Anthropometry of the sternum: An autopsy-based study for sex determination

Sex determination is one of the key components for establishing the individual's identity in forensic anthropology casework. It is a known fact that anthropometric assessment can have population-specific variations. The present autopsy study was conducted on the sterna of 102 cadavers (52 males and 50 females) of age more than 25 years at a tertiary care centre in Central India. Anthropometric measurements included the length of the manubrium (M), mesosternum (B) and combined length of manubrium and mesosternum (CL). Applicability of Hyrtl's law, Ashley's rule and the sternal index were also assessed for sex determination. A statistically significant correlation (p < 0.001) was observed between sternal measurements and the sex of the study population. The highest coefficient of correlation was seen between sex and the combined length (r = 0.726), followed by mesosternal length (r = 0.620), and manubrial length (r = 0.509). The difference between the means of the sternal index in males and females was not statistically significant (p > 0.05), and the difference between the means of the ratio of the body with manubrium in males and females for Hyrtl's law is also not found to be statistically significant (p > 0.05). It is concluded that the length of the body and the combined length of manubrium and mesosternum are valuable criteria for sexing the sternum in an adult population of Central India. The sternum can be useful for sex determination, particularly when bones like skull, pelvis, or long bones are not available or fragmented.

Correction of preexisting astigmatism by penetrating arcuate keratotomy in femtosecond laser-assisted cataract surgery

Purpose:

To evaluate the astigmatism correcting effect of penetrating arcuate keratotomy (AK) done during femtosecond laser-assisted cataract surgery (FLACS).

Methods:

In this nonrandomized prospective study, 80 eyes of 70 patients were studied. The study included patients who underwent combined FLACS and AK, with corneal astigmatism ranging from 0.4 to 1.5 diopters (D). Femtosecond laser-assisted penetrating arcuate keratotomies were created at 8 mm optical zone at 80% depth and were centered at the limbus. Keratometric astigmatism was measured prior to and 3 months post-surgery. Vector analysis was performed using Power vector analysis method.

Results:

The mean preoperative keratometric astigmatism without accounting for axis was 0.85 ± 0.27 D, which reduced significantly to 0.47 ± 0.27 D at 3-month follow-up. The mean astigmatism correction attained without accounting for axis was 0.38 ± 0.32 D. The vector corrected mean preoperative astigmatism was 0.85 ± 0.27 D which reduced significantly to 0.50 ± 0.31 D postoperatively (P < 0.001, 95% CI). Vector corrected mean astigmatism correction attained was 0.35 ± 0.38 D. There were no significant intraoperative or postoperative complications.

Conclusion:

Preexisting astigmatism can be tackled effectively with penetrating AK during FLACS although under correction is observed with present nomograms. Further refinements may achieve better correction.

Prospective Evaluation of Intravitreal Triamcinolone Acetonide Injection in Macular Edema Associated with Retinal Vascular Disorders

Purpose

To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and macular thickness using optical coherence tomography (OCT) in macular edema associated with various retinal vascular disorders.

Methods

This prospective nonrandomized clinical interventional study included 81 eyes (76 patients) comprised of Group I, 57 eyes (51 patients) with diabetic macular edema; Group II, 10 eyes (10 patients) with branch retinal vein occlusion; and Group III, 13 eyes (13 patients) with central retinal vein occlusion. All eyes received an intravitreal injection of 4 mg triamcinolone acetonide (with the solvent) in the operation theater under sterile conditions.

Results

Mean preinjection central macular thickness was 531.84±132 μm in Group I, 458.4±149 μm in Group II, and 750.81±148 μm in Group III. All groups showed a statistically significant decrease in mean central macular thickness at 1 month (300.7±119 μM in Group I, 218.2±99 μm in Group II, and 210.5 ±56 μm in Group III) and 3 months (253.19±109 μm in Group I, 187±47 μm in Group II, and 182±50 μm in Group III) after injection (p<0.05). Mean follow-up was 22±2.4 weeks. Mean visual acuity increased in all three groups (preoperative visual acuity in Group I, 1.2±0.4 logMAR units; Group II, 1.24±0.5 logMAR units; Group III, 1.1 ±0.4 logMAR units; 1 month postinjection in Group I, 0.88±0.3 logMAR units; Group II, 0.67±0.3 logMAR units; Group III, 0.86±0.4 logMAR units; 3 months postinjection in Group I, 0.84±0.4 logMAR units; Group II, 0.59±0.3 logMAR units; Group III, 0.82±0.5 logMAR units) (p<0.05). Forty-one eyes completed 6 months and 20 eyes completed 9 months follow-up. Twelve of 20 (41%) eyes in Group I, 2/6 (33%) eyes in Group II, 3/6 (50%) eyes in Group III, and 8/15 (53%) eyes in Group I, 1/3 (33%) eyes in Group II, and 2/2 (100%) eyes in Group III developed recurrence of macular edema with worsening of visual acuity at 6 and 9 months, respectively. Thirty-three (40.7%) eyes developed IOP elevation (at least one reading > 24 mmHg). One eye developed infective endophthalmitis.

Conclusions

Intravitreal injection of triamcinolone acetonide may be considered as an effective treatment for reducing macular thickening due to diffuse diabetic macular edema, venous occlusion associated macular edema, and may result in increase in visual acuity at least in the short term. Further follow-up and analysis is required to demonstrate its long-term efficacy.

Presumed Ocular Histoplasmosis Syndrome in India

The authors report a case series of presumed ocular histoplasmosis syndrome (POHS) from India. Patients with progressive diminution of vision and having subretinal neovascularisation (SRNVM) were evaluated thoroughly to look for signs of POHS. Three patients had features suggestive of POHS, which to the best of the authors' knowledge is the first case series reported from India. This study shows that patients with clinical features suggestive of POHS do exist in India. A thorough fundus examination of young adults with supposedly idiopathic SRNVM may help to uncover more cases of POHS in India.

The role of environmental factors and hereditary predisposition in the causation of low myopia

Various environmental factors have been implicated in the etiology of myopia. An attempt was made quantitatively to estimate some such environmental factors, as based on the presence or absence of a family history of myopia. Age range was 10-21 years. The 200 subjects included in the study were further divided according to emmetropia/myopia. The factors studied in the four subgroups were amount of near work done per day, head posture and illumination level while doing near work, acute fevers, chronic illness, acute or recurrent diarrhea, nutritional status, and income levels. A correlation was found between myopia and near work, head posture and income levels.

Comparison of observed body retention of uranium in natural condition in an average Indian adult with the values predicted by the ICRP biokinetic model

The daily intake of natural uranium and its contents in the lungs, skeleton, liver and kidney of an Indian adult population group was estimated using radiochemical neutron activation analysis (RNAA). These data on daily intake (through inhalation and ingestion) were used to compute the uranium contents in the lungs and other systemic organs such as the skeleton, liver and kidney, using the new human respiratory tract model (HRTM) and the new biokinetic model of uranium. The theoretically computed uranium contents in the lungs, skeleton, liver and kidney of an average Indian adult are 1.16, 1.96, 0.07 and 0.04 microg, respectively, and the corresponding experimentally measured values are 1.23 (1.76), 2.92 (2.5), 0.07 (1.76) and 0.19 (1.47) microg in an urban population group living in Mumbai. The values given in parentheses are geometric standard deviation (GSD). It is seen that the measured uranium contents in the lungs, skeleton and liver agree very well with the corresponding computed values, but the measured value for the kidney is observed to be on the higher side of the computed value. However, in view of many uncertainties, the overall agreement between the measured and the computed values can be considered to be good. Therefore, the result from this study can be taken as a validation of the new biokinetic model of uranium in Indian conditions.

Retinitis pigmentosa and congenital toxoplasmosis: A rare coexistence

We describe a previously unreported co-existence of retinitis pigmentosa and congenital toxoplasmosis. An eight year old male presented to our center with complaints of decreased night vision. Fundus evaluations in both the eyes demonstrated features typical of retinitis pigmentosa. There were well-defined punched out healed chorio-retinal scars suggestive of congenital toxoplasmosis. On the basis of history, clinical findings and reduction of a and b wave amplitudes on scotopic and photopic electroretinograph, a diagnosis of retinitis pigmentosa with congenital toxoplasmosis was made. Retinitis pigmentosa may co-exist with congenital toxoplasmosis that may affect the patient's overall ocular morbidity and visual acuity.

Comparison of observed skeleton retention of strontium in average indian adult with the value predicted by the ICRP biokinetic model

The daily dietary intake of strontium and its content in skeleton, for an Indian adult population group were estimated by experimentally measuring its concentration in total cooked diet and autopsy skeleton samples using radiochemical neutron activation analysis. The data on daily dietary intake of strontium were used to compute its contents in skeleton using ICRP Publication 67 biokinetic model for strontium. The theoretically computed value of strontium (213.8 mg) compared favourably with the measured values (GM 181.2 mg) in an urban population group living in Mumbai representing an average Indian adult (Reference Indian Man).

Ocular and cardiovascular autonomic function in diabetic patients with varying severity of retinopathy

The study was conducted to assess the ocular and cardiovascular autonomic function in diabetic patients with varying severity of diabetic retinopathy. Ocular and cardiovascular autonomic function tests were performed in 30 patients with type 2 Diabetes Mellitus (10 in each group of proliferative retinopathy, non-proliferative retinopathy and no retinopathy) of more than 5 years duration and 10 normal controls. Ocular autonomic function tests were done by measuring pupil cycle time and denervation hypersensitivity with 0.125% pilocarpine and 0.5% phenylephrine. Cardiovascular autonomic function was measured by a battery of standard tests. Denervation hypersensitivity to 0.125% pilocarpine and to 0.5% phenylephrine and pupil cycle time showed statistically significant differences (P value < 0.001) between controls and patients with proliferative retinopathy (PDR) and also between no retinopathy and PDR (P < 0.001). Systemic autonomic function tests namely expiration--inspiration ratio, difference in heart rate, 30th beat and 15th beat ratio in head up tilt and difference in diastolic blood pressure in head up tilt test also showed significant difference (P < 0.01) between controls and all 3 groups of diabetics. There was statistically significant difference found in para-sympathetic ocular autonomic dysfunction between NPDR and controls. Ocular and systemic autonomic dysfunctions are related to the severity of diabetic retinopathy.

Cytomegalovirus retinitis in a patient with non-Hodgkin's lymphoma: a diagnostic dilemma

PURPOSE

Patients with lymphoma can rarely develop cytomegalovirus (CMV) retinitis. Clinically it is difficult to distinguish from intraocular lymphoma. Also, in such cases the CD4+ count may be high. The authors report a rare case of bilateral CMV retinitis in a patient with non-Hodgkin's lymphoma with high CD4+ counts.

METHODS

Observational case report with review of literature.

RESULTS

CMV retinitis was clinically suspected due to the presence of large areas of retinal necrosis and hemorrhages in one eye and a demarcation line with white mottled retina in the other eye. Other differential diagnoses considered were intraocular lymphomatous infiltration and acute retinal necrosis due to herpes group of viruses. The diagnosis of CMV retinitis was confirmed by polymerase chain reaction performed on vitreous sample.

CONCLUSIONS

CMV retinitis can develop in cases of lymphoma despite high CD4+ counts. An early diagnosis can be established by performing PCR on vitreous biopsy.

Comparison of observed lung retention and urinary excretion of thorium workers and members of the public in India with the values predicted by the ICRP biokinetic model

The daily intake of natural Th and its contents in lungs, skeleton and liver of an Indian adult population group were estimated using radiochemical neutron activation analysis (RNAA) technique. These data on daily intake (through inhalation and ingestion) were used to compute Th contents in lungs and other systemic organs such as skeleton and liver using the new human respiratory tract model (HRTM) and the new biokinetic model of Th. The theoretically computed Th contents in lungs, skeleton and liver of an average Indian adult are 2.56, 4.00 and 0.17 microg, respectively which are comparable with the corresponding experimentally measured values of 4.31, 3.45 and 0.14 microg in an urban population group living in Mumbai. The measured lung contents of Th in a group of five occupational workers were used to compute their total body Th contents and the corresponding daily urinary excretions. The computed total body contents and daily urinary excretions of Th in the five subjects compared favourably with their measured values. These studies, thus, validate the new biokinetic model of Th in natural as well as in occupational exposures in Indian conditions.

Intraocular live cysticercus larva

Ocular cysticercosis is one of the most common parasitic infections of the eye in humans. Although the adult pork tapeworm, Taenia solium, resides in the lumen of the intestine, the only structural element of an adult worm is usually found within a tissue cyst in the eye, its adenexa, or other places in the body with a single invaginated scolex. An unusual case is described in which a 13- to 14-mm live cysticercus larva was found, removed from the eye, and confirmed by histopathologic examination.

Long term lung retention studies of 125Sb aerosols in humans

This paper describes the retention of 125Sb oxide aerosols in human lungs based on the data obtained from a group of seven accidental inhalation exposure cases. Long-term follow-up studies for periods of time ranging from 1 to 3 d post intake to 199 to 2,422 d post intake have indicated the biological lung clearance half-time of this material ranging from about 600 to 1,100 d for non-smokers and 1,700 to 3,700 d for smokers. The retention in the lungs after 180 d in all the seven cases is found to be much more than 51% of the estimated initial alveolar deposit, which is consistent with the present ICRP criteria of assignment to the lung absorption Type S. There is little previously reported human data on this radionuclide compound. In these studies reliable information on actual time of intake, the likely type of material, and the amount of retained body/lung activity in initial days after the incident was also available, which adds to the importance of these data. The results of these studies provide a basis for firm classification and suggest that oxides of antimony need to be removed from absorption Type M (earlier class W) where these are presently listed by ICRP and be placed in absorption Type S (earlier class Y). The range of measured retained lung activities after the initial rapid clearance phase (7 d post exposure) was about 3 to 14 kBq, which was sufficient for long-term follow up studies using the whole body counters.

Development of an automated shielded chair whole-body monitor

A standard shielded chair whole-body monitor has been developed as a computer controlled, unattended, walk-in-type of whole-body monitor for internal dosimetry of radiation workers. A radiation worker enters his personal computer code through the attached computer terminal and follows a few instructions on the screen. The chair door then opens automatically and after the worker has positioned himself into the counting geometry in the chair, the door closes. At the end of the whole-body monitoring for a pre-set time, the chair door opens again and the worker moves out. The monitoring data acquired on a 4K-MCA is saved in the computer memory automatically and the chair door closes again making it available for monitoring the next worker. The system also gives audio instructions to the worker to occupy the chair and to move out after the counting is over. A system supervisor can come at any convenient time and get a print out of the monitoring report in the standardised format or carry out any detailed analysis if required. The system has the software for calculating intakes and the committed effective doses using the latest ICRP methodologies, from the measured retained activities of the various important fission and activation products like 137Cs, 131I, 60Co, 125Sb etc. This type of system with trained staff is also expected to be of value in case of emergencies as a quick monitoring system.

Congenital porphyria with necrotizing scleritis in a 9-year-old child

Porphyria is a rare metabolic disorder that is characterized by the accumulation of photosensitive, toxic intermediates of the heme metabolic pathway in various organs of the body including the skin, eye and neural tissue. Porphyria as a potential cause for bilateral necrotizing scleritis in children is very infrequently emphasized in literature, probably due to the relatively rare occurrence and lack of well-documented cases. A case of a 9-year-old child with congenital porphyria who had developed necrotizing scleral ulceration in both eyes in addition to severe cutaneous hypersensitivity and facial disfigurement is herein presented.

Osseous choristoma of the choroid

Osseous choristoma of the choroid, also called choroidal osteoma, is a very rare and unusual form of intraocular ossification. We report a case of choroidal osteoma in a young healthy male that to the best of our knowledge is the first report from India.

Telephone mouthpiece as a possible source of hospital infection

A bacterial culture from telephone mouthpiece showed that 47 percent of the instruments carried pathogenic bacteria. Wiping with a disinfectant swab reduced the number of contaminated telephones. But for complete elimination of bacterial contamination changes in design of mouthpiece holes or type of instrument or using a polythene plastic cover over mouthpiece is recommended.

Endogenous cortisol profile in patients with central serous chorioretinopathy

AIM

To study the endogenous cortisol levels in patients with central serous chorioretinopathy (CSCR).

METHODS

Endogenous cortisol levels in urine and plasma were determined in 30 patients with acute CSCR and compared with 30 age and sex matched controls.

RESULTS

The mean values of the 8 am plasma cortisol (29.97 micrograms/dl v 18.76 micrograms/dl), 11 pm plasma cortisol (22.03 micrograms/dl v 13.06 micrograms/dl), and 24 hour urine cortisol (11.01 mg/24 h v 7.39 mg/24 h) revealed significantly higher values in the patient group (p < 0.001).

CONCLUSIONS

Increased levels of endogenous cortisol are present in patients with CSCR.

Neodymium: YAG laser iridolenticular synechiolysis in uveitis

Fifteen patients with "bound down" pupil or ring synechiae associated with chronic granulomatous uveitis in whom dilatation could not be obtained pharmacologically underwent iris-lens synechiolysis using relatively low energies from a Q-switched Nd:YAG laser. Pupil size increased significantly in all of the treated eyes; visual acuity improved in 40%. Postlaser elevated intraocular pressure developed in a significant number, but there were no serious long-term complications associated with the procedure. Although acuity improved in less than half of the patients, because this laser treatment is relatively safe and offers some possibility of visual improvement, we recommend it for routine use, but only if performed by an experienced laser microsurgeon.

Serous macular detachment in lymphoproliferative disorders

Two patients, one with Hodgkin's disease and the other with non-Hodgkin's lymphoma, presented with bilateral diminution of vision. Examination showed bilateral serous detachment of the macula. To our knowledge, this is only the second report in the literature of serous detachment of the macula in lymphomatous disorders.

Cataract induced glaucoma--an insight into management

The problem of phacomorphic glaucoma is a rather common entity in rural India owing to the delay in getting the cataract removed and the preponderance of cortical matter, compared with the Western world. The authors in India, South East Asia and Australia, have managed the problem differently leading to controversies. The pathogenesis has been investigated and is well understood. An aspect of phacomorphic glaucoma that remains quite unanswered, is of the relatively poor visual outcome and increased incidence of operative and post-operative complications. We endeavour to evaluate the management, intraoperative and post-operative complications of phacomorphic glaucoma (senile cataract induced). The effect of high intraocular pressure (I.O.P) and surgical trauma on the corneal endothelium is also assessed.

Iris neovascularization in Sturge-Weber syndrome

An unusual case of Sturge-Weber syndrome with raised intraocular pressure is presented. The slit lamp examination and anterior segment fluorescein angiography were consistent with iris neovascularization. Cause and effect relationship of iris neovascularization with glaucoma in this syndrome is discussed.

Conjunctival microbial flora in leprosy

Conjunctival sacs of seventy one leprosy patients, paramedical and medical personnel working in a leprosy home were cultured. None of these eyes had any pathology in the outer eye. Surprisingly, 46.2% of the eyes which showed a positive culture carried accepted pathogens; Staphylococcus aureus being the commonest. Determining the preoperative bacterial flora and their elimination before undertaking intraocular surgery is recommended.

Metastatic endophthalmitis: a reappraisal

In view of the lack of studies of metastatic endophthalmitis and the controversies surrounding its management, we did a retrospective study of ten cases of metastatic endophthalmitis admitted to our center in 1987. A disproportionately high incidence of pediatric patients was found. The etiologic diagnosis was possible in eight of the ten cases. Bacterial infection was responsible in five of the eight cases where positive cultures were grown. Pseudomonas aeruginosa was the most common bacterial pathogen isolated. Most of the cases responded poorly to medical management. Seven of the ten patients finally underwent vitrectomy. Four of these seven cases had a postoperative visual acuity equal to or greater than 6/60 after vitrectomy. We believe that pars plana vitrectomy has a definite role in the management of metastatic endophthalmitis.

Pupillary dilatation during cataract surgery--relative efficacy of indomethacin and flurbiprofen

In a prospective, randomized, double-blind trial, we evaluated the relative efficacy of indomethacin and flurbiprofen when used as adjuvants to routinely used mydriatics for maintenance of pupillary dilatation in patients with heavily pigmented iris undergoing extracapsular cataract extraction. The drugs were administered orally as well as topically according to a fixed regimen. The pupillary diameters, measured with calipers at various surgical steps, were significantly larger at every step in the study groups in which either of the adjuvants had been used than they were in the control group (P less than .001). Flurbiprofen tended to help maintain a larger pupillary diameter in the later stages of surgery than indomethacin, but this difference was not statistically significant. We conclude that it is important to use prostaglandin synthetase inhibitors as adjuvants to routine mydriatics, and that flurbiprofen may be somewhat more effective than indomethacin in this capacity.

SAFA test as an aid to the diagnosis of ocular tuberculosis

A prospective double blind study was carried out to evaluate the role of soluble antigen fluorescent antibody (SAFA) test to detect ocular Tuberculosis. The study material comprised 39 patients with suspected ocular tuberculosis suffering from interstitial keratitis, sclero keratitis, granulomatous uveitis, phlyctenular keratoconjunctivitis, Eales disease and central serous retinopathy. The cases of proven ocular tuberculosis showed up as 70 percent strong reactors and 30 percent weak reactors to SAFA while none had a negative response to SAFA. Of these cases skin hypersensitivity reaction was positive only in 40 percent of the cases. The control group revealed a strong SAFA reaction in only 4 percent of cases with a weak reaction in 44 percent of cases. It thus appears that SAFA test can provide a useful addition to the routine tests in diagnosing tuberculosis.

Conjunctival microbial flora in leprosy

Conjunctival sacs of seventy-one leprosy patients, paramedical and medical personnel working in a Leprosy Home were cultured. None of these eyes had any pathology of the outer eye. Surprisingly, 46.2% of the culturally positive eyes carried accepted pathogens, Staphylococcus aureus being the commonest. Determining the preoperative bacterial flora and their elimination before undertaking intraocular surgery is recommended.

Bilateral posterior lens dislocation in Marfan's syndrome

Complete dislocation of the lens is a rare feature of Marfan's Syndrome. We observed four cases of bilateral complete posterior dislocation of the lens in established cases of Marfan's Syndrome over a one year period. An ophthalmologist may encounter infrequently, unilateral posterior dislocation in one eye and ectopia lentis in the other, but bilateral spontaneous posterior dislocation is rare. All our cases had associated vitreous degeneration with vitreous herniating into the anterior chamber. The pathogenesis of complete posterior dislocation in Marfan's Syndrome is discussed.

Increased mitral valve insufficiency during precordial "whoop"

A patient with rheumatic mitral valve stenosis and regurgitation presented with shortness of breath and a "noise" in her chest. Cardiac auscultation revealed an intermittent late systolic "whoop." An increase in severity of mitral valve insufficiency during the periods of "whoop" was observed by pulsed Doppler, hemodynamic tracings and left ventriculography.

Study of the relationship between free amino acids and cataract in human lenses

There was a gradual decrease in the quantity of various amino acids associated with cataract formation due to reduced concentrations of glutamic acid, threonine, serine, glycine, alanine, leucine, isoleucine, phenylalanine and tyrosine in stages of cataract formation.