Comments on: Masters theses from a university medical college: Publication in indexed scientific journals bilateral

The publication rate of 30% in this report is very good. However, the number of publications from the institution could have additionally been ascertained from the respective departments, as the departments would best know their publications. Additionally, the authors could have evaluated the effect of clinical specialties versus non-clinical specialties on the publication rate. There is a perception among medical college faculty that the publications tend to be higher in nonclinical subjects.

The publication rate of 30% in this report is very good. However, the number of publications from the institution could have additionally been ascertained from the respective departments, as the departments would best know their publications. Additionally, the authors could have evaluated the effect of clinical specialties versus non-clinical specialties on the publication rate. There is a perception among medical college faculty that the publications tend to be higher in nonclinical subjects.
Knowledgeable guides are vital to thesis development. Rehashing earlier topics also results in unworthiness for publication, but we often find several successive theses on the same topic -one of us (SN) recently evaluated five Masters' theses. Four of these were related to cataract; three compared outcomes and complications in phacoemulsification, manual small incision surgery and standard extra-capsular surgeries in various permutations and combinations! Someone was reinventing the wheel! The topics should have been rejected in the synopsis stage. A mechanism for checking repetition of topics is imperative for all universities. We could also add poor funding, absence of good diagnostics, lack of follow-up and poor documentation as other causes -but there are many solutions available to these problems.
For guides and residents alike, there are many advantages of choosing potentially publishable topics. Publications enhance the reputation of the department and the institution. They are Medical Council of India (MCI) requirements for promotions. [3] Those planning further training can buttress their curriculum vitae with good publications. Publication should become the focus of thesis planning -use of a good "research question" and well-structured theses will then follow. As students are barely three months into their training when synopses are submitted, guides and co-guides should assist them in developing thesis proposals.
Some good theses do not get published as they are never sent for publication; the resident after course completion is busy finding suitable employment or further career openings, and has no time to think of publication. Here again, the guides could lend a helping hand in facilitating submission for publication,

Topiramate-associated bilateral anterior uveitis and angle closure glaucoma
Dear Editor, We congratulate the authors Senthil et al. for their paper on "Bilateral simultaneous acute angle closure caused by sulphonamide derivatives: A case series." [1] With reference to their paper, we want to share our experience in the management of topiramate-associated bilateral severe uveitis with angle closure glaucoma, a rare complication of topiramate therapy. In the literature there are no reports of uveitis associated with topiramate therapy although the drug literature mentions uveitis as one of its adverse effects. [2,3] A 49-year-old male sought treatment for severe bilateral headache, redness, and watering of eyes of 1-day duration. The patient gave history of topiramate therapy, initiated 2 weeks prior to the onset of ocular symptoms for alcohol deaddiction.
On examination, the best corrected visual acuity was <20/1200 in both eyes. There was bilateral circum-corneal congestion, severe corneal edema, and very shallow anterior chamber in both eyes. Intraocular pressure was 37 mmHg in both eyes as measured by applanation tonometry. Topical timolol 0.5% twice daily, brimonidine 0.1% three times daily, oral acetazolamide 250mg four times daily, and intravenous 20% mannitol 100 ml twice daily were administered, and topiramate was discontinued.
Twenty-four hours later corneal clarity improved, revealing severe nongranulomatous anterior uveitis with grade 4 cells and flare in both eyes [ Fig. 1a and b]. Diffuse fine-to-medium keratic precipitates were present on the posterior surface of the cornea. Ultrasound biomicroscopy (UBM) of the right Indian Journal of Ophthalmology Vol. 58 No. 6 eye revealed increased central corneal thickness and severe anterior chamber reaction, the angles were closed over 360°, caused by anterior rotation of the ciliary body and forward shift of the iris-lens diaphragm [ Fig. 2]. In the right eye, there was demonstrable choroidal effusion and peripheral choroidal detachment. Similar but less severe UBM findings were detected in the left eye.
Topical and systemic steroids along with topical atropine were administered for severe uveitis, while continuing antiglaucoma measures. After 1 week of treatment, the signs gradually reduced and the visual acuity improved to 20/120 in the right eye and to 20/30 in the left eye.
All medications were gradually tapered and stopped over 6 weeks. At 6 weeks the best corrected visual acuity was 20/40 in the right eye and 20/20 in the left eye. At 6-month follow-up, there was a residual membrane over the lens with 180° posterior synechiae in the right eye, with the left eye being normal. In both eyes IOP was normal.
In the literature, there are many reports of topiramateinduced myopia and angle closure glaucoma. [1,[4][5][6] However, to the best of our knowledge there is no report of topiramateinduced uveitis in the English language literature. Our patient had bilateral severe uveitis with angle closure glaucoma, which was temporally associated with the drug usage.
Causality assessment using Naranjo's algorithm and WHO Probability Scale was done. The pre-existing case reports, the presence of a temporal association between the administration of the drug and the onset of the adverse drug reaction (ADR), and the resolution of the ocular pathology following dechallenge puts this ADR under the "probable" category with a Naranjo's score of 7. [7] As the initial ADR was severe, with residual visual loss and posterior synechiae formation in the right eye, rechallenge was not done. Myopia, angle closure glaucoma, and uveitis can be considered as a progressively increasing severity of the idiosyncratic reaction to topiramate and other sulphonamide group drugs.
The above case highlights the importance of increasing the awareness of this rare, idiosyncratic ADR of topiramate and the need for timely intervention to avoid irreversible visual loss.  Dear Editor, We have read with interest the brief communication "Coinshaped epithelial lesions following an acute attack of erythema multiforme minor with confocal microscopy findings" by Babu et al. [1] We appreciate that the authors have drawn attention to this relatively uncommon finding. Regarding the treatment of erythema multiforme (EM) minor, we would like to present few points.

Nibedita Acharya, Suneetha Nithyanandam, Sripathi Kamat
EM is an acute and a self-limiting mucocutaneous hypersensitivity reaction associated with certain infections, medications, and other various triggers. EM minor is considered the mildest form of EM. It is characterized by skin eruption with or without mucosal involvement and may present with a wide spectrum of severity. Ocular involvement in EM minor is usually mild and may manifest as red conjunctivae, chemosis and lacrimation. We also recently came across a case of simultaneous presentation of bilateral coin-shaped discrete and few coalesced epithelial lesions with EM minor.
A 17-year-old female presented with sudden diminution of vision in both eyes since 5 hrs. She had watering and irritation in both eyes along with a history of cold and cough for 3 days. There was no history of any drug intake. On ophthalmic examination, her best-corrected visual acuity was 20/40 in both eyes. Slit-lamp examination in both eyes revealed multiple coin-shaped epithelial lesions, few coalesced and some showing central clearing [ Fig. 1a and b]. There was no involvement of stroma. Corneal sensation and the rest of anterior segment and posterior segment were normal. On general inspection, she had multiple papular rashes on face, arms, and legs [ Fig.  2] for which she was advised to consult a dermatologist, who diagnosed EM minor, and advised symptomatic treatment. The erythrocyte sedimentation rate was 45 mm/h and total white blood count was 11,000 cells/mm 3 with predominant neutrophils (70%). For corneal lesions, she was prescribed topical steroid drops four times a day along with lubricant drops and acyclovir eye ointment 3% three times a day. Corneal lesions resolved within a week. Visual acuity improved to 20/20 and slit-lamp examination showed normal corneal epithelium [ Fig. 3 a and b].