Combined trabeculotomy-trabeculectomy with antimetabolite and releasable suture: outcome with primary congenital glaucoma in a north Indian population

OBJECTIVE

To determine the surgical outcomes of combined trabeculotomy- trabeculectomy with mitomycin-C and releasable suture in children with primary congenital glaucoma (PCG) in a North Indian population.

DESIGN

Retrospective, interventional, consecutive, non-comparative case series.

MATERIALS AND METHODS

The medical records of 137 eyes of 77 patients who underwent combined trabeculotomy- trabeculectomy with 0.2 mg/ml mitomycin C (MMC) either bilaterally (49 patients) or unilaterally (28 patients) between January 2004 and March 2012 were reviewed retrospectively. The main outcome measures were postoperative intraocular pressures, corneal clarity and diameter, duration of follow-up, success rate and complications.

RESULTS

The mean preoperative intraocular pressure reduced from 34 ± 7 mm Hg (range 15- 54 mm Hg) to 17 ± 7 mm Hg (range 5 - 32 mm Hg) with a mean reduction of 44 % (P less than 0.001). The mean follow-up period was 24.4 ± 10.3 months (range 6 - 48 months). Complete success defined as intraocular pressure less than 21 mm Hg without any medication and clinically stable glaucoma at last follow-up was achieved in 113 eyes (83 %) while a 'qualified success' of intraocular pressure less than 21 mm Hg with one medication was achieved in ten eyes (7 %). The Kaplan-Meier survival analysis revealed success rates (at 'n' months) of 90 % (6), 85 % (12), 82 % (24), 80 % (36) and 77 % (48). There were no significant intraoperative or postoperative complications.

CONCLUSION

Primary combined trabeculotomy-trabeculectomy with mitomycin-C and releasable suture offers a viable surgical option in Northern Indian infants with primary congenital glaucoma. The use of 0.2 mg/ml mitomycin C for 2 minutes improves the overall success while the releasable suture decreases the risk of postoperative complications especially associated with the use of antimetabolites.

The association between bone mineral density and higher body mass index in men

BACKGROUND

A number of studies have identified that higher body mass index is associated with higher bone mineral density. However, a small number of previous studies have indicated an association between higher body mass index (> 35 kg/m(2)) and lower bone mineral density. No previous study has investigated the association between higher body mass index and bone mineral density in a large male population.

METHODS

Data of men aged over 50 years of age who attended for a dual energy X-ray absorptiometry scan at a UK teaching hospital were collated. The population was divided according to body mass index increments of 5 kg/m(2). The mean bone mineral density of both the lumbar spine and femoral neck was ascertained for each body mass index category. Multiple linear regression analysis, adjusted for age, was used to investigate for an association between body mass index and bone mineral density.

RESULTS

Data of 1263 men were collated. Increasing body mass index was associated with increasing bone mineral density of both the lumbar spine and femoral neck up to 35 kg/m(2); further increase in body mass index was not associated with an increasing bone mineral density.

CONCLUSIONS

The beneficial effect upon bone mineral density of increasing body mass index exists up to 35 kg/m(2); a body mass index higher than 35 kg/m(2) is not associated with further increase in bone mineral density.

I. Reactions of Uranium pentaethoxide with carboxylic acids

Reactions of carboxylic acids in different stoichiometric ratios have been carried out under anhydrous conditions, the compounds of the type U (OEt) 4 (OOCR), U (OEt) 3(OOCR)2 U (OEt) 2 (OOCR) 3 and U (OEt) (OOCR)4 (where R is CH3, C2H5, C3H7 and C6H5) have been isolated. Lactic acid yielded the compounds of the type U (OEt)3 (C3H4O3), U (OEt) (C3H4O3)2, U2 (C3H4O3) 5 and U (C3H4O3) (C3H5O3). Determination of molecular weight of some of the soluble derivatives of benzoic acid, suggest them to be dimeric in boiling benzene.

Digital holographic testing of biconvex lenses

Lenses are one of the most important optical elements for manipulation of wavefronts. For their proper selection, the wavefronts produced by the lenses should be analyzed. Digital holography is a tool which provides whole-field reconstructions of wavefronts, and here the use of digital holographic interferometry in complete characterization of wavefronts from lenses is investigated. Digital holograms of the wavefront from the test lens are recorded for various positions of the test lens from a point source. The reconstructed phase of the wavefront from the test lens is compared with a digitally inputted wavefront for measurement of parallelism as well as curvature. The focal length of the test lens is computed by measuring the change in curvature of the wavefront for two positions of the test lens. The radius of curvature of the test lens is determined by using the test lens in the reflection mode. Refractive index of the lens material is also determined using this method. Detailed theoretical and experimental analysis is provided.

A randomized, placebo-controlled phase 2 study of ganitumab or conatumumab in combination with FOLFIRI for second-line treatment of mutant KRAS metastatic colorectal cancer

BACKGROUND

Targeted agents presently available for mutant KRAS metastatic colorectal cancer (mCRC) are bevacizumab and aflibercept. We evaluated the efficacy and safety of conatumumab (an agonistic monoclonal antibody against human death receptor 5) and ganitumab (a monoclonal antibody against the type 1 insulin-like growth factor receptor) combined with standard FOLFIRI chemotherapy as a second-line treatment in patients with mutant KRAS mCRC.

PATIENTS AND METHODS

Patients with mutant KRAS metastatic adenocarcinoma of the colon or rectum refractory to fluoropyrimidine- and oxaliplatin-based chemotherapy were randomized 1 : 1 : 1 to receive intravenous FOLFIRI plus conatumumab 10 mg/kg (Arm A), ganitumab 12 mg/kg (Arm B), or placebo (Arm C) Q2W. The primary end point was progression-free survival (PFS).

RESULTS

In total, 155 patients were randomized. Median PFS in Arms A, B, and C was 6.5 months (HR, 0.69; P = 0.147), 4.5 months (HR, 1.01; P = 0.998), and 4.6 months, respectively; median overall survival was 12.3 months (HR, 0.89; P = 0.650), 12.4 months (HR, 1.27; P = 0.357), and 12.0 months; and objective response rate was 14%, 8%, and 2%. The most common grade ≥3 adverse events in Arms A/B/C included neutropenia (30%/25%/18%) and diarrhea (18%/2%/10%).

CONCLUSIONS

Conatumumab, but not ganitumab, plus FOLFIRI was associated with a trend toward improved PFS. Both combinations had acceptable toxicity.

Antimicrobial efficacy of metapex (calcium hydroxide with iodoform formulation) at different concentrations against selected microorganisms--an in vitro study

The objective of this study was to assess, in vitro, the effectiveness of several concentrations of Metapex (0.22 gm/ml, 0.022 gm/ml, 0.0022 gm/ml) in the elimination of selected microorganisms. Different concentrations of Metapex were prepared by dissolving it in ethanol (99.9%) Pre-sterilized Whatman paper discs, 6 mm in diameter and soaked with the test solution, were prepared and placed onto the previously seeded agar Petri plates. Plates were incubated aerobically for Enterococcus faecalis (E. Faecalis) and Candida albicans (C. albicans), anaerobically for Bacteroid fragilis (B. fragilis) and Propionibacterium acne respectivally. A zone of inhibition was recorded for each plate and the results were analysed statistically. There was significant reduction in the size of zone of inhibition against P. acne, as the concentration of metapex decreases. At lower concentrations of metapex there was no zone of inhibition observed against E. Faecalis, C. Albicans and B. Fragilis. The result of this study suggested that Metapex is a potent antimicrobial agent at higher concentration.

A novel study of screening and confirmation of modafinil, adrafinil and their metabolite modafinilic acid under EI-GC-MS and ESI-LC-MS-MS ionization

OBJECTIVE

Adrafinil and modafinil have received wide publicity and have become controversial in the sporting world when several athletes were discovered allegedly using these drugs as doping agents. By acknowledging the facts, the World Anti-Doping Agency (WADA) banned these drugs in sports since 2004. The present study explores the possibility of differentiating adrafinil and modafinil and their major metabolites under electron impact ionization in gas chromatograph-mass spectrometer (GC-MSD) and electrospray ionization in liquid chromatograph-mass spectrometer (LC-MS/MS) by studying the fragmentation pattern of these drugs.

MATERIALS AND METHODS

Adrafinil, modafinil and their major metabolite, modafinilic acid were analyzed on EI-GC-MSD and ESI-LC-MS/MS using various individual parameters on both the instruments. The analytical technique and equipment used in the analysis were an Agilent 6890N GC with 5973 mass selective detector for the GC-MSD analysis and an Agilent 1100 HPLC with API-3200 Triple quadrupole mass spectrometer for the LC-MS/MS analysis. Validation of both methods was performed using six replicates at different concentrations.

RESULT AND DISCUSSION

The results show that adrafinil, modafinil and their major metabolite modafinilic acid could be detected as a single artifact without differentiation under EI-GC-MSD analysis. However, all drugs could be detected and differentiated under ESI-LCMS/MS analysis without any artifaction. The GC-MSD analysis gives a single artifact for both the drugs without differentiation and thus can be used as a marker for screening purposes. Further, the Multiple Reaction Monitoring (MRM) method developed under LC-MS/MS is fit for the purpose for confirmation of suspicious samples in routine sports testing and in forensic and clinical analysis.