Early Childhood Caries and Dental Care Utilization in Mangalore, India: Parents' Perceptions

BACKGROUND

Parents often underuse dental care services for their children with early childhood caries (ECC), resulting in a high burden of untreated dental caries.

AIM

To describe parental perceptions and challenges in dental care utilization for their children with ECC.

DESIGN

A descriptive qualitative study was conducted with parents of children with ECC seeking dental care in Mangalore, India. Data were collected through focus group discussions using an interview guide. Manual line-by-line coding and content analysis methods were used for data analysis.

RESULTS

Three categories were generated from data obtained through 5 focus groups of 27 participants: dental care visiting patterns, the significance of dental visits, and challenges to dental care utilization. Parents would only visit the dentist when they perceived their children's tooth problems. The challenges faced include time constraints, misinformation, lack of awareness and motivation, costs, fear, and anxiety of the children and the parents themselves. Parents perceived improvements in the awareness of their children's oral health and quality of life after dental visits.

CONCLUSION

Attending dental services to treat their children's tooth problems was the primary way of attaining awareness about prevention among the parents of children with ECC. Increased oral health awareness and improved quality of life can motivate parents to seek further dental care for their children. Collaboration with multidisciplinary stakeholders is required to improve oral health awareness among parents of children with ECC.

KNOWLEDGE TRANSFER STATEMENT

The study's results will help plan targeted preventive programs for children with ECC. The study suggests dental care utilization by children with ECC is based on parental perceptions of their children's tooth problems. It outlines the challenges that affect dental visits of children with ECC and the role of multidisciplinary stakeholders. Improved oral health awareness and quality of life following dental treatment can facilitate further dental visits.

Effect of Bacillus coagulans Unique IS2 with Lactulose on Functional Constipation in Adults: a Double-Blind Placebo Controlled Study

In the present double-blind randomised study, the efficacy of combination of Bacillus coagulans Unique IS2 and lactulose was evaluated in the treatment of functional constipation in adults. One-fifty participants diagnosed with functional constipation (Rome III criteria) were randomised (1:1:1) and supplemented daily with 15 mL suspension of probiotic (B. coagulans Unique IS2, 2 × 10⁹ spores) with lactulose (10 g) (group 1) or lactulose (10 g) (group 2) or placebo (water) (group 3) for 4 weeks. The primary (stool frequency) and secondary outome measures (stool consistency, sensation of incomplete evacuation, defecation- and abdominal-pain) were recorded weekly for up to 4 weeks. Bacillus coagulans Unique IS2 with lactulose showed significant changes in stool frequency as compared to lactulose treatment; however, at the end of the trial, it was found insignificant due to the gradual increase of stool frequency score of lactulose treatment. The changes observed in stool consistency were early (2nd week) and remained consistent up to end of the trial. The significant reduction of sensation of incomplete evacuation, defecation-, and abdominal-pain correlated with the strains ability to produce short-chain fatty acids. No adverse events were observed in any of the groups, and all the vital parameters were normal during the course of the study. Overall, results indicated that B. coagulans Unique IS2 addition to lactulose reduced time required to relieve constipation as compared to lactulose alone. In conclusion, B. coagulans Unique IS2 with lactulose is more effective than lactulose alone to relieve symptoms of constipation in a shorter period. Trial registration: CTRI/2018/11/016399, dated 22/11/2018.

Early Feeding and Weaning Practices of Indian Children with Early Childhood Caries: A Qualitative Exploration

OBJECTIVE

To describe the early feeding, weaning, and oral hygiene practices of children with early childhood caries (ECC), their parents' knowledge and attitudes regarding infant feeding, and the feeding-related challenges faced by the parents.

METHODS

This descriptive qualitative study involved parents of children with ECC who sought dental treatment at an academic dental college in India. Data were collected though focus groups conducted with the 27 parents of children with ECC, using a focus group discussion guide. Data were analyzed using the content analysis method.

RESULTS

Community norms, such as learning from the older women in the families or neighborhoods, guided the feeding method, duration of feeding, and weaning. Breastfeeding or bottle-feeding at bedtime beyond 12 mo of age and feeding sugary drinks during weaning were standard practices, despite knowing the risk for dental caries. Parents faced multiple challenges regarding weaning and were unaware of the significance of infant oral hygiene practices.

CONCLUSION

In children with ECC, infant feeding practices included prolonged breastfeeding or bottle-feeding beyond the required age, feeding at bedtime, and feeding sugary drinks. Although the parents knew that these feeding habits could increase the risk for caries, they lacked the self-efficacy to translate their knowledge into action during weaning. Also, they lacked awareness regarding infant oral hygiene practices.

KNOWLEDGE TRANSFER STATEMENT

The study provides information on the feeding habits of infants that can increase the risk for caries, the challenges faced by the parents of these children in altering these risky habits, and their lack of knowledge on infant oral hygiene practices. Policy/decision makers can advocate for pediatricians and pediatric dentists to incorporate anticipatory guidance or motivational interviewing techniques to tailor the preventive program for ECC for Indian children.

Clinical effectiveness of alkasite versus nanofilled resin composite in the restoration of occlusal carious lesions in permanent molar teeth of children: a randomized clinical trial

PURPOSE

To evaluate and compare the clinical effectiveness of alkasite with nanofilled resin composite restorations for occlusal caries lesions in permanent molar teeth of children, at one-year follow-up.

METHODS

In this randomized controlled clinical trial with parallel design, 38 children aged 7-13 years with occlusal caries lesions on 59 first permanent molars were randomly allocated into two groups, Group 1: Filtek™ Z350XT (nanocomposite) and Group 2: Cention N^® (alkasite resin composite). The restorations were evaluated at one year using the United States Public Health Service (USPHS) criteria. Data were analyzed using Chi-square or Fisher's exact test.

RESULTS

All restorations had either Alpha or Bravo scores at one-year follow-up. In Group 1, all restorations scored Alpha, while one restoration each (3.6%) in Group 2 scored Bravo for fracture and marginal adaptation. All restorations in both groups scored Alpha for retention, secondary caries, and post-operative sensitivity. For anatomic form, all restorations in Group 1 scored Alpha, while three (10.7%) restorations in Group 2 had Bravo scores. For marginal discolouration, three restorations in both groups scored Bravo (11.5% and 10.7%, respectively). For surface roughness, one restoration (3.8%) in Group 1 and three restorations in Group 2 (10.7%) scored Bravo. The comparative results between the two groups for all the variables in the USPHS criteria were not statistically significantly different.

CONCLUSIONS

The performances of the nanofilled composite and alkasite were clinically acceptable and comparable. Alkasite can be an alternative material for the restoration of occlusal caries lesions in permanent molars of children.

CLINICAL TRIAL REGISTRATION

The clinical trial was registered at Clinical Trials Registry-India (CTRI Reg no: CTRI/2020/12/029830 Dated: 15/12/2020).

Why do employees leave? A study on employee’ psychology and its influence on engagement and organizational politics

In today’s VUCA world, companies are trying very hard to increase their overall organizational performance, which can majorly be possible if they are well engaged. It helps in increasing the productivity, as well overall morale of the workforce. However, increased turnover intentions are one of the major problems faced by organizations. This study aims to understand why employees leave and what impact engagement has on the employees’ turnover intentions. It shall also consider the role of perceived organizational politics. In order to understand what causes turnover intention in the pharma sector, we made use of a finely structured questionnaire to collect the responses. The respondents are employees from the pharma industry. We used the statistical tests namely, correlation, ANOVA, regression, to understand what influences turnover intentions. Findings: This study will analyze why employees leave and if employee engagement or organizational politics directly relates to turnover intention. Understanding why employees leave will help the management in devising engagement strategies, which would help decrease the overall turnover rate and enhance the employees’ job satisfaction levels. Engagement levels within the organization should be assessed by conducting annual surveys. Keeping organizational politics in check will also promote job satisfaction. It is an original study, which currently focuses on the pharma sector. However, this can be applied to others as well.

An in-vitro animal bone model study to predict spiral fracture strength of long bones in the young infant

INTRODUCTION

The risk of fracture from a non-accidental injury is highest in the infant age group. A spiral fracture of the long bone can occur equally from accidental and non-accidental causes, meaning the clinical judgement of non-accidental injury in an infant is particularly challenging. This study aimed to assist in differentiating accidental, from non-accidental, injury in infants, by establishing whether correlation exists between geometry and torsional strength in the immature long bone.

METHODS

Immature porcine third and fourth metacarpals (n = 21) were imaged with a dual energy x-ray absorptiometry (DEXA) scanner to measure their linear bone mineral content (BMC_L), bone mineral density (BMD) and section modulus (Z). The specimens were then subjected to a torque of one degree per second until failure. The failure strength and the three DEXA measures were analyzed for a correlation.

RESULTS

The mean failure strength of 11 successful tests was 13.71Nm (+/-SD 2.42Nm), with correlation to BMC_L, BMD and Z described by r² = 0.81, 0.283 and 0.75 respectively.

CONCLUSION

This study is a novel attempt at estimating torsional strength of long bones in a specific paediatric age group using a size-matched animal bone model. It found a strong correlation between bone and fracture strength parameters over the BMC_L range of 0.59-0.77 g/cm.

Seven additional families with spondylocarpotarsal synostosis syndrome with novel biallelic deleterious variants in FLNB

The location and/or type of variants in FLNB result in a spectrum of osteochondrodysplasias ranging from mild forms, like spondylocarpotarsal synostosis syndrome and Larsen syndrome, to severe perinatal lethal forms, such as atelosteogenesis I and III and Boomerang dysplasia. Spondylocarpotarsal synostosis syndrome is characterized by disproportionate short stature, vertebral anomalies and fusion of carpal and tarsal bones. Biallelic loss-of-function variants in FLNB are known to cause spondylocarpotarsal synostosis syndrome and 9 families and 9 pathogenic variants have been reported so far. We report clinical features of 10 additional patients from 7 families with spondylocarpotarsal synostosis syndrome due to 7 novel deleterious variants in FLNB, thus expanding the clinical and molecular repertoire of spondylocarpotarsal synostosis syndrome. Our report validates key clinical (fused thoracic vertebrae and carpal and tarsal coalition) and molecular (truncating variants in FLNB) characteristics of this condition.

EVALUATION OF MULTIPLEX LIGATION DEPENDENT PROBE AMPLIFICATION AS A TOOL FOR DIAGNOSIS AND CARRIER DETECTION IN FAMILIES WITH A DYSTROPHINOPATHY

We set out to evaluate multiplex ligation dependent probe amplification (MLPA) as a tool for diagnosis and carrier detection in families with a dystrophinopathy. Fifty three Indian families with provisional diagnosis of Duchene muscular dystrophy or Becker muscular dystrophy were evaluated by MLPA and multiplex polymerase chain reaction (PCR). Sanger sequencing was used to analyze the entire gene in one patient. Mothers were tested for carrier status whenever possible. Molecular analysis of DMD gene by combining MLPA and multiplex PCR yielded a mutation detection rate of 62% (33/53). Deletions were detected in 27/53 (51%) cases, duplications in 5/53 (9%) cases, a small deletion one case and Sanger sequencing detected a nonsense mutation in one case. Mutation was not detected in 36% (19/53) cases. Fifty six percent of mothers (9/16) were found to be carriers. MLPA helped to refine the results of multiplex PCR testing in 22 patients (5 duplications, 16 deletions and one small deletion). We also describe a situation where a deletion of single exon on MLPA (but not detected by multiplex PCR) was actually due to a deletion of two nucleotides in the probe ligation site. MLPA appears to score over multiplex PCR in diagnosis and carrier detection, specifically by detecting deletions and duplications that are not detected by traditional multiplex PCR.

Double trouble: tuberculosis and substance abuse in Nagaland, India

The diagnosis and treatment of tuberculosis (TB) in people who use and/or inject illicit drugs (PWUIDs) remains a barrier to achieving universal coverage for TB in India and globally. This report describes treatment outcomes in PWUIDs who received treatment for drug-susceptible TB at the Mon District Hospital in Nagaland, India, during 2012-2013. The median age of the patients was 39 years, and most (92%) were male. Two thirds (33/49) of the patients had a successful TB treatment outcome. A previous TB episode and residence in a semi-urban area were associated with unsuccessful treatment outcomes. Separate diagnostic and treatment algorithms, including regular adherence counselling and opioid substitution therapies, should be considered for PWUIDs.

Fluoride content and labelling of toothpastes marketed in India

OBJECTIVE

To enumerate the fluoride content and labelling practices of toothpastes marketed in India and to determine if the content is in accordance with the information provided on the packaging.

METHOD

In vitro analysis of total and free available fluoride in 5 adult and 5 children's fluoride toothpastes in India using fluoride ion electrode. Information on the tube and carton was checked to assess the labelling.

RESULTS

The mean Total Fluoride concentrations (TF) in the toothpastes labelled 1,000 ppm, 500ppm and 458 ppm were 1,000, 500 and 449mg/L (sd values 3, 5 and 4mg/L) respectively. The toothpastes' Total Soluble Fluoride (TSF) concentration was generally slightly less than the TF concentration. Overall mean percentage of TSF concentration was 94% sd 9%. The mean percentage of TSF concentration in SMFP (sodium monofluorophosphate)/CaCO3 (calcium carbonate) containing toothpastes was 86% sd 16% while that in NaF (sodium fluoride)/Si (silica) based toothpastes was 98% sd 1% and 95% sd 1% in the remaining toothpastes with unknown abrasive. NaF/Si based toothpastes had more TSF concentration than the others (p<0.05). All the information required by the Indian regulations was shown on all 10 toothpastes.

CONCLUSION

The available fluoride content of one of the ten toothpastes was substantially less than the total fluoride content. Although the toothpastes were labelled following the guidelines of the regulatory body of India, 3 of the 10 failed to mention the abrasive present.

Oral Health Related Knowledge And Attitude Of Anganwadi of Mangalore City, India

Dental caries is a common childhood disease. Its prevalence can be reduced by integrating dental strategies into primary health care approach. Knowledge, attitude and practice of anganwadi workers in the subject of oral health is imperative in achieving this goal. This study was therefore conducted to assess the knowledge and attitude towards oral health among anganwadi workers of Mangalore city. A questionnaire study, using convenience samples was conducted among 159 angan­wadi workers of Mangalore city. A close ended questionnaire consisting of 20 questions was used. Details of age and quali­fication were recorded. The data was analyzed using SPSS 11.5. Only 45.9% of the anganwadi workers knew that dental caries was a disease, 57.2% knew that the best time to eat sweets was during meal time, 58.5% workers stated dentists as their source of oral health information. Almost all of the Anganwadi workers were positive towards the importance of oral health education and expressed their willingness to teach children how to brush properly and obliged to advise a child need­ing dental care to go to dentist. An anganwadi worker can be a vital link in the health care delivery system. There is a need to educate them on oral health in order to reach children at an early and receptive age. It is very important on the part of the health department to carry out effective programmes on oral health for anganwadi workers. Journal of Chitwan Medical College 2013; 3(4); 6-8 DOI: http://dx.doi.org/10.3126/jcmc.v3i4.9545

Practice-based, clinical trial of a silorane-based composite resin system in posterior teeth

INTRODUCTION

Newer monomer systems have been introduced in an attempt to improve the success rate of direct composite restorations by minimising shrinkage.

AIMS AND OBJECTIVES

To evaluate the in vivo performance of a silorane-based resin composite system (Filtek Silorane, also known as P90), used together with a two-step self-etch bonding system (P90 System Adhesive, Self-Etch Primer and Bond), for the restoration of Class I and Class II cavities in human permanent posterior teeth.

MATERIALS AND METHODS

A total of 53 restorations were completed and patients were recalled one year later. The restorations were assessed by two ndependent clinicians, using the Modified U.S. Public Health Service evaluation criteria for the following parameters: retention, colour match, marginal discolouration, secondary caries, anatomic form, marginal adaptation, surface texture, occlusal and interproximal contacts.

RESULTS

Of the 41 restorations assessed at the one year follow-up, 92.7% showed clinically acceptable scores for all the parameters evaluated. Cronbach's alpha values ranged from 0.72-1.00 showing a good inter-examiner agreement and reliability.

CONCLUSION

Silorane-based composite, Filtek Silorane, when used in conjunction with the recommended adhesive system showed a clinically acceptable performance in posterior teeth restorations over a one year clinical service.

Unusual Presentation of Duodenal Dieulafoy’s Lesion in a Toddler

Dieulafoy’s lesion is a rare cause of massive upper gastrointestinal haemorrhage in any age. It predominantly occurs in the proximal stomach. We report on a child who presented with massive rectal haemorrhage and a clear nasogastric aspirate due toduodenal Dieulafoy’s lesion. Keywords: clear nasogastric aspirate; hematemesis; massive rectal haemorrhage; vascular malformation

Unusual presentation of duodenal Dieulafoy's lesion in a toddler

Dieulafoy's lesion is a rare cause of massive upper gastrointestinal haemorrhage in any age. It predominantly occurs in the proximal stomach. We report on a child who presented with massive rectal haemorrhage and a clear nasogastric aspirate due to duodenal Dieulafoy's lesion.

Nerve injuries sustained during warfare: part II: Outcomes

The outcomes of 261 nerve injuries in 100 patients were graded good in 173 cases (66%), fair in 70 (26.8%) and poor in 18 (6.9%) at the final review (median 28.4 months (1.3 to 64.2)). The initial grades for the 42 sutures and graft were 11 good, 14 fair and 17 poor. After subsequent revision repairs in seven, neurolyses in 11 and free vascularised fasciocutaneous flaps in 11, the final grades were 15 good, 18 fair and nine poor. Pain was relieved in 30 of 36 patients by nerve repair, revision of repair or neurolysis, and flaps when indicated. The difference in outcome between penetrating missile wounds and those caused by explosions was not statistically significant; in the latter group the onset of recovery from focal conduction block was delayed (mean 4.7 months (2.5 to 10.2) vs 3.8 months (0.6 to 6); p = 0.0001). A total of 42 patients (47 lower limbs) presented with an insensate foot. By final review (mean 27.4 months (20 to 36)) plantar sensation was good in 26 limbs (55%), fair in 16 (34%) and poor in five (11%). Nine patients returned to full military duties, 18 to restricted duties, 30 to sedentary work, and 43 were discharged from military service. Effective rehabilitation must be early, integrated and vigorous. The responsible surgeons must be firmly embedded in the process, at times exerting leadership.

Nerve injuries sustained during warfare: part I--Epidemiology

We describe 261 peripheral nerve injuries sustained in war by 100 consecutive service men and women injured in Iraq and Afghanistan. Their mean age was 26.5 years (18.1 to 42.6), the median interval between injury and first review was 4.2 months (mean 8.4 months (0.36 to 48.49)) and median follow-up was 28.4 months (mean 20.5 months (1.3 to 64.2)). The nerve lesions were predominantly focal prolonged conduction block/neurapraxia in 116 (45%), axonotmesis in 92 (35%) and neurotmesis in 53 (20%) and were evenly distributed between the upper and the lower limbs. Explosions accounted for 164 (63%): 213 (82%) nerve injuries were associated with open wounds. Two or more main nerves were injured in 70 patients. The ulnar, common peroneal and tibial nerves were most commonly injured. In 69 patients there was a vascular injury, fracture, or both at the level of the nerve lesion. Major tissue loss was present in 50 patients: amputation of at least one limb was needed in 18. A total of 36 patients continued in severe neuropathic pain. This paper outlines the methods used in the assessment of these injuries and provides information about the depth and distribution of the nerve lesions, their associated injuries and neuropathic pain syndromes.

Water jet dissection technique for endoscopic third ventriculostomy minimises the risk of bleeding and neurological complications in obstructive hydrocephalus with a thick and opaque third ventricle floor

BACKGROUND

Endoscopic third ventriculostomy (ETV) is a procedure of choice in the treatment of obstructive hydrocephalus. Neurovascular injury while perforating the ventricular floor can occur when using a conventional probe, especially in patients with a thick and opaque third ventricle floor. The water jet dissection technique can be useful in such cases to perform an initial perforation.

PATIENTS/MATERIAL AND METHODS

The water jet dissection technique was used to perform ETV in 36 patients with obstructive hydrocephalus with a thick and opaque third ventricle floor over a 3-year period. A water jet was generated using a syringe connected to a 2-mm catheter.

RESULTS

The water jet dissection technique successfully created a patent ETV stoma in 31 patients. 5 patients needed a re-operation due to a blocked stoma. There were no complications related to the procedure. An improvement in clinical function was seen in 28 (83.3%) patients at a median follow-up of 29 months.

CONCLUSION

The water jet dissection is a useful technique while performing ETV to prevent neurovascular injury. Our improvised technique of creating a water jet is safe, inexpensive, readily available and can be practiced at any centre performing ETV.

[Vitreoretinal surgery in Oman]

PURPOSE

Vitreoretinal diseases in Middle Eastern countries currently rank in importance behind cataract, trachoma and glaucoma. This study reports on the most frequent causes of vitreoretinal diseases and the results of vitreoretinal surgery in Oman in order to gain insights into requirements in training and equipment.

METHODS

Demographic data and biomicroscopic examinations were performed over a 5-year period. Pars plana vitrectomies were carried out with the Accurus 800CS (Alcon) and EyeLite® 532 nm Laser (Alcon), endotamponade with silicone oil 5600 cs (adatomed) or C₃F₈ Ispan (Alcon), oval silicone sponge scleral buckles 5.5 x 7.5 mm type 507 (Geuder®) in adults and oval silicone sponge scleral buckles 3.0 × 5.0 mm type 506 (Geuder®) in children (up to 12 years) were sutured with Mersilene parallel to the limbus. Patients were followed after 4 weeks and 1 year. Evaluation of data was done by descriptive statistics (Fisher exact and χ²-tests).

RESULTS

From 2002 to 2006, 2,910 vitreoretinal surgeries were performed on 784 adult and 101 pediatric eyes. Main indications were proliferative diabetic vitreoretinopathy (PDVR) (229/784 eyes=29%), followed by trauma (166/784=21%), and PVR retinal detachment (112/784=14.3%) in adults and in children the main indication was trauma (73/101 eyes=73%). The postoperative vision in adults with trauma, PVR retinal detachment, epiretinal gliosis and IOL extraction was significantly different and better (p=0.003, p=0.044, p=0.029, p=0.001, respectively) and the postoperative vision in PDVR with uncontrolled diabetes mellitus II significantly different and worse (p=0.001). Of the eyes with PDVR in uncontrolled diabetes mellitus 165 out of 229 (72%) lost distance vision (p=0.00014). All patients with serious macular edema and an HbA(1c) of ≥9.5% lost 5 m distance in vision. The mean HbA(1c) in all patients who experienced postoperative blindness was 13.5%. Postoperative vision was significantly better in children operated for trauma complications (p=0.046) whereby patients with contusion of the globe had a significantly better final result (p=0.0302) than patients with penetrating injuries. Revision surgery was indicated most frequently after surgery for proliferative vitreoretinopathy due to prior retinal detachment surgery.

CONCLUSIONS

The most frequent causes of preventable retinal blindness in Oman are pediatric trauma and advanced diabetic vitreoretinopathy. Eyes operated for trauma had a better outcome than PDVR in patients with uncontrolled diabetes mellitus. The large number of eyes with PDVR in the final stages and sequelae of trauma legitimates preventive medical measures and an expansion of vitreoretinal services with supportive external training of specialists and allied health professions.

Conjunctival intraepithelial neoplasia in an HIV-positive patient

We describe the case of a 37-year-old African woman with an asymptomatic lesion on her right conjunctiva; histology of the lesion revealed the presence of conjunctival intraepithelial neoplasia. HIV-positive patients from Africa are at increased risk of developing conjunctival malignancies, and early diagnosis and treatment can prevent serious consequences.

[Ipsilateral autorotational keratoplasty and cataract extraction in patients with trachoma and trauma in Oman. Report on visual rehabilitation]

AIM

To report on the results of visual rehabilitation by ipsilateral rotational keratoplasty (IRK) and cataract extraction in 17 patients with trachoma and with trachoma and trauma in Oman over 3 years.

PATIENTS

Of 25 patients operated from 2001-2004 with IRK, extracapsular cataract extraction, and intraocular lens implantation, 17 eyes of 17 patients with cicatricial trachoma (WHO stage CO) could be followed up after 1 year. Group 1 comprised 11 eyes with ciatricial trachoma. In group 2, six eyes had additional traumatic corneal scars.

METHODS

Surgery was performed using a motor trephine Keratron (Geuder), the Accurus 800 (Alcon) phacovitrectomy machine, and calculation for intraocular lens implantation (IOL: MZ60BD, Alcon) with a topography (Atlas, Humphrey Zeiss)-supported SRK II formula (OcuScanRxP, Alcon).

RESULTS

Although only four of 17 patients had preoperative visual acuity (VA) at 5 m and one of 17 had VA at 1 m, postoperatively seven of 17 patients gained VA at 5 m and six of 17 at 1 m. Ambulatory vision was regained in 13 of 17 (78%) patients. Patients with trachoma and trauma benefited more from the surgery [vision increase in trachoma: eight of 11 eyes (73%); trachoma and trauma: five of five eyes (100%)]. Postoperative spherical refraction was -12.0D to +4.0D (median:+4.0D), and astigmatism ranged from 10D to 0.3D (median 5.35D). One eye was lost because of uncontrolled keratitis.

CONCLUSIONS

IRK with cataract extraction may provide ambulatory vision in patients with cicatricial trachoma and secondary dry eye syndrome living in developing countries where donor grafts are difficult to obtain and where postoperative follow-up of high-risk keratoplasty is impaired.

[Diseases of the adnexa in the tropics: amnion membrane transplantation for noninfectious trachoma-associated corneal ulcers]

BACKGROUND

Corneal ulcers with fornix shortening associated with late stages of cicatrizing trachoma contribute significantly to blindness in many developing countries. We report on the outcome of ocular surface and fornix reconstruction using amnion membrane transplantation.

PATIENTS AND METHODS

From 2001 to 2005, cryopreserved human amnion membrane without mitomycin C was grafted to 25 eyes of 17 patients with trophic corneal ulcers and symblepharon (cicatrizing trachoma: 19 eyes of 14 patients, Stevens-Johnson syndrome: 4 eyes of 2 patients, alkali burns: 2 eyes of 1 patient) in a controlled case series. Follow-up was done up to 6 months.

STATISTICS

Fischer's exact probability test.

RESULTS

Of 25 eyes, 9 of 19 eyes with trachoma, 3 of 4 eyes with Stevens-Johnson syndrome, and 2 of 2 eyes with chemical burns showed complete reepithelialization and stromal recovery after 28-35 days (mean: 31+/-2.3 days). The primary success rate of trachoma eyes was not significantly different from the other indications (p=0.256). At 6 months post-op, 15 of 19 trachoma eyes (79%) compared to 2 of 6 non-trachoma eyes (33.3%) had developed a recurrence of symblephara (p=0.0592), and 13 of 15 eyes (86.6%) with a cicatricial trachoma compared to 1 of 6 with non-trachoma diagnosis experienced a recurrence of corneal vascularization (difference nonsignificant: p=0.1752). Persistent long-term reepithelialization was observed only in 1 of 19 trachoma eyes (5.3%) versus 4 of 6 non-trachoma eyes (66.7%, p=0.005); 3 of 19 trachoma eyes with a recurrence of ulcers had perforated after 6 months.

CONCLUSIONS

Human amnion membrane without mitomycin C can be used for ocular surface reconstruction in selected patients with cicatrizing trachoma. Its efficacy in the long-term rehabilitation of cicatrizing trachoma seems to be limited due to the progressive scarring.

Microperimetric evaluation of macula in retinopathy of membranoproliferative glomerulonephritis type II: a case report

PURPOSE

To report on the microperimetric evaluation of the central visual field in a patient with retinopathy due to membranoproliferative glomerulonephritis.

METHODS

The central 20 degrees visual field was evaluated using fundus-related perimetry with (Nidek MP1) microperimeter in a patient with proven membranoproliferative glomerulonephritis type II, who had multiple drusen-like lesions involving the posterior pole of both eyes, with corresponding window defects on fundus fluorescein angiogram.

RESULTS

Static threshold perimetry of the central 20 degrees using a 10 dB threshold, Goldmann size II stimulus, with (Nidek-MP1) microperimeter showed reduction in retinal sensitivity in the parafoveal and in the temporal paramacular areas in both the eyes that had drusen-like lesions.

CONCLUSIONS

Early loss of function in retinopathy of membranoproliferative glomerulonephritis type II can probably be detected by fundus-related microperimetry.

Mikrobielle Keratitis

PURPOSE

To determine the risk factors and the influence of complementary/alternative medicines (CAM) for infectious keratitis in a monsoon-free region of the Sultanate of Oman.

STUDY DESIGN

Retrospective single center cohort study.

OUTCOME MEASURES

Demographic data, risk factors, and pathogens.

METHODS

Patients with purulent stromal keratitis admitted from 2001-2004 were evaluated for clinical and microbiological data, CAM use, duration of hospitalization, and outcome of treatment.

STATISTICS

chi(2)-test, Z-test.

RESULTS

A total of 320 patients (326 eyes) out of 7,524 admissions had severe infectious stromal keratitis requiring inpatient treatment. The average age was 35.1+/-2.5 years (range 1.5-63 years), the male:female ratio was 2:3 in the age group >or=13 years and 2:1 in the age group <or=12 years. Unsuccessful treatment by traditional healers prior to presentation was recorded for 203 patients (62.3%). Ocular risk factors included severe trachomatous dry eye conditions, meibomianitis and soft contact lens overwear. Systemic compromising risk factors were diabetes mellitus and medical immunosuppression. A total of 215 patient eyes (66%) had delayed or no healing (therapy drop-outs), and hospitalization (45 days) was significantly prolonged compared to the 111 antibiotic responders (26 days) (p<0.001). All eyes of patients with prior CAM had worse vision at admission and after therapy (p<0.001), and 97 eyes of patients with uncontrolled diabetes (p<0.001) and 68 eyes of patients with immunosuppression (p<0.001) had a poor visual outcome (vision <0.1). Thirteen eyes perforated. A negative microbiological result correlated with worse final vision (p<0.05). All 13 perforated eyes had received prior CAM (p<0.001).

CONCLUSIONS

Trachoma, trauma and contact lens overwear are significant risk factors for infectious keratitis in Oman and correlate with specific age groups. Delay in treatment due to the first-line utilization of CAM showed a significant adverse impact on outcome.

Kataraktpatienten mit Pseudoexfoliations- (PEX-)Syndrom in einer Bevölkerung mit hoher PEX-Prävalenz

BACKGROUND

Cataracts are the most frequent treatable cause of noninfectious blindness in Oman. Therefore, in 2002 a study was performed at our department of ophthalmology to evaluate cataract patients for pseudoexfoliation.

METHODS

In a prospective comparative cohort study, 370 age-related cataract eyes out of an evaluable population of 498 cataracts were evaluated by biomicroscopy, confocal corneal analysis, and electron microscopy and followed up after 6 months.

RESULTS

Of 370 age-related cataracts without glaucomas 171 had PEX. Preoperative manifestations were 89 subluxations, 15 vitreous prolapses, 6 ciliolenticular blocks, and 7 intravitreal dislocations. In 40 Omani cataract eyes without PEX the endothelial cell count was normal compared to the age-matched US norm and corneal thickness was less than Caucasians, but more than Afro-Americans.

CONCLUSIONS

This study reports on a high incidence and frequent preoperative complications (68%) of the surgical cataract cases in an Arabic population. The development of serious complications and blindness is related to the duration of the disease and the lack of timely surgery.

Patienten mit sekundärem Offenwinkelglaukom bei Pseudoexfoliations- (PEX-)Syndrom in einer Bevölkerung mit hoher PEX-Prävalenz

BACKGROUND

The second most frequent treatable cause of noninfectious blindness in Oman is high-pressure glaucoma. Therefore, in 2002 a study was performed at our department of ophthalmology to evaluate pseudoexfoliation (PEX) in glaucoma patients.

METHODS

In a prospective comparative cohort study, of 204 glaucoma eyes, 135 open-angle glaucomas were evaluated by biomicroscopy, papillometry, and electron microscopy and followed up after 6 months.

RESULTS

The incidence of PEX glaucomas relative to all glaucomas was 50.9% and to open-angle glaucomas 77%. The IOP level in PEX was higher than in POAG; the CDR, neuroretinal rim zone, and the visual field loss were not significantly different. In 38 of 104 operated PEX glaucoma eyes, the postoperative visual acuity deteriorated although the IOP was controlled.

CONCLUSIONS

PEX high-pressure glaucomas account for half of all glaucomas in the eastern region of the Arabian peninsula. Surgical outcomes feature a high percentage of postoperative reduction of vision in the late PEX stage.

Keratomycosis due to Trichophyton mentagrophytes

We report the case of an Omani lady who presented with keratitis that grew Trichophyton mentagrophytes on culture media and responded to treatment with topical fluconazole.

Physical fitness of urban American children

The Bruce treadmill protocol was used to evaluate the exercise endurance in a pediatric urban population. The sample population consisted of 525 healthy children 4 to 18 years of age (303 males and 222 females). Endurance time increased with age in males and increased up to 10 to 12 years of age in females, thereafter leveling off. Results were compared with those of a widely used standard reference of normal for treadmill exercise testing in children. Mean endurance times were significantly shorter compared to those of the reference study (p < 0.03). When the subjects were grouped in percentiles based on the reference study, 61% of males and 81% of females performed below the 25th percentile. There was a strong negative correlation between body mass index and endurance time (p < 0.0001), suggesting that obesity is a major contributor to decreased physical fitness. Compared to subjects in the reference study, children from a large U.S. metropolitan area have markedly diminished exercise endurance times, suggesting poor physical fitness. Inactivity with consequent lack of fitness, if unchecked, are likely to lead to cardiovascular disorders in adulthood. Efforts should be made to encourage physical fitness in children.

Conjunctival ulcer--mucocutaneous or ocular manifestation of Behçet's disease? A case report

PURPOSE

To report the rare occurrence of conjunctival ulceration in a patient with Behcet's disease.

METHODS

Case report. A 35 year old "Behçet's suspect" on azathioprine presented to the ophthalmic emergency room with a painful ulceration involving the inferior palpebral conjunctiva of her left eye.

RESULTS

The ulcer responded to treatment with topical steroids and healed without scarring.

CONCLUSIONS

Conjunctival ulceration is not a common manifestation of Behcet's disease. Its occurrence during maintenance therapy with azathioprine in a patient with Behcets could be either incidental or indicate inadequate immunosuppression.

Differential regulation of SR calcium transporters by thyroid hormone in rat atria and ventricles

Thyroid hormone exerts positive inotropic effects on the heart mediated in part by its regulation of calcium transporter proteins, including sarco(endo)plasmic reticulum Ca(2+)-ATPase (SERCA2), phospholamban (PLB), and Na(+)/Ca(2+) exchanger (NCX). To further understand the potential cardiac chamber-specific effects of thyroid hormone action, we compared the triiodo-L-thyronine (T(3)) responsiveness of calcium transporter proteins in atrial versus ventricular tissues. Rats were rendered hypothyroid by ingestion of propylthiouracil, and a subgroup of animals was treated with T(3) for 7 days (7 microg/day by constant infusion). Atrial and left ventricular (LV) tissue homogenates were analyzed for expression of SERCA2, PLB, and NCX proteins by Western blot analysis. SERCA2 protein significantly decreased by 50% in hypothyroid LV and was normalized by T(3) treatment. In contrast, SERCA2 protein in atria was unaltered in the hypothyroid state. PLB protein expression significantly increased by 1.6- and 5-fold in the hypothyroid LV and atria, respectively, and returned to euthyroid levels with T(3) treatment. Expression of NCX protein showed a greater response to T(3) treatment in atria tissue than in ventricular tissue. Sarcoplasmic reticulum calcium cycling is determined in part by the ratio of SERCA2 to PLB. This ratio was sixfold higher in the atria compared with LV, suggesting that PLB may play a minor role in the regulation of SERCA2 function in normal atria. We conclude that calcium transporter proteins are responsive to thyroid hormone in a chamber-specific manner, with atria showing a greater change in protein content in response to T(3). The differential effect on atria may account for the occurrence of atrial rather than ventricular arrhythmias in response to even mild degrees of thyrotoxicosis.

Frosted retinal branch angiitis in an immunocompetent adult due to herpes simplex virus

A case of acute severe loss of vision due to perivasculitis typical of frosted retinal branch angiitis due to Herpes simplex virus in an otherwise healthy young Omani lady is presented.

Thyroid hormone metabolism and cardiac gene expression after acute myocardial infarction in the rat

In a rat model of acute myocardial infarction (MI) produced by coronary artery ligation, thyroid hormone metabolism was altered with significant reductions (54%) in serum triiodo-L-thyronine (T(3)), the cellular active hormone metabolite. T(3) has profound effects on the heart; therefore, rats were treated with T(3) after acute MI for 2 or 3 wk, at either replacement or elevated doses, to determine whether cardiac function and gene expression could be normalized. Acute MI resulted in a 50% (P < 0.001) decrease in percent ejection fraction (%EF) with a 32-35% increase (P < 0.01) in compensatory left ventricle (LV) hypertrophy. Treatment of the MI animals with either replacement or elevated doses of T(3) significantly increased %EF to 64 and 73% of control, respectively. Expression levels of several T(3)-responsive genes were altered in the hypertrophied LV after MI, including significant decreases in alpha-myosin heavy chain (MHC), sarcoplasmic reticulum calcium-activated ATPase (SERCA2), and Kv1.5 mRNA, whereas beta-MHC and phospholamban (PLB) mRNA were significantly increased. Normalization of serum T(3) did not restore expression of all T(3)-regulated genes, indicating altered T(3) responsiveness in the postinfarcted myocardium. Although beta-MHC and Kv1.5 mRNA content was returned to control levels, alpha-MHC and SERCA2 were unresponsive to T(3) at replacement doses, and only at higher doses of T(3) was alpha-MHC mRNA returned to control values. The present study showed that acute MI in the rat was associated with a fall in serum T(3) levels, LV dysfunction, and altered expression of T(3)-responsive genes and that T(3) treatment significantly improved cardiac function, with normalization of some, but not all, of the changes in gene expression.

Regulation of rat cardiac Kv1.5 gene expression by thyroid hormone is rapid and chamber specific

Thyroid hormone affects the contractile and electrophysiological properties of the cardiac myocyte that result in part from changes in the expression of thyroid hormone-responsive cardiac genes, including those that regulate membrane ion currents. To determine the molecular mechanisms underlying this effect, expression of a voltage-gated K+ channel, Kv1.5, was measured in response to thyroid hormone. Using quantitative RT-PCR methodology, the content of Kv1.5 messenger RNA (mRNA) in left ventricles of euthyroid rats was 4.25+/-0.6x10(-20) mol/microg total RNA and was decreased by 70% in the hypothyroid rat ventricle to 1.27+/-0.80x10(-20) mol/microg RNA (P<0.01). Administration of T3 to hypothyroid animals restored ventricular Kv1.5 mRNA to control levels within 1 h of treatment, making this the most rapid T3-responsive cardiac gene reported to date. The half-life of Kv1.5 mRNA was 1.9 h and 2.0 h in euthyroid and hypothyroid ventricles, respectively, and T3 treatment of the rats did not alter its half-life. In atrial myocardium, expression of Kv1.5 mRNA (6.10+/-0.37x10(-20) mol/microg RNA) was unaltered by thyroid hormone status. The myocyte-specific and chamber-selective expression of Kv1.5 mRNA was confirmed in primary cultures of rat atrial and ventricular myocytes.

Characterization of determinants for envelope binding and infection in tva, the subgroup A avian sarcoma and leukosis virus receptor

Tva is the cellular receptor for subgroup A avian leukosis and sarcoma virus (ALSV-A). The viral interaction domain of Tva is determined by a 40-residue, cysteine-rich module closely related to the ligand binding domain of the human low-density lipoprotein receptor (LDLR). In this report, we examined the role of the LDLR-like module of Tva in envelope binding and viral infection by mutational analysis. We found that the entire LDLR module in Tva is essential for efficient binding to the viral envelope protein. However, the 17 N-terminal residues of this module can be deleted without affecting receptor function, suggesting that the major determinants for viral entry are located at the C terminus of the module. The effect on viral infection of many amino acid substitutions and deletions in the LDLR module is context dependent, suggesting that the residues important for viral entry are dispersed throughout the LDLR module. In addition, we found that all 27 mutations at residues D46, E47, and W48 greatly reduced envelope binding. These results are discussed in relation to a recently elucidated structure for an LDLR module.