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Bhargava R.,Santosh Medical College and Hospital | Kumar P.,Santosh Medical College and Hospital | Kumar M.,Narayan Medical College and Hospital | Mehra N.,Santosh Medical College and Hospital | Mishra A.,Santosh Medical College and Hospital
International Journal of Ophthalmology

AIM: To evaluate the role of dietary supplementation of omega-3 fatty acids in dry eye syndrome. METHODS: A prospective, interventional, placebo controlled, double blind randomized trial was done at two referral eye centers. Two hundred and sixty-four eyes of patients with dry eye were randomized to receive one capsule (500mg) two times a day containing 325mg EPA and 175mg DHA for 3 months (omega-3 group). The omega-3 group was compared to a group of patients (n=254) who received a placebo (placebo group). There were 4 patient visits (at baseline, 1 month, 2 months and 3 months). On each visit, recording of corrected distance visual acuity (CDVA), slit lamp examination and questionnaire based symptom evaluation and scoring was done. A symptomatic score of 0-6 was mild, 6.1-12 moderate and 12.1-18 severe dry eye. Response to intervention was monitored by routine tear function tests like Schirmer I test, tear film break-up time (TBUT), Rose Bengal staining and most notably, conjunctival impression cytology. RESULTS: Sixty-five percent of patients in the omega-3 group and 33% of patients in placebo group had significant improvement in symptoms at 3 months (P =0.005). There was a significant change in both Schirmer's test value and TBUT values in the omega-3 group (P< 0.001), both comparisons. However, there was a larger drift in TBUT values in omega-3 than the placebo group, in comparison to Schirmer's test values. The mean TBUT score was 2.54±2.34 in the omega-3 group and 0.13±0.16 in placebo group, respectively. The mean reduction in symptom score in omega-3 group was 2.02 ±0.96 as compared to 0.48 ±0.22 in placebo group (P<60.001). Despite a slight increase mean score, the Schirmer scores did not correlate well with symptomatic improvement. CONCLUSION: Omega-3 fatty acids have a definite role for dry eye syndrome. The benefit seems to be more marked in conditions such as blepharitis and meibomian gland disease. The role of omega fatty acids in tear production and secretion needs further evaluation. Source

Kumar M.K.,Narayan Medical College and Hospital | Thakur S.N.,Narayan Medical College and Hospital
Journal of Nepal Paediatric Society

Wasps and bees descend from order Hymenoptera. All social wasps belong to family Vespidae. Their stings are not usually life threatening, causing mainly local reactions and rarely anaphylaxis and serious systemic manifestations. Though a few stings cause no major problems, multiple stings can cause serious effects like massive hemolysis, acute renal failure, encephalopathy, multiorgan dysfunction. We report a six years boy with acute renal failure and seizure following multiple wasp stings. Source

Kumar M.K.,Narayan Medical College and Hospital | Suman S.K.,Narayan Medical College and Hospital
Journal of Clinical and Diagnostic Research

Radial club hand is a longitudinal deficiency along the radial side of the upper extremity. Complete absence is the most common longitudinal deficiency. It can be diagnosed on the inspection of the forearm in an X-ray. It is frequently syndromatic and so it is imperative to look for associated congenital abnormalities or syndromes by doing a thorough clinical examination and appropriate investigations. An early diagnosis and a timely operative correction give a better outcome. We report here, a 7 year old neglected case of radial club hand as an isolated anomaly. Source

Kumar M.K.,Narayan Medical College and Hospital | Singh B.B.,Narayan Medical College and Hospital
Annals of Indian Academy of Neurology

Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a rare neurodegenerative disease seen mainly in the Aggarwal community in India. It is characterized by early-onset macrocephaly with mild motor developmental delay, gradual onset ataxia, spasticity, seizures and usually late onset mild cognitive deterioration. Very few familial cases of MLC have been reported in the world literature, and to the best of our knowledge, there is no published study of all three siblings affected with MLC in a same family. Here, we are reporting three siblings belonging to a non-Aggarwal Hindu family, affected with MLC, who presented with early-onset macrocephaly and gradual onset ataxia. Source

Kumar M.K.,Narayan Medical College and Hospital | Kumar P.,Narayan Medical College and Hospital | Singh A.,Narayan Medical College and Hospital
Journal of Natural Science, Biology and Medicine

Despite over 2.3 million (26% of global burden) cases of tuberculosis (TB) in India the accurate diagnosis of childhood TB remains a major challenge. Children with TB usually have paucibacillary disease and contribute little to disease transmission within the community. Consequently the treatment of children with TB is often not considered a priority by TB control programmes. Adequate and timely assessment of TB infection in childhood could diminish epidemiological burden as underdiagnosed pediatric patients can eventually evolve in to an active state and have the potential to disseminate the etiological agent Mycobacterium tuberculosis, notably increasing this worldwide public health problem. In this review we discuss the most important recent advances in the diagnosis of childhood TB: (1) Symptom-based approaches, (2) novel immune-based approaches, including in vitro interferon-γ IGRA release assays IGRA tests; and (3) bacteriological and molecular methods that are more rapid and/or less expensive than conventional culture techniques for TB diagnosis and/or drug-resistance testing. Recent advances have improved our ability to diagnose latent infection and active TB in children, nevertheless establishing a diagnosis of either latent infection or active disease in HIV-infected children remains a major challenge. Source

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