Psychological consequences of chronic physical illnesses in children and adolescents

Chronic illnesses in children and adolescents have devastating influence on them and their families. The patients have to cope up with illness, medication and it’s influence on their development. Consequently a large number of them have emotional disorders which influence the course and outcome of physical disorder. In recent few years, research has shifted its focus from merely figuring out the prevalence of the emotional disorders to understanding the adjustment to chronic illness under defined theoretical constructs. Apart from temperamental variation, family burden and functioning have been identified as factors operating in determining adjustment. Distress experienced by the family and disturbed family functioning directly influences the emotional outcome in physically disordered children. Comprehensive coordinated care services are required for integration of these patients into the community.     

Trisomy 21 with XYY

A case of double aneuploidy involving chromosome 21 and Y is reported in an eight-month-old infant with developmental delay and failure to thrive. Patient had all classical phenotypical features of trisomy 21 except, absence of epicanthal folds. The diagnosis was confirmed by cytogenetic study performed on peripheral blood leucocyte culture using G-banding. Literature review revealed only 17 cases of XYY and trisomy 21 reported so far. No such case is reported in Indian literature. Relevant literature is reviewed and possible effects of trisomy 21 on XYY and that of XYY on trisomy 21 has been discussed. A routine chromosomal study even in patient with classical features of Down syndrome has been advocated. Interestingly, our patient also had left to right shunts at atrial and ductal level and tricuspid regurgitation. Given the rarity of the disorder and scanty published data the incidence, phenotype and recurrence risk are difficult to establish.     

Plasma homocysteine levels in Indian patients with essential hypertension and their siblings

BACKGROUND: An association between plasma homocysteine and essential hypertension and their non-hypertensive siblings is controversial. METHODS AND RESULTS: Plasma homocysteine levels were measured in subjects with essential hypertension (n = 50), their normotensive siblings (n = 50) and normotensive controls (n = 50). All the subjects were non-diabetic, had no past history of myocardial infarction, stroke or peripheral vascular disease and had normal renal functions. The mean homocysteine values were 18.96 +/- 8.08 micromol/L in patients, 14.84 +/- 5.55 micromol/L in siblings and 10.50 +/- 4.92 micromol/L in controls. Plasma homocysteine level were found to be significantly higher in patients with hypertension (p < 0.0001) and their normotensive siblings (p < 0.0001) when compared to controls. Also patients with hypertension had their higher plasma homocysteine levels compared to their siblings (p < 0.0036). CONCLUSION: Plasma homocysteine levels are significantly elevated in Indian patients with essential hypertension and their normotensive siblings. Thus, plasma homocysteine may serve as a marker for the development of essential hypertension.     

Lung function tests in electroplaters of East Delhi

The presence of high concentration of metals (Cr, Cd, Co, Ni, Pb, etc.) in the work place environments of various types of industries including electroplating units are well known to influence respiratory system. Pulmonary function tests including forced expiratory capacity (FVC), volumes, mechanics and slow vital capacity (SVC) were studied in 80 males, divided into group I and Group II of 40 each were drawn from electroplating and non-electroplating units, respectively from East Delhi factories. The lung function tests were measured using computerized Spiro-232 of P.K. Morgan, Values of majority of lung function parameters such as FEV1/FVC%, FEF50 FEF75, PIFR, FIF50, MVV and SVC were decreased in electroplaters, perhaps due to the exposure to metals and their lower anthropmetric results as compared with non electoplaters. Where as results of TLC, FRC, RV & RV/ TLC% were higher in electroplaters and this may be attributed to higher values of RV in them as compared with non electroplaters.     

Risk factors for failure of 5-fluorouracil needling revision for failed conjunctival filtration blebs

PURPOSE: To investigate the risk factors for failure of 5-fluorouracil (5-FU) needling revision, a useful procedure for restoring a failed filtration bleb. DESIGN: Interventional case series.METHODS: Retrospectively conducted study. SETTING: Institutional. STUDY POPULATION: Sixty-four eyes of 64 consecutive glaucoma patients that underwent 5-FU needling revisions for failed filtering bleb following either trabeculectomy or phaco-trabeculectomy with or without adjunctive mitomycin C (MMC). OBSERVATION PROCEDURES: Goldmann applanation tonometry, Kaplan-Meier survival analysis, and Cox proportional hazards regression analysis. MAIN OUTCOME MEASURES: Successful outcome of the initial 5-FU needling revision, arbitrarily defined as target intraocular pressure (IOP) control with not more than two topical glaucoma medications and no additional 5-FU needling or other surgical procedures, was analyzed by Kaplan-Meier survival analysis, and risk factors for failure of the initial 5-FU needling revision were analyzed by Cox proportional hazards regression analysis. RESULTS: The cumulative success rate of the initial 5-FU needling revision was 45% at 1 year, 33% at 2 years, and 28% at 4 years. Failure of the initial 5-FU revision correlated significantly with preneedling IOP > 30 mm Hg (P =.0003), lack of MMC use during the previous filtration surgery (P =.013), and IOP >10 mm Hg immediately following needling revision (P =.0012) according to Cox's proportional hazards regression analysis.CONCLUSIONS: Pre-needling IOP > 30 mm Hg, lack of MMC use during the previous filtration surgery, and IOP > 10 mm Hg immediately after needling were found to be significant risk factors for failure of the initial 5-FU needling procedure. Therefore, it is important to monitor IOP closely following needling revision in those patients with such risk factors. They are more likely to require additional therapeutic interventions, including repeat needling revisions.     

Outcomes of primary phakic trabeculectomies without versus with 0.5- to 1-minute versus 3- to 5-minute mitomycin C

PURPOSE: To compare the intraocular pressure and hypotony outcomes of primary phakic trabeculectomies with no mitomycin C (MMC), shorter MMC, and longer MMC exposure.METHODS: We evaluated primary phakic trabeculectomies with no MMC (36 eyes of 36 patients), 0.5- to 1-minute MMC (50 eyes of 50 patients), and 3- to 5-minute MMC (38 eyes of 38 patients) at the concentration of 0.5 mg/ml. Successful trabeculectomy was defined as an intraocular pressure of 21 mm Hg or less without development of a marked visual acuity loss associated with prolonged hypotony (intraocular pressure < 6 mm Hg over 3 months) and without the need for additional surgery to control intraocular pressure or treat postoperative complications.RESULTS: The three groups were similar in demographics, preoperative intraocular pressure, and medical dependency. However, the incidence of hypotony during the postoperative periods of 3 to 12 months was significantly higher in the 3- to 5-minute MMC group (P < .05, chi-square test). Severe visual acuity loss associated with hypotony was also more frequently found in the 3- to 5-minute MMC group than in the 0.5- to 1-minute (P = .009, chi-square test) group or the control group (P = .014, chi-square test). In addition, the success probabilities were significantly different among the three groups (P = .001, Kaplan-Meier survival analysis with log-rank test) and were the highest in the 0.5- to 1-minute MMC group and the lowest in the 3- to 5-minute MMC group.CONCLUSION: Shorter application (0.5 to 1 minute) of MMC appears to be optimal for the successful outcome of primary phakic trabeculectomy compared with no MMC or longer application of MMC at a concentration of 0.5 mg/ml.