Overview of sclerocornea

Sclerocornea is a rare non-progressive, non-inflammatory usually bilateral congenital corneal opacity that can be associated with both ocular and systemic abnormalities. It could be inherited in 50% of cases. Ill-defined limbal architecture and vascularization in association with ocular comorbidities results in poor outcomes with corneal transplantation. This narrative review summarizes the current literature on etiology and clinical presentation in sclerocornea. With regards to keratoplasty, it focusses on key elements in decision making, highlights the role of investigations and discusses practical surgical pearls to enhance outcome of keratoplasty in these eyes.

Role of polymerase chain reaction-based viral detection in pterygia

Purpose

Pterygium is a fibrovascular disease that originates in the conjunctiva and commonly spreads to the corneal surface, thereby posing a threat to eyesight. Despite intensive research, the pathophysiology of this disease remains unclear. Recent research suggests that oncogenic viruses, such as human papillomavirus (HPV), cytomegalovirus, and Epstein-Barr virus (EBV), may play a role in pterygia development. Although there are questions concerning the function of oncogenic viruses in pterygium pathogenesis, existing research shows a lack of consensus on the subject, demonstrating the heterogeneity of pterygium pathophysiology. Therefore, we aimed to simultaneously detect the three common viral pathogens that have been reported in pterygium tissue obtained after excision.

Methods

Thirty-five tissue specimens of pterygium from patients undergoing pterygium surgery (as cases) were analyzed for evidence of viral infection with multiplex polymerase chain reaction (PCR), and virus-specific real-time quantitative PCR was used for the samples that were detected positive by multiplex PCR.

Results

Of the 35 patients, one sample was positive for EBV and two samples were positive for HPV. Further PCR-based DNA sequencing of the HPV PCR-positive product showed identity with HPV-16. Real-time quantitative PCR on samples that showed EBV or HPV positivity did not yield any detectable copy number.

Conclusion

Our study results confirmed that PCR positivity could be due to transient flora, but it was not quantitatively significant to conclude as the causative factor of pterygium pathogenesis. However, additional studies with larger sample populations are warranted to fully determine the role of the virus in pterygium.

Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)

BACKGROUND

Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery.

METHODS

A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed.

RESULTS

Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011).

CONCLUSION

The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years.

REGISTRATION NUMBER

ISRCTN25616490 (http://www.controlled-trials.com).

Anterior staphyloma repair following trauma and surgery - A retrospective review of techniques and outcomes over 25 years

Purpose

To review surgical options, techniques, and outcomes of anterior staphyloma repair done following trauma and surgery.

Methods

This was a retrospective case study of patients who underwent staphyloma repair with scleral or tibial periosteal patch grafts following trauma and surgery with a minimum follow-up of 3 months postoperatively. Preoperative risk factors, choice of graft materials, surgical details, and outcomes in terms of graft uptake and tectonic integrity were analyzed.

Results

Seventeen eyes of 17 patients underwent successful staphyloma repair (scleral 15, tibial periosteal two). Mean follow-up was 47.1 months (3-159 months). Postoperative intraocular pressure rise noted in four eyes was controlled medically or surgically. Three patients underwent successful repeat patch grafting (graft melt one and recurrent ectasia two). Tectonic integrity of the eyeball was restored and maintained in all patients at the final follow-up.

Conclusion

Comprehensive evaluation of the risk factors, control of ocular comorbid conditions, and early and meticulous surgery can optimize results.

Management of coexisting bilateral ocular surface disease in xeroderma pigmentosum - sequence and outcomes

PURPOSE

To report a rare presentation of bilateral, coexisting ocular surface disease in a case of Xeroderma pigmentosum and its successful management.

METHODS

Case report.

RESULTS

A 21-year-old male with Xeroderma pigmentosum presented with bilateral ocular surface squamous neoplasia (OSSN) along with central guttae in the right eye and corneal decompensation of the left eye. Subsequently, the patient developed dry eyes and lid margin keratinization in both eyes followed by perforation in the left eye. Sequential procedures both medical and surgical, including excision of the tumour, corneal transplantation and mucous membrane grafting addressing each of these ocular surface issues resulted in a successful outcome. There was no recurrence of the tumour over 3 years. Corneal transplantation is preferably done after a minimum of 6 months following excision. Mucous membrane grafting performed for progressive lid margin keratinization resulted in surface stabilization.

CONCLUSIONS

In Xeroderma Pigmentosum, multiple ocular surface features can rarely coexist and be bilateral. Periodic evaluation of the surface for tumours, progressive dry eyes and endothelial function is recommended as a part of routine evaluation in Xeroderma pigmentosum. Surface procedures should precede intraocular intervention. Sequential management can result in successful outcomes.

Next generation risk assessment for skin allergy: Decision making using new approach methodologies

Our aim is to develop and apply next generation approaches to skin allergy risk assessment (SARA) that do not require new animal test data and better quantify uncertainties. Significant progress has been made in the development of New Approach Methodologies (NAMs), non-animal test methods, for assessment of skin sensitisation and there is now focus on their application to derive potency information for use in Next Generation Risk Assessment (NGRA). The SARA model utilises a Bayesian statistical approach to infer a human-relevant metric of sensitiser potency and a measure of risk associated with a given consumer exposure based upon any combination of human repeat insult patch test, local lymph node, direct peptide reactivity assay, KeratinoSens™, h-CLAT or U-SENS™ data. Here we have applied the SARA model within our weight of evidence NGRA framework for skin allergy to three case study materials in four consumer products. Highlighting how to structure the risk assessment, apply NAMs to derive a point of departure and conclude on consumer safety risk. NGRA based upon NAMs were, for these exposures, at least as protective as the historical risk assessment approaches. Through such case studies we are building our confidence in using NAMs for skin allergy risk assessment.

An Investigation on the Oral Microbiota in Plaque Samples during Orthodontic Treatment

Malocclusion can be corrected by fixed orthodontic appliance therapy. However, ‌the‌ ‌complex‌ ‌appliance design‌‌ ‌and ‌‌the‌ ‌material‌ surface ‌characteristics of the appliance make mechanical debriding difficult, enabling biofilm formation. This‌ ‌study‌ ‌was performed‌ ‌to‌ investigate‌ the‌ ‌microbial‌ ‌load‌ ‌in‌ ‌‌plaque‌ at‌ ‌different‌ time ‌periods‌ ‌of‌ ‌the‌ ‌orthodontic‌ ‌therapy in participants with professionally well-maintained oral hygiene.‌ ‌This‌ ‌prospective‌ ‌study‌ was ‌conducted‌ ‌among‌ ‌12‌ ‌adult‌ ‌‌male‌ ‌participants. Six control (C batch) and six under orthodontic treatment (T batches). Simplified oral hygiene index OHI (S), Plaque index (PlI) and Russell’s Periodontal index (PI) scoring was performed for all subjects prior to sample collection. Plaque‌ ‌samples‌ ‌were‌ ‌collected‌ from both batch T,.and C at similar multiple intervals, corresponding with the sequential archwires for group T in regular use. ‌Six‌ ‌bacterial‌ ‌phyla‌‌ and‌ one‌ ‌fungal‌ ‌phyla ‌examined by subculture.‌ ‌Index scoring revealed that hygiene was maintained throughout study in both the control and treatment batches. A general increase in the microorganisms‌ was noticed,‌ in treatment group ‌reaching‌ ‌a‌ ‌peak‌ ‌at‌ ‌18th ‌month‌ ‌of‌ ‌treatment at T4 and reduced to pretreatment‌ ‌levels on debonding. Though, the microorganisms count increased during treatment, it was not exponential and can be considered favourable flora which matched with the good clinical oral health.

Stromal rejection in penetrating keratoplasty following COVID-19 vector vaccine (Covishield) - A case report and review of literature

Endothelial rejection has been described following both m-RNA and vector-based vaccines for COVID-19. There is one case report of a stromal rejection described following influenza vaccination. We report a case of stromal rejection following vector-based COVID-19 vaccination, which might be the first case reported so far.

Preliminary experience & rationale of primary allo Simple Limbal Epithelial Transplantation (SLET) following surgical excision of Ocular Surface Tumors

AIM

To report the preliminary outcomes and elucidate the possible rationale of alloSLET for primary ocular surface reconstruction following excision of extensive ocular surface tumors.

METHODS

Retrospective interventional case series with a minimum postoperative follow up of 1 year. AlloSLET was performed along with wide surgical excision and cryotherapy in 3 eyes.

RESULTS

Of the 2 eyes with extensive OSSN and one with an extensive pigmented lesion, there was no occurrence of symblepharon in all 3 eyes. No features suggestive of LSCD was noted in 2 eyes. In the child with xeroderma pigmentosum and OSSN, early peripheral vascularization was noted at 1 year of follow up with reduced vision secondary to amblyopia.

CONCLUSION

Primary alloSLET could be an alternative to primary autoSLET in eyes with extensive ocular surface tumors, commonly seen with ocular surface squamous neoplasia (OSSN) and pigmented lesions. This facilitates ocular surface reconstruction with reduced occurrence of symblepharon formation as well as limbal stem cell deficie4ncy (LSCD). It possibly, is the only option in eyes with OSSN with coexistent bilateral limbal insufficiency. It may obviate the need for autoSLET, primary or secondary in eyes with adequate residual limbus.

357 Improving Surgical Consent – A Quality Improvement Project to Enhance the Consenting Process

Introduction

RCS guidelines on consent, recently updated, encourage a dialogue where all risks material to that patient are discussed and are clear. An audit was performed to assess whether practice at Oxford Hospitals is compliant with these guidelines – that all patients for elective surgery are consented prior to admission.

Method

Thirty-two undergoing elective Functional Endoscopic Sinus Surgery (FESS), Tonsillectomy and Septoplasty were interviewed in May-June 2019. Baseline data were presented at a local educational meeting, along with education on the recent changes to the RCS guidelines. Repeat audit took place in August-September 2020.

Results

All 32 patients were consented as per RCS guidelines and understood the reason for their surgery, but only 31% could explain the risks, and 56% could explain alternative options. Twenty (63%) consent forms were easily legible on randomised heuristic assessment. After education and change in department practice, understanding of the operation was much improved (80-100%). One outcome was to create pre-filled consent forms for common ENT operations.

Conclusions

Whilst RCS policy on completing consent prior to admission is being achieved, patient interviews suggest a lack of understanding of the operation. Standardised consent forms have the potential to enhance this understanding, as well as saving time.

Exploring the effects of California's COVID-19 shelter-in-place order on household energy practices and intention to adopt smart home technologies

To contain the spread of the novel coronavirus (COVID-19), local and state governments in the U.S. have imposed restrictions on daily life, resulting in dramatic changes to how and where people interact, travel, socialize, and work. Using a social practice perspective, we explore how California's Shelter-in-Place (SIP) order impacted household energy activities. To do so, we conducted an online survey of California residents (n = 804) during active SIP restrictions (May 5-18, 2020). We asked respondents about changes to home occupancy patterns and household energy activities (e.g., cooking, electronics usage) due to SIP restrictions, as well as perspectives toward smart energy technologies. Households reported increased midday (10am-3pm) occupancy during SIP, and this increase is related to respondent and household characteristics, such as education and the presence of minors in the home. Examining change in the frequency of household activities during SIP, presence of minors and increased midday occupancy proved important. Finally, we considered relationships to intention to purchase smart home technologies, with the presence of minors and increased activity frequency relating to greater intention to purchase. These findings demonstrate how household activities and occupancy changed under COVID restrictions, how these changes may be related to energy use in the home, and how such COVID-related changes could be shaping perspectives toward smart home technology, potentially providing insight into future impacts on household practices and electricity demand.

Exploring the effects of California's COVID-19 shelter-in-place order on household energy practices and intention to adopt smart home technologies

To contain the spread of the novel coronavirus (COVID-19), local and state governments in the U.S. have imposed restrictions on daily life, resulting in dramatic changes to how and where people interact, travel, socialize, and work. Using a social practice perspective, we explore how California's Shelter-in-Place (SIP) order impacted household energy activities. To do so, we conducted an online survey of California residents (n = 804) during active SIP restrictions (May 5-18, 2020). We asked respondents about changes to home occupancy patterns and household energy activities (e.g., cooking, electronics usage) due to SIP restrictions, as well as perspectives toward smart energy technologies. Households reported increased midday (10am-3pm) occupancy during SIP, and this increase is related to respondent and household characteristics, such as education and the presence of minors in the home. Examining change in the frequency of household activities during SIP, presence of minors and increased midday occupancy proved important. Finally, we considered relationships to intention to purchase smart home technologies, with the presence of minors and increased activity frequency relating to greater intention to purchase. These findings demonstrate how household activities and occupancy changed under COVID restrictions, how these changes may be related to energy use in the home, and how such COVID-related changes could be shaping perspectives toward smart home technology, potentially providing insight into future impacts on household practices and electricity demand.

Evaluation of a commercial loop-mediated isothermal amplification assay, 3MTM Molecular Detection Assay 2 - Campylobacter, for the detection of Campylobacter from poultry matrices

1. The objective of this study was to evaluate performance of a commercial loop-mediated isothermal amplification (LAMP) method as an alternative method for the detection of Campylobacter spp. in primary production samples, poultry rinses and raw poultry products, as compared to the US Department of Agriculture Food Inspection Service Microbiology Laboratory Guide Book PCR reference method, MLG 41A.2. The Campylobacter spp. LAMP was used in conjunction with a ready-to-use enrichment broth that does not require microaerophilic incubation. After enrichment, boot swabs from poultry farms, carcase rinses and raw poultry products were tested by the LAMP method and the MLG 41A PCR method.3. The ready-to-use enrichment broth enabled the growth of Campylobacter spp. within 22 to 28 hours under aerobic incubation conditions. The LAMP method enabled Campylobacter detection in the enriched samples of various poultry matrices and had equivalent sensitivity and specificity to the MLG 41A PCR method.4. No significant difference (95% confidence interval) was found between the alternative and the MLG 41A PCR method, as determined by probability of detection analysis, except for neutralising buffered peptone water post-chill rinsates. For the post-chill neutralising buffered peptone water rinsates, the LAMP method had significantly higher confirmed portions.

Voriconazole Induced Ocular Surface Dysplasia - Report of Two Cases

PURPOSE

To report ocular surface dysplasia induced by voriconazole treatment in two patients with recalcitrant fungal keratitis.

METHODS

Observational study.

RESULTS

Case 1 - A 49 year old female who was a known case of fungal keratitis and treated with prolonged topical voriconazole therapy, underwent penetrating keratoplasty and the histopathological examination of corneal specimen showed multiple keratin pearls with dyskeratotic cells suggestive of squamous cell carcinoma.Case 2 - A 78-year-old man who was diagnosed as fungal keratitis in his left eye and treated with topical voriconazole 1% and itraconazole 1% for 6 months underwent therapeutic penetrating keratoplasty. Histopathology of the host corneal tissue showed squamous cells with irregular thickening with dyskeratotic cells and squamous eddies suggestive of voriconazole induced dysplasia.

CONCLUSION

Prolonged topical voriconazole treatment in fungal keratitis can induce ocular surface dysplasia. Early diagnosis and treatment of the dysplastic changes can result in complete remission and prevent recurrence.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Choroidal thickness in lupus nephritis

OBJECTIVE

This study aimed to compare choroidal thickness between patients with systemic lupus erythematosus (SLE) and lupus nephritis (LN) in complete renal remission to that of patients with SLE without LN.

METHODS

This was a retrospective case-control study of 23 SLE patients meeting either the American College of Rheumatology or Systemic Lupus International Collaborating Clinics classification criteria and followed at Washington University School of Medicine Rheumatology or Nephrology, and Ophthalmology outpatient clinics. The diagnosis of LN was based on renal pathology, and complete renal remission was defined as proteinuria <500 mg/daily and serum creatinine at baseline. Extra-renal flare status was determined using modified Fortin criteria. Choroidal thickness was measured using spectral-domain optical coherence tomography and read by blinded reviewers.

RESULTS

In SLE patients without extra-renal flare, choroidal thickness of LN patients was 281 ± 78 µm compared to 288 ± 70 µm in non-LN SLE patients (p = 0.766) at the fovea.

CONCLUSION

Choroidal thickness was not different in patients with LN in remission compared to non-LN SLE patients in remission. Additional studies are needed to examine choroidal thickness in patients with SLE with active LN.

Subconjunctival bevacizumab and argon laser photocoagulation for preexisting neovascularization following deep lamellar anterior keratoplasty

We report a rare case of deep anterior lamellar keratoplasty (DALK) neovascularization managed with combination of subconjunctival bevacizumab and argon laser photocoagulation. A 24 year old male underwent Deep anterior lamellar keratoplasty for corneal stromal opacity following presumed viral keratitis. Deep corneal neovascularization was observed postoperatively which was successfully managed using a combination of subconjunctival bevacizumab and argon laser photocoagulation within one week of DALK. The neovascularization resolved by 3 months and at 2 years follow up, patient maintained good visual acuity of 6/12 Snellen's without recurrence of vascularization. A combination of bevacizumab and argon laser may be an effective approach to manage neovascularisation in the immediate postoperative phase (Post DALK) and improve graft survival.

Reduction of Aromatic Nitro Compounds with Hydrazine Hydrate over a CeO2–SnO2 Catalyst

A CeO2 (10%)-SnO2 catalyst prepared by a co-precipitation method efficiently catalyses the transfer hydrogen reduction of a number of aromatic nitro compounds with hydrazine hydrate under mild conditions.

Clinical profile, risk factors and outcome of medical, surgical and adjunct interventions in patients with Pythium insidiosum keratitis

PURPOSE

To report clinical profile and compare management options for Pythium keratitis.

METHOD

Retrospective interventional study of 46 patients diagnosed as Pythium keratitis by PCR DNA sequencing from January 2014 to July 2017. Interventions were categorised into medical management (MM) (topical azithromycin and linezolid with oral azithromycin at presentation), surgery (S) (therapeutic penetrating keratoplasty, TPK), surgical adjunct (SA) (cryotherapy±alcohol with TPK) and medical adjunct (MA) (MM after TPK).

RESULTS

Primary treatment included MM (1 eye), SA (3 eyes) and S (42 eyes). Recurrence occurred in 27/43 eyes (MM+S group). Second surgery (S) was required in 11 eyes (TPK-2), with additional procedures (SA) in 10 eyes and evisceration in five eyes. 8/43 eyes received MA after TPK-1. One eye required TPK-3. Recurrence occured in all eyes that received MA (100%) and in 28 of 54 TPKs (51.8%) (TPK 1+2+3) in 42 eyes. Recurrence was noted in 1/14 (7.1%) that underwent SA.

CONCLUSION

The currently available and recommended treatment for Pythium keratitis is surgical by means of a TPK and in worse cases evisceration. In our study, MM/MA measures showed no benefit with recurrence or worsening of infection requiring resurgery. Almost 50% of TPKs had a recurrence requiring resurgery. However, adjunctive procedures during TPK appear to have additional benefit with low risk of recurrence and could be included as routine care.

Analysis of candidate genes ZEB1 and LOXHD1 in late-onset Fuchs' endothelial corneal dystrophy in an Indian cohort

BACKGROUND

Fuchs' endothelial corneal dystrophy (FECD) is a complex degenerative disease of the corneal endothelium with genetic predisposition. Pathogenic rare variants have been identified in SLC4A11, LOXHD1, ZEB1, and AGBL1. Association of single nucleotide polymorphisms (SNPs) and CTG trinucleotide repeat expansions in the intron of TCF4 gene to FECD has been studied across multiple ethnicities. Recently, genome-wide association studies have also identified KANK4, LAMC1, and ATP1B1 as novel loci for FECD. Here, we report the contribution of ZEB1 and LOXHD1 genes in our sporadic late-onset FECD cohort.

MATERIALS AND METHODS

In the experimental study, coding regions of ZEB1 and LOXHD1 were screened by Sanger DNA sequencing in 52 late-onset and 5 early-onset FECD cases of Indian origin, recruited at a tertiary eye care center. Further, bioinformatics analysis was done.

RESULTS

One reported missense mutation, c.2522A>C; p.(Q841P), and one variant of uncertain significance (VUS), c.619A>G; p.(S207G), were identified in the ZEB1 gene. One VUS, c.6413G>Ap.(R2138Q), was observed in LOXHD1. A 3D structural bioinformatic analysis of the missense variant in LOXHD1 predicted the variant to affect the structure-function relationship of the protein.

DISCUSSION

While mutations in ZEB1 contributed to 2% of the late-onset FECD cases, the exact role of the two VUS identified in ZEB1 and LOXHD1 in FECD pathogenesis needs to be studied.

Unusual ulcerative keratitis caused by Prototheca wickerhamii in a diabetic patient

The purpose of the study was to report a case of ulcerative keratitis caused by an unusual algae Prototheca wickerhamii in a diabetic patient. This study design was a case report. A 46-year-old male, who was a known diabetic for 3 years, had an injury to the left cornea with the sparks of fire from wielding at work that developed into an ulcerative keratitis over a period of next 3 months as the patient was not on any medication. Corneal scraping culture report and Vitek 2 system investigation result confirmed it to be a P. wickerhamii infection. The patient was started on intensive topical 1% voriconazole and 5% natamycin for 1 month and with no improvement subsequently underwent penetrating keratoplasty. No recurrence of infection postoperatively was noted. This opportunistic algae rarely known to cause human eye infections is so far reported in either patients with severe systemic immunosuppression causing posterior segment eye involvement or as postcorneal surgery infections. We report an ulcerative keratitis by P. wickerhamii in a diabetic patient post corneal trauma with no prior ocular surgery.

Amelioration of mild and moderate depression through Pranic Healing as adjuvant therapy: randomised double-blind controlled trial

OBJECTIVES

Depression is a mental disorder, affecting the quality of life. Our study explores the efficacy of Pranic Healing (PH), as an adjuvant therapy in treating depression Methods: In this randomised double-blind controlled trial, 52 participants with a mean age of 34.4 years, with mild to moderate depression were assessed using the Hamilton Depression Rating (HAM-D) scale during the 5-week study. Both Medication + PH (MedPH) and Medication + Mock PH (MedMockPH) groups comprising 26 members received Pranic and mock healing lasting 20 minutes per session respectively once a week for 4 weeks, along with the antidepressant drug.

RESULTS

The average decrease in HAM-D score in MedPH was median 11 (Interquartile Range (IQR) 7-12) and was significantly higher compared with the MedMockPH group median 6.5 (IQR 3-9). At pre-assessment, both groups had 8 cases of mild and 18 cases of moderate depression. At post-assessment, HAM-D showed that the improvement in depression category was seen in 69.2% of participants in the MedMockPH group and 100% in MedPH group.

CONCLUSIONS

These results give first the evidence that PH can aid as an adjuvant therapy for depressed people.

Association of polymorphisms in the intron of TCF4 gene to late-onset Fuchs endothelial corneal dystrophy: An Indian cohort study

Purpose:

Fuchs endothelial corneal dystrophy (FECD) is a progressive degenerative disease of the corneal endothelium. It is genetically heterogeneous and follows either an autosomal dominant or sporadic pattern of inheritance. Here, we have explored the association of four previously reported intronic single nucleotide polymorphisms and intronic CTG repeat expansions in TCF4 gene to FECD in an Indian cohort.

Methods:

The cohort consisting of 52 sporadic late-onset cases, 5 early-onset cases, and 148 controls was taken for the study. rs2286812 and rs613872 were genotyped by allele specific polymerase chain reaction (ASPCR) and PCR-based restriction digestion, respectively; rs17595731 and rs9954153 were genotyped by Taqman assay using real-time PCR. The quantitative assessment of the CTG repeat region was performed by PCR/Sanger DNA sequencing. The repeats were assessed qualitatively by short tandem repeat and triplet repeat primed PCR assays. The statistical analysis was performed using two-tailed Fisher's exact probability test.

Results:

SNPsrs613872 (G/T) for the ‘G’ allele (P value: 4.57 × 10⁻⁵) and rs17595731 (C/T) for the ‘C’ allele (P value: 1.87 × 10⁻⁵), respectively, showed a significant association to sporadic late-onset FECD. CTG repeat expansions were found to be associated with FECD with a P value = 2.4 × 10⁻³.

Conclusion:

rs613872, rs17595731, and CTG repeat expansions in intronic region of TCF4 are associated with increased risk of sporadic late-onset FECD in the Indian cohort studied.

Six-month bracket failure rate with a flowable composite: A split-mouth randomized controlled trial

INTRODUCTION:

The use of flowable composites as an orthodontic bonding adhesive merits great attention because of their adequate bond strength, ease of clinical handling and reduced number of steps in bonding.

OBJECTIVE:

The aim of this Randomized Controlled Trial was to comparatively evaluate over a 6-month period the bond failure rate of a flowable composite (Heliosit Orthodontic, Ivoclar Vivadent AG, Schaan) and a conventional orthodontic bonding adhesive (Transbond XT, 3M Unitek).

METHODS:

53 consecutive patients (23 males and 30 females) who fulfilled the inclusion and exclusion criteria were included in the study. A total of 891 brackets were analyzed, where 444 brackets were bonded using Heliosit Orthodontic and 447 brackets were bonded using Transbond XT. The survival rates of brackets were estimated with the Kaplan-Meier analysis. Bracket survival distributions for bonding adhesives, tooth location and dental arch were compared with the log-rank test.

RESULTS:

The failure rates of the Transbond XT and the Heliosit Orthodontic groups were 8.1% and 6% respectively. No significant differences in the survival rates were observed between them (p= 0.242). There was no statistically significant difference in the bond failure rates when the clinical performance of the maxillary versus the mandibular arches and the anterior versus the posterior segments were compared.

CONCLUSIONS:

Both systems had clinically acceptable bond failure rates and are adequate for orthodontic bonding needs.

VIRULENCE STUDIES OF PASTEURELLA MULTOCIDA IN MICE, DUCKLINGS AND ADULT DUCKS

Pasteurella multocida is a Gram negative bacterium causing severe disease in a multitude of hosts; the A: 1 strain of this bacterium is extremely virulent to hosts. In this study, the virulence of P. multocida A: 1 strain was assessed in one month old ducklings, six months old ducks and eight weeks old albino mice. The groups of experimental animals were inoculated with the different dilutions of the bacteria through subcutaneous route. The control groups were sham inoculated with sterile phosphate buffered saline via respective routes. Mortality was recorded for two weeks post inoculation. All the dead animals and birds were examined for specific gross lesions of pasteurellosis and attempted re-isolation of the organism on blood agar from their internal organs. The median lethal dose was calculated using Reed and Muench method. For ducklings, the median lethal dose was 13 colony forming units and the dilution giving 50 % end point with 0.1 ml subcutaneous dose was 10-7.4. The median lethal dose could not be arrived at for mice and adult ducks as the strain killed all the inoculated mice even in the lowest dilution tested, while most of the adult ducks were resistant to infection.

Hughes Abdominal Repair Trial (HART) - Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial

Background

Incisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs.

The ‘Hughes Repair’ combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision.

Methods/design

This is a 1:1 randomised controlled trial comparing two suture techniques for the closure of the midline abdominal wound following surgery for colorectal cancer. Full ethical approval has been gained (Wales REC 3, MREC 12/WA/0374). Eight hundred patients will be randomised from approximately 20 general surgical units within the United Kingdom. Patients undergoing open or laparoscopic (more than a 5-cm midline incision) surgery for colorectal cancer, elective or emergency, are eligible. Patients under the age of 18 years, those having mesh inserted or undergoing musculofascial flap closure of the perineal defect in abdominoperineal wound closure, and those unable to give informed consent will be excluded. Patients will be randomised intraoperatively to either the Hughes Repair or standard mass closure. The primary outcome measure is the incidence of incisional hernias at 1 year as assessed by standardised clinical examination. The secondary outcomes include quality of life patient-reported outcome measures, cost-utility analysis, incidence of complete abdominal wound dehiscence and C-POSSUM scores. The incidence of incisional hernia at 1 year, assessed by computerised tomography, will form a tertiary outcome.

Discussion

A feasibility phase has been completed. The results of the study will be used to inform current and future practice and potentially reduce the risk of incisional hernia formation following midline incisions.

Trial registration

Trial Registration Number: ISRCTN 25616490. Registered on 1 January 2012.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1573-0) contains supplementary material, which is available to authorized users.

A Bemisia tabaci midgut protein interacts with begomoviruses and plays a role in virus transmission

Begomoviruses are a major group of plant viruses, transmitted exclusively by Bemisia tabaci (Gennadius) in a persistent circulative non-propagative manner. The information regarding molecular and cellular basis underlying Begomovirus - whitefly interaction is very scarce. Evidences have suggested that the insect gut possesses some crucial protein receptors that allow specific entry of virus into the insect haemolymph. We have performed yeast two hybrid gut cDNA expression library screening against coat protein of Tomato leaf curl New Delhi virus (ToLCV) and Cotton leaf curl Rajasthan virus (CLCuV) as bait. Midgut protein (MGP) was the common protein found interacting with both ToLCV and CLCuV. MGP was localized in whole mount B. tabaci as well as in dissected guts through confocal microscopy. Pull down and dot blot assays confirmed in vitro interaction between ToLCV/CLCuV coat protein and MGP. Immunolocalization analysis also showed colocalization of ToLCV/CLCuV particles and MGP within insect's gut. Finally, anti-MGP antibody fed B. tabaci, exhibited 70% reduction in ToLCV transmission, suggesting a supportive role for MGP in virus transmission.

Distribution of Bemisia tabaci Genetic Groups in India

The whitefly Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) is a phloem-feeding, economically important pest of crops worldwide. In addition to direct damage, it also vectors a number of plant viruses belonging to the family Geminiviridae. Its populations differ biologically with respect to insecticide resistance, virus transmission and host range. Therefore, understanding genetic variation among populations is important for management. We sequenced 850 bp of the mitochondrial COI (mtCOI) gene from B. tabaci populations surveyed across India. BLAST analysis of the mtCOI sequences generated in this study with sequences from the mtCOI dataset showed the presence of one invasive group, MEAM1, and eight other groups of B. tabaci in India. mtCOI sequence analyses showed the presence of Asia I, Asia I-India, Asia II-1, Asia II-5, Asia II-7, Asia II-8, and Asia II-11 genetic groups. We also found China-3 in a field in Birbhum district, West Bengal, India, suggesting a role of anthropogenic activities in the distribution of B. tabaci. Interestingly, more than one genetic group was found coexisting in the same field.

Multi-phased anaerobic baffled reactor treating food waste

This study was conducted to identify the performance of a multi-phased anaerobic baffled reactor (MP-ABR) with food waste (FW) as the substrate for biogas production and thereby to promote an efficient energy recovery and treatment method for the wastes with high organic solid content through phase separation. A four-chambered ABR was operated at an HRT of 30 days with an OLR of 0.5-1.0 g-VS/Ld for a period of 175 days at 35 ± 1°C. Consistent overall removal efficiencies of 85.3% (CODt), 94.5% (CODs), 89.6% (VFA) and 86.4% (VS) were observed throughout the experiment displaying a great potential to treat FW. Biogas generated was 215.57 mL/g-VS removed d. Phase separation was observed and supported by the COD and VFA trends, and an efficient recovery of bioenergy from FW was achieved.

A Case of Histoid Leprosy in a HIV Infected Person on HAART not responding to conventional MB MDT

A 46 year old male diagnosed case of Acquired Immuno Deficiency Syndrome (AIDS) on Highly Active Anti Retroviral Therapy (HAART) presented with raised nodular skin lesions of two months duration which on skin biopsy was diagnosed as Histoid leprosy. Individual was put on standard Multi Bacillary Multi Drug Therapy (MB MDT) for two months has shown exacerbation of lesion and was later put on daily Rifampicin, Ofloxacin and Minocycline (ROM) for which he responded. Interesting feature is rarity of association of HIV with Histoid Leprosy where the patient did not respond to the conventional MB MDT and later responded to daily ROM.

Comparative evaluation of botulinum toxin versus iontophoresis with topical aluminium chloride hexahydrate in treatment of palmar hyperhidrosis

BACKGROUND

Hyperhidrosis is generalised or focal excessive sweating and carries a substantial psychological and social burden. This study compares botulinum toxin versus iontophoresis with topical aluminium chloride hexahydrate in palmar hyperhidrosis.

METHODS

The study included 60 cases of palmar hyperhidrosis randomly allocated to 2 groups. One group was given botulinum toxin type A 100 units per palm and the other group subjected to digital iontophoresis with topical application of aluminium chloride hexahydrate lotion for 4 weeks. They were assessed 4 weeks later and those without improvement were crossed over to the other arm for another 4 weeks. Those with improvement were followed up in the same arm for 6 months.

RESULTS

Botulinum therapy showed significant improvement in the initial (80%) as well as cross over cases (75%) as compared to iontophoresis and aluminium chloride (47%) for initial cases and (17%) for cross over cases.

CONCLUSION

Better improvements were seen with botulinum therapy than with iontophoresis and topical therapy. Residual effects of relief lasted on an average for 4 months for botulinum toxin whereas it was one month with iontophoresis and topical therapy. Advantage with iontophoresis and topical therapy was that it was non invasive and did not require regional anaesthesia as with botulinum therapy.

A case of histoid leprosy in a HIV infected person on HAART not responding to conventional MB-MDT

A 46 year old male diagnosed case of Acquired Immune Deficiency Syndrome (AIDS) on Highly Active Anti Retroviral Therapy (HAART) presented with raised nodular skin lesions of two months duration which on skin biopsy was diagnosed as Histoid leprosy. Individual was put on standard Multi Bacillary Multi Drug Therapy (MB MDT) for two months has shown exacerbation of lesion and was later put on daily Rifampicin, Ofloxacin and Minocycline (ROM) for which he responded. Interesting feature is rarity of association of HIV with Histoid Leprosy where the patient did not respond to the conventional MB MDT and later responded to daily ROM.

Molecular characterization and analysis of bacterial diversity in Aleurocanthus woglumi (Hemiptera: Aleyrodidae)

Aleurocanthus woglumi Ashby (Hemiptera: Aleyrodidae), commonly referred to as citrus blackfly, is a sap-sucking hemipteran insect. Although polyphagous, citrus is its most preferred host plant. Samples of this insect were collected from Murraya koenigii (L.). The cytochrome c oxidase subunit I gene (mtCO1)-based analysis by sequencing helped in molecular identification of the insect. Phylogenetic analysis of cytB-nd1-LrDNA showed the coevolution of A. woglumi with its primary bacterial symbiont Portiera. Sequencing a 16S rDNA library from insect DNA revealed three bacterial phylotypes, namely, Portiera, Wolbachia, and Erwinia chrysanthemi. Further, we used fluorescence in situ hybridization to visualize the endosymbionts in a whole mount of A. woglumi. Culturable bacteria were obtained on different media and were classified on the basis of 16S rDNA. In total, 30 bacterial phylotypes belonging to 14 different genera, namely, Bacillus, Kocuria, Micrococcus, Staphylococcus, Paenibacillus, Rhodococcus, Rummellibacillus, Arthrobacter, Curtobacterium, Psychrobacillus, Listeria, Brevibacillus, Bhargavae, and Pantoea, were isolated by culturable methods.

Detection and localization of Rickettsia sp in mealybug

Mealybug, Phenacoccus solenopsis Tinsley, is a sap-sucking hemipteran insect. It is an agricultural pest that is now widely distributed in India. In this study we report the presence of Rickettsia from P. solenopsis. We constructed a 16S rRNA gene library to study the bacterial diversity associated with this insect and we found that all the clones from the library were only of Candidatus Tremblaya phenacola. This study also highlights that the normal protocol adopted to study the bacterial diversity from environmental sample, by preparation of a 16S rRNA gene library, does not work when the bacterial population is highly skewed in favor of one bacteria (primary endosymbiont in this case). Hence, we used bacterial genus specific polymerase chain reaction primers to test the presence of any of the widely known secondary endosymbionts associated with insects. We tested for the presence of Cardinium, Rickettsia, Wolbachia, and Arsenophonus in P. solenopsis collected from 10 different locations across India. Only Rickettsia was detected from four locations while we were not able to find any other bacteria. We confirmed the presence of these bacteria by localizing Rickettsia and the primary endosmbiont, Candidatus Tremblaya sp. to the bacteriocyte of P. solenopsis using fluorescent in situ hybridization.