Assessment of climate change pattern in the Pauri Garhwal of the Western Himalayan Region: based on climate parameters and perceptions of forest-dependent communities

This study assessed the climate change in Pauri district, Uttarakhand, India, a region highly vulnerable to climate change with potentially high loss of livelihoods and lives. The scale of change in the district's climate was analyzed using meteorological station data (1901-2000) and grid data (1985-2015). Perceptions of climate change among forest-dependent communities in three altitude zones (< 1200 m asl (zone A); 1200-1800 m asl (zone B), and > 1800 m asl (zone C)) in the study region were surveyed with respect to 14 climate-specific indicators. Annual mean, maximum, and minimum temperature of seasonal data indicated increasing trends except monsoon. Percentage cloud cover showed an increase, of approximately 3%, while diurnal temperature displayed decreasing trends. Rainfall in the district showed a decreasing trend, with more than 50% of years 1985-2015 receiving less rainfall than the annual average. More than 90% of respondents in zones A and B, and around 65-70% respondents in zone C, reported changes in climate parameters. These findings confirm the long-term observable changes in climate in the region and demonstrate the utility of station data, grid data, and surveys of local communities' perceptions when analyzing climate change. The analysis provided important clues about the nature of climate changes in the district. The results can be used to reduce the gap between bottom-up understanding and top-down policies and to formulate precautionary and ongoing site-specific adaptation practices for communities in different altitude zones in the study region, leading to effective and efficient mitigation of climate change impacts.

A common variant near TGFBR3 is associated with primary open angle glaucoma

Primary open angle glaucoma (POAG), a major cause of blindness worldwide, is a complex disease with a significant genetic contribution. We performed Exome Array (Illumina) analysis on 3504 POAG cases and 9746 controls with replication of the most significant findings in 9173 POAG cases and 26 780 controls across 18 collections of Asian, African and European descent. Apart from confirming strong evidence of association at CDKN2B-AS1 (rs2157719 [G], odds ratio [OR] = 0.71, P = 2.81 × 10⁻³³), we observed one SNP showing significant association to POAG (CDC7–TGFBR3 rs1192415, OR_G-allele = 1.13, P_meta = 1.60 × 10⁻⁸). This particular SNP has previously been shown to be strongly associated with optic disc area and vertical cup-to-disc ratio, which are regarded as glaucoma-related quantitative traits. Our study now extends this by directly implicating it in POAG disease pathogenesis.

Diode laser cycloablation in adult glaucoma: long-term results of a standard protocol and review of current literature

BACKGROUND

To study the long-term efficacy and safety of diode laser cycloablation under a standard protocol in refractory glaucoma.

METHODS

A retrospective study involving 42 eyes (39 patients), observed for 36-84 (mean 65.7) months after cycloablation involving 14 burns of 2-W power and 2-s duration, over 270 degrees of the ciliary body.

RESULTS

By final review, mean intraocular pressure (IOP) had dropped by 50.3% from 31.4 +/- 8.8 mmHg before treatment to 15.6 +/- 6.3 mmHg (P < 0.0001). Thirty-seven of the 42 eyes (88.1%) achieved IOP < 22 mmHg. Thirty-five of the 42 eyes (83.3%) eyes achieved IOP reduction > or = 30% from baseline levels. The mean number of antiglaucoma medications per eye dropped from 2.55 +/- 0.83 to 1.71 +/- 1.44 (P = 0.0004). The percentage of eyes requiring oral acetazolamide dropped from 92.9% to 11.9% (P < 0.0001). About 59.6% of eyes required multiple treatment sessions (mean 2.17). Twenty-seven (64.3%) eyes suffered deterioration, 11 (26.2%) maintained stability and 4 (9.5%) exhibited improvement of visual acuity. No relationship between the number of treatment sessions and visual outcome was evident.

CONCLUSIONS

This conservative repeatable protocol affords delivery of the minimum dose of photocoagulation necessary to achieve a safe, long-term ocular hypotensive response, while minimizing the risk of serious adverse effects, and is valuable in the difficult treatment of refractory glaucoma.

Single perioperative triamcinolone injection versus standard postoperative steroid drops after uneventful phacoemulsification surgery

PURPOSE

To evaluate the safety and efficacy of a single perioperative sub-Tenon's injection of triamcinolone following cataract surgery and its effect on the incidence of early pseudophakic cystoid macular edema (CME).

SETTING

Ophthalmology Department, Queen's Medical Centre University Hospital, Nottingham. United Kingdom.

METHODS

This prospective randomized controlled trial included 54 eyes (54 patients) having routine cataract surgery. Twenty-seven eyes received the conventional postoperative care with steroid drops (drops group), whereas the other 27 were given a perioperative sub-Tenon's injection of triamcinolone (injection group); 10 of these received 20 mg, and the remaining 17 eyes had 30 mg triamcinolone. All patients were evaluated preoperatively and at days 1, 8, 30, and 90. The outcome measures evaluated were logMAR best corrected visual acuity (BCVA), anterior chamber flare (Kowa-500 flare meter), intraocular pressure, and slitlamp biomicroscopy. Oral fluorescein angiograms were performed at 30 and 90 days to detect angiographic CME.

RESULTS

The mean logMAR BCVA improved from a baseline of 0.38 +/- 0.38 (SD) and 0.44 +/- 0.26 to 0.02 +/- 0.14 and 0.0 +/- 0.07 at 90 days in the steroid drops and injection groups, respectively. (P = .59). The mean flare increased from a baseline of 8.9 +/- 3.2 photons/ms and 8.3 +/- 3.7 photons/ms in the steroid drops and injection groups, respectively, to a maximum of +/-14.1 photons/ms and 25.8 +/- 7.5 photons/ms at day 8. Mean flare decreased to 15.8 +/- 9.7 photons/ms and 13.8 +/- 10.1 photons/ms at 30 days (P = .48, difference between groups) and 10.4 +/- 3.6 photons/ms and 9.8 +/- 3.1 photons/ms at 90 days, respectively, in the 2 groups. Subanalysis revealed lowest peak flare (17.9 +/- 7.9 photons/ms) at 8 days in the group that received 30 mg triamcinolone.

CONCLUSIONS

A single sub-Tenon's injection of 30 mg triamcinolone seem to be safe and effective as a route of steroid delivery after uneventful phacoemulsification surgery. Larger numbers in patients at high risk are required to assess its effectiveness in reducing the risk for pseudophakic CME.

Epidemiology of a new focus of localized cutaneous leishmaniasis in Himachal Pradesh

A new focus of localised cutaneous leishmaniasis has emerged along the Satluj River valley in the mountainous region of north west Himachal Pradesh. The main endemic region extends from Pooh subdivision of Kinnaur district to Kumarsain subdivision of Shimla district with adjoining Nirmand subdivision of Kullu District comprising 86 villages. The climate of the affected areas varies from temperate to subtropical. A total of 285 cases were recorded from 1988 to January, 2005. The age of these patients varied from 10 months to 75 years, with 63 children (<12Years), and a male to female ratio of 1: 0.9. The duration of disease was 15 days to 48 months with majority (85%) presenting between 1-6 months. The number of lesions varied from 1-8, and were mostly seen on exposed parts of the body. Morphologically, lesions were asymptomatic, dry, nodular or crusted nodulo-ulcerative plaques. Tissue smear positivity for amastigotes was 43%. The characterization of 14 strains of these Leishmania revealed presence of both Leishmania tropica (n=3) and Leishmania donovani (n=11). Identification of the 42 sandflies collected from the peridomestic environment of the patients, revealed Phlebotomus longiductus - 29, P. major 8, P. kandelaki 2, while 2 remained unidentified. The patients were treated with intralesional sodium stibogluconate and majority showed excellent response.

Intravitreal triamcinolone improves vision in eyes with chronic diabetic macular oedema refractory to laser photocoagulation

PURPOSE

To evaluate the clinical and visual outcome of an intravitreal injection of triamcinolone in patients with diabetic macular oedema refractory to laser treatment.

MATERIAL AND METHODS

Prospective, interventional nonrandomised case series of 24 eyes of 24 patients that underwent intravitreal injection of 4 mg triamcinolone for chronic diabetic macular oedema refractory to previous laser treatment. All patients had best corrected visual acuity (bcva) on the LogMAR scale, near vision, slit-lamp biomicroscopy for the presence of clinically significant macular oedema, and intraocular pressure check at 1, 3, and 6 months.

RESULTS

The average duration of macular oedema before the injection was 38.2 months (range=6-120 months) with the mean number of laser treatments before the injection being 2.2 (range=1-5). The visual acuity improved in 19 of the 23 (83%) eyes at 1 month, 16 of the 21 eyes (76%) at 3 months and six of 11 eyes (55%) at 6 months follow-up. The mean bcva improved by an average of 10, nine, and six letters, respectively, compared to the baseline at 1, 3, and 6 months (P=0.0002 at 1 month and 0.001 at 3 months with the Wilcoxon signed-ranked test). The intraocular pressure rose by an average of 2.4, 2.8, and 2.7 mmHg at the same follow-up visits.

CONCLUSION

Intravitreal triamcinolone appears to be promising in the short term, for improving the vision in eyes with chronic diabetic macular oedema unresponsive to conventional laser treatment. Randomised controlled trials utilising varying doses of steroid are now required to define optimum treatment regimens.

Does the site of filtration influence the medium to long term intraocular pressure control following microtrabeculectomy in low risk eyes?

AIMS

To evaluate the influence of varying surgical site on the medium to long term intraocular pressure (IOP) control in patients undergoing unenhanced small flap trabeculectomy (microtrabeculectomy) in eyes at low risk of failure.

METHODS

A retrospective non-concurrent analysis was performed on two cohorts of patients who underwent unenhanced microtrabeculectomy at different sites by a single surgeon (SAV). The first cohort of eyes was part of a trial to study the astigmatic effect of microtrabeculectomy (results published elsewhere) and all had flaps centred at the 12 o'clock meridian (superior flaps). The second cohort consisted of eyes with flaps created on either side of the 12 o'clock-that is, superonasal in left eyes and superotemporal in right eyes. All case notes were reviewed for the preoperative and presenting IOPs, the number and duration of antiglaucoma medication use preoperatively and, postoperatively, any intraoperative, early, or late postoperative complications. All IOPs measured at 6 months and then yearly intervals were recorded. The baseline characteristics and IOPs at each follow up were compared between the eyes with the superonasal and superotemporal flaps of the non-12 o'clock group against those with superior flaps in the 12 o'clock group up to a maximum of 72 months. Survival was assessed by the site of microtrabeculectomy, with failure considered as any IOP above 22 and 15 mm Hg with or without medications.

RESULTS

All patients had a minimum follow up of 12 months and 12/17 patients in the 12 o'clock group and 17/28 in the non-12 o'clock group completed the full follow up of 72 months. The IOPs at all points in time were lower in the left eyes with superonasal flaps compared to both the superior and the superotemporal groups. This difference was statistically significant between the three groups to the end of 4 years (p = 0.001) and remains clinically significant thereafter with the mean last recorded IOPs of 15.9, 12.4 (p = 0.03), and 14.3 mm Hg in the superior, superonasal and superotemporal groups respectively, with a smaller mean number of drops in the non-12 o'clock group. Kaplan-Meier curves showed a significantly better outcome for the cutoff IOP of 15 mm Hg in the superonasal group (p = 0.003) compared with both the other groups.

CONCLUSION

Eyes with superonasal flaps achieve and maintain lower IOPs when compared with both the superior and superotemporal flaps. The results suggest that, when a low target IOP is desired, the site of surgery in an unenhanced filtering procedure should be superonasally sited.

Isolated posterior dislocation of the radial head in an adult

Isolated posterior dislocation of the radial head was detected on X-ray in a patient following a vehicular accident. Such a dislocation without an associated fracture is extremely rare in adults. Immobilization of the elbow in full pronation and 90 degrees flexion for 4 weeks normalized the position of the head of the radius.