Functional Foods

Cholesterol-reducing effect of ergosterol is modulated via inhibition of cholesterol absorption and promotion of cholesterol excretion Publication date: June 2019 Source: Journal of Functional Foods, Volume 57 Author(s): Wen-Sen He, Dandan Cui, Lingling Li, Li-Tao Tong, Jiaxin Rui, He Li, Huijuan Zhang, Xinqi Liu Abstract Ergosterol is the common sterol found in edible mushrooms. This study investigated the cholesterol-reducing effect of ergosterol and its related potential mechanism in Sprague-Dawley rats. Thirty-two male rats were divided into four groups fed either a basic diet (NG) or one of three experimental diets, namely high-cholesterol diet (HC), and the two HC diets containing 0.5% ergosterol (EL) and 1.5% ergosterol (EH), respectively, for 8 weeks. Results demonstrated that feeding EL and EH diets decreased serum total cholesterol (TC) by 19.4–21.6%, low density lipoproptein cholesterol (LDL-C) by 42.0–42.6%, and TC/HDL-C ratio by 7.1–10.5%. This was accompanied by 46.8–53.2% reduction in liver cholesterol and 51.0–59.3% increase in fecal cholesterol excretion with up-regulation on gene expression of liver sterol regulatory element-binding protein 2 (SREBP-2), low-density lipoprotein receptor (LDL-R) and Hydroxy-3-Methylglutaryl-Coenzyme A Reductase (HMG-CoR). Results from micelles formation assay in vitro clearly demonstrated that ergosterol could significantly inhibit the entry of cholesterol into micelles. Therefore, the cholesterol-reducing effect of ergosterol was regulated by suppressing intestine cholesterol absorption and promoting the excretion of fecal cholesterol via modulating the expression of hepatic cholesterol-related genes. Graphical abstract

Strawberry tree honey as a new potential functional food. Part 2: Strawberry tree honey increases ROS generation by suppressing Nrf2-ARE and NF-кB signaling pathways and decreases metabolic phenotypes and metastatic activity in colon cancer cells Publication date: June 2019 Source: Journal of Functional Foods, Volume 57 Author(s): Sadia Afrin, Tamara Y. Forbes-Hernández, Danila Cianciosi, Francesca Pistollato, JiaoJiao Zhang, Mattia Pacetti, Adolfo Amici, Patricia Reboredo-Rodríguez, Jesus Simal-Gandara, Stefano Bompadre, Josè L. Quiles, Francesca Giampieri, Maurizio Battino Abstract The aim of the present study was to evaluate the effects of Strawberry tree honey (STH) on oxidative stress, metabolic phenotype, migration, invasion and epithelial-mesenchymal transition in adenocarcinoma (HCT-116) and metastatic (LoVo) colon cancer cells as well as in human dermal fibroblasts (HDF). Significant oxidative stress was observed through the increase of intracellular ROS generation, lipid and protein damage and reduction of antioxidant enzyme activities in colon cancer cells; in HDF these effects were limited or none. The expression of NF-кB, p-IкBα, Nrf2 was suppressed after STH treatment in colon cancer cells. All the parameters of mitochondrial respiration and glycolysis were reduced after STH treatment in cancer cells, while they were unchanged in HDF. Wound-closure percentages and the expression of MMP-2, MMP-9, N-cadherin, β-catenin decreased, while those of E-cadherin increased after STH treatment in colon cancer cells. Thus, STH can be used for its potential in cancer prevention. Graphical abstract

Daily intake of Lactobacillus gasseri CP2305 relieves fatigue and stress-related symptoms in male university Ekiden runners: A double-blind, randomized, and placebo-controlled clinical trial Publication date: June 2019 Source: Journal of Functional Foods, Volume 57 Author(s): Daisuke Sawada, Yuki Kuwano, Hiroki Tanaka, Susumu Hara, Yoshihide Uchiyama, Tomonori Sugawara, Shigeru Fujiwara, Kazuhito Rokutan, Kensei Nishida Abstract The heat-inactivated, enteric-colonizing Lactobacillus gasseri CP2305 (CP2305) ameliorates psychological stress-related symptoms. In this study, we examined effects of CP2305 on top athletes experiencing physical and mental stresses. Forty-nine male university Ekiden (long distance relay race) runners daily took the CP2305-containing beverage for 12 weeks during training for and competing in All-Japan university championships. The CP2305 intake significantly facilitated recovery from fatigue and relieved anxiety and depressive mood, compared with placebo intake. The CP2305 intake significantly prevented the training-induced reduction of hemoglobin and facilitated exercise-induced increase in serum growth hormone levels. The CP2305 intake significantly increased the alpha- and beta-diversities of fecal microbiota, and the compositions of Bifidobacteriumand Faecalibacterium. Gene expression profiling of peripheral blood leukocytes indicated that CP2305 prevented the stress-induced changes in the expression of genes related to mitochondrial functions. Our results suggest that daily intake of paraprobiotic CP2305 may be beneficial to athletes facing stressful situations. Graphical abstract

Soyasaponin Ab alleviates postmenopausal obesity through browning of white adipose tissue Publication date: June 2019 Source: Journal of Functional Foods, Volume 57 Author(s): Han-Jun Kim, Eun-Ji Choi, Hyo Sung Kim, Chan-Woong Choi, Sik-Won Choi, Sun-Lim Kim, Woo-Duck Seo, Sun Hee Do Abstract Postmenopausal obesity is becoming a serious global health concern. Soyasaponin Ab (SA) inhibits adipocyte differentiation; however, the preventive and therapeutic potential of SA in postmenopausal obesity has not been clearly established. Here, we investigated the anti-obesity effects of SA in postmenopausal obesity in vitro and in vivo. SA inhibited adipocytic differentiation of 3T3-L1 cells and reduced lipid accumulation and lipid droplet formation. Moreover, SA significantly decreased weight gain, adipocyte area, serum metabolic profiles in OVX mice. SA also inhibited the lipid metabolism-related factors but increased the thermoregulatory factors in both in vitro and in vivo. SA treatment further increased energy expenditure through beige fat activation. Overall, we found that SA effectively accelerated energy consumption by stimulating beige fat activation, even under estrogen-deficient conditions. Thus, SA treatment may be a promising strategy for the prevention of postmenopausal obesity by promoting weight loss, reducing fat accumulation, and improving obesity-related metabolic disorders. Graphical abstract

Strawberry tree honey as a new potential functional food. Part 1: Strawberry tree honey reduces colon cancer cell proliferation and colony formation ability, inhibits cell cycle and promotes apoptosis by regulating EGFR and MAPKs signaling pathways Publication date: June 2019 Source: Journal of Functional Foods, Volume 57 Author(s): Sadia Afrin, Francesca Giampieri, Danila Cianciosi, Francesca Pistollato, Johura Ansary, Mattia Pacetti, Adolfo Amici, Patricia Reboredo-Rodríguez, Jesus Simal-Gandara, Josè L. Quiles, Tamara Y. Forbes-Hernández, Maurizio Battino Abstract The aim of this work was to assess the phytochemical composition and anticancer effects of Strawberry-tree honey (STH) on cellular proliferation, cell cycle and apoptosis in human colon adenocarcinoma (HCT-116) and metastatic (LoVo) cancer cells. Kaempferol and gallic acid were the major phenolic compounds. STH showed higher cytotoxic and anti-colonogenic effects in a time- and dose-dependent manner; it arrested cell cycle in S and G2/M and regulated cell cycle genes, such as cyclin D1, cyclin E, CDK2, CDK4, p21Cip, p27Kip and p-RB. STH treatment promoted apoptosis by modulating key genes (p53, caspase-3, c-PARP) as well as intrinsic (Bax/Bcl2, Cyto C and caspase-9) and extrinsic (Fas L and caspase-8) apoptotic factors. STH also caused endoplasmic reticulum stress by increasing ATF-6 and XBP-1 expressions, suppressed EGFR, HER2 and downstream markers (p-Akt and p-mTOR) and elevated p-p38MAPK and p-ERK1/2. In conclusion, STH have shown a chemo-preventive action on different colon cancer cell models. Graphical abstract

Improvement of bioavailability for resveratrol through encapsulation in zein using electrospraying technique Publication date: June 2019 Source: Journal of Functional Foods, Volume 57 Author(s): Heera Jayan, M. Maria Leena, S.K. Sivakama Sundari, J.A. Moses, C. Anandharamakrishnan Abstract Resveratrol has proven antioxidant, anticancer, anti-inflammatory and cardioprotective effects. However, poor water solubility, low bioavailability and UV light sensitivity hinder its usage in food applications. Encapsulation of resveratrol can help to overcome these problems. In this work, encapsulation by electrospraying was adopted, owing to the possibility of obtaining spherical and nano-sized particles at room temperature. This study proved that resveratrol can be efficiently encapsulated with zein without modifying its native form. Size of nanoencapsulated particles obtained ranged from 230 to 330 nm. Nanoencapsulation through electrospraying process yielded 68.49% encapsulation efficiency at 1:50 resveratrol to zein w/w%. Further, nanoencapsulated resveratrol showed better stability and sustained release profiles as compared to the unencapsulated form. Nanoencapsulation with zein protected resveratrol in simulated stomach conditions and released resveratrol in the intestinal condition. Additionally, nanoencapsulated resveratrol showed increased permeability of 1.15 fold in ex-vivo dynamic engineered small intestinal system which in turn relates to improved bioavailability. Prepared nanoparticles can be used for oral administration by incorporation into food products or in tablet form. Graphical abstract

Comparative analysis of prebiotic effects of seaweed polysaccharides laminaran, porphyran, and ulvan using in vitrohuman fecal fermentation Publication date: June 2019 Source: Journal of Functional Foods, Volume 57 Author(s): Hyunbin Seong, Jae-Han Bae, Ji Sun Seo, Seul-Ah Kim, Tae-Jip Kim, Nam Soo Han Abstract Laminaran, porphyran, and ulvan are major seaweed polysaccharides in brown, red, and green algae, respectively. We compared their prebiotic effects using individual microbial fermentability test and in vitro fecal fermentation. The fermentability test showed that these polysaccharides were selectively utilized by Bifidobacteria, Lactobacilli, and Bacteroides (ΔOD580 nm, 0.2–1.0), while no growth of harmful bacteria was observed. In vitro fecal fermentation for 24 h showed growth stimulation effect of laminaran on Bifidobacteria (Δ8.3%/total bacteria) and Bacteroides (Δ13.8%/total bacteria) promoting the production of acetate and propionate. Ulvan exhibited same result on Bifidobacteria (Δ8.5%/total bacteria) and Lactobacillus (Δ6.8%/total bacteria) promoting the production of lactate and acetate; however, porphyran showed little prebiotic effect. Laminaran was fermented slowly compared to fructooligosaccharides and this may permit production of short-chain fatty acids in distal colon. This in vitro study demonstrates that the seaweed polysaccharides tested, particularly laminaran and ulvan, have prebiotic effects on microbiota in human colon. Graphical abstract

Effect of Konjac mannan oligosaccharides on diphenoxylate-induced constipation in mice Publication date: June 2019 Source: Journal of Functional Foods, Volume 57 Author(s): Xiaoyan Liu, Sai Chen, Qiaojuan Yan, Yanxiao Li, Zhengqiang Jiang Abstract The effects of Konjac mannan oligosaccharides (KMOS) on diphenoxylate-induced constipation in mice were investigated in the present study. After administration with KMOS at 1800 mg/kg·bw, the weight and number of black feces within 24 h, and the gastrointestinal transit ratio were distinctly increased by 96.8%, 156.5% and 45.3%, respectively. Furthermore, KMOS regulated the levels of enteric nervous system parameters, including motilin, somatostatin, substance P, acetyl cholinesterase, endothelin and vasoactive intestinal peptide. Additionally, KMOS could recover the characteristics of small intestine villi and inhibit the reduction of mucosal thickness. KMOS administration produced more short chain fatty acids and lactic acid compared with the control group. The availability of 5-hydroxytryptamine and the expression of serotonin transporter were ameliorated in the KMOS treatment groups. Collectively, these findings suggested that KMOS could be considered as a functional food material for regulating intestinal function and alleviating constipation. Graphical abstract

Attenuation of high-fat diet-induced fatty liver through PPARα activation by stevioside Publication date: June 2019 Source: Journal of Functional Foods, Volume 57 Author(s): Chang-Hao Jia, Jun-Yan Zhang, Wei Shen, Xi Zhao, Mei-Lin Xie Abstract This study aimed to investigate the effect of stevioside on fatty liver. Rats with hyperlipidemic fatty liver were treated with 75–150 mg/kg stevioside for 6 weeks. After oral administration of stevioside, the levels of serum and hepatic lipids and degree of hepatic steatosis were decreased. Stevioside treatment increased the expressions of hepatic peroxisome proliferator-activated receptor (PPAR)α and carnitine palmitoyltransferase-1A proteins and decreased the expressions of hepatic sterol regulatory element-binding protein-1c, fatty acid synthase and diacylglycerol acyltransferase proteins. Following treatment of oleic acid-stimulated hepatocytes with 100–400 μM stevioside, the intracellular lipids were also decreased. In the hepatocytes of PPARα gene silence, the lipid-lowering effect of stevioside was abolished, and its regulatory effects on PPARα-mediated target proteins were reversed. These findings demonstrated that stevioside was effective in treating fatty liver, and its mechanisms were associated with the increment of hepatic PPARα expression and subsequent modulation of its target gene expressions. Graphical abstract

In vitro probiotic properties of selected lactobacilli and multi-strain consortium on immune function, gut barrier strengthening and gut hormone secretion Publication date: June 2019 Source: Journal of Functional Foods, Volume 57 Author(s): Yanath Belguesmia, Jeanne Alard, Rezak Mendil, Rozenn Ravallec, Corinne Grangette, Djamel Drider, Benoit Cudennec Abstract Lactobacillus reuteri ICVB395, L. gasseri ICVB392 and L. gasseri ICVB396 strains, isolated from vaginal microbiota, were investigated for their probiotic traits. L. reuteri ICVB395 strain and the 3RG consortium, associating these three Lactobacillus strains, showed the best anti-inflammatory profile on peripheral blood mononuclear cell (PBMC) while L. gasseri ICVB392 was the most potent together with the 3RG consortium to strengthen a Caco-2-derived epithelial barrier. The three studied strains induced various secretion levels of glucagon-like peptide 1 (GLP-1) and cholecystokinin (CCK) by STC-1 enteroendocrine cells, whereas the 3RG consortium was globally less performing. Specific antagonists of protein G receptors, CaSR (Calcium-Sensing Receptor) and GPRC6A (G protein-coupled receptor family C group 6 member A), and inhibitor of the peptide transporter Pept-1 provoked differential modulation of the GLP-1 and CCK secretion by STC-1 cells, indicating that different mechanisms are involved in the capacity of lactobacilli and the 3RG to modulate gut hormones secretion. Graphical abstract

Neonatology

Incidence of meningitis in neonates with late-onset sepsis at a Tertiary Care Center in Western India: An observational study Sameet Umate, Bhawan Deep Garg, Nandkishor S Kabra Journal of Clinical Neonatology 2019 8(2):67-70 Objective: The objective of this study was to determine the incidence of meningitis in neonates with late-onset sepsis (LOS) in the West India population. Materials and Methods: This prospective observational study enrolled 208 neonates with signs and symptoms suggestive of sepsis with positive C-reactive protein at or more than 72 h of postnatal age. Results: Out of total 208 neonates with LOS, 12.5% neonates had meningitis. The incidence of LOS in preterm and low-birth-weight neonates were 73.6% and 72.1%, respectively. Most common presenting features in neonates with LOS with or without meningitis were respiratory distress (72.6%), followed by lethargy (68.8%) and refusal to feed (63%). Blood culture was positive in 53.8% neonates who had meningitis. Mortality in neonatal meningitis was 3.84%. Conclusion: This study demonstrated that a significant number of neonates with LOS have coexistent neonatal meningitis. Our study highlights the diagnostic utility of routine lumbar puncture in neonates with clinical features of sepsis.

Experience of tracheo-esophageal fistula in neonates in a Tertiary Care Center - Case series Siddu Charki, MK Priyadarashini, Laxmi Hadalgi, Surendra Agarwal, Trimal Kulkarni, Ramaning Loni, Laxman H Bidari Journal of Clinical Neonatology 2019 8(2):71-74 Introduction: Tracheoesophageal fistula (TEF) is one of the most common neonatal emergencies. The most common presentation being polyhydramnios detected antenatally, excessive salivation and vomiting, respiratory distress after birth, recurrent pneumonia later in life. The incidence is 1 in 3000 to 1 in 4500 live births. Clinical Profile: Of 1206 admissions in 2017 to the neonatal intensive care unit (NICU), 51 required surgery. Out of which 11 babies were diagnosed with TEF and were subjected to surgery. Antenatal scans revealed polyhydramnios in four babies. Nine babies were born at term with an average weight of 2–2.5 kg and two babies were born preterm at 30 weeks (1.3 kg) and 32 weeks (1.8 kg). Eight babies presented on day 1–2 of life and three babies on day 2–3. The most common clinical presentation was excessive frothing from the mouth noticed since birth and respiratory distress. Nine babies (82%) presented with chest infection of varying severity. Only two babies (18%) had a clear chest. Babies were stabilized in NICU and connected to Replogle tube with continuous negative suction. All babies were subjected to surgery within 24 h of admission. Type C was the most common. Babies were subjected to contrast study to rule out anastomotic leak. Feeding initiated after 72 h of life and was gradually started on trophic feeds and reached full feeds. Outcome: Out of 11 babies, 9 babies recovered and were discharged. One baby was discharged against medical advice and one baby died due to sepsis. Growth is satisfactory and development has been normal at 1 year of age in all discharged babies at follow-up. Discussion: Success in the survival of neonate with TEF is attributed to improved neonatal intensive care with surgical advances and postoperative care. Early recognition, prompt and efficient management of the cases was possible due to multidisciplinary approach by neonatologist, intensivist, and the surgeon. A precise surgical technique with proper mobilization of upper pouch and good anastomosis is key events.

Retrocolic isoperistaltic gastrojejunostomy as an alternative to Kimura's duodenoduodenostomy in low- and very low-birth-weight babies of duodenal atresia: A 5 year retrospective study Apoorva Kulkarni, Abhaya Gupta, Paras Kothari, Shalika Jayaswal, Vishesh Dikshit, Geeta Kekre Journal of Clinical Neonatology 2019 8(2):75-78 Background: Duodenal atresia is a frequent occurrence in babies requiring emergent surgical intervention. Conventionally, Kimura's diamond duodenoduodenostomy has been considered as the gold standard. However, in low-birth-weight (LBW), very LBW (VLBW), and extremely LBW (ELBW) babies, we have found it to be a procedure that is not well tolerated and resulted in mortality. In these conditions, a retrocolic isoperistaltic gastrojejunostomy is well tolerated by patients. Most of the patients that public hospitals cater to are from the lower socioeconomic strata belonging to poor families, immigrant population, and daily wagers. Aim: The aim of the study is to evaluate gastrojejunostomy as an alternative to Kimura's duodenoduodenostomy in LBW, VLBW, and ELBW neonates having duodenal atresia without major cardiac malformations. Materials and Methods: We did a retrospective analysis of all patients with birth weight <2 kg operated for duodenal atresia in our institute in the last 5 years (2012–2017). Neonates having cardiac abnormality were excluded from the study. Patients were followed up regularly. Results: Out of 5 neonates operated for gastrojejunostomy, all survived postoperatively. Out of 4 neonates operated for Kimura's duodenoduodenostomy, none survived postoperatively. Most common cause of mortality was sepsis and anastomotic leak. Conclusion: In a setting of LBW and VLBW deliveries, gastrojejunostomy is a good alternative to duodenoduodenostomy achieving favorable results.

Adverse events following blood exchange transfusion for neonatal hyperbilirubinemia: A prospective study Swathi Chacham, Jogender Kumar, Sourabh Dutta, Praveen Kumar Journal of Clinical Neonatology 2019 8(2):79-84 Background: Exchange transfusion (ET) for hyperbilirubinemia is associated with many complications. The complications are underreported as most of the published studies are retrospective, used varying definitions of adverse events (AEs) and variable follow-up periods. Aim: We evaluated the incidence of clinical, biochemical, hematological, and radiological AEs, including serious AEs, within 2 weeks of ET for hyperbilirubinemia in neonates, using standard definitions. Materials and Methods: This prospective observational study was conducted in level III newborn unit of north India from February 2008 to February 2009. We enrolled consecutive inborn and outborn neonates admitted with hyperbilirubinemia and required ET. Babies requiring partial exchange for anemia/polycythemia or ET for indications other than hyperbilirubinemia were excluded. They were prospectively monitored for clinical, biochemical, hematological, and radiological AEs up to 2 weeks following the procedure. We calculated the incidence/AE rate (AER) as the rate of events per 100 ET and compared them among various groups using the Chi-square test. The SPSS v20 was used for the analysis, and value of P < 0.05 was considered as statistically significant. Results: A total of 202 neonates were screened and 141 neonates (182 ET) were enrolled. The overall AER was 112/100 ETs. The most common AE was biochemical (45.6/100 ET), followed by hematological (44.5/100 ETs), clinical (15.9/100 ETs), and radiological (8.9/100 ETs). Severe AER was 12.6/100 ETs. The AER was significantly more in lower gestation and birth weight groups. Conclusion: ET is a high-risk procedure and should be performed only when the benefit of the procedure offsets the risks.

Study of feeding practice and factors influencing it among preterm babies getting Kangaroo mother care in a Tertiary Care Hospital Gargi Gayen, Arijit Bhowmik, Mausumi Nandy Journal of Clinical Neonatology 2019 8(2):85-89 Background: Kangaroo mother care (KMC) is an effective way to reduce mortality and morbidity of low-birth-weight babies. KMC feeding aims at the establishment of exclusive breastfeeding (EBF) for every baby. This study was conducted to analyze the actual feeding pattern and factors influencing it. Methods: Babies getting KMC were prospectively observed and the data related to feeding practice were collected. At discharge, the babies were divided into two groups: EBF and non-EBF. Different factors were compared between these groups. Results: Among 387 babies, 63.56% were on EBF. Postnatal counseling, early contact and initiation of feeding, early expression of breast milk, and first feeding with EBM played a pivotal role behind the establishment of EBF (P < 0.0001). Longer duration of KMC marginally helped in EBF (P = 0.0445). Conclusion: To establish EBF in KMC, the promotional measures should be taken since birth even when the baby was critically sick and separated from the mother and KMC was not initiated yet.

Evaluation and comparison of stool calprotectin level in necrotizing enterocolitis infected and noninfected neonates of <1500 g Behzad Barekatain, Hossein Saneian, Ardalan Ebrahimi, Behzad Mahaki Journal of Clinical Neonatology 2019 8(2):90-95 Background: Necrotizing enterocolitis (NEC) is one of the most prevalent digestive emergencies in neonates, leading to mortality and morbidity in premature neonates. Since there is no specific test for NEC diagnosis, only clinical symptoms and radiological findings are used for diagnosis. Therefore, if a reliable biomarker found to detect NEC, it can help to reduce the mortality and morbidity; hence, the present study evaluated the stool calprotectin levels in the infected and noninfected neonates weighing &#60;1500 g. Methods: This case-control study was performed on 35 neonates with NEC and 35 healthy neonates. Demographic information and calprotectin levels were measured, and the values were recorded and compared between the two groups. Results: The results of this study revealed that the level of stool calprotectin in the case group with the mean of 459.66 &#177; 172.63 was significantly higher than the control group with the mean of 103.03 &#177; 30.97 (P &#60; 0.001). Furthermore, the level of calprotectin had a significant relation with the severity of the disease. Moreover, this biomarker can be a good diagnostic criterion for detecting NEC (cutoff &#62;176 &#956;g/g, sensitivity &#61; 97.14&#37;, Specificity &#61; 100&#37;, P &#60; 0.0001). Conclusion: Given that the level of calprotectin in the stool was not associated with factors such as the sex of neonate, gestational age, birth weight, and type of delivery, it appears that stool calprotectin level can be used as a reliable biomarker for NEC diagnosis.

Incidence and Predictors of Neonatal Malaria among Newborns admitted within the first 28 days of Life to a Tertiary Healthcare Facility in South-East Nigeria Linda Nwokeji-Onwe, Abraham B Onwe, Kenechukwu K Iloh, Uzoamaka Muoneke, Nnaemeka K Omeje, Ogochukwu Iloh, Chidiebere D I Osuorah Journal of Clinical Neonatology 2019 8(2):96-101 Background: The burden of malaria in newborn babies has been a subject of concern as there are variations in published reports. However, incidence and prevalence of malaria parasitemia among newborn babies aged zero to 28 days has not been well reported in Nigeria. Objective: This work sought to determine the incidence of malaria parasitemia in newborn babies aged 0&#8211;28 days and determinants of malaria parasitemia in these newborns. Methodology: This descriptive study was conducted over a 7-month period. Four hundred and thirty neonates admitted in the Federal Teaching Hospital Abakaliki that met the inclusion criteria were consecutively enrolled after obtaining consent from their parent(s)/caregiver. Data on sociodemographics of the mother and neonates were obtained using interviewer-administered questionnaire. Blood samples were collected from neonates for malaria parasitemia using blood film microscopy. Results: Of the 430 newborns admitted during the study period, 19 (4.4&#37;) had neonatal malaria with 94.7&#37; (18/19) of those diagnosed between birth and the 7th day of life. This resulted to an in-hospital incidence rate of 44.19 (95&#37; confidence interval 24.33&#8211;64.05) per 1000 admitted newborns. Only the use of insecticide-treated bed net during pregnancy was significantly associated with reduction of malaria transmission from the mother to their babies. Conclusions: Malaria in neonates is a prevalent but commonly overlooked cause of morbidity in newborn in the first 28 days of life. Adequate measures to prevent malaria infection in pregnant mothers could help in reducing morbidity and mortality associated with malaria in neonates.

Comparison of efficacy of nasal continuous positive airway pressure and heated humidified high-flow nasal cannula as a primary mode of respiratory support in preterm infants Pravesh Kumar Sharma, Anil Kumar Poonia, Rajiv Kumar Bansal Journal of Clinical Neonatology 2019 8(2):102-105 Background: Nasal continuous positive airway pressure (NCPAP) is a well-recognized mode of noninvasive respiratory support (NIV) for newborns with respiratory distress. Evidence for the heated humidified high-flow nasal cannula (HHHFNC) as an alternative mode of respiratory support is scarce. The aim of this work was to evaluate whether HHHFNC is equally efficacious to NCPAP as providing primary respiratory support in the first 6 h of life for preterm neonates with respiratory distress. Methods: Preterm infants (gestation 26&#8211;34 weeks) with respiratory distress were randomized to either HHHFNC or NCPAP. The primary outcomes of the study were inferred in terms of total duration of NIV support (in hours) and total duration of oxygen supplementation (NIV &#43; oxyhood/oxygen by nasal prongs) required. The secondary outcomes measured and compared between the two study groups were total time taken to reach full feeds; incidence and severity of nasal trauma; incidence of air leaks, bronchopulmonary dysplasia, patent ductus arteriosus, and retinopathy of prematurity. Results: The mean duration of NIV support in NCPAP and HHHFNC group was 69.1 &#177; 37.75 and 67.57 &#177; 45.48 h, respectively (P &#61; 0.867). The mean durations of total oxygen supplementation in NCPAP and HHHFNC groups were 96.88 &#177; 100 and 83.73 &#177; 107 h, respectively (P &#61; 0.062). The failure rate was similar in both the study groups (P &#61; 1.000). Conclusions: We conclude from the present study that HHHFNC is equally efficacious to NCPAP as a primary mode of respiratory support for respiratory distress in preterm infants.

Knowledge, attitude, and practice study on awareness of retinopathy of prematurity among pediatricians in Goa Tanvi Poy Raiturcar, Jagadish A Cacodcar, Anagha Dubhashi, Marushka Aguiar Journal of Clinical Neonatology 2019 8(2):106-109 Context: The improvement in neonatal care has led to more number of premature infants surviving. This has led to more number of babies requiring screening for retinopathy of prematurity (ROP). Thus, there is a need to bridge the knowledge gap between pediatricians and ophthalmologists for ROP management. Limited studies done among pediatricians across India had shown that there is a need for greater awareness and timely screening of pre-terms for ROP. No such study was carried out in Goa and adjoining Western India. Hence, the present study was undertaken. Aims: The aim of the study is to assess the knowledge, attitude, and practices about ROP among practicing pediatricians in Goa. Settings and Design: This is a cross-sectional study. Materials and Methods: A pretested pro forma was given to 58 pediatricians, which contained 19 questions related to their educational and practice profile, about the risk factors for ROP, screening protocol, referral criteria, facilities for referral, treatment options, and problems faced by them for referral of babies requiring treatment for sight-threatening ROP. Statistical Analysis Used: Percentages and proportions are used for analysis. Results: Among the 58 pediatricians, 75.86&#37; were practicing in government hospitals including Goa Medical College and Hospital, whereas 14 (24.13&#37;) were private practitioners. 50&#37; had been practicing for 5&#8211;10 years. All participants had heard about ROP and were aware of the most common risk factors for ROP. 87.93&#37; were aware of the timing of first screening of preterm infants for ROP; 84.48&#37;were aware of referral to an ophthalmologist for screening and management of ROP. 77.58&#37; had knowledge about the treatment modalities. 56.89&#37; reported that they faced barriers to referral. Conclusions: There is a very high level of awareness among pediatricians in Goa about the risk factors and screening of ROP.

Encouraging the use of mother's own milk as first feed for preterm and very low birth weight neonate admitted to the neonatal intensive care unit: A quality improvement initiative Ravi Sachan, Sonia Thomas, Boby Varghese, Aaradhana Singh Journal of Clinical Neonatology 2019 8(2):110-115 Objectives: Benefits of mother&#39;s only milk (MOM) for preterm infants are numerous. We realized that usage of MOM in our unit is less and often delayed for days. The proportion of MOM usage as the first feed after birth of total feed, was only 19&#37;. In view of this existing evidence and identified problem, we decided to start quality improvement (QI) initiative in our unit with the primary objective &#8220;To encourage the use of MOM as first feed in preterm (PT) and very low birth weight (VLBW) neonate from existing 19&#37; to &#62;50&#37; over a period of 3 month.&#8221; Materials and Methods: This QI study involved the systematic implementation of evidence-based practices using Point of Care QI methodology developed by the WHO-SEARO. Results: After several Plan, Do, Study, Act, during the intervention phase, usage of MOM increases from baseline 19&#37; to 91.3&#37;. Postintervention, sustained usage of MOM after 6 months is at close to 80&#37;. Conclusions: Effective implementation of comprehensive communication bundles (CCB) is feasible in resource-constraint setting and resulted in sustained increase in the usage of MOM in PT and VLBW neonates.

Mycopathologia

Favus of Scrotum Due to Trichophyton rubrum in Immunocompetent Patients: A Clinical, Mycological and Ultrastructural Study Abstract Purpose To characterize the clinical and mycological features of favus of scrotum due to Trichophyton rubrum. Methods A single-site prospective study was carried out in an outpatient dermatology clinic. Microscopic examination and fungal culture were done using skin scrapings. Scales on the scrotum were stained with PAS and visualized by microscopy, including in vivo reflectance confocal microscopy (RCM). Two strains were analyzed by RAPD typing. Scutular lesions were fixed for scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Results Cultures of the scale from the scrotum and/or groin in all patients showed a growth of T. rubrum. T. rubrum strains from scrotum and groins in one patient were demonstrated as the same strain by RAPD typing. The average age of patients was 34.1 ± 12.78 years. The mean course was 8.2 ± 5.07 days. All the patients received only topical treatment for 2 weeks without recurrence. Direct smear, calcofluor-white staining and in vivo RCM study of the scrotal favus in patients showed a massive number of septate branching hyphae, while fewer septate hyphae in scales in the groin. Abundant hyphae were found only in the outer layer of the stratum corneum of the scrotum under SEM and TEM with intact bilateral cell walls, and normal nucleus, liposomes and reticulum. Few distorted hyphae structures, cell wall degeneration, degenerated cytoplasm and the autophagy phenomenon could be seen in scales from groin under TEM. Conclusions Scrotal favus due to T. rubrum is still a true infection, which most often occurred in immunocompetent patients.

Molecular and Phenotypic Characterization of Nannizzia ( Arthrodermataceae ) Abstract Phylogenetic studies of the family Arthrodermataceae have revealed seven monophyletic dermatophyte clades representing the genera Trichophyton, Epidermophyton, Nannizzia, Lophophyton, Paraphyton, Microsporum, and Arthroderma. Members of the genus Nannizzia are geo- or zoophiles that occasionally infect humans. With the newly proposed taxonomy, the genus Nannizzia comprises thirteen species, i.e., Nannizzia aenigmatica, N. corniculata, N. duboisii, N. fulva, N. graeserae, N. gypsea, N. nana, N. incurvata, N. perplicata, N. persicolor, N. praecox, and two novel species. Nannizzia polymorpha sp. nov. was isolated from a skin lesion of a patient from French Guiana. For the strain originally described as Microsporum racemosum by Borelli in 1965, we proposed Nannizzia lorica nom. nov. The species are fully characterized with five sequenced loci (ITS, LSU, TUB2, RP 60S L1 and TEF3), combined with morphology of the asexual form and physiological features. A key to the species based on phenotypic and physiological characters is provided.

Antifungal Susceptibility Profile of Candida Albicans Isolated from Vulvovaginal Candidiasis in Xinjiang Province of China Abstract We investigated the antifungal susceptibility profiles of 207 independent Candida albicans strains isolated from patients with vulvovaginal candidiasis (VVC) in Xinjiang Province of China. Using CLSI M27-A3 and M27-S4 guidelines, anidulafungin and micafungin were the most active drugs against C. albicans showing an MIC50/MIC90 corresponding to 0.016/0.0313 µg/mL, followed by caspofungin (0.25/0.25 µg/mL), posaconazole (0.125/0.5 µg/mL), ravuconazole (0.063/1 µg/mL), itraconazole (0.125/1 µg/mL), amphotericine B (0.5/1 µg/mL), isavuconazole (0.063/2 µg/mL), 5-flucytosine (1/2 µg/mL), voriconazole (0.125/4 µg/mL), and fluconazole (0.5/4 µg/mL). 96.1% (199)–100.0% (207) isolates were sensitive to the three echinocandins tested, amphotericine B and 5-flucytosine. The in vitro activity of triazoles against all isolates tested was variable; itraconazole and voriconazole had reduced the activity to almost half of the isolates (55.1% (114) and 51.2% (106) susceptible, respectively). Fluconazole was active against 76.3% (158) isolates tested. The new triazoles ravuconazole, isavuconazole and posaconazole showed good in vitro potency against 89.9% (186)–95.2% (197) of isolates with the geometric mean MIC (µg/mL) of 0.10, 0.12 and 0.14 µg/mL, respectively. In conclusion, our study indicates that for effective management of systemic candidiasis in Xinjiang Province of China, it is important to determine the susceptibility profiles of isolated C. albicans from patients with VVC.

Elbow Malformation with Osteoarthritis and Bone Destruction Caused by Chromoblastomycosis

Persistent hematogenous dissemination in pulmonary P. jiroveci infection Abstract Pneumocystis jiroveci pneumonia in non-HIV patients is infrequent and characterized by atypical presentations and increased severity. Although hematogenous dissemination from the lungs can lead to extrapulmonary infections, isolation of oocysts from blood in human subjects has not been documented. We report a case of P. jiroveci pneumonia with persistent isolation of oocysts from blood and positivity of P. jiroveci polymerase chain reaction. The patient presented with bilateral diffuse pulmonary nodules and received prolonged treatment with trimethoprim/sulfamethoxazole.

Fungal Keratitis Caused by Colletotrichum dematium : Case Study and Review Abstract Colletotrichum species are known as important pathogens of plants with an impact on crop production. Some of these species are also known as a cause of rare ophthalmic infections in humans. A case of keratitis caused by Colletotrichum dematium after corneal trauma in a 56-year-old woman is presented. Infection was diagnosed based on positive microscopy and culture. The fungal isolate was identified by morphological characteristics and DNA sequencing of the ITS rDNA region, β-tubulin (tub2) and glyceraldehyde-3-phosphate dehydrogenase (gapdh) genes. The patient responded well to topical therapy with amphotericin B combined with intravenous amphotericin B but improvement was associated with the corneal collagen cross-linking. The review of the literature revealed another 13 cases of C. dematium keratitis, all but one patient having at least one keratitis risk factor in their history. Almost all patients (n = 12) were treated with topical polyene antibiotics (natamycin or amphotericin B), improvement and cure were achieved in eight of them.

A Large Deep Skin Ulcer as an Initial Manifestation of Systemic Cryptococcosis Abstract An 82-year-old woman presented to our hospital with a deep skin ulcer in her right lower limb. Although the skin biopsy showed necrosis and neutrophil infiltration, we could not initially detect any pathogen. Chest radiography showed multiple nodules despite the lack of respiratory symptoms or fever, and the serum latex agglutination test for cryptococcus showed an elevated titer (1:512). Considering these findings, we performed additional stains of periodic acid–Schiff reaction and Grocott to the skin-biopsy specimen and detected multiple yeast-like fungi. The cultures of the skin and lung-biopsy specimens revealed Cryptococcus neoformans. In this case, it is suggested that a large deep skin ulcer can be an initial manifestation of systemic cryptococcosis, as, in some cases, pulmonary cryptococcosis may be asymptomatic. Second, cutaneous cryptococcosis of an unexposed area such as the thigh can contribute to the diagnosis of systemic cryptococcal infection because it is attributable to bloodstream dissemination from other organs.

Isolation of Aspergillus caninus (Synonym: Phialosimplex caninus ) from a Canine Iliac Lymph node Abstract Aspergillus caninus (synonym: Phialosimplex caninus) is an anamorphic fungus species associated with systemic infections in dogs that has been transferred from the genus Phialosimplex to Aspergillus. Here, we report the first case of canine A. caninus infection in Japan. A castrated Japanese Shiba Inu (6 years old; weight, 12.5 kg) was referred to the Yamaguchi University Animal Medical Center, Yamaguchi, Japan, in June 2017 showing vitality loss and depression. Computed tomography revealed iliac and splenic hilum lymphopathies, and histologic examination of an iliac lymph node by biopsy revealed granulomatous lesions with numerous oval to round yeast-like fungal cells. Aspergillus caninus was isolated from the biopsy samples, and in vitro susceptibility tests of the isolate to the antifungal drugs amphotericin B (AMB), fluconazole (FLZ), itraconazole (ITZ), voriconazole (VRZ), and micafungin (MCF) were performed by the E-test method. The isolate from this dog exhibited a minimal inhibitory concentration of < 0.002 µg/ml to AMB, > 256 µg/ml to FLZ, < 0.002 µg/ml to ITZ, < 0.002 µg/ml to VRZ, and < 0.002 µg/ml to MCF, indicating that the isolate was not susceptible to FLZ and susceptible to AMB, ITZ, VRZ, and MCF. Since the response of the patient dog to ITZ and VRZ treatments was poor, more aggressive management using combination therapies of ITZ with other antifungals may be necessary for treating canine A. caninus infection in dogs.

A Case of Chromoblastomycosis Caused by Fonsecaea Pedrosoi and Investigation of the Pathogenic Fungi

Disseminated Phaeohyphomycosis Caused by Curvularia tuberculata in a Previously Healthy Man Abstract Disseminated phaeohyphomycosis is an extremely rare clinical syndrome, especially in a host without apparent immunological defect. Here, we report a case of disseminated phaeohyphomycosis in a 22-year-old previously healthy man who showed nonmassive hemoptysis from diffuse lung nodules and cavities, together with a hard palate ulcer and generalized subcutaneous nodules. Histopathology, cultures and subsequent molecular assay from two different sites confirmed Curvularia tuberculata infection. The patient was successfully treated with amphotericin B and itraconazole.

Family Medicine and Primary Care

Universal health coverage – Time to dismantle vertical public health programs in India Raman Kumar Journal of Family Medicine and Primary Care 2019 8(4):1295-1296 Primary care has traditionally meant different concepts for developed and developing economies/countries. Immediately after independence, India pushed aside the recommendations of the Bhore committee, which was for implantation of comprehensive primary healthcare. Instead, we opted for the path of selective primary care modeled on vertical disease–based programs under the guidance of international development agencies. After several decades of implementing selective primary healthcare, India has now embarked upon ambitious journey of universal health coverage (UHC) with announcement of Ayushman Bharat – National Health Protection Mission. How much we resolve and how much we refer (90% vs 10% and 10% vs 90%) within primary care will determine the overall cost of the health system, be it out of pocket or publicly funded. Implementation of comprehensive primary healthcare and UHC along with existing disease focused vertical public health programs is a unique situation to India. Will the Indian economy be able to sustain the double burden of UHC and the vertical programs? Or is it indeed the time to dismantle the vertical programs and implement comprehensive primary care towards containing over all cost of the health system to the country. Continuing both may be a good bankruptcy plan.

NOMOPHOBIA: NO MObile PHone PhoBIA Sudip Bhattacharya, Md Abu Bashar, Abhay Srivastava, Amarjeet Singh Journal of Family Medicine and Primary Care 2019 8(4):1297-1300 The term NOMOPHOBIA or NO MObile PHone PhoBIA is used to describe a psychological condition when people have a fear of being detached from mobile phone connectivity. The term NOMOPHOBIA is constructed on definitions described in the DSM-IV, it has been labelled as a “phobia for a particular/specific things”. Various psychological factors are involved when a person overuses the mobile phone, e.g., low self-esteem, extrovert personality. The burden of this problem is now increasing globally. Other mental disorders like, social phobia or social anxiety, and panic disorder may also precipitate NOMOPHOBIC symptoms. It is very difficult to differentiate whether the patient become NOMOPHOBIC due to mobile phone addiction or existing anxiety disorders manifest as NOMOPHOBIC symptoms. The signs and symptoms are observed in NOMOPHOBIA cases include- anxiety, respiratory alterations, trembling, perspiration, agitation, disorientation and tachycardia. NOMOPHOBIA may also act as a proxy to other disorders. So, we have to be very judicious regarding its diagnosis. Some mental disorders can precipitate NOMOPHOBIA also and vice versa. The complexity of this condition is very challenging to the patients' family members as well as for the physicians as NOMOPHOBIA shares common clinical symptoms with other disorders. That's why NOMOPHOBIA should be diagnosed by exclusion. We have to stay in the real world more than virtual world. We have to re-establish the human-human interactions, face to face connections. So, we need to limit our use of mobile phones rather than banning it because we cannot escape the force of technological advancement.

Basthi Dawakhana of Hyderabad: The first Urban Local Body led community clinics in India Chandrakant Lahariya Journal of Family Medicine and Primary Care 2019 8(4):1301-1307 Basthi Dawakhana initiative was launched by the Greater Hyderabad Municipal Corporation (GHMC) in Telangana state of India, in April 2018. This article documents, reviews, and analyzes the key design aspects of Basthi Dawakhana, delve into why such clinics are important for strengthening primary health care in Indian cities and urban settings, and proposes a few strategies for implementation effectiveness. In the main text of the article, evolution of urban health services, national urban health mission in India, and Mohalla clinics of Delhi has been provided. The implementation challenges and potetnial solutions for scaling up Basthi Dawakhana have been discussed. The author argues that Basthi Dawakhana initiative is aligned with the 73rd and 74th amendments in the Constitution of India, which transferred the responsibilities for primary care and public health to the Urban Local Bodies (ULBs). The article concludes that Basthi Dawakhana are arguably the first ULB-led community clinics initiative and an opportunities for ULBs in India to lead efforts to strengthen primary healthcare. These Dawakahna along with Mohalla Clinics, can serve platform to reform urban primary healthcare services and advance universal health coverage (UHC) in the country.

Oral tuberculosis - Current concepts Supriya Sharma, Jyoti Bajpai, Pankaj K Pathak, Akshyaya Pradhan, Priyanka Singh, Surya Kant Journal of Family Medicine and Primary Care 2019 8(4):1308-1312 Tuberculosis (TB) is a chronic infectious disease that can affect various parts of the body including the oral cavity. It primarily affects the lungs. TB bacilli can spread hematogenously to different parts of the body and this also involves maxilla or mandible. Although oral lesions are infrequent, they are crucial for the early diagnosis and interception of primary TB. Intercepting the disease early will limit the morbidity and mortality of the patients. It becomes the responsibility of the dentist to include TB in the differential diagnosis of suspicious oral lesions to prevent delay in the treatment of the disease. It would not be an exaggeration if the dental identification of the TB lesions has the potential of serving as a significant aid in the first line of control for this hazardous and often fatal disease. This article will also emphasize the advancing role of oral pathologists in making the final diagnosis of this dreaded disease.

Medication concordance in modern medicine – A critical appraisal from an Indian perspective Shubham Atal, Balakrishnan Sadasivam, Shah Newaz Ahmed, Avik Ray Journal of Family Medicine and Primary Care 2019 8(4):1313-1318 Modern medicine encompasses a holistic approach toward patient care that seeks to integrate the social, psychological, and pathological aspects of a disease. In line with this, the traditional model of improving treatment outcomes through improved compliance or adherence has given way to the concept of “concordance” that respects the integrity of the patient, autonomy, and self-determination. A self-conscious patient actively and equally participating in her or his comprehensive healthcare can bring a paradigm shift in the perceptions and functioning of the healthcare sector. Medication concordance can be expected to play a key role in improving patient well-being, clinical outcomes, and healthcare delivery. However, it is fraught with numerous questions to be addressed ranging from lack of clarity or standard protocol, medicolegal intricacies, cultural–linguistic barriers, illiteracy, shortage of time, infrastructure, and manpower. There are major challenges in the effective implementation of this initiative which has definite potential to prove beneficial in Indian healthcare settings. The success of this novel approach can only be accomplished by coordinated, inclusive, and persistent efforts from all participants of healthcare with fostering of a milieu of trust, belief, and communication. A systematic literature search was conducted using key words from relevant articles and MeSh terms on Google Scholar and PubMed. Data were abstracted according to their relevance to subheadings of the review and synthesis of concepts was done through multiple reviews by atleast two reviewers for any subsection.

Knowledge, attitude, and practice of family planning services among healthcare workers in Kashmir – A cross-sectional study Rabbanie Tariq Wani, Imrose Rashid, Sheikh Sahila Nabi, Hibba Dar Journal of Family Medicine and Primary Care 2019 8(4):1319-1325 Background: Researches have shown highest awareness but low utilization of contraceptives making the situation a serious challenge. Most of women in reproductive age group know little or have incorrect information about family planning methods. Even when they know the name of some of the contraceptives, they do not know where to get them or how to use it. These women have negative attitude about family planning, whereas some have heard false and misleading information, the current study aimed in assessing the knowledge, attitude, and practice of family planning among female healthcare workers in Kashmir valley. Method: A self-administered questionnaire was served to the female multipurpose health workers of District Anantnag and Baramulla at a training conducted in Department of Community Medicine, Government Medical College, Srinagar, Kashmir. Result: All the participants had heard about family planning methods. The major sources of information were trainers (78.8%). About 90.4% of the study participants gave correct response regarding the types of family planning. About 80.1% of the respondents had a favorable attitude toward family planning. Around three-fourths of the study participants practiced one or other method of family planning. Conclusion: Our study lead to the conclusion that the level of knowledge and attitude toward family planning was relatively low and FP utilization was quite low among the healthcare workers. In order to imbibe positive attitude among general public, the health workers need to be trained so as to inculcate the positive attitude in them leading to increased awareness among general public with regard to family planning.

A study on the change in HbA1c levels before and after non-surgical periodontal therapy in type-2 diabetes mellitus in generalized periodontitis Akshay Munjal, Yashika Jain, Sowmya Kote, Vineesh Krishnan, Rafi Fahim, Samruddhi Swapnil Metha, Deepak Passi Journal of Family Medicine and Primary Care 2019 8(4):1326-1329 Aim: The aim of this study was to evaluate and investigate changes in HbA1c levels before and after non-surgical periodontal therapy in type-2 diabetes mellitus patients with generalized periodontitis. Materials and Methods: A statistically significant number of type-2 diabetes mellitus subjects diagnosed with chronic generalized periodontitis were included in the study. The selected subjects were randomly allocated to 2 groups. Group 1: Control group: Subjects who received only scaling and root planning. Group 2: Test group: Subjects received antibiotic coverage with non-surgical periodontal therapy (scaling and root planning). Clinical parameters included plaque index, gingival index, PRO MIG pocket depth, and clinical attachment level. In addition, the metabolic parameters were recorded at the same time intervals, which included fasting blood sugar, random blood sugar, and HbA1c levels. Statistical Analysis: ANOVA test was applied to the parameters. Results: HbA1c more significantly reduced by test group compared to the other group. Conclusion: there is definitely a positive effect of nonsurgical on HbA1c levels in type 2 diabetes mellitus. This point levels significantly reduced after conventional non-surgical periodontal therapy. Conclusion: There is definitely a positive effect of non-surgical periodontal therapy on HbA1c levels in type 2 diabetes patients with chronic periodontitis.

Family medicine residents' educational environment and satisfaction of training program in Riyadh Abdullah H Al Helal, Yousef Al Turki Journal of Family Medicine and Primary Care 2019 8(4):1330-1336 Background: Improving health outcome indicators worldwide needs well-trained family physicians, and the Kingdom of Saudi Arabia is of no exception from that need. Objectives: To address the level of satisfaction and assess the educational environment among residents of family medicine (FM) in Riyadh city. Methodology: A cross-sectional study; the Postgraduate Hospital Educational Environment Measure (PHEEM) was used to assess the educational environment for all FM residents in fully structured training centers that include all levels of residents in Riyadh during 2016. Results: About 187 surveys were distributed and 140 were collected, with a response rate of 74.87%. Cronbach's alpha scored at 0.917 for overall items. Out of 160 maximum score, the overall score of the PHEEM was 86.73 (standard deviation [SD]: 19.46). The perception of teaching score was 33.11 (SD: 8.80) out of 60, the perception of role autonomy score was 28.60 (SD: 7.35) out of 56, and the perception of social support was 25.02 (SD: 5.43) out of 44. Conclusion: The educational environment is an important determinant of medical trainees' achievements and success. The results are better than what had been found in the previous studies, but more attention and effort should be done, especially for the poorly rated points in this study. We recommend a continuous evaluation and reconstruction of the Saudi Board of FM program, and such results could be a tool that might help in fostering better and stronger educational program.

Comparison of psychiatric screening Instruments: GHQ-28, BSI and MMPI Jamileh Jahangirian, Hossein Akbari, Ehsan Dadgostar Journal of Family Medicine and Primary Care 2019 8(4):1337-1341 Background: Clinical interview comprises a method for of psychiatric disorders diagnosis. Given the cost, time, and expertise required for clinical assessment; alternative tools to accurately substitute clinical interviews are having high value. We conduct this study to compare the screening accuracy of GHQ-28, BSI, and MMPI. Materials and Methods: Considering a diagnostic value, this study was conducted on 983 students and 3 psychiatric screening tools; GHQ-28, BSI, and MMPI were completed by students. Among the whole participants, 237 students were interviewed by the clinical psychiatrists on the basis of DSM-IV-IR Criteria. Based on ANOVO and Chi-square, results compare was made. Kappa correlation -coefficient was calculated in a pairwise manner; eventually the diagnostic accuracy of each tool was determined by the means of ROC analysis. Results: The diversity of psychiatric disorders by GHQ-28, was about 39.1, on the basis of BST was 44.8% and 44% for MMPI. The sensitivity and specificity of GHQ-28 was 85.9% and 87.8% considering 21.5 as the cut-off point; respectively. Considering 41/5 as the cut-off point for the BSI test, sensitivity and specificity were 81.2% and 90.8%; respectively, and 88.2% and 91.4% for the MMPI test with the cut-off point of 63.5 compared to clinical interview, the MMPI test was associated with the greatest accurate staging, ranging about 90.3%. Conclusions: The results of this study according to clinical assessment reveal that GHQ-28, BSI, and MMPI psychiatric tools have high sensitivity and specificity and MMPI possessed the greatest efficiency compared to other evaluated tools.

An investigation into the sensitivity of shear wave ultrasound elastography to measure the anterior bladder wall pressure in patients with neurogenic bladder Alireza Ghorbani Bavani, Mohammad Ghasem Hanafi, Mohsen Sarkarian Journal of Family Medicine and Primary Care 2019 8(4):1342-1346 Introduction and Objective: Urodynamic testing (urodynamics) is widely used for evaluating bladder function as a result of high detrusor compliance. This aggressive and uncomfortable test is especially difficult for children. This study aimed to determine the sensitivity of shear wave ultrasound elastography (SWE) as a new method for evaluating the biomechanical characteristics of bladder to measure the anterior bladder wall pressure in children with neurogenic bladder (NB). Materials and Methods: The present prospective clinical study was carried out on 30 children with allegedly NB and 20 healthy children as control group. These children referred to Ahwaz Golestan Hospital in 2018. After clinical evaluations, urodynamics was performed for children with NB and detrusor compliance was measured in cm/H2O. The ultrasonography of the SWE was performed on the anterior wall of the bladder (Estimated bladder capacity (EBC) 50%) for the two groups. The relationship between shear wave speed (SWS) and detrusor compliance was estimated using Pearson's correlation coefficient. Independent t-test was used to compare SWS between two groups. Results: In patients with NB, there was a significant relationship between the mean SWS of the anterior bladder wall and detrusor compliance (R = 0.89, P = 0.0001). The comparison between normal and NB groups showed that the mean SWS of the anterior bladder wall in the patients was significantly higher than the healthy group (1.88 ± 0.88 m/s vs. 0.94 ± 0.15; P = 0.0001). There was also no significant relationship between SWS, gender, age, weight, and body mass index of patients (P > 0.05). Conclusion: The results showed that SWE can be used as a useful alternative for urorodynamic testing in the evaluation of NB (bladder dysfunction) in children.

Oral Health and Research

Role of digital technology in prosthodontics: A step toward improving dental care Chanchal Gupta, Anil Mittal Indian Journal of Oral Health and Research 2018 4(2):35-41 Advancements in dental technology enable patients to receive modern solutions of conventional dental problems. Prosthodontists can incorporate digital technology into their practices to improve their workflow efficiency and ease of collaboration with laboratories. In this article, digital technologies that are available for prosthetic dentistry such as digital radiography, electronic prescriptions, computerized case presentations, virtual articulator and facebow, computer-aided design/computer-aided manufacturing restorations, digital impressions, and shade selection are described along with emphasis on advantages and limitations of digital technology.

Differential expression of cell proliferation and apoptosis markers in squamous cell carcinoma of the tongue in young and old patients Saede Atarbashi-Moghadam, Dorsa Yousef Monji, Mahshid Namdari, Sepideh Mokhtari Indian Journal of Oral Health and Research 2018 4(2):42-46 Introduction: Squamous cell carcinoma (SCC) is the most common malignant neoplasm of tongue. Some investigations show that tongue SCC (TSCC) in young patients has a more aggressive behavior. Tumor progression is believed to be influenced by tumor cell proliferation as well as anti-apoptotic activity. The present study was conducted to assess ki-67 and bcl-2 expression in TSCC between young and older patients. Materials and Methods: Thirty paraffin block sections of TSCC were stained with monoclonal antibodies against bcl-2 and Ki-67. Data were analyzed by Mann–Whitney and Spearman correlation coefficient test. Results: Samples from 19 men and 11 women, with a mean age of 56 years, were evaluated. The patients were divided into two groups, A (>45 years) and B (≤45 years). Clinical and microscopic data such as tumor size, grade, and muscle invasion were extracted. Bcl-2 expression was negative for all the samples except one. Ki-67 expression was assessed as a percentage of Ki-67-positive neoplastic cells and scored subsequently. There was a significant association between the expression of ki-67 with microscopic grade and age (P < 0.05). Conclusion: These findings suggest that the more aggressive behavior of TSCC in younger age may be related with ki-67 expression and may serve as a valuable prognostic factor.

Antimicrobial efficacy of medium-chain fatty acids, 2% Chlorhexidine, and 5% sodium hypochlorite against Enterococcus faecalis: An in vitro study Krishnapriya Devan, Faizal C Peedikayil, TP Chandru, Soni Kottayi, N Dhanesh, K Rahul Suresh Indian Journal of Oral Health and Research 2018 4(2):47-51 Background: The current trend globally is to “Go Natural.” Medium-chain fatty acids (MCFAs) are natural derivatives with proven antimicrobial properties. Enterococcus faecalis is a persistent microbe frequently associated with endodontic treatment failures. Thus, the aim of this study was to compare the antimicrobial efficacy of MCFAs, 2% chlorhexidine, and 5% sodium hypochlorite (NaOCl) against E. faecalis. Materials and Methods: Lauric acid (LA), decanoic acid (DA), octanoic acid (OA), 2% chlorhexidine, 5% NaOCl, and ethanol were used against pure strains of E. faecalis. Six wells of approximately 10 mm were bored in Mueller-Hinton Agar medium using a well cutter and the different test solutions were added. The plates were then incubated at 37°C for 24 h. The antibacterial activity was assayed by measuring the diameter of the inhibition zone formed around the wells. Results: The results were tabulated and statistically analyzed using analysis of variance and Tukey's post hoc tests. There was a statistically significant difference between the six groups compared. Maximum antibacterial activity was shown by 2% chlorhexidine (21.66 mm), followed by LA (17.66 mm) and NaOCl (16.33 mm). The mean zone of inhibition exhibited by DA and OA were 14.00 mm and 12.33 mm, respectively. Least antibacterial activity was shown by ethanol (9.66 mm). Conclusion: Within the limitations of the study, it can be concluded that LA exhibited antimicrobial efficacy comparable to that of 5% NaOCl. However, the clinical efficacy of LA must take into account the intricate canal anatomy and polymicrobial nature of root canal infections.

Reasons for permanent tooth extraction and the current status of the existing teeth among patients visiting dental clinics in Guntur, Andhra Pradesh: A cross-sectional study Nijampatnam P. M. Pavani, P Srinivas, T Devaki, Viswa Chaitanya Chandu, Nandita Rani Kothia, Suresh Chand Yaddanapalli Indian Journal of Oral Health and Research 2018 4(2):52-58 Introduction: Tooth loss impairs the quality of life, often substantially, and affects the well-being of the person as missing teeth can interfere with chewing ability, diction, and esthetics. Aim and Objectives: The aim of the present research was to investigate the reasons for extractions of permanent teeth and the current status of the existing teeth in adult patients visiting dental clinics in Guntur. Methodology: Places where the dental services are available were stratified. One government general hospital (GGH) in Guntur where dental services are available and one teaching-based private dental institution (Sibar Institute of Dental Sciences [SIDS]) were included in the study. Fifteen private clinics were randomly selected from a total of 107 dental clinics present in Guntur city. The estimated sample size was 746. It was rounded off to 750 for the purpose of convenient segregation. The survey pro forma prepared included demographic information along with clinical examination. Discussion: The highest (2.92) mean number of teeth to be extracted was seen in SIDS followed by GGH (1.94), and the difference in all the three types of clinics was statistically significant (P = 0.000). Post hoc test showed significant difference between private dental clinics and SIDS, private teaching dental institution and the other two types of clinics, and GGH and SIDS. Conclusion: It was revealed from the study that dental caries and periodontitis are the most common reasons for extraction.

Atrophic lichen planus of gingiva and its management Rashmi Ganesh Phadnis, Lata Kale, Anuja Pawar, Manjusha Jadhav Indian Journal of Oral Health and Research 2018 4(2):59-61 Lichen planus (LP) is an autoimmune mucocutatenous disorder. Orally, the most commonly involved sites are buccal mucosa, tongue, and gingiva. About 10% of the patients with oral LP have lesions confined to the gingiva. The purpose of this article is to report a case of atrophic LP of gingiva in 30-year-old female patient with a chief complaint of burning sensation in the oral cavity from the past 1 year. Histopathological examination was carried out to confirm the diagnosis. The patient was treated with topical corticosteroids using occlusal tray following which the lesions and symptoms of burning sensation in the mouth are resolved. Thus, this case report highlights the correct diagnosis and the treatment plan and timely management of such cases.

Management of a mid-treatment flare-up Cinderella D'souza, Vanitha U Shenoy, MV Sumanthini, Akash More Indian Journal of Oral Health and Research 2018 4(2):62-65 The primary aim of endodontic treatment is biomechanical preparation of the root canal and to hermetically seal it with no discomfort to the patient, providing conditions for the periradicular tissues to heal. The occurrence of interappointment pain and swelling is not a rare event even when endodontic treatment has followed acceptable standards. A flare-up can be defined as pain and/or swelling of the facial soft tissues and the oral mucosa in the area of the endodontically treated tooth that occur within a few hours or a few days following the root canal treatment, when clinical symptoms are strongly expressed and the patient visits a health care institution sooner than scheduled. Flare-up can manifests as pain of varying intensity which occurs following an access opening without instrumentation. Although the reasons for such exacerbations are not always clear, there are a number of hypotheses for its occurance: alteration of the local adaptation syndrome, changes in periapical tissue pressure, microbial factors, effects of chemical mediators, changes in cyclic nucleotides, immunological phenomena and various psychological factors. This case report describes the management of Mid-treatment flare-up in the Permanent Maxillary anterior teeth.

Management of extraoral sinus via nonsurgical root canal treatment Leena Padhye, Ian Naipaul Jagan, Priyanka Unnikrishnan, Lalitagauri Mandke, Radhika Kulkarni, Nikita Toprani Indian Journal of Oral Health and Research 2018 4(2):66-69 Cutaneous sinus tracts of dental origin have been well-documented in the medical literature. However, these lesions continue to be a diagnostic dilemma. A review of several reported cases reveals that patients have had multiple surgical excisions, radiotherapy, multiple biopsies, and multiple antibiotic regimens, all of which have failed, with a recurrence of the cutaneous sinus tract, as the primary etiology was dental that was never correctly diagnosed or addressed. This case report demonstrates the healing of an extraoral draining sinus by means of conventional nonsurgical root canal treatment.

Ophthalmology

A note from the Editor Hassan A Al-Dhibi Middle East African Journal of Ophthalmology 2019 26(1):1-1

Assessment of macular pigment optical density using fundus reflectometry in diabetic patients Mary Varghese, Joel Antony Middle East African Journal of Ophthalmology 2019 26(1):2-6 PURPOSE: Diabetic retinopathy (DR) is a major cause of visual disability and may be associated with reduction in macular pigment (MP) density and insufficient data are available. We present MP optical density (MPOD) measured by fundus reflectometry in eyes with and without early and moderate DR. SUBJECTS AND METHODS: This was a cross-sectional study conducted in the year 2014–2015. Participants were divided into three groups: the normal individuals without diabetes constituted Group I, while diabetic patients without DR and the patients with mild-to-moderate DR constituted Group II and Group III, respectively. MPOD and maximum optical density (Max OD) were measured using a Visucam 500 fundus camera (Carl Zeiss Meditec AG, Jena, Germany). RESULTS: Fifty diabetic patients without DR, 50 with mild and moderate DR, and 50 healthy individuals underwent MPOD and Max OD measurements. The mean pigment density was the same in all the three groups (0.12). HbA1c levels were inversely correlated with MPOD (P = 0.01) and Max OD (P = 0.002). There was no relationship between MP density and age (P = 0.66), gender (P = 0.24), or duration of diabetes (P = 0.85). The duration of diabetes was compared between the two groups of diabetic patients with and without DR. CONCLUSIONS: The mean pigment density assessed by fundus reflectometry was 0.12 in each of the three groups studied. Higher HbA1c levels in diabetic patients correlated with decreased MPOD and Max OD. Better glycemic control may influence macular health in diabetic patients.

Retinopathy of prematurity among syrian refugees: Incidence and severity Pehmen Yasin Ozcan Middle East African Journal of Ophthalmology 2019 26(1):7-10 PURPOSE: The aim of this study is to compare the incidence and severity of retinopathy of prematurity (ROP) in premature newborns of Syrian refugees and those of Turkish origin. METHODS: This retrospective, the single-center study included 1545 premature infants assigned to two groups based on maternal origin. Group 1 comprised 1366 premature infants of Turkish origin, and Group II comprised 179 premature infants born to Syrian refugees. All the premature infants were screened for ROP by the same ophthalmologist who is experienced in the screening and treatment of ROP. All data including gestational age (GA), birth weight (BW), the presence of ROP, and severe ROP collected from 2014 to 2017 were recorded for each group. The outcomes were compared between the two groups. RESULTS: The mean GA at birth was 30.6 ± 2 weeks and was significantly lower in Group II (P = 0.03). The overall incidence of ROP was similar in both groups. The incidence of severe ROP in Group II was nearly seven times higher than in Group I (1.5% and 10%, respectively). The incidence of severe ROP seen in Group II evaluated according to different ranges of GA and BW was higher than in Group I. CONCLUSION: The higher incidence of severe ROP in the premature newborns of Syrian refugees could play an important role in identifying ongoing health problems of refugees.

The outcome of corneal collagen cross-linking in patients with advanced progressive keratoconus: A 2-year follow-up study Reza Soltani Moghadam, Mitra Akbari, Yousef Alizadeh, Abdolreza Medghalchi, Reza Dalvandi Middle East African Journal of Ophthalmology 2019 26(1):11-16 PURPOSE: The aim of this study was to evaluate the safety and efficacy of collagen cross-linking (CXL) in advanced progressive keratoconus with a maximum keratometry (Kmax) value of more than 58 diopters (D). METHODS: This prospective interventional case series involved patients with advanced progressive keratoconus with a Kmax of more than 58 D. The best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), Kmax, mean keratometry (Kmean) value, corneal astigmatism, and thinnest corneal thickness before surgery and 24 months after CXL were determined for 30 eyes of 27 patients. A Pentacam was used to measure the paraclinical parameters. RESULTS: The mean age of the patients was 24.47 ± 3.33 years. The mean logarithm of the minimum angle of resolution (logMAR) of the uncorrected visual acuity UCVA decreased from 0.73 ± 0.36 D at baseline to 0.48 ± 0.30 D (P = 0.01), while the mean thinnest point thickness of the cornea decreased from 438.65 ± 40.11 μm to 431.43 ± 61.92 μm (P = 0.005) after 24 months. The decreases in the mean logMAR of the BCVA, Kmax and Kmean values, and corneal astigmatism were not statistically significant (P > 0.05) at the 24-month follow-up. Progression was halted in 29 eyes (96.6%); only 1 eye (3.3%) showed an increase in the Kmax value of more than 2.0 D, which was indicative of treatment failure. In contrast, most other eyes showed a decrease in the Kmax value although it was not statistically significant. There were no major complications in any of the patients during the study period. CONCLUSION: Standard CXL treatment was safe and stabilized both the visual acuity and tomographic parameters at the 2-year follow-up in eyes with advanced progressive keratoconus.

Improved refractive outcomes of small-incision extracapsular cataract surgery after implementation of a biometry training course Jay J Meyer, Hans R Vellara, Riyaz Bhikoo, Lucilla Ah-Ching Sefo, Salome Lolokabaira, Neil L Murray, Charles N J McGhee Middle East African Journal of Ophthalmology 2019 26(1):17-22 PURPOSE: To determine whether a biometry training course could improve refractive outcomes of patients undergoing manual small-incision extracapsular cataract surgery (SICS). MATERIALS AND METHODS: This was a prospective, interventional, cohort study at the Pacific Eye Institute, Fiji. SICS refractive outcomes were evaluated before and after a structured biometry teaching course. Eyes that underwent evaluation and subsequent SICS with placement of a posterior chamber intraocular lens (IOL) were included. Axial length measurements were obtained using A-scan applanation ultrasound and keratometry with a handheld keratometer. Main outcome measures included mean absolute prediction error of IOL calculations, percentage of eyes within ±0.5 D and ±1.0 D of intended spherical equivalent, and proportion of eyes with ≥6/18 uncorrected visual acuity. RESULTS: A total of 240 eyes were analyzed: 120 eyes before and 120 eyes after the structured biometry training. The mean absolute prediction error was 50% lower following the training (1.13 ± 0.84 D pre vs. 0.56 ± 0.44 D post; P < 0.001). A higher percentage of the eyes had a postoperative spherical equivalent within ±0.5 D (26.7% pre vs. 52.5% post; P < 0.001) and ±1.0 D (55.0% pre vs. 90.0% post; P < 0.001) of the intended target. A higher proportion of the eyes achieved ≥6/18 uncorrected visual acuity (77.5% pre vs. 91.7% post, P = 0.004), while the proportion with ≥6/18 corrected visual acuity was similar (94.4% pre vs. 98.3% post; P = 0.28). CONCLUSIONS: A structured biometry training course may improve the accuracy of preoperative IOL calculations to achieve the postoperative refractive target. Ophthalmology training programs should include structured biometry teaching in their curricula.

Ocular surface microbial flora in patients with chronic limbal stem cell deficiency undergoing cultivated oral mucosal epithelial transplantation Srilathaa Gunasekaran, Rebika Dhiman, Murugesan Vanathi, Sujatha Mohanty, Gita Satpathy, Radhika Tandon Middle East African Journal of Ophthalmology 2019 26(1):23-26 PURPOSE: The purpose of this study is to analyze the ocular surface microbial flora in patients with chronic limbal stem cell deficiency (LSCD) due to Stevens–Johnson Syndrome (SJS) and ocular chemical injury undergoing cultivated oral mucosal epithelial transplantation (COMET). METHODS: Patients of SJS and chemical injury who had bilateral total LSCD planned for COMET were studied. Conjunctival swab was taken before surgery. Parameters evaluated were organism cultured, sensitivity pattern, frequency of positive culture, and clinical impact on management strategy. RESULTS: Thirteen patients were included in which nine were males and four females. All patients had positive conjunctival swab culture. Most common organism isolated was Staphylococcus epidermidis, followed by Staphylococcus aureus and Pseudomonas aeruginosa. The staphylococcal species isolated were sensitive to all the conventional antibiotics while Pseudomonas cultured showed resistance to cefuroxime, ceftriaxone, and ceftazidime. Repeat conjunctival swab sent after a week of topical antibiotic therapy yielded positive culture of the same organism twice in 25% (3/12), thrice in 58.3% (7/12), and four times in 16.6% (2/12) of the patients. One patient had a polymicrobial flora with positive yield of S. aureus (thrice), S. epidermidis (twice), and P. aeruginosa (twice) in consecutive conjunctival swab culture in the absence of clinical infection. Two patients with persistent positive cultures had to undergo repeat oral mucosal harvesting as the transplantation of the cultivated explants had to be deferred. CONCLUSION: Ocular surface in LSCD patients yielded pathogenic organisms on culture. Poor ocular surface with absent tear film could be the contributing factors. It is important to perform the conjunctival swab culture before COMET surgery.

Prevalence and determinants of dry eye disease among 40 years and older population of Riyadh (Except Capital), Saudi Arabia Ziaul Haq Yasir, Deepti Chauhan, Rajiv Khandekar, Ches Souru, Sejo Varghese Middle East African Journal of Ophthalmology 2019 26(1):27-32 PURPOSE: The prevalence and determinants of dry eye disease (DED) among 40 years and older population of Riyadh (except capital), Saudi Arabia. SUBJECTS AND METHODS: A population-based survey was conducted in Riyadh district between 2013 and 2017. All Saudi aged >40 years attended at the Primary Health Center were the study population. McCarty Symptom Questionnaire was adopted. A representative sample was examined. The best-corrected visual acuity and anterior and posterior segment assessment were performed. DED was graded as absent, mild, moderate, and severe. RESULTS: We examined 890 participants. The age- and sex-adjusted prevalence of DED was 45.1% (95% confidence interval [CI] = 44.8–45.4). One-third of the participants had DED. However, two-third of DED cases were of mild grade. The prevalence of DED among females was significantly higher. The variation of DED by age group was not statistically significant (χ2 = 2.6, Degree of freedom = 3, and P = 0.1). Presence of glaucoma was significantly associated to DED (odds ratio [OR] = 2.6, [95% CI = 1.2–5.6], and P = 0.01). Use of topical glaucoma medication was significantly associated to DED (OR = 4.6 [95% CI = 1.8–11.8], and P = 0.001). However, severity of DED was not found to be associated with glaucoma medication (χ2 = 2.6, P = 0.1). Associations of diabetes and hypertension to DED were not statistically significant (OR = 0.97 [95% CI = 0.73–1.3], and P = 0.84) (OR = 1.1 [95% CI = 0.8–1.4], and P = 0.6). The severe visual impairment was not associated to the grade of DED (P = 0.55). CONCLUSION: The prevalence of DED among Saudi is high, but severe DED is found to be less. Association with female gender, glaucoma, and topical glaucoma medications was reported. Association with diabetes, hypertension, and age group variation was not significant.

Fibrin glue-assisted intraocular lens fixation in weill–Marchesani syndrome Charudutt Kalamkar, Nishant V Radke, Amrita Mukherjee, Snehal N Radke Middle East African Journal of Ophthalmology 2019 26(1):33-36 PURPOSE: To report visual and intraocular pressure (IOP) outcomes of 4 eyes in 2 patients with Weill Marchesani Syndrome having ocular fearures of spherophakia and secondary glaucoma who underwent fibrin glue assisted intrascleral fixation of intraocular lens (IOL). METHODS: Detailed anterior and posterior segment evaluation assessing best corrected visual acuity (BCVA), IOP, central corneal thickness was done in all. Lensectomy, vitrectomy with glued Intrascleral fixation of 3 piece intraocular lens was done. Post operative BCVA and IOP were assessed. RESULTS: Visual acuity and IOP control improved post-operatively. CONCLUSIONS: Glued IOL implantation is an effective method to visually rehabilitate and control glaucoma in patients with Weill Marchesani Syndrome.

Marcus gunn jaw-winking syndrome associated with morning glory disc anomaly Abdulaziz A Alshamrani, Fahad A Alghulaydhawi, Mohammed Al Shamrani Middle East African Journal of Ophthalmology 2019 26(1):37-39 Marcus Gunn jaw-winking syndrome (MGJWS) is a rare form of congenital blepharoptosis and one of the congenital cranial dysinnervation disorders (CCDD). In addition, morning glory disc anomaly (MGDA) is a congenital optic disc anomaly of unknown etiology. The present report is the first to describe an association between MGJWS and MGDA in an otherwise healthy 7-year-old boy. He also had counting finger vision, anisometropia, esotropia, and monocular elevation deficiency in the same eye. In the literature, both MGJWS and MGDA have been reported to be associated with Duane retraction syndrome, a form of CCDD.

Corneal toxicity after self-application of Calotropis procera (Ushaar) Latex: Case report and analysis of the active components Huda Al Ghadeer, Ahmad Al Gethami, Hamad Al Sulaiman, Thamer Bukhari Middle East African Journal of Ophthalmology 2019 26(1):40-42 Calotropis procera (ushaar) produces a copious amount of latex, which has both inflammatory and anti-inflammatory pharmacological properties. Local application produces an intense inflammatory response and causes significant ocular morbidity. We report corneal toxicity following self-application of latex from C. procera in a 74-year-old man. He reported painless decreased vision in the affected eye with diffuse corneal edema, and specular microscopy revealed a reduced endothelial cell count. After he was treated with topical corticosteroids, his visual acuity improved from hand motion to 20/80. The composition of the active compounds in the latex was analyzed. When topically administered, the latex may cause severe ocular injuries and a loss of endothelial cells over a period of time. Public education, early recognition of such injuries, and timely intervention may prevent permanent ocular damage.