Comparison of intra-articular analgesics for analgesia after arthroscopic knee surgery

Post Arthroscopic intra-articular analgesia is a better method to avoid post-operative pain after arthroscopic surgery, thus avoiding the adverse effects of systemic analgesics. In this prospective randomized double blind study conducted on 90 patients, 30 patients in group A received 20 ml of intra-articular saline, 30 patients in Group B received 10 ml of intra-articular saline and 10 ml of 0.25% bupivacaine and 30 patients in Group C received 10 ml of 0.25% bupivacaine, 1 ml (30 mg) of ketorolac and 9 ml of saline intra-articularly. Ambulatory status, duration of analgesia and requirement for supplemented analgesia were compared in these three groups. Patients receiving this intra-articular analgesic combination of bupivacaine and ketorolac required significantly less supplemental postoperative analgesics. This combination significantly prolonged the duration of analgesia. Patients receiving this combination of drugs for intra-articular analgesia ambulated earlier.

Bilateral spontaneous rupture of Achilles tendons: a case report

Spontaneous bilateral rupture of Achilles tendon is rare. Rupture of the Achilles tendon has been described in patients on oral corticosteroid therapy. The sudden dorsiflexion of the plantar-flexed foot is the usual mechanism of injury. Spontaneous bilateral rupture is common in the degenerated tendon, which is often seen in patients with long-term corticosteroid therapy. This case is unusual because the patient has never taken steroids. We discuss the mechanism of injury and other probable causes.

Astigmatism in Chinese preschool children: prevalence, change, and effect on refractive development

AIM

To study the prevalence, type, and progression of astigmatism in Chinese preschool children, and its effect on refractive development.

METHODS

A cross sectional study of preschool children was carried out in two randomly selected kindergartens. A cohort study was performed on a subset of children, five years after initial examination. Refractive error (measured by cycloplegic autorefraction) and axial ocular dimensions (measured by ultrasonography) were the main study outcomes.

RESULTS

522 children participated in the study; the mean age was 55.7 months (SD 10.9; range 27 to 77). Mean cylinder reading was -0.65 D (SD 0.58; range 0.00 to -4.75), and with the rule astigmatism was predominant (53%). In the 108 children studied longitudinally, the mean cylinder reading reduced from -0.62 D to -0.50 D (p = 0.019). The presence of astigmatism in initial examination predisposed the eyes towards greater myopisation (p<0.001). In addition, children with increased astigmatism had greater myopic progression (p<0.001) and axial length growth (p = 0.002).

CONCLUSIONS

This study reports a high prevalence of astigmatism in Chinese preschool children. The presence of astigmatism, and particularly with increasing astigmatism, appears to predispose the children to progressive myopia. Further studies are warranted.

Timing of fornix reconstruction for postoperative conjunctival prolapse

BACKGROUND AND OBJECTIVE

To describe fornix reconstruction for conjunctival prolapse occurring after ocular surgery.

MATERIALS AND METHODS

Two patients with persistent conjunctival prolapse of variable duration following ocular surgery underwent fornix reconstruction using the method described by Barrett. The two patients underwent different surgical methods. In the second patient, no attempt was made to include the malar periosteum.

RESULTS

Case 1 with longer duration of prolapse needed further surgery to excise residual prolapsing conjunctiva that had hyperplastic squamous epithelium. Case 2 in which fornix reconstruction was done 2 months after prolapse showed a good result after only one surgical operation.

CONCLUSION

Forniceal reconstruction is recommended for persistent postoperative conjunctival prolapse. Early surgery appears to have better results.

Corneal topography and Schirmer testing in eyes with the Hudson-Stahli line

PURPOSE

To evaluate corneal topographic features and tear secretion in eyes with the Hudson-Stahli line.

METHODS

Keratometry, computerized videokeratography and Schirmer testing were performed in 50 cases with bilateral Hudson-Stahli line, and 55 controls without the Hudson-Stahli line. Similar tests were performed in 21 subjects with unilateral Hudson-Stahli line.

RESULTS

Corneal topographic features and keratometry in the horizontal meridian were similar in cases and controls, and in fellow eyes of subjects with unilateral Hudson-Stahli line. Keratometry in the vertical meridian in cases (43.01 +/- 2.01) was significantly lesser than in controls (43.94 +/- 1.77) (P = 0.01). This value was not different in fellow eyes of patients with unilateral Hudson-Stahli line. Schirmer testing revealed significantly greater tear secretion in cases (16.72 +/- 4.99 mm) compared to controls (12.57 +/- 3.62 mm) (P < 0.01). In subjects with unilateral Hudson-Stahli line, mean Schirmer values in the eye with the line (17.52 +/- 6.86 mm) were significantly greater than in eyes without (13.67 +/- 4.64 mm) (P = 0.04).

CONCLUSION

Formation of the Hudson-Stahli line may be dependent on the presence of normal tear secretion in the eye.

Combined intravenous pulse methylprednisolone and oral cyclosporine A in the treatment of corneal graft rejection: 5-year experience

PURPOSE

To report the mid-term results of a treatment strategy using topical steroids, intravenous pulse methyl prednisolone and oral cyclosporine A (CSA) for the treatment of acute corneal graft rejection.

METHODS

Noncomparative, interventional case series. Treatment of corneal graft rejection included 1% prednisolone eye drops, intravenous infusion of 500 mg methyl prednisolone, and oral CSA in two regimens--standard dose was 15 mg/kg/day for 2 days, 7.5 mg/kg/day for 2 days, then adjusted to maintain trough blood levels of 100-200 microg/l; low dose was 2 mg/kg/day with no loading dose.

RESULTS

Outcome in 34 eyes of 34 patients (21 M;13 F) aged 60 +/- 17.7 years (range 9-83 years), who presented after an average duration of 6.6 +/- 6.3 days (range 0-30 days) following acute corneal graft rejection, are reported. Twenty-five patients received standard dose CSA while nine patients received the low dose regimen. Mean duration of treatment before reversal of graft rejection was 13.6 +/- 12.1 days (range 3-54 days). Treatment was successful in reversing the graft rejection in 32/34 (94%) eyes. Irreversible graft failure occurred in one eye in each group. During a mean follow-up period of 19.2 +/- 16.7 months (range 1-55 months), further episodes of graft rejection were seen in 1/32 (3%) eyes. Complications due to treatment included: duodenal ulcer in one patient that responded to medical treatment, and transient elevation in serum creatinine levels in three patients, which returned to normal after decrease in dosage or cessation of oral CSA.

CONCLUSION

Our 5-year experience with the use of oral CSA in the treatment of acute corneal graft rejection has shown this treatment approach to be safe and effective in reversing the rejection process. This approach may also protect the graft from subsequent episodes of allograft rejection. A randomised controlled trial to further delineate the role of CSA in reversing acute graft rejection seems warranted.

Topical chloramphenicol for eye infections

Topical chloramphenicol has been widely used in the treatment and prevention of superficial eye infections due to its broad spectrum of activity and low cost. The use of this drug has decreased considerably in the United States since the first case of aplastic anaemia associated with topical chloramphenicol was reported in the 1960s. This medication, however, is still widely used in many other countries. This paper evaluates the evidence for and against the use of topical chloramphenicol in ocular diseases.

Screening and in vitro production of diplodiatoxin from the isolates of Stenocarpella maydis and its toxigenic effect on bacterial strains

Stenocarpella maydis from different maize growing regions in South Africa were collected and screened for the presence of diplodiatoxin. The presence of diplodiatoxin in these isolates was detected by thin layer chromatography and further confirmed by atomic pressure chemical ionization mass spectrometry. Samples containing diplodiatoxin showed a strong positive ion at m/z=307. MC34, MC35, MC43 and MC50 isolates of Potchefstroom region produced high amount of diplodiatoxin, whereas some of the isolates from Potchefstroom (D72, D74, D78, D79 and D80) and Cedara (CH3 and U3H) regions did not contain diplodiatoxin. Experiments were conducted to optimize in vitro production of diplodiatoxin using the isolate MC 43. A varied range of pH (3.0 to 5.0) and various culture media viz., PDB, CME, CLM and MSM were tested. Growth of mycelium and production of diplodiatoxin was maximum in PDB media at pH 4.5 and it was observed that diplodiatoxin was produced in detectable quantity in the cultures older than 6 weeks in this media. Further, diplodiatoxin was isolated and purified from 8-weeks-old cultures of MC43 isolate and confirmed by nuclear mass resolution. The standard and the compound purified showed similar NMR spectrum. Sixty-gram (fresh weight) mycelium yielded 19.52 mg of diplodiatoxin. Effect of diplodiatoxin on the growth of various bacterial strains in agar-gelled LB media was studied. They showed different range of tolerance to diplodiatoxin. The increasing order of tolerance to diplodiatoxin was Stenocarpella maydis < B. cereus < B. subtulus < P. fluorescense < E. coli. Further, the effect of different concentrations (4.88-49.70 microg/mL) of diplodiatoxin on the growth of S. aureus in LB liquid media was studied. Presence of diplodiatoxin in the media reduced cell growth as compared to the control thus, confirming anti-bacterial activity of diplodiatoxin.

The diagnostic value of seminal a-glucosidase enzyme index for sperm motility and fertilizing capacity

OBJECTIVE

To find out the diagnostic value of seminal a-glucosidase enzyme index in the ejaculated semen samples of proven-fertility and primary infertility patients, for the sperm motility and fertilizing capacity.

METHODS

The study which lasted approximately 2 years was carried out in the Andrology Department of the Arab Fertility Center, Jeddah, Kingdom of Saudi Arabia. Eighty-five healthy male patients (age 25-38 years) were admitted into the study. They were divided into 2 main groups as proven-fertility group and primary infertility group. Each group was again subdivided into 4 classes based on the sperm concentrations. The sperm motility assessment was carried out quantitatively by Semi automated Computer assisted Semen analysis using Autosperm analyzer. Simultaneously, a-glucosidase enzyme index was determined in all the semen samples.

RESULTS

The results were tabulated as per the standard sperm motility grades of the World Health Organisation, under the classified sperm concentrations of the study. The progressive motility grades were compared with the enzyme index of a-glucosidase in both the groups. The total progressive motility was found higher in the high-density (classes I and II) than the low-density (classes III and IV) semen samples. The enzyme index readings of the various classes of sperm concentrations were significant (p<0.05) and showed a stepwise fall from 89% +/-9% to 52%+/-3% in the proven fertility group. Although, a similar trend has been observed (48%+/-5% to 20%+/-2%) in the primary infertility group, the enzyme index class II sperm concentration (44%+/-6%) was not found significant with class 1 (48%+/-5%) sperm concentration, but the significance was achieved with the other 2 classes. The readings of enzyme index between the groups were found highly significant (p, 0.001).

CONCLUSION

The enzyme index of a-glucosidase estimations in semen samples may indicate a positive correlation with progressive motility and fertilizing capacity of spermatozoa and may serve as diagnostic value in individuals showing normal levels of sperm concentration and serum androgen.

Capsulorhexis phimosis in retinitis pigmentosa despite capsular tension ring implantation

A 56-year-old man with retinitis pigmentosa presented with dense nuclear sclerosis and scattered zonular loss with laxity confirmed by ultrasound biomicroscopy. He had extracapsular cataract extraction with a 6.0 mm continuous curvilinear capsulorhexis and implantation of a capsular tension ring (CTR) and a single-piece poly(methyl methacrylate) (PMMA) intraocular lens (IOL) in the capsular bag in his left eye. Severe anterior capsule fibrosis and contracture of the capsulorhexis opening with nasal decentration of the IOL were noted 4 months after surgery. A neodymium:YAG (Nd:YAG) laser anterior capsulotomy was performed to prevent further zonular stress and IOL decentration. The centripetal forces of capsular fibrosis after cataract surgery may exceed the centrifugal resistance of the standard CTR and PMMA IOL in patients with retinitis pigmentosa. Such patients must be carefully monitored postoperatively. An Nd:YAG laser anterior capsulotomy is a safe and effective option to manage anterior capsule fibrosis.

Interface fluid after laser in situ keratomileusis

We report a case in which raised intraocular pressure (IOP) was associated with interface fluid after uneventful bilateral laser in situ keratomileusis (LASIK). The patient presented with diffuse lamellar keratitis in both eyes 3 weeks postoperatively that was treated aggressively with topical corticosteroids. A steroid-induced rise in IOP resulted in interface fluid accumulation and microcystic edema. Measurements with the Goldmann tonometer revealed an IOP of 3.0 mm Hg in both eyes. However, Schiotz tonometry recorded a pressure of 54.7 mm Hg in both eyes. Reduction in the dosage of topical corticosteroid and medical treatment of the raised IOP resulted in resolution of the microcystic edema and interface fluid accumulation. This case highlights the inaccuracies of IOP measurement after LASIK and the resulting complications.

Bilateral penetrating keratoplasty--indications, results and review of literature

PURPOSE

To analyze the indications, functional results, and rates of graft rejection and failure after bilateral penetrating keratoplasty (PK) in a major eye care hospital and research center in India.

METHODS

Retrospective review of the case records of 38 patients who underwent bilateral PK and had at least 6 months follow-up after corneal transplantation in the second eye.

RESULTS

The mean age of the 38 patients (20 M, 18 F) was 35 +/- 25 years (range, 0.5 to 79 years). Mean follow-up was 49 +/- 23 months (range, 13.4 to 116.4 months) after surgery in the first eye and 31 +/- 22 months (range, 6.6 to 103.6 months) after surgery in the second eye. The average time interval between surgery in the first and second eye was 18 +/- 10 months (range, 0 to 38 months). The commonest indications for surgery were corneal dystrophies (50%), aphakic bullous keratopathy (21%), and keratoconus (11%). Postoperatively, secondary glaucoma occurred in 2 first and 3 second eyes. Best-corrected visual acuity at last follow-up was > 6/12 in 34% of first eyes and 50% of second eyes, and was < 6/60 in 26% and 18% of first and second eyes respectively. Allograft rejection occurred in 4 of the first eyes and 3 of the second eyes. The two-year graft survival rate in first eyes was 70% and in second eyes was 83%. Worse outcomes were noted in grafts performed for secondary endothelial failure. Earlier graft failure occurred in first eyes (54 +/- 5 months) compared to second eyes (79 +/- 10 months) (Logrank Test p = 0.2311).

CONCLUSIONS

Bilateral penetrating keratoplasty has reasonable success in selected patients. Corneal transplantation in the second eye does not seem to increase the risk of graft rejection in either eye.

Influence of cage density and prior dietary phosphorus level on phosphorus requirement of commercial leghorns

Two studies were conducted to determine whether cage density and prior dietary nonphytate P (NPP) level affect hens' P requirements. In Experiment 1, hens were housed at three cage densities (300, 400, and 600 cm2 or 46.5, 62.0, and 93.0 inches2/hen) and fed four levels of NPP (0.15, 0.25, 0.35, and 0.40%) for 6 wk to determine the effect of cage density on the P requirement. Egg production (EP), feed consumption (FC), egg weight (EW), and egg specific gravity (ESG) were measured to evaluate performance. Cage density influenced EP within Week 1 (P < 0.01), and during Weeks 5 and 6, there was a cage density x NPP-level interaction (P < 0.05). At 300 cm2, EP was more severely affected by 0.15 and 0.25% NPP than at 400 and 600 cm2. A linear decrease (P < 0.001) in FC was observed because of decreased NPP. Hens at 300 cm2 consumed 4 g less feed/hen per d than hens at 400 cm2. A linear decrease in EW was observed as the NPP level decreased (P < 0.01) from 0.25 to 0.15%, and there was no effect of cage density. Experiment 2 was conducted to determine the effect of prior dietary P levels on time required to create a P deficiency. Hens fed 0.4% NPP were divided into two groups and fed 0.25 and 0.4% NPP for 4 wk. At the end of 4 wk, hens fed 0.25% NPP were further divided into three groups and were fed diets containing 0.09, 0.25, and 0.30% NPP for an additional 6 wk. Hens fed 0.4% NPP were divided into three groups and fed diets containing 0.09, 0.4, and 0.45% NPP. Reduction of NPP from 0.4 and 0.25% to 0.09% reduced EP by 8.5 and 6.8%, respectively, within 3 wk. Prior NPP levels had no influence on time required to create a P deficiency in terms of EP. Reduction of NPP from 0.4 and 0.25% to 0.09% reduced (P < 0.05) FC. A decline in FC occurred 2 wk earlier in hens previously fed 0.4% than those fed 0.25% NPP. This result indicates that hens fed 0.4% NPP became P deficient more quickly than hens fed 0.25%. We concluded that cage density and prior NPP level affect the hen P requirements or time required to create a P deficiency.

Single microassay for matrix degrading enzymes

Matrix degrading enzymes are implicated in several disease processes such as abdominal aortic aneurysms and emphysema, however, monitoring proteolytic activity in a single assay is not well-established. Numerous assays have been developed to measure matrix degrading enzymes, which use artificial substrates or substrates derived from natural substrate protein. We have recently developed an assay for elastolytic activity based on the detection of primary amines, using trinitrobenzene sulfonic acid (TNBSA), following the digestion of succinylated elastin. The assay is also versatile enough to allow the detection of other proteases through the use of succinylated substrate specific for given protease. In order to improve the sensitivity and versatility of the assay we have refined the buffer conditions (PBS pH 7.2/1 mM CaCl2) to provide a 60 % increase in sensitivity to elastolytic activity and also formulated a substrate mixture containing succinylated elastin, collagen and gelatin. The combination of a substrate mixture and an optimum buffer will allow a spectrum of enzymes to be detected in a single reaction, providing a more complete picture of total proteolytic activity in a biological sample. This assay may also provide a tool to use proteolytic activity as a marker to monitor pathologic conditions involving matrix turn-over.

Developing customer databases

There is a growing consensus among pharmaceutical companies that more product and customer-specific approaches to marketing and selling a new drug can result in substantial increases in sales. Marketers and researchers taking a proactive micro-marketing approach to identifying, profiling, and communicating with target customers are likely to facilitate such approaches and outcomes. This article provides a working framework for creating customer databases that can be effectively mined to achieve a variety of such marketing and sales force objectives.

Observations on the breeding habitat of Aedes species in the steel township, Rourkela

Prompted by report of large number of dengue fever cases in township of Rourkela steel plant, entomological surveys were carried out to know the distribution and extent of Aedes breeding in and around the dengue fever affected areas. Out of 2062 water containers searched, 819 were positive for Aedes larvae. The house index (HI), container index (CI) and Breteau index (BI) were 53.4, 39.7 and 118.5 respectively. 27.9% of the houses had single breeding habitats. The breateau index of single storeyed houses and double storeyed buildings was 149.8 and 54.6 respectively, showing that the single storeyed houses have more potential for Aedes breeding. The breeding preference ratio (BPR) was highest for plastic containers. Three species of Aedes were found breeding in different habitats and Aedes aegypti was found breeding in coolers, cement tanks, tyres and miscellaneous containers with a prevalence rate of 13.2%. The role of entomological surveillance and health education has been highlighted for the control of disease through community participation.

Cystoid macular edema after pediatric intraocular lens implantation: fluorescein angioscopy results and literature review

PURPOSE

To evaluate the occurrence of cystoid macular edema (CME) after lens extraction, anterior vitrectomy, and intraocular lens implantation (IOL) in children using angioscopy after administration of oral fluorescein.

SETTING

Centers in Tamil Nadu, India, and Hong Kong, China.

METHODS

This study comprised 18 children (28 eyes) who had cataract extraction, posterior capsulorhexis, anterior vitrectomy, and in-the-bag IOL implantation. The presence of CME was evaluated 1 week and 4 to 6 weeks after surgery using fluorescein angioscopy.

RESULTS

Anterior chamber fibrin occurred in 4 eyes (14.3%). Fluorescein angioscopy was performed 1 week after surgery in all eyes and after 1 month in 25 eyes (89.3%). No eye demonstrated the presence of CME on fluorescein angioscopy.

CONCLUSIONS

Cystoid macular edema did not occur in the early period after pediatric cataract surgery using current surgical techniques. Longer follow-up is required to ascertain the incidence of CME in the late postoperative period.

Management of atypical epicapsular star

An 18-year-old woman had brown pigment deposits on the central anterior capsule of the lens associated with poor visual acuity and significant anisometropia. Surgical removal of the deposits, phacoemulsification, and intraocular lens implantation resulted in visual improvement. Epicapsular stars are formed by the confluence of multiple fine pigmentary deposits. Although they cause amblyopia, this does not appear to be dense. Surgical removal of these central deposits may improve vision, even if the patient presents as an adult.