Inadvertent intracorneal injection of local anesthetic during lid surgery.
To report a case of inadvertent intracorneal injection of anesthetic agents during lid anesthesia and corneal penetration without full-thickness perforation.



Case report.



Corneal edema with acute loss of vision was noted. The patient was treated with topical, antibiotic, cycloplegic, hyperosmotic agent and lubricant. While the edema slowly subsided, a loss in endothelial cell count was noted.



The effects of intracorneal injection of lignocaine, bupivacaine, and its preservatives have not previously been reported in the literature. A lower postinjection endothelial cell count and associated clinical features in our case indicate that endothelial toxicity occurred. This potential complication should be kept in mind with necessary precautions taken during injection of the eyelid, particularly in cases with preexisting lid laxity.

title: Epithelial ingrowth following surgery of recurrent pterygium
abstract: Epithelial ingrowth is a rare but devastating condition of the eye, known to complicate incisional ocular procedures. We report a case of secondary glaucoma due to epithelial ingrowth following limbal conjunctival autograft in a case of recurrent pterygium. To prevent such devastating conditions from occurring dissection of recurrent pterygium demands special care to avoid anterior chamber penetration.

title: Posthepatitis aplastic anaemia presenting only with bilateral vision loss.
abstract: Aplastic anaemia is pancytopenia with marrow hypocellularity. Hepatitis-associated aplastic anaemia is a varient or aplastic anaemia that follows an acute attack of seronegative hepatitis. Here a case of hepatitis-associated aplastic anaemia presenting with sudden onset of severe simultaneous bilateral vision loss and without any other usual presenting signs is reported. Partial recovery of blood cell count occurred following immunosuppressive therapy. Posterior hyalodotmy helped rapid resolution of premacular subhyaloid haemorrhage. Although bilateral vision loss may rarely be the initial presentation of aplastic anaemia, no such report is known in hepatitis-associated aplastic anaemia. Posthepatitis vision loss needs careful investigation to exclude an underlying haematological disorder.

title: Visual impairment in urban school children of low-income families in Kolkata, India.
abstract: To evaluate pattern of visual impairment in school children from low-income families in Kolkata, India, an institutional cross-sectional study was conducted among 2570 children of 10 primary schools. Ocular examination including refraction was done and pattern of visual impairment and refractive error was studied. The age range was 6-14 years. Refractive error was seen in 14.7%. Only 4 children were already wearing correction. Myopia and hypermetropia was present in 307 (11.9%) and 65 (2.5%) children, respectively. Visual acuity of less than 6/12 in better eye was present in 109 (4.2%) and 5 (0.2%) children pre- and post-correction, respectively. Eighteen children had amblyopia. Although prevalence of refractive error in this group is less compared to school children of all income categories reported from other cities of India, it is more compared to school children of all income categories from the same city. Refractive error mostly remains uncorrected in this group.

title: Correlation of macular thickness and posterior hyaloid change following bevacizumab and triamcinolone in diffuse diabetic macular edema in middle-aged patients
abstract: To compare changes in posterior vitreous detachment (PVD) following intravitreal injection of bevacizumab and triamcinolone in diffuse diabetic macular edema in middle-aged type 2 diabetes patients and to correlate this change with change in central macular thickness (CMT).  Fifteen consecutive patients treated by intravitreal bevacizumab (group A) and ten patients treated by intravitreal triamcinolone (group B). Institutional study carried out by retrospective analysis of patient registers including serial optical coherence tomography (OCT) images at baseline, and after 1 and 4 months. A central macular thickness (CMT) and vitreomacular relationship was noted on OCT. PVD was graded on a linear scale (0–4). Change in grade of PVD was correlated with change in CMT at each follow-up. At month 4, the decrease in mean CMT from baseline was 51.2 μ (P = 0.000) and 45 μ (P = 0.022) in group A and group B, respectively, with no significant difference between the two groups (P = 0.874). A change in grades of PVD from baseline to month 4 was significant in both group A (P = 0.001) and group B (P = 0.004) with no significant difference between the two groups (P = 0.906). A significant correlation between change in PVD and reduction of CMT was observed in group A (P = 0.011) but not in group B (P = 0.315). Both bevacizumab and triamcinolone caused a significant reduction in macular thickness and a significant change in grade of PVD. Change in PVD played an influential role in the reduction of macular thickness following bevacizumab.

title: Idiopathic intracranial hypertension in a child after hemodialysis.
abstract: Idiopathic intracranial hypertension remains a disease of unknown etiology. Epidemiology, associations, features, and prognosis in children have changed over the years. The main clinical complaint of pediatric idiopathic intracranial hypertension is headache with visual disturbance. We report on a patient with childhood idiopathic intracranial hypertension, who presented without headache after hemodialysis for acute renal failure. Idiopathic intracranial hypertension without headache is believed to have a poor prognosis. However, this child demonstrated a favorable outcome with medical therapy. The child was followed with serial optical coherence tomography of retinal nerve fiber layer thickness around the optic nerve head. In the absence of a reliable procedure to evaluate the therapeutic efficacy in the follow-up of patients with idiopathic intracranial hypertension, the importance of optical coherence tomography, a noninvasive, objective, and reproducible procedure, is highlighted as a useful adjunct in the management of idiopathic intracranial hypertension.

title: Domain specific association of small fluorescent probe trans-3-(4-monomethylaminophenyl)-acrylonitrile (MMAPA) with bovine serum albumin (BSA) and its dissociation from protein binding sites by Ag nanoparticles: spectroscopic and molecular docking study.
abstract: Photoinduced intramolecular charge transfer produced a polar excited state in trans-3-(4-monomethylaminophenyl)acrylonitrile (MMAPA), rendering the resulting emission sensitive to the medium polarity. Strong binding interaction of silver nanoparticles with the probe was observed, causing fluorescence quenching through the static quenching process. The probe MMAPA was found to bind to the less polar hydrophobic, restricted proteinous environment of bovine serum albumin (BSA) resulting in the blue shift of the emission maximum with an increase in emission intensity and fluorescence anisotropy. Studies using site markers of flufenamic acid and phenylbutazone coupled with molecular docking results predicted that the binding site of the probe is in between subdomains IIIA and IB of BSA and is different from the conventional Sudlow sites. The denaturation of the probe-bound BSA by urea or heat released the probe from this proteinous environment to water marked by exactly reverse spectral changes. On the interaction of silver nanoparticles with the probe bound protein, the probe was observed to move from its binding site in the protein to the Ag(0) nanoparticle surface involving conformational changes of the protein near the probe binding site.

title: Fatal Outcome Despite Full Lympho-Hematopoietic Reconstitution After Allogeneic Stem Cell Transplantation in Atypical Ataxia Telangiectasia
abstract: Allogeneic hematopoietic stem cell transplantation (HSCT) has not been a therapeutic option in ataxia telangiectasia (AT) due to overwhelming toxicity of conditioning in the context of the global DNA repair deficiency. Furthermore HSCT is unable to cure neurological involvement of AT. We report on a Turkish child with a Hyper IgM phenotype disorder, in which clinical aspects of AT were absent and thus, AT not diagnosed. He was transplanted with a reduced toxicity, but full intensity conditioning regimen comprising treosulfan, fludarabine and ATG. The peritransplant period was uneventful and the patient was discharged at day +57. 8 months after HSCT, the patient developed hepatopathy with monoclonal gammopathy of unclear significance and died due to hepatic failure and encephalopathy at the age of 32 months. Post mortem high throughput sequencing revealed a mutation in the ATM gene.

title: Endotoxin-induced organ injury.
abstract: To review the effects of endotoxemia on the major organ systems of the body and discuss potential mechanisms of tissue injury.



Appraisal of 60 articles representing a cross section of studies relating to in vivo and in vitro responses to endotoxin.



Cell cultures, isolated tissue preparations, animal and human studies.



Endotoxemia results in the activation of numerous cellular and hematogenous mediators. These mediators range from prostaglandins, thromboxanes, and leukotrienes, to complement components. Tumor necrosis factor may be responsible for initiating many of the observed responses to endotoxin. Species and tissue specificity are a prominent feature of the response to endotoxin.



No single agent can yet be implicated as the common mediator of endotoxin-induced organ injury. Endotoxin initiates the elaboration of a cascade of secondary mediators that amplify the response to the initial insult. The relative importance of individual agents as mediators of the response to endotoxin varies with the experimental model studied.

title: Comparison of the cortical connections of areas 4 gamma and 4 delta in the cat cerebral cortex.
abstract: Area 4 of the cat cerebral cortex has been subdivided into several regions based on cytoarchitectonic studies: areas 4 gamma, 4 delta, 4sfu, and 4fu (Hassler and Muhs-Clement [1964] J. Hirnforsch. 6:377-420). In a previous study, we found separate representations of contralateral limb movements in areas 4 gamma and 4 delta (Ghosh [1997] ). To investigate the relationship between these representations, the ipsilateral cortical connections of area 4 gamma and 4 delta were compared by the use of the retrograde neural tracers. After intracortical microstimulation of area 4, tracer was injected into one or two of the following regions: the forelimb regions of the rostral and caudal subdivisions of areas 4 gamma and 4 delta (r4 gamma, r4 delta, c4 gamma, c4 delta, separated by the cruciate sulcus) and the hindlimb regions of c4 gamma and c4 delta. Retrogradely labeled neural profiles were counted in every fourth section of the coronal series and located in cytoarchitectonic areas of the ipsilateral cortex. We found topographically organized reciprocal connections between areas 4 gamma and 4 delta; these connections were part of a rich network of interconnections between the cytoarchitectonic subdivisions of area 4. The forelimb regions of c4 gamma and c4 delta, of r4 gamma and c4 delta, and of r4 gamma and r4 delta were interconnected. These findings support the location of a secondary motor area in 4 delta. No interconnections between the forelimb regions of r4 gamma and c4 gamma, and of r4 delta and c4 gamma, could be found. Area 6 (particularly area 6a gamma) was found to project strongly to the forelimb regions of r4 gamma and r4 delta and relatively weakly to the forelimb region of c4 delta. Retrogradely labeled neurons were also detected in areas 3a, 3b, 1, 2pri, 5, 7, and insula after tracer injections in area 4.

title: C-terminal phenylalanine of bacteriophage T7 single-stranded DNA-binding protein is essential for strand displacement synthesis by T7 DNA polymerase at a nick in DNA.
abstract: Single-stranded DNA-binding protein (gp2.5), encoded by gene 2.5 of bacteriophage T7, plays an essential role in DNA replication. Not only does it remove impediments of secondary structure in the DNA, it also modulates the activities of the other replication proteins. The acidic C-terminal tail of gp2.5, bearing a C-terminal phenylalanine, physically and functionally interacts with the helicase and DNA polymerase. Deletion of the phenylalanine or substitution with a nonaromatic amino acid gives rise to a dominant lethal phenotype, and the altered gp2.5 has reduced affinity for T7 DNA polymerase. Suppressors of the dominant lethal phenotype have led to the identification of mutations in gene 5 that encodes the T7 DNA polymerase. The altered residues in the polymerase are solvent-exposed and lie in regions that are adjacent to the bound DNA. gp2.5 lacking the C-terminal phenylalanine has a lower affinity for gp5-thioredoxin relative to the wild-type gp2.5, and this affinity is partially restored by the suppressor mutations in DNA polymerase. gp2.5 enables T7 DNA polymerase to catalyze strand displacement DNA synthesis at a nick in DNA. The resulting 5'-single-stranded DNA tail provides a loading site for T7 DNA helicase. gp2.5 lacking the C-terminal phenylalanine does not support this event with wild-type DNA polymerase but does to a limited extent with T7 DNA polymerase harboring the suppressor mutations.