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Philip S.S.,Christian Medical College and Hospital
Indian Journal of Ophthalmology | Year: 2017

Aim: The aim of this study is to describe the setting up of a cerebral visual impairment (CVI) clinic in a tertiary care hospital in South India and to describe the spectrum of cases seen. Materials and Methods: The CVI clinic, set up in February 2011, receives interdisciplinary input from a core team involving a pediatrician, neurologist, psychiatrist, occupational therapist, pediatric ophthalmologist, and an optometrist. All children, <18 years of age, with cerebral palsy (CP), learning disability, autism, neurodegenerative diseases, and brain trauma are referred to the clinic for functional vision assessment and opinion for further management. Results: One thousand four hundred and seventy-eight patients were seen in the CVI clinic from February 2011 to September 2015. Eighty-five percent of the patients were from different parts of India. In the clinic, 61% had CP, 28% had seizure disorders, autism was seen in 9.5%, and learning disability, neurodegenerative conditions, and brain injury together constituted 1.5%. Most of the children (45%) had moderate CP. Forty percent of CVI was due to birth asphyxia, but about 20% did not have any known cause for CVI. Seventy percent of patients, who came back for follow-up, were carrying out the habilitation strategies suggested. Conclusions: Average attendance of over 300 new patients a year suggests a definite need for CVI clinics in the country. These children need specialized care to handle their complex needs. Although difficult to coordinate, an interdisciplinary team including the support groups and voluntary organizations is needed to facilitate the successful implementation of such specialized service. © 2017 Indian Journal of Ophthalmology | Published by Wolters Kluwer-Medknow.


Badyal D.K.,Christian Medical College and Hospital | Desai C.,BJ Medical College
Indian Journal of Pharmacology | Year: 2014

The use of animals in research and education dates back to the period when humans started to look for ways to prevent and cure ailments. Most of present day′s drug discoveries were possible because of the use of animals in research. The dilemma to continue animal experiments in education and research continues with varied and confusing guidelines. However, the animal use and their handling vary in each laboratory and educational institution. It has been reported that the animals are being subjected to painful procedures in education and training unnecessarily. The extensive use of animals in toxicity studies and testing dermatological preparations has raised concerns about the ways animals are sacrificed for these «irrelevant experiments». On the other side of the coin are scientists who advocate the relevant and judicious use of animals in research so that new discoveries can continue. In this review, we discuss the evolution of the use of animals in education and research and how these have been affected in recent times owing to concerns from animal lovers and government regulations. A number of computer simulation and other models have been recommended for use as alternatives to use of animals for pharmacology education. In this review we also discuss some of these alternatives.


Mathew P.T.,Schell Eye Hospital | David S.,Christian Medical College and Hospital | Thomas N.,Christian Medical College and Hospital
Cornea | Year: 2011

Purpose: Cataract surgery is known to change the corneal endothelial cell density and morphology. In patients with diabetes, this change is more pronounced. This prospective cohort study was conducted to assess and compare the endothelial cell loss and change in central corneal thickness (CCT) after manual small incision cataract surgery (SICS) in patients with diabetes versus age-matched patients without diabetes. Methods: Consecutive patients with diabetes (153) in the age group 40-70 years and age-matched patients without diabetes (163) undergoing manual SICS were enrolled. Preoperative and 1 week, 6 weeks, and 3 months postsurgery assessments of corneal endothelial loss and change in CCT were done using specular microscopy and ultrasound pachymetry. Results: There was a steady drop in the endothelial density in both the groups postoperatively, with the percentage of endothelial loss at 6 weeks and 3 months being 9.26 ± 9.55 and 19.24 ± 11.57, respectively, in patients with diabetes and 7.67 ± 9.2 and 16.58 ± 12.9, respectively, in controls. The percentage of loss between 6 weeks and 3 months was found to be of significant difference (P < 0.023). In both the groups, an initial increase in CCT till the second postoperative week was followed by a reduction of CCT in the subsequent follow-up (sixth week) and a further reduction in the last follow-up (3 months). The change in CCT between the second and sixth weeks was significantly higher in the diabetic group (P = 0.045). Conclusions: The diabetic endothelium was found to be under greater metabolic stress and had less functional reserve after manual SICS than the normal corneal endothelium. Copyright © 2011 by Lippincott Williams & Wilkins.


Mathews V.,Christian Medical College and Hospital | Savani B.N.,Vanderbilt University
Bone Marrow Transplantation | Year: 2014

Allogeneic hematopoietic SCT remains the only treatment that can correct the hematological manifestations in patients with thalassemia major. Improving the clinical outcomes of high-risk, heavily transfused patients with liver fibrosis and inadequate iron chelation remains a challenge. Because of the relatively high probability of graft rejection and regimen-related toxicity in many patients receiving SCT for advanced thalassemia major, further development of new treatment regimens is warranted. This review addresses the reported clinical studies in patients with advanced thalassemia major and we have summarized our suggested conditioning approach to improve the outcome after SCT. © 2014 Macmillan Publishers Limited.


Chander A.,Christian Medical College and Hospital
Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH | Year: 2013

To compare the efficacy and safety of bimatoprost (0.03 %) and travoprost (0.004 %) in patients with primary open angle glaucoma (POAG). Patients with POAG were randomized to receive either bimatoprost or travoprost once daily. Detailed ocular examination was done and intraocular pressure (IOP) was measured at 9.00 am, 1.00 pm and 4.00 pm at the baseline and at 1, 2, 4, 6 and 12 weeks of therapy. A total of 31 patients were analysed. The patients were randomly divided into two groups (Bimatoprost group = 16; Travoprost group = 15). Both the groups had a statistically significant reduction from the baseline IOP at all follow up visits at 9.00 am, 1.00 pm and 4.00 pm. The mean IOP decreased from a baseline of 25 ± 2.32 mm Hg to 15.93 ± 1.79 mm Hg after 12 weeks in the bimatoprost group (p less than 0.001), and from 24.2 ± 1.60 mm Hg to 16.53 ± 1.56 mm Hg in the travoprost group (p less than 0.001). A better mean reduction of IOP was obtained with bimatoprost than with travoprost at the end of the study at 12 weeks (p = 0.03). Mild ocular redness was the commonest side effect in both the groups but was not significant in either group. Both drugs lowered IOP effectively but bimatoprost showed a greater reduction in the mean IOP than did travoprost at 12 weeks and both are safe for ocular use. © NEPjOPH.


Mathew A.,Christian Medical College and Hospital
The Journal of the Association of Physicians of India | Year: 2011

Massive envenomation by honey bees is capable of causing multiorgan dysfunction as a result of direct toxic effect of massive envenomation and secondary to systemic anaphylactic reactions. Acute myocardial ischemia due to bee envenomation is a rare event. We report the case of a 65 year old lady who presented with acute myocardial ischemia, severe rhabdomyolysis and angioedema following massive bee envenomation.


Philip S.S.,Christian Medical College and Hospital | Dutton G.N.,Glasgow Caledonian University
Clinical and Experimental Optometry | Year: 2014

Cerebral visual impairment (CVI) comprises visual malfunction due to retro-chiasmal visual and visual association pathway pathology. This can be isolated or accompany anterior visual pathway dysfunction. It is a major cause of low vision in children in the developed and developing world due to increasing survival in paediatric and neonatal care. CVI can present in many combinations and degrees. There are multiple causes and it is common in children with cerebral palsy. CVI can be identified easily, if a structured approach to history-taking is employed. This review describes the features of CVI and describes practical management strategies aimed at helping affected children. A literature review was undertaken using 'Medline' and 'Pubmed'. Search terms included cerebral visual impairment, cortical visual impairment, dorsal stream dysfunction and visual function in cerebral palsy. © 2014 Optometrists Association Australia.


Choudhrie A.V.,Christian Medical College and Hospital
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia | Year: 2012

Amoebic liver abscess (ALA) is by far the most common extraintestinal manifestation of invasive amoebiasis. The vast majority of these resolve with treatment; however, a small percentage of the treated ALAs are known to persist asymptomatically. Herein, we present a prospective renal allograft recipient with a residual liver abscess who had a successful renal transplant after treatment. In our opinion, persistence of a radiological finding of residual abscess in the absence of clinical disease does not appear to be a contraindication to renal transplantation.


Sureka J.,Christian Medical College and Hospital | Jakkani R.K.,Christian Medical College and Hospital
British Journal of Radiology | Year: 2012

Bilateral temporal lobe hyperintensity (BTH) is a commonly encountered MRI finding in a wide spectrum of clinical conditions and often poses a diagnostic challenge to the radiologist. The purpose of this paper is to elucidate several diseases that manifest as BTH on MRI, based on a retrospective review of cranial MRI of 65 cases seen in our institution between October 2007 and September 2010. We found BTH in different clinical scenarios that included infective diseases (herpes simplex virus, congenital cytomegalovirus infection), epileptic syndrome (mesial temporal sclerosis), neurodegenerative disorders (Alzheimer's disease, frontotemporal dementia, Type 1 myotonic dystrophy), neoplastic conditions (gliomatosis cerebri), metabolic disorders (mitochondrial encephalopathy, lactic acidosis and stroke-like episodes, Wilson's disease, hyperammonemia), dysmyelinating disease (megalencephalic leukoencephalopathy with subcortical cysts), and vascular (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) and paraneoplastic (limbic encephalitis) disorders. The conventional MRI findings with advanced MRI such as diffusion-weighted imaging, susceptibility-weighted imaging and MR spectroscopy along with laboratory results are potentially helpful in distinguishing the different clinical conditions and thus affect the early diagnosis and clinical outcome. © 2012 The British Institute of Radiology.


Dutta A.K.,Christian Medical College and Hospital
Tropical gastroenterology : official journal of the Digestive Diseases Foundation | Year: 2012

Single balloon enteroscopy (SBE) is a recently developed diagnostic modality to assess small bowel mucosa. The data on learning curve of SBE is scanty. We aimed to assess the learning curve, diagnostic yield and safety of SBE. All patients who underwent SBE at our centre from December 2007 to December 2010 were included retrospectively. The clinical details, enteroscopy findings and procedure related details were obtained for each patient from a prospectively maintained database. The extent of small bowel visualised with increasing number of procedures by a single endoscopist (Endoscopist A) who performed most of the procedures was used to estimate the learning curve using locally weighted regression curve. The diagnostic yield and complications rates of SBE were also estimated. The study was approved by the institute review board and ethics committee. Ninety SBEs were performed in 84 patients (age: 42+15 years, 27.4% females). 57 procedures were performed (32 antegrade and 25 retrograde) by endoscopist A. There was gradual improvement in the extent of small bowel visualised during the first 15 procedures via antegrade route followed by flattening of curve. The retrograde route showed no definite trend towards improvement during the procedures performed. The overall diagnostic yield of SBE was 32.1%. There was no complication except for mild self-limiting abdominal pain in one patient. SBE via antegrade route has a higher success rate and better learning curve than the retrograde route. SBE is a safe procedure and helps in establishing a diagnosis in one-third of the patients examined.

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