic CSR. Bilateral CSR has an incidence as high as 40%.[3] The only sign of trauma in the index eye is minimal uveitis (1+ cells). The trauma may have been coincidental. Rather, as the patient had low vision (history of retinal detachment surgery) in the right eye, CSR would have caused drop in visual acuity and predisposed the patient to blunt trauma. Therefore, it becomes necessary to know the actual events and nature of trauma. We hope our analysis adds value to the discussion and await the authors' response. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Endogenous aspergillosis is a rare occurrence. Endogenous Aspergillus endophthalmitis is a rare but devastating infection usually associated with disseminated aspergillosis or with intravenous drug abuse. We report a case of an isolated Aspergillus iris granuloma in a young immunocompetent male patient with review of the literature.

We report a case of Type 2A idiopathic parafoveal telangiectasis treated by Photodynamic Therapy (PDT), resulting in retinal pigment epithelial (RPE) atrophy corresponding to the size of the laser spot used. This raises a doubt regarding the safety of photodynamic therapy in CNVM secondary to type 2A parafoveal telangiectasis.

Dear Editor We read with great interest the article entitled ”Diagnosis of subretinal neovascularization associated with idiopathic juxtafoveal retinal telangiectasia—fluorescein angiography versus spectral-domain optical coherence tomography by Chhablani J et al. [1]. This article compares the ability of fundus fluorescein angiography (FFA) and spectral-domain optical coherence tomography (SD-OCT) to diagnose subretinal neovascularization (SRNV) secondary to idiopathic juxtafoveal retinal telangiectasia (IJRT) type 2A, and also highlights the pitfalls of FFA and OCT in detecting and confirming SRNV in cases of IJRT type 2. However we have made the following observations.

Choroidal osteoma is a rare benign tumor. We report a male child diagnosed with bilateral choroidal osteoma, high myopia and secondary choroidal neovascularization (CNV) membrane in one eye. Co-existence of posterior staphyloma made the clinical diagnosis of choroidal osteoma difficult due to the osteoma filling the depression of the posterior staphyloma. Typical findings on fundus fluorescein angiography, optical coherence tomography, B-scan and indocyanine green angiography confirmed the diagnosis. A review of literature was performed. CNV secondary to choroidal osteoma was treated with intravitreal bevacizumab and it responded well. Regular follow-up is essential for recurrence of CNV and decalcification of the osteoma.

Tube implants or glaucoma drainage devices have become an important method of intraocular pressure reduction when treating complex cases of traumatic glaucoma. However, it is not uncommon to have complications associated with tube implants. The optimal treatment of patients who have undergone glaucoma implant surgery complicated by vitreous incarceration is uncertain. If vitreous is present or is able to prolapse into anterior chamber, as in aphakic or pseudophakic patient without an intact posterior capsule, a concurrent anterior vitrectomy is usually performed. In such cases, pars plana vitrectomy has been found to be more effective in several studies. However, there are no set guidelines for management of such a case in a phakic eye and the management can be more challenging especially when there is no obvious deficiency in posterior capsule, zonular dialysis, or loose vitreous gel in the anterior chamber prior to or during tube implantation. We describe a case of 14-year-old phakic patient with traumatic glaucoma without vitreous gel in anterior chamber whose tube implant became occluded by vitreous resulting in increased intra ocular pressure. This is the first documented report of vitreous incarceration in a phakic patient and its successful management.

Dear Editor, We read with interest the article titled “The effects of renal transplantation on diabetic retinopathy: Clinical course and visual outcomes.”[1] We would like to comment on a few observations we made on reading this article. We are all aware that a good metabolic control plays a vital role in the slow progression of diabetic retinopathy. There are other risk factors like lipid profile, blood sugar levels, hemoglobin, and blood pressure, which too would have an effect on the progression of the diabetic retinopathy. However, in this article, the metabolic status of the patients before and after renal transplantation has not been mentioned[2,3] The second observation is that the status of the diabetic macular edema has not been mentioned before and after renal transplantation, which would have maximum correlation with the improvement in visual acuity post renal transplantation Furthermore, documentation with color fundus photographs would have made the grading of diabetic retinopathy more objective and avoided subjective variation The improvement in diabetic retinopathy has not been defined, and the number of patients in each follow-up quartile of the study is not mentioned. It is an interesting observation made in this study of the role of renal transplantation on progression of diabetic retinopathy. However, a prospective study with all metabolic parameters defined and color fundus photographs documentation would be more valuable.

Sturge-Weber syndrome is a rare neurocutaneous disorder characterized by a facial nevus flammeus and extensive angiomatous changes involving the leptomeninges, the dura, and vessels of the gray and white matter. Oculodermal melanocytosis is characterized by hyperpigmentation of the facial skin in the distribution of the ophthalmic, maxillary, and occasionally mandibular division of the trigeminal nerve.

Patients who undergo stem cell transplant are at increased risk of developing bacterial lung infections. We have developed a murine model of syngeneic bone marrow transplant to try to understand the mechanisms which may be responsible for impaired innate immunity post-transplant. Our results demonstrate that syngeneic BMT mice are more susceptible to Pseudomonas aeruginosa post-transplant. This is mediated in part by reduced expression of the MARCO scavenger receptor. We now report that the BMT mice are also deficient in the production of surfactant protein A post-BMT. Levels of SpA in the bronchoalveolar lavage fluid are diminished post-BMT. Phagocytosis assays demonstrate that phagocytosis of Pseudomonas aeruginosa can be enhanced in the presence of exogenous SpA. We have evidence to suggest that exogenous SpA allows Pseudomonas aeruginosa to be phagocytosed by binding to the scavenger receptor A (SRA) I/II. Current studies are underway to determine why SpA is reduced post-BMT and to determine the influence of SpA on bacterial killing post-BMT.

Pheochromocytoma of urinary bladder are rare tumors. They present with nonspecific clinical signs and symptoms, so imaging plays an important role in diagnosing and localizing the tumor. We present two cases of bladder pheochromocytoma, one of them presented with vague abdominal pain and the other with hematuria. Biphasic CT in both the cases showed hypervascular intravesical mass suggestive of bladder pheochromocytoma. The lesions were confirmed biochemically or on postoperative histopathology. A brief review of the imaging in bladder pheochromocytoma is also presented.

Choroidal neovascular membrane (CNVM) is one of the most common causes of submacular hemorrhage (SMH). Conventional treatment involves management of the SMH with pneumatic displacement with or without tissue plasminogen activator (TPA) followed by intravitreal injection of bevacizumab in a second sitting. We decided to assess the efficacy of treating SMH secondary to CNVM with pneumatic displacement using sulphur hexafluoride (SF6) gas and intravitreal bevacizumab. Four patients with SMH secondary to CNVM were included in this study. Intravitreal bevacizumab, 0.05 ml, along with 0.5 ml of SF6 was injected through the pars plana into the vitreous cavity. Postoperative best corrected visual acuity improved in all eyes with complete or partial displacement of SMH out of the foveal area.

Purpose The purpose of this study is to report a case of ocular infection with Gliocladium species due to an exposed scleral buckle. Design Interventional case report was used as the study design. Methods A 60-year-old diabetic male patient presented with persistent pain, redness, and discharge in his left eye since 2 months. He had been treated previously with both topical and systemic steroids for a diagnosis of autoimmune scleritis. He had undergone scleral buckling surgery with cryotherapy for an inferior rhegmatogenous retinal detachment in the past. His best-corrected visual acuity was 6/6, N6 and 6/6, N6 in the right and left eyes, respectively. Retraction of the left lower lid revealed an exposed scleral buckle with an overlying necrotic conjunctiva. Scleral buckle removal was done. Microbiological examination showed Gliocladium species growing on blood agar and Sabouraud dextrose agar. Treatment was started with topical antifungal medication and oral antibiotics. Results Following treatment, signs of infection showed resolution. Patient underwent retinal reattachment surgery with favorable anatomic and visual outcome. Conclusion Ocular infection with Gliocladium species has not been previously reported. Poor response to steroids and uncontrolled diabetes should make the clinician aware of a possible fungal infection. Removal of the scleral buckle, identification of the causative organism, and use of appropriate antibiotics are important for the accurate management of the case.

Background The aim of this study is to report a case of sympathetic ophthalmia with sensorineural hearing loss following penetrating trauma. This is an interventional case report. A 23-year-old male presented with bilateral, sudden, profound visual and hearing loss, disorientation, and dizziness. He had a past history of penetrating trauma with an iron rod in the right eye for which he underwent scleral tear repair, vitreo-retinal surgery with intraocular foreign body removal and silicon oil injection. His best corrected visual acuity in the right eye was counting fingers close to the face and was perception of light in the left eye. Clinical evaluation with slit biomicroscopy, indirect ophthalmoscopy, ultrasonography, and pure tone audiometry was suggestive of sympathetic ophthalmia with sensorineural hearing loss. Treatment was started with intravenous methyl prednisolone, oral corticosteroids, and immunosuppressants. Findings Following treatment, signs of panuveitis showed resolution and improvement in visual, hearing, and neurological symptoms. Conclusions Sympathetic ophthalmia associated with sensorineural deafness and neurological symptoms is a rare clinical syndrome. Prompt diagnosis and treatment with systemic corticosteroids and immunosuppressant medication may result in clinical improvement.