Prevalence of refractive error in rural Myanmar: the Meiktila Eye Study

OBJECTIVE

To determine the prevalence of refractive error and associated risk factors in the Meiktila District of central rural Myanmar.

DESIGN

Population-based cross-sectional study.

PARTICIPANTS

Randomized stratified cluster sampling of the inhabitants 40 years or older from villages in Meiktila was performed; 2481 eligible participants were identified, 2076 participated in the study, and adequate refractive data were obtained on 1863 individuals (75.1%).

METHODS

Demographic data including age, gender, and education level were obtained from all participants. The ophthalmic examination included autorefraction, nuclear opalescence (NO) grading at the slit lamp, and applanation tonometry.

MAIN OUTCOME MEASURES

Refractive errors were classified by type of ametropia and their prevalence was determined. Univariate and multivariate analyses were performed and odds ratios were calculated for the predictors of refractive error within the statistical models.

RESULTS

Mean refractive error measured -1.3 diopters (D) (standard deviation [SD], 2.9) and mean cylindrical error measured 1.1 D (SD, 1.5). Myopia of >-1.0 and >-6.0 D occurred in 42.7% (95% confidence interval [CI], 40.4%-44.9%) and 6.5% (95% CI, 5.4%-7.6%) of subjects, respectively. Myopic refractive error was associated significantly with a higher degree of NO (P<0.001) and age. Hypermetropia of >+1.0 D occurred in 15% (95% CI, 5.4%-7.6%) of the population and was associated with higher education levels (P<0.001). Astigmatism worse than 1.0 D occurred in 30.6% (95% CI, 28.5%-32.7%) of the population and was associated with age (P<0.001) and NO (P<0.001).

CONCLUSION

Myopia was more prevalent in older subjects and in those with increased NO. The prevalence rates of myopia in the > or =40 age group are higher than those found in other Asian regions and are likely to contribute to visual impairment.

Sponge eating: is it an obsessive compulsive disorder or an unusual form of pica?

Association of pica, iron deficiency anaemia (IDA) and celiac disease (CD) have been reported in the literature. An unusual but completely reversible form of pica in the form obsessive compulsive sponge eating (pervasive disorder) was reported as an odd manifestation of IDA and CD.

CONCLUSION

The medical practice is full of challenges and complexity; and clinicians need to be vigilant all the time in their practice to appreciate unusual and rare manifestations of common clinical conditions like IDA and CD.

Fate and behavior of Benthiocarb--a herbicide in transplanted paddy under East-Indian climatic condition

A two season field experiment was conducted to study the magnitude of Benthiocarb residue in transplanted paddy field soil of plough layer (6''), beyond the plough layer (12'') as well as in harvested straw, grain and husk. Transplanted paddy fields were treated once with Benthiocarb (Saturn 50 EC) @1500 g.a.i., 2500 g.a.i. and 3000 g.a.i.ha(-1). Irrespective of any season, the initial deposits (4 h after spraying) of Benthiocarb in 6'' soil layer were found in varying range of 4.01-4.22 ppm, 5.98-6.56 ppm and 7.47-8.19 ppm at recommended (T(1)), intermediate (T(2)) and double the recommended doses (T(3)) respectively. In paddy field soil Benthiocarb residue dissipated 70% and 90% within 3 and 30 days respectively. Irrespective of any dose and season no residues were detected in 12'' soil layer as well as in straw, grain and husk samples at harvest.

Elucidation of the heat-flux limit from magnetic-island heating

Recent experiments on heating of magnetic islands in a tokamak are analyzed to assess plasma transport characteristics. By comparing with the experimental data, both perpendicular and parallel components of the electron heat conductivity in the island are determined. As a consequence, the so-called heat-flux limit factor xi, the ratio of the parallel heat conduction flux in a collisionless plasma to that transferred by free-streaming electrons, can be estimated. The found factor xi does not contradict that established earlier by interpreting laser plasma experiments.

The effect of cannula material on the incidence of peripheral venous thrombophlebitis

The incidence of thrombophlebitis following the use of two types of cannulae, a new generation polyurethane cannula Biovalve PUR and a polyurethane hybrid co-polymer Vialon cannula, was compared in a randomised trial. Seventy patients scheduled for elective cardiac surgery were randomly assigned to have either a Biovalve cannula or a Vialon cannula inserted before induction of anaesthesia. Postoperatively, the cannulae were removed either as soon as signs of thrombophlebitis were observed or at the end of seven days, whichever was earlier. There was a significantly lower incidence of thrombophlebitis in the Biovalve PUR group (17%) compared to the Vialon group (60%) at the end of seven days (p < 0.001). None of the cannulae tip cultures resulted in the growth of micro-organisms. There was also a lower incidence of the need for re-siting with the Biovalve than with the Vialon cannulae.

ParDOCK: an all atom energy based Monte Carlo docking protocol for protein-ligand complexes

We report here an all-atom energy based Monte Carlo docking procedure tested on a dataset of 226 protein-ligand complexes. Average root mean square deviation (RMSD) from crystal conformation was observed to be approximately 0.53 A. The correlation coefficient (r(2)) for the predicted binding free energies calculated using the docked structures against experimental binding affinities was 0.72. The docking protocol is web-enabled as a free software at www.scfbio-iitd.res.in/dock.

Measurement of transverse single-spin asymmetries for Dijet production in proton-proton collisions at sqrt[s]=200 GeV

We report the first measurement of the opening angle distribution between pairs of jets produced in high-energy collisions of transversely polarized protons. The measurement probes (Sivers) correlations between the transverse spin orientation of a proton and the transverse momentum directions of its partons. With both beams polarized, the wide pseudorapidity (-1< or = eta < or = +2) coverage for jets permits separation of Sivers functions for the valence and sea regions. The resulting asymmetries are all consistent with zero and considerably smaller than Sivers effects observed in semi-inclusive deep inelastic scattering. We discuss theoretical attempts to reconcile the new results with the sizable transverse spin effects seen in semi-inclusive deep inelastic scattering and forward hadron production in pp collisions.

Hypomagnesaemia in cystic fibrosis patients referred for lung transplant assessment

BACKGROUND

Hypomagnesaemia in patients with cystic fibrosis (CF) is under-recognized although the true incidence is unknown. Many patients are asymptomatic, although severe deficiency may be associated with muscle weakness, cramps and tetany. Hypomagnesaemia may be a risk factor for post-transplant complications including convulsions, which may be exacerbated by the use of calcineurin inhibitors. The aims of the present study were to describe serum magnesium levels and to investigate the relationship between magnesium levels and age, and renal function measurements in patients with CF referred to a transplant centre for lung transplant assessment.

METHODS

We reviewed the data of all 106 CF patients referred for transplant assessment from January 1995 to December 2003. Demographic and biochemical data were recorded and the explanatory variables were subjected to univariate analysis and linear regression analysis.

RESULTS

Mean serum magnesium level was 0.75 mmol/L (range 0.46-1.03, normal range 0.74-1.1). 57% of patients had hypomagnesaemia. Serum magnesium levels were not associated with age, serum creatinine or GFR.

CONCLUSIONS

Hypomagnesaemia is a common finding in patients with CF referred for lung transplant assessment. Serum magnesium levels should be monitored in all CF patients being referred for lung transplant irrespective of the results of other renal function tests.

Immunomodulatory activity of an extract of the novel fungal endophyte Entrophospora infrequens isolated from Nothapodytes foetida (Wight) Sleumer

A novel camptothecin-producing endophytic fungus viz., Entrophospora infrequens was isolated from an important Indian medicinal plant Nothapodytes foetida. The present study reports evaluation ofbioactivities of two novel extracts viz., chloroform (CEEI) and methanolic (MEEI) extracts of Entrophospora infrequens with respect to their immunomodulatory potential in vitro and in vivo (in Balb/c mice). The endophyte E. infrequens was found to synthesize camptothecin, which tested positive in CEEI. The immunomodulatory potential of CEEI and MEEI was compared with standard camptothecin (CPT). Doses of the chloroform extract (CEEI) ranging from 12.5-100 mg/kg body weight, significantly (p < 0.05) stimulated the humoral and cell-mediated immune responses in a dose-dependent manner. MEEI on the other hand significantly (p < 0.05) stimulated the delayed type hypersensitivity (DTH) reaction (by nearly 80%), plaque forming cell (PFC) assay (33%), phagocytic response (38%) and haemagglutination antibody (HA) titre [IgM by 79.07% and IgG by 62.05%] at a dose of 12.5 mg/kg body weight. The present study is the first report of the immunomodulatory potential of this neoteric camptothecin-producing endophyte from Nothapodytes foetida.

Combined 25- and 23-gauge surgery: a new sutureless vitrectomy technique

The 25- and 23-gauge sutureless vitrectomy techniques decrease the surgical trauma and improve patients' postoperative comfort. The disadvantages of the 25-gauge system include pliable instrument and slower gel removal. The 23-gauge system provides faster speed of vitrectomy and the instruments have stiffer shafts, but it requires a larger incision. To circumvent some of these limitations, a new sutureless transconjunctival vitrectomy technique that combines 23- and 25-gauge cannulas and instruments was studied. Fifty-three patients underwent vitreoretinal surgery using two 25-gauge ports for the infusion and light probe and one 23-gauge port for the vitreous cutter and various instruments. No intraoperative or postoperative complications were noted and no cases required conversion to another technique.

Successful surgery for epilepsy due to early brain lesions despite generalized EEG findings

OBJECTIVE

To understand the role of epilepsy surgery in children with generalized or bilateral findings on preoperative scalp EEG.

METHODS

From our pediatric epilepsy surgery series, we identified 50 patients in whom 30 to 100% of preoperative epileptiform discharges (ictal, interictal, or both) were generalized or contralateral to the side of surgery.

RESULTS

All patients had severe refractory epilepsy and an epileptogenic lesion on brain MRI. Ninety percent of the lesions were congenital, perinatal, or acquired during infancy, predominantly malformations of cortical development (44%) or cystic encephalomalacia (40%). Age at surgery was 0.2 to 24 (median 7.7) years. Surgeries were hemispherectomy (64%) or lobar or multilobar resection. At last follow-up (median 24.0 months), 72% of patients were seizure-free, 16% had marked improvement with only brief episodes of staring or tonic stiffening, and 12% were not improved. The rate of seizure-free outcome was not significantly associated with age at seizure onset or surgery, presence of hemiparesis or focal clinical features during seizures, type of lesion, or surgery type. Postoperative seizure-free rate did not differ from that in a comparison group of similar patients who matched the study group except for their high percentage (70 to 100%) of ipsilateral ictal and interictal epileptiform discharges on preoperative EEG.

CONCLUSIONS

Epilepsy surgery may be successful for selected children and adolescents with a congenital or early-acquired brain lesion, despite abundant generalized or bilateral epileptiform discharges on EEG. The diffuse EEG expression may be due to an interaction between the early lesion and the developing brain.

Tubercular and chronic pyogenic osteomyelitis of cranio-facial bones: a retrospective analysis

AIM

To analyse current trends in our population with respect to the presentation, diagnosis and management of tubercular and chronic pyogenic osteomyelitis of the cranio-facial bones.

DESIGN

Retrospective study.

SETTING

Tertiary healthcare centre.

PATIENTS AND METHODS

The study population comprised 14 patients with tubercular and chronic pyogenic osteomyelitis who were managed in the otorhinolaryngology department between May 2002 and December 2005.

RESULTS

Odontogenic infections, sinus infections and aural infections were the most commonly identified aetiological factors. Most of the patients presented with swelling, pain and discharging sinus. The diagnosis was established on the basis of clinical evaluation, radiological investigations and histopathological analysis, with six cases diagnosed with tubercular osteomyelitis and eight cases with chronic pyogenic osteomyelitis. All the patients were initially commenced on oral antibiotics, which were continued for two weeks in all cases with chronic pyogenic osteomyelitis. All the patients with pyogenic osteomyelitis underwent surgical management, with one patient requiring repeated surgical interventions. All the patients with tubercular osteomyelitis received anti-tubercular chemotherapy, with complete cure.

CONCLUSIONS

Osteomyelitis of the cranio-facial bones is an uncommon entity which requires a high index of clinical suspicion along with radiological and histopathological investigations in order to establish the diagnosis. Tubercular osteomyelitis is clinically and radiologically indistinguishable from pyogenic osteomyelitis, and the two conditions can be differentiated only on the basis of histopathological evaluation of involved tissue.

Posterior sympathetic ophthalmia: a single centre long-term study of 40 patients from North India

OBJECTIVE

To report 'posterior sympathetic ophthalmia' in North Indian population as an early manifestation of sympathetic ophthalmia.

METHODS

Forty consecutive patients with a diagnosis of sympathetic ophthalmia seen between 1989 and 2004 at our centre were studied for their clinical presentation and disease course. All received systemic corticosteroids and 12 patients, in addition, also received immunosuppressive agents.

RESULTS

There were 28 male and 12 female patients with a median age of 29.4 years. In 22 of the 40 sympathizing eyes, the only presenting sign was the fundus lesions without any associated anterior segment inflammation. Only four eyes showed classically described granulomatous anterior uveitis at presentation. The fundus lesions predominately included exudative retinal detachment (29 eyes), yellowish-white mid-peripheral lesions (10 eyes), optic disc oedema (15 eyes), vasculitis (three eyes), and peripapillary choroidal neovascular membrane (two eyes). Over a median follow-up of 5.2 years, recurrences were seen in 12 of 40 (30%) eyes and were mainly in the anterior segment. Over a median follow-up of 5.2 years, a final visual acuity of 20/40 or better could be achieved in 29/36 (80.5%) eyes.

CONCLUSION

In the early stage, sympathetic ophthalmia may present only in the posterior segment without any associated anterior segment inflammation and carries a good visual prognosis. Anterior segment inflammation, however, maybe seen during recurrences.

Ocular adnexal lymphoma subtyped according to the REAL classification: A 12-year experience from a single institution

18541

Background: The Revised European and American Lymphoma (REAL) classification (1994) provided a useful and practical tool to define lymphomas. The aim is to report our experience with this unusual malignancy diagnosed since the REAL classification was implemented. Methods: Retrospective review was performed on patients (pts) with ocular adnexal lymphoma between 1994 and 2006. Medical records, diagnostic imaging procedures, and pathology reports, including immunophenotyping studies, were reviewed. Histologic definition of lymphoma was based on the REAL Classification. Results: 10 pts were identified. All but one were females. Median age at diagnosis was 69 years (54–84). Primary sites included conjunctiva (5), orbital soft tissue (3), and eyelid (2). No lacrimal gland location was found. Ann Arbor stage at diagnosis was IE in most cases (7). One patient (pt) had stage IIE (conjunctival and maxillary sinus) and 2 pts had simultaneous bone marrow involvement (stage IV). 6 pts had marginal zone B-cell subtype, and the remaining 4 pts had small lymphocytic B-cell lymphoma. Radiation as single treatment modality was given to all 7 pts with stage IE, and all those achieved a complete remission (CR). CR was also achieved using chemotherapy with cyclophosphamide (C), vincristine (V), doxorubicin, prednisone (P), and rituximab followed by radiation in the pt with stage IIE. Of the 2 pts with stage IV, 1 achieved a CR with rituximab-based chemotherapy, and 1 never achieved a CR despite chemotherapy (chlorambucil, CVP). With a median follow-up of 23 months (9–70), the 9 pts that achieved a CR after initial treatment remain alive and disease-free. The only pt that did not achieve a CR lost follow-up at 18 months. Conclusions: In our patient population, radiation alone appears to be an effective treatment modality for stage IE. Achieving a CR seems to be a crucial factor for long-term control of the disease.

No significant financial relationships to disclose.

Gestational trophoblastic disease: Experience at a tertiary care center from a developing country

16041

Background: We retrospectively analyzed case records of patients diagnosed to have Gestational Trophoblastic Disease (GTD) to determine clinical characteristics, risk groups, treatment outcome, and reproductive function post treatment. Methods: Between Jan 1991 to Dec 2005, 102 patients (mean age: 28.2 years, range 19–50) were diagnosed to have GTD. 35 patients were nulliparous and 8 had prior molar pregnancy. Vaginal bleeding was the most common presenting symptom (77.5%). The antecedent pregnancy was vesicular mole in 50%, abortion - 34.3%, ectopic pregnancy - 4% and term pregnancy in 11.8% patients. The mean value of B hCG was 1225386 mIU/ml. The histopathology (n=85) was complete mole in 30, partial mole - 28, invasive mole- 9, PSTT -1 and choriocarcinoma in 17 patients. 68(66.7%) patients had non-metastatic disease. Sites of metastasis were - lung (38.2%), vagina (11%), brain (8.8%), liver (6.9%) and kidney, Urinary bladder and peritoneum in one patient each. According to modified WHO risk scoring - 78(76.5% had low risk and 24 (23.5%) were high risk. Results: Eighty-seven (85.3%) patients received chemotherapy using methotrexate with leucovorin (n=63), EMA/CO (n=19) and BEP (n=5). 77/87 (89.5%) achieved complete remission (CR) ; the response rate was higher in non-metastatic GTD (p<0.05). Two of 7(28.6%) patients with liver and 5/9 (55,6%) of brain metastasis achieved CR. Two patients had grade III oral mucositis and diarrhoea with methotrexate. One patient died of Methotrexate hypersensitivity. 19 patients received second line chemotherapy using EMA/CO (n=11), EMA/EP (n=2), BEP (n=1), actinomycin-D (n=1) and MAC (methotrexate, actinomycin D and Cyclophosphamide) n=1; 14 patients achieved CR. At a mean follow up of 180 months, 5-year survival for patients with low risk is 100% and that of high risk is 95%. Eight patients had recurrent disease including recurrent molar pregnancy in four. 16 patients had 24 successful deliveries after completion of treatment and 10 of them were primiparae. No fetal abnormalities were found. We did not observe second malignancy or other therapy related sequele. Conclusions: Present study confirms excellent outcome for patients with gestational trophoblastic disease. The potential for childbearing is well maintained.

No significant financial relationships to disclose.

Impact of screening on presentation and survival of colorectal cancer

1535

Background: There is an increasing emphasis and utilization of colorectal cancer (CRC) screening. We evaluated the effect of screening on CRC presentation and outcome. Methods: We reviewed all the invasive CRC cases diagnosed between Jan 1995-Dec 2005 at the Cincinnati Veteran’s Affairs hospital. Individual case records were reviewed and the data collected including patient demographics, treatment, outcome, mode of presentation as well as whether CRC was detected as a result of screening. Results: Altogether 288 patients were diagnosed with CRC during the study period. The median age at presentation was 69.3 years and 18.8% were African-Americans. Early stage CRC was diagnosed in 63.4% cases (stage 1: 32.7%, stage 2: 30.8%) and 33.3% were diagnosed at advanced stage (stage 3: 18.1% and stage 4: 15.3%). Seventy seven (26.7%) CRCs were asymptomatic at presentation and were diagnosed as a result of screening. Predominant screening modalities included fecal occult blood testing (46.8%) and flexible sigmoidoscopy (22.1%). The proportion of screen- detected cases increased from 19% in 1995–1999 to 32% in 2000–05 (p = 0.047). Demographics, including age and race, as well as the site of CRC were similar to symptomatic cases. Screen-detected cancers presented early, with 77.9% presenting at early stage (stage 1: 55.8%, stage 2: 22.1%), compared to 51.5% (stage 1: 21.0%, stage 2: 30.5%) of symptomatic cancers (p <0.01). Only 1.3% of screen-detected CRC was found to be metastatic as compared to 21.0% of the symptomatic cases. The screen-detected cancers had significant survival advantage compared to symptomatic cases; with median survival being 81 months vs. 43 months in the latter (p =0.018). A proportional hazard regression analysis indicated that this improvement in survival was related to the fact that screening resulted in earlier stage at diagnosis. Only 20.3% of screen-detected CRC received adjuvant chemotherapy compared to 41.4% of symptomatic cases (p=0.002). Conclusions: An increasing proportion of CRC is being diagnosed as a result of screening. These cancers present at an earlier stage and are associated with a significantly improved survival. However, most CRC still presents symptomatically and more effective population screening is needed.

No significant financial relationships to disclose.