Indrish Bhatia

Spectrum of clinical disease in a series of 135 hospitalised HIV-infected patients from north India

BackgroundLiterature on the spectrum of opportunistic disease in human immunodeficiency virus (HIV)-infected patients from developing countries is sparse. The objective of this study was to document the spectrum and determine the frequency of various opportunistic infections (OIs) and non-infectious opportunistic diseases, in hospitalised HIV-infected patients from north India.MethodsOne hundred and thirty five consecutive, HIV-infected patients (age 34 ± 10 years, females 17%) admitted to a tertiary care hospital in north India, for the evaluation and management of an OI or HIV-related disorder between January 2000 and July 2003, were studied.ResultsFever (71%) and weight loss (65%) were the commonest presenting symptoms. Heterosexual transmission was the commonest mode of HIV-acquisition. Tuberculosis (TB) was the commonest OI (71%) followed by candidiasis (39.3%), Pneumocystis jiroveci pneumonia (PCP) (7.4%), cryptococcal meningitis and cerebral toxoplasmosis (3.7% each). Most of the cases of TB were disseminated (64%). Apart from other well-recognised OIs, two patients had visceral leishmaniasis. Two cases of HIV-associated lymphoma were encountered. CD4+ cell counts were done in 109 patients. Majority of the patients (82.6%) had CD4+ counts <200 cells/μL. Fifty patients (46%) had CD4+ counts <50 cells/μL. Only 50 patients (37%) received antiretroviral therapy. Twenty one patients (16%) died during hospital stay. All but one deaths were due to TB (16 patients; 76%) and PCP (4 patients; 19%).ConclusionsA wide spectrum of disease, including both OIs and non-infectious opportunistic diseases, is seen in hospitalised HIV-infected patients from north India. Tuberculosis remains the most common OI and is the commonest cause of death in these patients.

Determinants of hospital mortality of HIV infected patients from north India

A majority of the HIV infected population lives in developing nations. Most patients require hospitalisation for management of opportunistic infections (OIs) sometime during the course of their illness. Locally endemic infections and underlying malnutrition tend to influence the manifestations and course of the disease.1 However, there is paucity of data on pattern of disease and determinants of immediate outcome of such patients from Indian subcontinent.2 We report the determinants of hospital mortality in a cohort of 135 consecutive cases of HIV/AIDS, aged 13 years and above, admitted to the All India Institute of Medical Sciences (AIIMS), New Delhi, during the period of January 2000 through July 2003. These patients had …

Effect of Intravenous Mannitol on Intraocular Pressure in Vitrectomized Silicone-Oil-Filled Eyes

ABSTRACT Purpose: To evaluate the effect of intravenous mannitol (IVM) on intraocular pressure (IOP) in vitrectomized eyes. Methods: Thirty-one patients with raised IOP after retinal surgery with silicone oil injection were included. Patients were administered IVM (20% solution, 1g/Kg, over 30 minutes) and IOP was noted at regular intervals. IOP reduction in vitrectomized eyes (Group 1) was compared with the normal eyes (Group 2). Result: Percentage IOP reduction was higher in Group 1 than in Group 2 at all time intervals, 24.5% vs. 19.2% at 15 minutes (p=0.34), 22.6% vs. 9.8% at 45 minutes (p=0.003), 19.1% vs. 9.9% at two hours (p=0.023), and 16.1% vs. 7.8% at four hours (p=0.04), respectively. In Group 1, 40% eyes had an IOP reduction of 2–6 mmHg while 30% eyes had IOP reduction >6 mmHg at four hours post-IVM. Conclusion: IVM is useful for short-term IOP reduction in vitrectomized eyes. IOP reduction is independent of baseline IOP, and sustained and higher as compared to normal eyes.

Bilateral Macular Folds as a Diagnostic Clue to Late-Presenting Posterior Microphthalmos

Abstract Posterior microphthalmos with macular folds is a very uncommon condition. We report such an unusual late-presenting case of posterior microphthalmos where macular folds uncovered the diagnosis and discuss the possibility of worsening of macular folds with advancing age.

Clinical Patterns and risk factors for rhegmatogenous retinal detachment at a tertiary eye care centre of northern India

PURPOSE To identify patterns and risk factors for rhegmatogenous retinal detachment (RD) in northern India. METHODS This was a retrospective study conducted at a tertiary care centre in northern India. 378 consecutive records of patient, operated between January 2011 to June 2012 were included for analysis. Clinical history, signs and risk factors of RD were evaluated. Comparison was done with available literature from other developing nations. RESULTS Mean age of the patients was 40.12 + 20.43 years (Range 12-85 years); 81% were male and half of the patients presented after 1 month of visual symptoms. Retinal breaks were discovered commonly in the temporal region, while no break was found in10% of the patients. PVR more than grade C was seen in a third of the patients. Prior surgery for cataract was found to be the most common identifiable risk factor for RD (40%). Bilateral RD was seen in 13% of the patients. CONCLUSION Pseudophakia is the commonest risk factor for RD. If no retinal break is discovered pre operatively, the surgeon should seek a retinal break temporally during surgery. Bilateral RD is a serious concern for rural northern India, probably linked to delayed presentation.

Predictors of successful laser capsulotomy for significant posterior capsule opacification after phacoemulsification

Purpose: This study aimed to determine the reasons behind the failure of laser capsulotomy (LC) performed for significant posterior capsular opacification (PCO). Methods: Eighty-eight eyes of 88 patients referred for LC at a tertiary care center were retrospectively analyzed. The data recorded included the cause of cataract, visual acuity, duration of PCO, location of PCO, intraocular lens (IOL) position, IOL type, and lens capsule status. These data were later analyzed for determining the requirement of high pulse energy during LC and the success rate of primary LC. Results: The mean age of the participants was 55.77 ± 18.60 years with 58 (65.9%) male patients. The mean duration between cataract and LC surgeries was 45.58 ± 37.33 months. Senile (n=58), uveitic (n=12), post-pars plana vitrectomy (PPV) (n=12), and traumatic (n=6) cataracts were the common causes. Late-presenting PCO, trauma, uveitis, sulcus placement of IOLs, irregular capsulorhexis shape, and polymethyl methacrylate (PMMA) IOLs were significantly associated with unsuccessful LC and/or higher pulse energy settings during LC. Conclusion: Significant PCO is often associated with cataract caused by uveitis or trauma, and after PPV. PCO associated with trauma, sulcus placement of IOLs, and PMMA IOLs may need multiple LCs.

Comment on Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery.

Dear Sir, We read with interest the article “repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery “by Rishi et al.[1] While managing such situations is indeed a challenge, we made few observations. Optical coherence tomography (OCT) shows presence of “inner retinal dimpling” seen prominently temporal to the fovea after the first procedure. In fact, this dimpling seems to have increased after the repeat macular surgery. Previously named dissociation of optic nerve fiber layer,[2] these are now considered to be due to an interplay between trauma and healing processes constrained by nerve fiber layer and not because of dissociation of optic nerve fibers.[3] It is believed that this morphological pattern observed late after inner limiting membrane (ILM) peeling (after 1–3 months) represents traction caused on the Muller cell end plates during the peeling itself and may even represent a successful peel.[4] In this case, it well corroborates with absence of ILM/ILM re proliferation noted during the second surgery. The OCT images after the second surgery also show characteristic temporal thinning seen frequently in long-term after ILM peeling.[4] Retinal thinning represents surgical trauma endured by the macula. Reasons for this asymmetric macular morphology however are not very clear and have been attributed to the resistant nature of nasal macula due to tight packing of nerve fibers. In fact decreased temporal macular nerve fiber layer thickness has been well documented after ILM peeling and thus may be cause of macular thinning.[5] Furthermore foveal displacement toward the optic disc might be responsible for the stretching and thinning of the retinal parenchyma in the temporal subfield.[5] Although ILM peel definitely causes architectural changes, until now no detrimental effect on quantitative visual acuity has been proven.[4] Finally, as per authors C3F8 gas has been used during the repeat surgery. However fundus picture two weeks after the repeat procedure does not show any gas bubble. Could it be related to wound leak? A similar leak during the first surgery could have been the cause of failure of primary surgery.