Dengue Encephalopathy

Dengue encephalopathy or dengue hemorrhagic fever (DHF) with CNS involvement used to be considered a relatively rare condition; but the number of cases reported in human studies has been increasing every year. Diagnosis of dengue encephalopathy is based on clinically diagnosed DHF according to the W.H.O. criteria (1980), with CNS manifestations consisting of abrupt onset of hyperpyrexia, nontransient alteration of consciousness, headache, vomiting-with or without seizures -and normal CSF. Many factors may be considered to be directly or indirectly associated with CNS signs and symptoms in DHF, the main pathology being leakage of plasma into serous spaces and abnormal hemostasis, leading to hypovolemic shock and hemorrhage in many organs of the body. Acute liver failure is considered to be one of the main factors causing brain pathology. One hundred fifty-two cases of dengue encephalopathy admitted during 3 periods at the Cipto Mangunkusumo Hospital in Jakarta were studied retrospectively. The overall incidence was 152 out of 2,441 DHF cases, or 6.2%. The most pronounced symptoms were hyperpyrexia, alteration of consciousness and convulsions. Laboratory examination showed an unusually high increase of serum transaminases, hyponatremia, and hypoxia. Neurologic abnormalities detected were hemiparesis and tetraparesis of the extremities, and second nerve atrophy; such abnormalities were found in 10 out of the 152 cases, or 6.5%.     

Heritability of refractive error and ocular biometrics: the Genes in Myopia (GEM) twin study

PURPOSE: A classic twin study was undertaken to assess the contribution of genes and environment to the development of refractive errors and ocular biometrics in a twin population. METHODS: A total of 1224 twins (345 monozygotic [MZ] and 267 dizygotic [DZ] twin pairs) aged between 18 and 88 years were examined. All twins completed a questionnaire consisting of a medical history, education, and zygosity. Objective refraction was measured in all twins, and biometric measurements were obtained using partial coherence interferometry. RESULTS: Intrapair correlations for spherical equivalent and ocular biometrics were significantly higher in the MZ than in the DZ twin pairs (P < 0.05), when refraction was considered as a continuous variable. A significant gender difference in the variation of spherical equivalent and ocular biometrics was found (P < 0.05). A genetic model specifying an additive, dominant, and unique environmental factor that was sex limited was the best fit for all measured variables. Heritability of spherical equivalents of 88% and 75% were found in the men and women, respectively, whereas, that of axial length was 94% and 92%, respectively. Additive genetic effects accounted for a greater proportion of the variance in spherical equivalent, whereas the variance in ocular biometrics, particularly axial length was explained mostly by dominant genetic effects. CONCLUSIONS: Genetic factors, both additive and dominant, play a significant role in refractive error (myopia and hypermetropia) as well as in ocular biometrics, particularly axial length. The sex limitation ADE model (additive genetic, nonadditive genetic, and environmental components) provided the best-fit genetic model for all parameters.     

Inadvertent retention of Descemet Membrane in penetrating keratoplasty

PURPOSE: To present a case of inadvertently retained Descemet Membrane (DM). METHODS: Case report. RESULTS: A 41-year-old male with previous history of retinal detachment surgery underwent a repeat penetrating keratoplasty; the first graft decompensated secondary to silicone oil. Postoperatively, an inadvertently retained DM was observed forming a physical barrier to the silicone oil. CONCLUSION: Retained DM is a rare complication of penetrating keratoplasty, with only a few cases reported in the literature. This membrane served a protective role from the effects of silicone oil on the donor cornea but later opacified and required surgical intervention.     

Ileocecal masses in patients with amebic liver abscess： Etiology and management

AIM:To assess the causes of ileocecal mass in patientswith amebic liver abscess.METHODS:Patients with amebic liver abscess andileocecal mass were carefully examined and investigatedby contrast-enhanced CT scan followed by colonoscopyand histological examination of biopsy materials fromlesions during colonoscopy.RESULTS:Ileocecal masses were found in seventeenpatients with amebic liver abscess.The cause of themass was ameboma in 14 patients,cecal tuberculosisin 2 patients and adenocarcinoma of the cecum in 1patient.Colonic ulcers were noted in five of the six(83%)patients with active diarrhea at presentation.Theileocecal mass in all these patients was ameboma.Ulcerswere seen in only one of the 11(9%)patients withoutdiarrhea.The difference was statistically significant fromthe group with diarrhea(P<0.005).CONCLUSION:Ileocecal mass is not an uncommonfinding in patients with amebic liver abscess.Although,the ileocecal mass is due to ameboma formation in mostcases,it should not be assumed that this is the case inall patients.Colonoscopy and histological examinationof the target biopsies are mandatory to avoid missing amore sinister lesion.     

Endovascular clamping of porcelain aorta in aortic valve surgery using Foley Catheter

Unclampable calcified aorta is an uncommon condition that all cardiac surgeons may encounter and performing aortic valve surgery in this condition with a non cross-clamping technique of using Foley Catheter has rarely been reported. Aortic valve surgery invariably becomes a high-risk, challenging procedure to cardiac surgeon or even a contraindication to surgery when the ascending aorta cannot be clamped due to extensive calcification precluding safe dissection and clamping. We describe and recommend a non cross-clamping technique of using Foley Catheter and report it successful use in two patients who underwent aortic valve replacement with "porcelain" unclampable aorta.     

Aluminum phosphide-induced esophageal strictures: a new cause of benign esophageal strictures

Fifteen consecutive patients presenting with dysphagia due to aluminum phosphide (AP)-induced esophageal strictures were studied retrospectively to elucidate the natural history of AP-induced esophageal strictures and to evaluate the efficacy of bougie dilation. The median time lag between consumption of AP and occurrence of dysphagia was 3 weeks. All patients had a single stricture and could be dilated using a bougie dilator. Thirteen patients were relieved of dysphagia on a mean (SD) follow-up of 18 (7.3) months. Two patients had recalcitrant strictures and needed needle-knife incision of the stricture followed by balloon dilation. The strictures opened up well in both the patients and they were relieved of dysphagia. AP-induced esophageal stricture is a new cause of benign esophageal stricture. Most patients present with dysphagia around 3 weeks after consumption of AP tablets. A single esophageal stricture is found in these patients. Most strictures respond very well to bougie dilation. However, some of the strictures may be recalcitrant and may require needle-knife incision and balloon dilation.     

Antidermatophyte and antimelanogenesis compound from <Emphasis Type="Italic">Eleutherine americana</Emphasis> grown in Indonesia

An active compound from the bulb of Eleutherine americana L. Merr. (Iridaceae) collected from East Kalimantan, Indonesia, was tested for its antidermatophyte and antimelanogenesis activity. Antifungal assay-directed fractionation of the n-hexane-soluble fraction of the methanolic extract of the bulb of E. americana led to the isolation of 1 as an active compound. The compound was identified as the naphthoquinone eleutherin by EI-MS and ¹H-, ¹³C-, and two-dimensional NMR analyses. Antidermatophyte assay of 1 at concentrations of 10, 20, 40, 60, and 80 μg/disk and myconazole, a commercial antidermatophyte, at 10 μg/disk displayed 7, 8, 13, 16, 17, and 14 mm of inhibition zone against Trichophyton mentagrophytes, respectively. In a melanin formation inhibition assay, compound 1 displayed potent antimelanogenesis activity at 5 ppm with low toxicity compared with arbutin, a commercial skin-whitening agent. The results showed the high potential of 1, an active compound from E. americana, to be applied as an antidermatophyte and antimelanogenesis agent.