Lacrimal gland activity in lacrimal drainage obstruction: exploring the potential cross-talk between the tear secretion and outflow

PURPOSE

To investigate the effects of lacrimal drainage obstructions on the lacrimal gland activity and if there exists a potential link between the two.

METHODS

Direct assessment of the lacrimal gland activity from the palpebral lobe was performed in consecutive patients diagnosed with unilateral primary acquired nasolacrimal duct obstruction (PANDO), along with Ocular Surface Disease Index (OSDI), non-invasive tear break up time (NIBUT; Oculus K5M), tear meniscus height and Schirmer I. The primary outcome measure was the difference in the tear flow rate between the eye with PANDO and the contralateral uninvolved eye.

RESULTS

Thirty patients (median age, 45.5 years; 25 females) with unilateral PANDO had epiphora for a mean duration of 20 months. The mean OSDI score was 6.3. NIBUT (mean 11.56 vs 11.58 s; p=0.49) and Schirmer I values (mean 18.83 vs 19.4 mm; p=0.313) were not significantly different between PANDO and non-PANDO eyes. The morphology of the palpebral lobe (size 29.3 vs 28.6 mm2, p=0.41) and the number of lacrimal ductular openings (median 2 vs 2.5) were similar between the two eyes. The mean tear flow from the lacrimal glands of the PANDO side was significantly reduced compared with the contralateral uninvolved side (0.8 vs 0.99 µL/min; p=0.014)).

CONCLUSION

Tear flow rate from palpebral lobes of patients with unilateral lacrimal outflow obstruction shows a significant reduction compared with the contralateral side. The potential ways of communications between the tear drainage and the tear production mechanisms need to be explored further.

Resolving fetal hydrops - A rare entity

Non-immune hydrops fetalis (NIHF) is abnormal accumulation of serous fluid in ≥2 interstitial spaces with no evidence of maternal red cell alloimmunization. Leaving a few treatable conditions, it is generally considered as a sign of poor fetal outcome. Bi-allelic variants in THSD1 have been found to be to be associated with phenotypes ranging from lethal NIHF to persistent edema. Here, we report a family with non-immune hydrops in two successive pregnancies. Whole exome sequencing in second pregnancy identified a homozygous truncating variant in THSD1 (NM_018676:c.892G>T:p.Glu298Ter). Postnatal follow up showed gradual resolution of the accumulated fluid and normal development. This report further strengthens the association of variants in THSD1 with NIHF.

Tear film changes in symptomatic versus asymptomatic video display terminal users following computer challenge test

PURPOSE

To assess the real-time changes in the tear film and ocular surface of symptomatic video display terminal (VDT) versus asymptomatic users.

METHODS

A total of 35 symptomatic (29 ± 5.6 years; Group 1, mild dry eye disease) and 35 asymptomatic (24.1 ± 4.6 years; Group 2) VDT users with a mean OSDI of 28 ± 11 and 0.86 ± 2.1, respectively, had tear film examination (Oculus Keratograph 5 M and Tearlab Osmolarity System) at baseline and after 1 h of watching a movie on the laptop inside a controlled environment chamber along with blink rate calculation.

RESULTS

The mean VDT use was 11.4 ± 3.2 h/day in Group 1 and 2.3 ± 2.3 h/day in Group 2. In Group 1, the mean pre- and post-VDT task values for NIBUT and bulbar congestion were 10.7 ± 3.7s and 6.7 ± 3.1s (P = 0.007), and 0.8 ± 0.4 and 1.1 ± 0.5 (P = 0.01), respectively. There were no significant changes in tear meniscus height (P = 0.77), Schirmer I (P =0.14), corneal staining score (P = 1.0), and tear osmolarity (P > 0.05). Group 2 showed insignificant change in all parameters. Only 16.2% individuals in Group 1 met modified TFOS-DEWS II diagnostic criteria at baseline that increased to 67.6% following VDT task. The blink rate reduced significantly during the last 15 min (6.8 ± 3.4 vs. 9.3 ± 4.5; P = 0.006) compared to the first 15 min of the task in Group 1, whereas no significant change occurred in Group 2.

CONCLUSION

Tear film instability and increased bulbar congestion are observed in symptomatic VDT users after computer work despite baseline stable tear film. The changes are significantly altered in symptomatic VDT users compared to asymptomatic users.

Morphologic variants of Meibomian glands: age-wise distribution and differences between upper and lower eyelids

Purpose

To evaluate the distribution of various Meibomian gland morphologies across different age groups in healthy individuals.

Methods

The infrared meibographic morphologies of the Meibomian glands from the upper and lower eyelids of 236 healthy individuals (472 eyes; mean age 38.4 ± 17.5 years; 80 female participants: 156 male participants) were evaluated for their prevalence and differences across six decades of life, from 10 to 80 years. A linear mixed-effects modeling test was performed for statistical analysis.

Results

Of 14,452 glands, 8,830 (61%) glands were located in the upper eyelid. No significant differences in frequency were noted between different age groups for distorted, tortuous, hooked, overlapping, abnormal gap, fluffy areas, dropout (except for 51-60 vs. 10-20 years, P = 0.023), and thick and thin morphologies. Short glands were significantly more common in individuals aged over 30 years (P = 0.015), whereas moderately short and severely short glands were more common in the upper eyelids of individuals older than 50 years compared to those aged 10-20 years (P = 0.035). The frequency of distorted, hooked, tortuous, overlapping, and tadpole-shaped Meibomian glands was significantly higher in the upper eyelids than in the lower eyelids for all age groups. Dropout glands were more common in the lower eyelids of individuals younger than 50 years, but no difference was observed in the upper and lower eyelids of individuals over 50 years. Dropout (P = 0.006) and severely short glands (0.026) of the lower eyelid were associated with low non-invasive tear break-up time (NIBUT) values.

Conclusion

Various morphologic characteristics of the Meibomian glands that are considered abnormal can be present in healthy individuals, and only moderate to severely short glands display an increase in abnormal morphologic characteristics of the Meibomian glands with age.

Repeatability of Non-invasive Tear Film Evaluation in Healthy Rabbit Eyes

PURPOSE

The current study investigated the normative data values and repeatability of non-invasive tear film tests using Oculus Keratograph 5M in rabbit eyes.

METHODS

Triplicate analysis of tear film parameters [tear meniscus height (TMH), non-invasive tear break up time (NIBUT), bulbar congestion, meibography] of 38 healthy adults New Zealand white rabbits (mean age, 13 ± 4.7 months) was performed using Oculus keratograph 5M (K5M). Bland-Altman analysis was used for testing repeatability.

RESULTS

Thirty-eight rabbits (N = 76 eyes) weighing 2.5 ± 0.4 kg were studied. The mean NIBUT values of the right and left eye were 14.3 ± 5.8 and 12.3 ± 5.8 s, respectively. The mean central TMH values were 0.43 ± 0.23 and 0.33 ± 0.14 mm in the right and left eye, respectively. Meibography showed closely placed, wide meibomian glands running vertically with no distorted or gland loss areas. There were no differences between the eyes for the above parameters. Bland-Altman plot showed good repeatability for both NIBUT and TMH values.

CONCLUSION

The non-invasive tear film parameters show good repeatability using keratograph 5M and can be used as an objective parameter for rabbit ocular surface experiments.

Repeatability, reproducibility and agreement between three different diagnostic imaging platforms for tear film evaluation of normal and dry eye disease

PURPOSE

To assess the repeatability and reliability of different commercially available diagnostic platforms in the objective assessment of tear film parameters and if there exists any agreement between them.

METHODS

Thirty healthy individuals (N = 60 eyes) and fifteen DED patients (N = 30 eyes) had their tear film parameters (Lipid layer thickness (LLT), Tear meniscus height (TMH), Non-invasive tear break up time (NIBUT)) assessed using three instruments - LipiView® II, IDRA ocular surface analyser (IDRA-OSA) and Oculus keratograph 5 M (K5M). Bland-Altman analysis and linear mixed effects modelling & Generalized Linear Hypothesis Test were used for analysis and coefficient of variation (CoV).

RESULTS

There is poor repeatability but good reproducibility of LLT values measured with Lipiview, or IDRA. NIBUT using K5M & IDRA-OSA shows good repeatability and reproducibility in control group but poor repeatability in DED patients. TMH values obtained with K5M or IDRA-OSA had poor repeatability with high CoV. Between two observers, good reproducibility is observed for TMH and NIBUT values using both K5M & IDRA-OSA but not for LLT values. Between instruments, all the measurements (LLT, NIBUT and TMH) were significantly different on Bland Altman analysis.

CONCLUSION

No two dry eye diagnostic platforms can be used interchangeably and non-invasive tear film values should be interpreted keeping in mind the individual machine's variability. The high coefficient of variation in DED patients compared to normal reflects inherent variability in tear film irrespective of the device used.

Lacrimal and meibomian gland evaluation in dry eye disease: A mini-review

Lacrimal and meibomian glands contribute to the aqueous and lipid components of tear film, respectively. Their evaluation remains central to diagnosing and managing dry eye disease (DED). The review discusses the differences and reliability of various diagnostic tests and commercially available devices used for DED diagnosis. Slit-lamp-based techniques are direct palpebral lobe and tear flow assessment, Schirmer test, meibum quality and expressibility, and evaluation of tear meniscus height. Non-invasive tear meniscus height (TMH), tear break-up time (TBUT), lipid layer thickness (LLT), and meibography are machine-based diagnostic tests. The structure-function correlation of the tear-producing glands gives more comprehensive details than either information alone. Many devices are available in the market, which make DED diagnosis an easy feat, but the tests should be interpreted keeping in mind the intra-observer and inter-observer repeatability. Also, the tear film displays a huge variability as per the environmental conditions and impact of blinking. Hence, the examiner should be well versed with the techniques and repeat the test two to three times to obtain an average reading, which is more reliable. The recommended sequence of tests for diagnosing DED is a dry eye questionnaire, TMH, LLT, NIBUT (FBUT if non-invasive test is unavailable but should be performed after osmolarity), tear osmolarity, meibography, and ocular surface staining. Invasive tests such as Schirmer should be performed after the non-invasive tear film diagnostic testing.

Impact of demographic profile on nutritional labelling usage by working women population of Varanasi, India

Nutritional labelling is the nutritional description of the food on the label to help the consumer in food selection. The present study aimed to assess the knowledge, attitude and practices adopted by the subjects and correlate them to have a better understanding of their nutritional background. Nutrition labels are a prominent first-glance article that needs to be very catchy and easy to interpret. The organizations responsible for formulating the rules and regulations must keep them updated and devise new formats of the display to enhance the usage of food labels up to the maximum possible level. A cross-sectional research study on 100 working women of Varanasi, aged between 20-50 years was conducted through a self-structured questionnaire to evaluate their KAP level. In view of the COVID-19 pandemic, the questionnaire was administered to the respondents through the online medium using Google forms. It can be inferred from the study that 58 % of the total respondents surveyed were aware of the labels, 61% of them had a positive attitude towards its usage but only 52% practised healthy shopping more often. About 70% of the participants preferred back-of-pack labelling rather than front-of-pack because the former provides elaborative information. The factors like qualification and occupation of women participants had negative associations with the satisfaction of the display format. The women having knowledge regarding traffic light labelling showed a positive association with the usefulness of the same. The average practice percentage adopted by the consumers had a negative association with factors like qualification, income, and occupation. The need for simplifying the display format and providing basic nutrition information to the population is highlighted in this study.

Non-invasive Tear Film Assessment in Normal Population: Effect of Age, Sex, and Interparametric Relationship

Purpose:

To investigate age- and sex-related differences in tear film parameters of normal Indian population and study interparametric relationships.

Methods

Healthy subjects with no ocular disease (median ocular surface disease index = 0) were subjected to an automated evaluation of tear meniscus height (TMH), non-invasive tear breakup time (NIBUT) using Keratograph 5M (OCULUS GmbH, Wetzlar, Germany), and tear osmolarity using the TearLab Osmolarity System (TearLab Corporation, California, USA). A mixed-effects model with random intercepts at the patient level was used to evaluate the relationships between explanatory (age, gender, and tear osmolarity) and outcome variables (TMH and NIBUT).

Results

A total of 237 subjects (474 eyes; 150 males) were enrolled with a mean age of 40 ± 17 years (range, 10-78 years). The mean values (± standard deviation) of TMH, NIBUT, and tear osmolarity were 0.34 ± 0.07 mm, 10.95 ± 2.02 s and 289.0 ± 5.8 mOsm/L, respectively. Age had a significant positive relationship with TMH (p < 0.0001; 0.002 mm/year; r = 0.12), but there was no effect on NIBUT (p = 0.26) and tear osmolarity (p = 0.27). There were no sex-based differences in tear film parameters. Interparametric relationship revealed no significant association between TMH and NIBUT (p = 0.12) or tear osmolarity and TMH (p = 0.83) or tear osmolarity and NIBUT values (p = 0.48).

Conclusions

In a normal Indian population, TMH is weakly affected by age and is independent of sex, NIBUT, and tear osmolarity. Tear breakup time and osmolarity show no significant age- and sex-related variation.

A nationwide analysis of risk factors for mortality and time to endoscopy in upper gastrointestinal haemorrhage

BACKGROUND

We analysed nationwide in-patient data from 2002 to 2007 to determine significant demographic variables when predicting mortality and receipt of prompt oesophagogastroduodenoscopy (OGD) for acute variceal haemorrhage (AVH) and nonvariceal upper gastrointestinal haemorrhage (NVUGIH).

AIM

To study the effects of demographic variables in predicting time to endoscopy and mortality in AVH and NVUGIH.

METHODS

We analysed the United States' Nationwide Inpatient Sample (NIS), for risk factors for mortality and receipt of OGD within 1 day of admission for upper gastrointestinal haemorrhage.

RESULTS

Risk factors for increased mortality in AVH included: age >60, men, African Americans, comorbidities, insurance type and delayed OGD. Risk factors for increased mortality in NVUGIH were similar to AVH, except race which was not significant. After correction for factors such as insurance type, comorbidity, hospital location and time to endoscopy, this increased risk of mortality persisted, suggesting that none of these factors was the primary cause of the observed differences. For AVH, OGD within 1 day of admission was more likely in men, White Americans, patients aged 18-40 years, privately insured and those with no comorbidities. OGD within 1 day of admission in NVUGIH was more likely in men, patients age 40-60, Whites, Hispanics, privately insured and those with a single comorbidity.

CONCLUSIONS

In multivariate analysis, in-patient mortality in AVH and NVUGIH increased with age, comorbidity, male gender, and delayed time to endoscopy. Young, healthier men were most likely to receive OGD within 1 day of admission. African Americans were less likely to receive OGD within 1 day of admission and had increased mortality in cases of AVH.

Short-term changes in magnetic resonance imaging and disease activity in response to infliximab

Objectives:

To characterise and quantify short-term changes in local inflammation using magnetic resonance imaging (MRI), and to correlate the findings with clinical disease activity in response to infliximab in patients with spondyloarthritis.

Methods:

28 consecutive patients with established spondyloarthritis under successful long-term treatment with infliximab underwent MRI immediately before and one week after re-administration of the TNF blocker. C-reactive protein and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were assessed at both time points. The MRI protocol included coronal and sagittal turbo-short T1 inversion recovery (STIR) images as well as contrast-enhanced sagittal T1-weighted, fat-suppressed images. Images were assessed in independent sessions using the ASspiMRI-a score, the signal-difference-to-noise ratios (SDNR) and volumetry to assess oedematous and inflamed tissues.

Results:

BASDAI values were expectedly low at study entry (3.3, SD 2.3). One week after administration of infliximab, 46% of patients reached a BASDAI 20, 39% a BASDAI 50. Kappa values for qualitative assessments and all measurements were excellent (range between 0.83 and 1.0) The ASspiMRI-a dropped most in the thoracic (3.3 points), less in the lumbar (1.21 points) and least in the cervical spine (0.38 points). The decrease of the ASspiMRI-a, the SDNR and the inflamed volumes in response to infliximab re-treatment was significant (p<0.01). The BASDAI showed a weak correlation with the ASspiMRI-a (r  =  0.41).

Conclusions:

MRI proves to be a valid method to assess and quantify short-term effects of therapy in spondyloarthritis. Comparison between MRI and BASDAI changes show that the BASDAI may underestimate local inflammation. It suggests an explanation for the structural disease progression despite clinical remission.

Removal of copper by Pseudomonas putida strain S4 isolated from copper mines

A bacterial strain, Pseudomonas putida S4, was isolated from smelter drainage of copper mines. The strain exhibited resistance to several heavy metals, like aluminium (Al), zinc (Zn), nickel (Ni), cobalt (Co) besides copper (Cu). Strain S4 could accumulate Cu from the Cu-supplemented growth medium. In the present study, we have demonstrated the Cu2+ removal capacity of this strain from various samples such as mine effluent, low-grade ore and ore-tailings, collected from the mining site. Moreover, approximately 80% of the accumulated Cu2+ could be recovered from the loaded biomass by a simple desorption procedure.

MR imaging of the wrist in rheumatoid arthritis using gadobenate dimeglumine

OBJECTIVE

To determine the dosage of gadobenate dimeglumine (Gd-BOPTA) necessary for MRI of rheumatoid arthritis of the wrist.

DESIGN AND PATIENTS

Seven wrists inflamed with rheumatoid arthritis were imaged using a dedicated 0.2-T MR unit. Four cumulative dosages of 0.0125, 0.025, 0.05 and 0.1 mmol/kg body weight (BW) Gd-BOPTA were tested. Three-dimensional T1-weighted gradient-recalled echo sequences (GRE; TR: 100 ms, TE: 18 ms, flip angle 90 degrees , 4:55 min) were acquired prior to an intravenous injection and after each additional dosage of Gd-BOPTA. Relative enhancement, signal-difference-to-noise ratios (SDNRs) and the size of the inflamed tissue were quantified. Three radiologists independently evaluated the image quality, the size and the contrast of the enhancing tissue.

RESULTS

The readers agreed on a dose of 0.05 mmol/kg BW as satisfactory for the evaluation of the size of the inflammatory tissue and for determination of bone involvement (kappa = 0.9, P < 0.001). Highly inflammatory pannus was depicted with adequate image contrast using 0.025 mmol/kg BW Gd-BOPTA. According to the SDNR and relative enhancement findings, a dose of 0.05 mmol/kg BW suffices for both off-center and centered regions of tissue inflammation (t-test, P < 0.05).

CONCLUSION

Gadolinium-BOPTA is an alternative contrast agent for MRI of rheumatoid disease. This study shows that a dose of 0.05 mmol/kg BW suffices at low field strength.

Quantitative ultrasound of the tibia depends on both cortical density and thickness

This study investigated whether tibial speed of sound (SOS; SoundScan 2000, Myriad Ultrasound Systems, Israel) reflects not only bone mineral density (BMD) but also tibial cortical thickness, as assessed by dual-energy X-ray absorptiometry (DXA) and Quantitative CT (QCT) at a site-matched location. The secondary focus of the study was how tibial SOS compares with BMD at the spine and the hip, the most widely used locations for densitometry. Twenty-two young normal (N) and 23 postmenopausal women with spinal fractures (Fx) (mean (SD) age 35 (8) and 70 (5) years) underwent quantitative ultrasound (QUS) SOS measurement at the left tibial midshaft. From site-matched QCT scans (three 3-mm slices spaced along the QUS measurement region), BMD and cortical thickness were computed (QCT-cBMD, QCT-cTh). The cortex in the CT images was then subdivided into three concentric and equally spaced bands, and QCT-cBMD was computed separately for each band. DXA was performed at the mid-tibia (TIB BMD), at the spine (SPINE BMD) and the hip (total hip, HIP BMD). Correlation coefficients between parameters were determined with least-square linear fits. Intergroup differences were assessed by analysis of covariance, whose r2 value reflects the percentage variation in the data explained by group assignment. SOS correlated significantly with site-matched parameters (QCT-cBMD, OCT-cTh and TIB BMD, all r = 0.6, p < 0.001), SPINE BMD and HIP BMD (both r = 0.5, p < 0.001). Multiple regression with both QCT-cBMD and QCT-cTh against SOS yielded r = 0.7 with both parameters contributing significantly. For the cortex band subdivision, SOS correlated better with QCT-cBMD in the outermost band of the cortex (r = 0.67) than with the more central bands (r = 0.59 and r = 0.53). Group assignment could best explain SPINE BMD (r2 = 0.62) and HIP BMD (r2 = 0.51). SOS was comparable to TIB BMD (r2 = 0.3 vs. r2 = 0.35).: Our findings suggest that the tibial SOS measurement depends on both the thickness and density of the tibia, but is more strongly influenced by the density of the cortex near the surface than by its interior parts. The power of tibial ultrasound to discriminate between normal and fracture patients was less than that of spinal and femoral DXA BMD and comparable to site-matched DXA BMD.

Carpal tunnel syndrome: assessment by turbo spin echo, spin echo, and magnetization transfer imaging applied in a low-field MR system

PURPOSE

The purpose of this work was to evaluate patients with carpal tunnel syndrome (CTS) using a low-field extremity MR system (E-MRI: 0.2 T).

METHOD

Twenty-two patients with typical findings of CTS and 30 control persons were imaged on an E-MRI. Axial T2-weighted turbo SE (TSE), T1-weighted SE sequences, and 2D GRE magnetization transfer (MTC) sequences were compared. SE and MTC sequences were obtained before and after contrast agent administration (0.1 mmol/kg body wt of Gd-DTPA). Two readers evaluated typical MR findings of CTS independently.

RESULTS

Patients with CTS demonstrated palmar bowing of the flexor retinaculum significantly more often. The normal or edematous median nerve was best identified on TSE and MTC scans (kappa = 0.59 and 0.8). The MTC sequences showed perineural enhancement significantly better than respective T1-weighted SE sequences but were rated second in comparison with T2-weighted TSE scans.

CONCLUSION

At low-field strength, median nerve edema is best depicted on T2-weighted TSE sequences, whereas MTC sequences are most sensitive to perineural contrast enhancement.

Backside nonconformity and locking restraints affect liner/shell load transfer mechanisms and relative motion in modular acetabular components for total hip replacement

Nonconformity between the polyethylene liner and the metal shell may exist in modular acetabular components by design, due to manufacturing tolerances, or from locking mechanisms that attach the polyethylene liner to the metal shell. Relative motion at the liner/shell interface has been associated with backside wear, which may contribute to osteolysis which has been clinically observed near screw holes. The purpose of this study was to investigate the effect of nonconformity and locking restraints on the liner/shell relative motion and load transfer mechanisms in a commercially available, metal-backed acetabular component with a polar fenestration. The finite element method was used to explore the hypothesis that backside nonconformity and locking restraints play important roles in long-term surface damage mechanisms that are unique to modular components, such as backside wear and liner extrusion through screw holes. The three-body quasi-static contact problem was solved using a commercially available explicit finite element code, which modeled contact between the femoral head, polyethylene liner, and the metal shell. Four sets of liner boundary conditions were investigated: no restraints, rim restraints, equatorial restraints, and both rim and equatorial restraints. The finite element model with a conforming shell predicted between 8.5 and 12.8 microm of incremental extrusion of the polyethylene through the polar fenestration, consistent with in vitro experiments of the same design under identical loading conditions. Furthermore, idealized rim and/or equatorial liner restraints were found to share up to 71% of the load across the liner/shell interface. Consequently, the results of this study demonstrate that backside nonconformity and locking restraints substantially influence backside relative motion as well as load transfer at the liner/shell interface.

Validation of a small punch testing technique to characterize the mechanical behaviour of ultra-high-molecular-weight polyethylene

The small punch or miniaturized disc bend test has been used successfully to characterize the ductility and fracture resistance of metals and ceramics with specimens measuring 0.5 mm in thickness. This study was performed to demonstrate the feasibility of performing small punch tests on implant grade ultra-high-molecular-weight polyethylene (UHMWPE). Large-deformation finite element simulations were developed and validated to explore the hypothesis that the macroscopic constitutive behaviour of UHMWPE may be inferred from a miniature specimen testing technique which can be used to characterize the ductility and work to failure for UHMWPE. The load-displacement curve was insensitive to cyclic preconditioning of the test specimen and only mildly sensitive to the loading rate. Furthermore, the initial slope of the small punch load-displacement curve was used to determine the elastic modulus of the UHMWPE with the help of the inverse finite element method. The ultimate goal of this research is to develop the capability to perform local measurements of material tensile and static fracture properties in as-manufactured, as-sterilized and as-retrieved UHMWPE components.

Serial echocardiography in transplanted heart: an initial report of five cases

Role of echocardiography including Doppler is established in selection of donor and in the care of patients after cardiac transplantation. Its value for recognition of transplant rejection is however still evolving. We present here, serial echocardiographic findings in five male patients, aged 22 to 46 years who underwent cardiac transplantation at our institution. There was no appreciable change on follow-up in the left ventricular dimensions, thickness of left ventricular posterior wall and interventricular septum and left ventricular systolic function. Transient pericardial effusion was noted in two patients. Trivial to mild mitral and tricuspid regurgitation was observed. The diastolic function of the left ventricle, as assessed by mitral valve inflow wave pattern, was normal in four patients. However in the fifth patient, there was evidence of diastolic dysfunction of the left ventricle and this change was accompanied by rejection episode (IIIB changes) in the endomyocardial biopsy. With resolution of rejection in biopsy, the diastolic function by Doppler also returned to normal. We conclude that echocardiography has a definite role in the general care of patients after cardiac transplantation. Transient small pericardial effusion and mild atrioventricular valve regurgitation are common after the operation. Echocardiography may also be of use in recognition of rejection episode by demonstrating evidence of diastolic dysfunction of the left ventricle. Currently, endomyocardial biopsy remains the gold standard for diagnosis of rejection.

Magnesium and antioxidant vitamin status and risk of complications of ageing in an elderly urban population

This cross-sectional survey was conducted in 20 randomly selected streets in Moradbad city in North India to determine the association of magnesium and antioxidant vitamins with risk of ageing. There were 595 subjects (314 males, 281 females) between 50-84 years of age inclusive. The overall prevalence of hypo-magnesemia was 11.8 per cent (n = 60) with a prevalence of 13.2 per cent (n = 33) in males and 10.6 per cent (n = 27) in females. The prevalence of hypomagnesemia showed significant declining trend in the concentration of serum magnesium, vitamin C, vitamin E and beta-carotene and a rising trend in lipid peroxides and diene conjugates with increase in age from 50-59 years to 70-84 years in both men and women. Multivariate logistic regression analysis showed that serum magnesium, vitamin C, vitamin E and beta-carotene were significant risk factors of ageing in both men and women. The findings suggest that some urban populations of India can benefit by consuming higher dietary magnesium, potassium and antioxidant vitamins for prevention of ageing.

Epidemiological study of coronary artery disease and its risk factors in an elderly urban population of north India

OBJECTIVE

In view of the rapid increase in the prevalence of coronary artery disease (CAD) in developing countries, our aim was to determine the prevalence of CAD and its risk factors and lifestyle factors in an elderly population from north India.

METHODS

A random sample of 595 elderly subjects between 50 to 84 years of age was obtained from the urban population of Moradabad. The response rate was 90.1%. The survey methods included a questionnaire containing information on 7-day food intake, other lifestyle factors, Rose questionnaire for diagnosis of angina pectoris, a standard 12-lead electrocardiogram, blood pressure measurements and blood examination.

RESULTS

The total prevalence of CAD based on clinical history and electrocardiogram was 121/1000 (95% CI 72 to 165). The prevalence rate was slightly higher in males (130/1000) than in females (110/1000). The prevalence of CAD based on the Rose questionnaire was 57/1000 and based on electrocardiogram in 561 asymptomatic subjects was 67/1000. CAD was significantly higher in the elderly (65 to 84 years) group than in the middle-aged (50 to 64 years) group (168 vs. 97 per 1000), respectively. While the prevalence of hypertension was significantly higher in the elderly than middle-aged group respectively (214 vs. 168 per 1000), the prevalence of central obesity was significantly higher in the middle-aged than elderly group (674 vs. 632 per 1000). Other risk factors including smoking were comparable in the two subgroups. Prevalence of major risk factors and central obesity were significantly higher among patients with CAD than in the rest of the subjects. Prevalence of CAD was significantly higher in the middle and higher socio-economic groups compared to the lower income group. These higher income groups were also eating significantly higher amounts of visible fat and had a higher prevalence of physical inactivity (93.3%) compared to the lower income group.

CONCLUSIONS

CAD and its risk factors such as hypertension, hypercholesterolemia, diabetes and central obesity are of sufficient magnitude in the elderly population of India to be a major public health problem. The findings also indicate that CAD is more commonly associated with middle and higher socio-economic status which may be due to greater consumption of dietary fat and more sedentariness compared to lower socioeconomic groups.

Stimulation of neutrophil respiratory burst and degranulation by Japanese encephalitis virus-induced macrophage derived factor

The effects of Japanese encephalitis virus (JEV) and JEV-induced macrophage derived neutrophil chemotactic factor (MDF) on respiratory burst and granule exocytosis in neutrophils were studied and were compared with N-formyl-methionyl-leucyl-phenylalanine (FMLP). JEV-stimulated neutrophils released reactive oxygen metabolites with maximum activity between days 7 and 9. The response in mice was sensitive to anti-JEV-antisera treatment. Stimulation by MDF resulted in quick release of superoxide and granule enzymes from neutrophils upon both in-vivo and in-vitro stimulation in a dose dependent manner. The effect was abrogated by the MDF-specific antisera treatment. These responses were similar in kinetics and magnitude to those produced in response to FMLP. The respiratory burst elicited by MDF was abrogated by staurosporine, indicating that neutrophil activation and signal transduction by MDF and FMLP are dependent on protein kinase C.