Prevalence of celiac disease among school children in Punjab, North India

BACKGROUND: Celiac disease, as of today, is said to exist in almost all parts of the world, although it is rare among people of purely African-Caribbean, Japanese and Chinese background. The disease has also been considered uncommon in India until recently. Hospital records have revealed an increasing trend of the disease in predominantly wheat-eating areas of North India. The aim of the present study was to determine the prevalence of celiac disease among school children in Punjab, North India. METHODS: The study was carried out in the Ludhiana district of Punjab, Northern India. A total of 4347 children aged 3-17 years attending different schools were enrolled. A structured questionnaire was used to collect sociodemographic data and symptoms and signs related to celiac disease and various sociodemographic factors. The screening for celiac disease for the suspected celiacs was done by testing for antitissue transglutaminase (anti-tTG) by indirect solid-phase immunometric assay (ELISA). All children with high anti-tTG whose parents consented underwent upper gastrointestinal endoscopy for small bowel biopsy from the second part of the duodenum. Histopathology was expressed according to the Marsh classification of 1992. Follow up was carried out among children who were put on a gluten-restricted diet, at monthly intervals for 3 months and every 3 months thereafter. The diagnosis of celiac disease was established on the basis of the revised European Society of Paediatric Gastroenterologists and Nutritionists (ESPGAN) criteria (confirmed cases). RESULTS: A total of 4347 school children (1967 girls, 2380 boys, age range 3-17 years) were screened for celiac disease. Out of these, 198 suspected children were identified for further evaluation. Twenty-one children tested positive for anti-tTG assay (10.6%, 95% confidence interval: 16.91-34.79). Seventeen of these 21 children agreed to undergo biopsy; of these, 14 had histological changes consistent with celiac disease and all these 14 children had clinical response to gluten restriction. Three children with high anti-tTG had normal mucosa on duodenal biopsy and were not labelled as being in the celiac disease group. In the final analysis the disease prevalence was one in 310 children. CONCLUSIONS: This is the first study on celiac disease prevalence among school children from India. Although this disease frequency of one in 310 is thought to be an under-assessment, it clearly shows that celiac disease is not rare in wheat-eating areas of North India.     

Topotecan vitreous levels after periocular or intravenous delivery in rabbits: an alternative for retinoblastoma chemotherapy

PURPOSE: To determine the extent and the mechanism by which topotecan, a candidate agent for the treatment of retinoblastoma, gains access to the vitreous when administered by periocular injection or intravenous infusion. METHODS: In vivo experiments were conducted in which albino rabbits received 1 mg topotecan by periocular injection (POI group; n = 30) or as a 30-minute intravenous infusion (IV group; n = 16). Plasma and vitreal topotecan concentrations were analyzed during the 10 hours after administration. A population pharmacokinetic model was fit to the data. Additionally, periocular injections were performed postmortem to study the effect of removing the blood vasculature barrier. RESULTS: Potentially active lactone topotecan levels were detected in the vitreous in the POI and IV groups. Both administration schedules induced high total topotecan plasma exposures because of absorption from the periocular depot, though plasma lactone area under the curve (AUC) was significantly higher in the IV group. Similar vitreal concentrations were found in treated and control eyes in the POI group. The transfer from the periocular compartment to the vitreous was negligible. The absence of drug levels in the control eye of the postmortem-injected rabbits confirmed the systemic delivery of topotecan. Local toxicity was not observed. CONCLUSIONS: As a consequence of a favored passage across the blood-retinal barrier, considerable topotecan vitreous levels were detected in a rabbit model after systemic or periocular administration. Transscleral entry in vivo was constrained by rapid clearance from the administration site.     

Corneal bee sting misdiagnosed as viral keratitis

PURPOSE: To report a case of chronic keratouveitis caused by a missed bee sting injury. METHODS: A 17-year-old boy was referred for management of unresponsive viral keratouveitis. Ocular examination revealed corneal edema and scarring, atrophic patches on the iris, and anterior polar cataracts. Surprisingly, examination also revealed a retained intracorneal bee stinger. A retrospective inquiry confirmed a bee sting injury 2 years ago. RESULTS: The patient was started on medical treatment and underwent operative removal of the bee stinger. Postsurgery, visual acuity improved, and the corneal edema regressed over a 1-month follow-up. CONCLUSIONS: In cases of chronic keratouveitis, a meticulous examination is mandatory to rule out unusual causes like a retained corneal bee stinger. A retained intracorneal bee stinger may result in long-term corneal inflammation, which may not be controlled adequately with topical steroids. It should be removed, irrespective of the duration since the injury.     

Spectacle-induced ocular trauma: an unusual mechanism

PURPOSE: To report an unusual, spectacle-related injury. METHODS: A 16-year-old boy wearing spectacles with polycarbonate lenses presented with an unusual, spectacle-related injury. Impact with the ball during a ball sport (cricket) led to extreme torsion of the frame with resultant direct blunt trauma to the right eye by the spectacle arm. On examination, the patient had a 10 x 10-mm area of conjunctivalized scleral dehiscence superiorly in Zones 2 and 3, with uveal prolapse. Superior retinal detachment was also noted. RESULTS: Patient underwent wound repair with a scleral patch graft with transscleral cryotherapy and sulfur hexafluoride injection. CONCLUSION: Although increased impact resistance of newer spectacle lens materials is assumed to reduce the incidence of ocular trauma, such unusual mechanisms may still lead to severe ocular trauma. We report this case to highlight an unusual mechanism of spectacle injury, hitherto unreported, and to show the continued need for use of eye protection while wearing spectacles.     

Self-competence and self-liking in the prediction of change in bulimic symptoms

OBJECTIVE: To examine the relationship of self-competence and self-liking (two distinct dimensions of self-esteem) to bulimic symptoms. METHOD: Two separate longitudinal studies were conducted on undergraduate women from two universities (Study 1, N=129; Study 2, N=406). Measures of self-competence, self-liking, and bulimic symptoms were administered on two occasions, separated by several weeks. RESULTS: Self-competence demonstrated a stronger relationship than self-liking to change in bulimic symptoms over time. DISCUSSION: These findings have significant theoretic implications for the construct of self-esteem and implications for risk for and treatment of bulimia.