Effect of surgical intervention on serum insulin-like growth factor 1 in patients with obstructive sleep apnoea

OBJECTIVE

To evaluate the effect of surgical intervention on serum insulin-like growth factor 1 levels in patients with obstructive sleep apnoea.

METHODS

A prospective study was conducted in a tertiary care hospital of adult patients with obstructive sleep apnoea for whom continuous positive airway pressure therapy failed or was refused. All patients underwent polysomnography and serum insulin-like growth factor 1 evaluation pre-operatively and at three months post-operatively. The site of surgery was determined using Müller's manoeuvre and ApneaGraph AG 200.

RESULTS

Fifteen patients were included with a mean age of 38 years: 11 males and 4 females. The mean pre-operative Apnoea-Hypopnoea Index using polysomnography was 53.7 events per hour, and the mean post-operative Apnoea-Hypopnoea Index at three months was 15.3 events per hour (p = 0.0001). The mean pre-operative serum insulin-like growth factor 1 was 160.2 μg/l, while the mean post-operative value was 236.98 μg/l (p = 0.005).

CONCLUSION

In adult patients with obstructive sleep apnoea for whom continuous positive airway pressure therapy fails, site-specific surgical intervention to treat the obstruction leads to an increase in serum insulin-like growth factor 1 levels.

Genome-wide mapping of gene-microbe interactions in the murine lung microbiota based on quantitative microbial profiling

BACKGROUND

Mammalian lungs comprise a complex microbial ecosystem that interacts with host physiology. Previous research demonstrates that the environment significantly contributes to bacterial community structure in the upper and lower respiratory tract. However, the influence of host genetics on the makeup of lung microbiota remains ambiguous, largely due to technical difficulties related to sampling, as well as challenges inherent to investigating low biomass communities. Thus, innovative approaches are warranted to clarify host-microbe interactions in the mammalian lung.

RESULTS

Here, we aimed to characterize host genomic regions associated with lung bacterial traits in an advanced intercross mouse line (AIL). By performing quantitative microbial profiling (QMP) using the highly precise method of droplet digital PCR (ddPCR), we refined 16S rRNA gene amplicon-based traits to identify and map candidate lung-resident taxa using a QTL mapping approach. In addition, the two abundant core taxa Lactobacillus and Pelomonas were chosen for independent microbial phenotyping using genus-specific primers. In total, this revealed seven significant loci involving eight bacterial traits. The narrow confidence intervals afforded by the AIL population allowed us to identify several promising candidate genes related to immune and inflammatory responses, cell apoptosis, DNA repair, and lung functioning and disease susceptibility. Interestingly, one genomic region associated with Lactobacillus abundance contains the well-known anti-inflammatory cytokine Il10, which we confirmed through the analysis of Il10 knockout mice.

CONCLUSIONS

Our study provides the first evidence for a role of host genetic variation contributing to variation in the lung microbiota. This was in large part made possible through the careful curation of 16S rRNA gene amplicon data and the incorporation of a QMP-based methods. This approach to evaluating the low biomass lung environment opens new avenues for advancing lung microbiome research using animal models.

A phase II study of metformin plus pemetrexed and carboplatin in patients with non-squamous non-small cell lung cancer (METALUNG)

Immune checkpoint inhibitors (ICIs) ± chemotherapy is the standard treatment for driver mutation-negative non-small cell lung cancer (NSCLC). However, accessibility to ICIs in LMICs is limited due to high cost, and platinum-based chemotherapy remains the mainstay of treatment. Metformin has anticancer properties, and studies suggest synergism between metformin and pemetrexed. Based on preclinical evidence, this combination may be more beneficial for STK11-mutated NSCLC, a subgroup, inherently resistant to ICIs. In this Simon two-stage, single-arm phase 2 trial, we investigated metformin with pemetrexed-carboplatin (PC) in patients with treatment-naive stage IV non-squamous NSCLC. The primary outcome was 6-month progression-free survival (PFS) rate. Secondary outcomes were safety, overall survival (OS), overall response rate (ORR), proportion of STK11 mutation, and effect of STK11 mutation on 6-month PFS rate. The study was terminated for futility after interim analysis. The median follow-up was 34.1 months. The 6-month PFS rate was 28% (95% CI 12.4-0.46). The median PFS and OS were 4.5 (95% CI 2.2-6.1) and 7.4 months (95% CI 5.3-15.3), respectively. The ORR was 72%. Gastrointestinal toxicities were the most common. No grade 4/5 toxicities were reported. Targeted sequencing was possible in nine cases. Two patients had STK11 mutation and a poor outcome (PFS < 12 weeks). We could not demonstrate the benefit of metformin with CP in terms of improvement in 6-month PFS rate; however, the combination was safe (CTRI/2019/02/017815).

High burden of cardiometabolic risk factors in spouses of Indian women with hyperglycaemia in pregnancy

AIM

To evaluate the burden and association of cardiometabolic risk factors in the spouses of women with and without hyperglycaemia in pregnancy.

METHODS

Women with (n = 204) and without (n = 197) hyperglycaemia in pregnancy, along with their spouses, participated in this cross-sectional study. The hyperglycaemia in pregnancy group included women with gestational diabetes and diabetes in pregnancy. A detailed questionnaire was completed for all participants (men and women), documenting relevant personal and medical history, along with biochemical investigations (men).

RESULTS

A total of 401 couples were evaluated at the time point during the pregnancy of 24.7 ± 5.2 gestational weeks (mean ± sd). Dysglycaemia (prediabetes or diabetes), overweight/obesity (BMI ≥25 kg/m² ) and metabolic syndrome were detected in 120 (58.9%), 123 (60.3%) and 98 spouses (48.3%) of women with hyperglycaemia in pregnancy, respectively. In the fully adjusted model, an increased risk of dysglycaemia [odds ratio 1.43 (95% CI 0.95-2.17); P = 0.088], overweight/obesity [odds ratio 1.49 (95% CI 0.98-2.27); P = 0.064] and metabolic syndrome [odds ratio 2.00 (95% CI 1.30-3.07); P = 0.001] was seen in the spouses of women with hyperglycaemia in pregnancy. The prevalence of these metabolic conditions was higher in spouses of women with diabetes in pregnancy compared to spouses of women with gestational diabetes mellitus.

CONCLUSIONS

A high burden of cardiometabolic risk factors was observed in the spouses of women with hyperglycaemia in pregnancy. The opportunity provided by pregnancy could be used by the healthcare system not only to improve the health of the woman and her offspring, but also her spouse.

Upgraded Giant Metrewave Radio Telescope timing of NGC 1851A: a possible millisecond pulsar - neutron star system

In this work, we present the results of 1 yr of upgraded Giant Metrewave Radio Telescope timing measurements of PSR J0514-4002A, a 4.99-ms pulsar in a 18.8-d eccentric ([Formula: see text]) orbit with a massive companion located in the globular cluster NGC 1851. Combining these data with earlier Green Bank Telescope data, we greatly improve the precision of the rate of advance of periastron, [Formula: see text] which, assuming the validity of general relativity, results in a much refined measurement of the total mass of the binary, [Formula: see text]. Additionally, we measure the Einstein delay parameter, γ, something that has never been done for any binary system with an orbital period larger than [Formula: see text]10 h. The measured value, [Formula: see text], is by far the largest for any binary pulsar. Furthermore, we measure the proper motion of the system ([Formula: see text] and [Formula: see text]), which is not only important for analysing its motion in the cluster, but is also essential for a proper interpretation of γ, given the latter parameter's correlation with the variation of the projected semimajor axis. The measurements of γ and the proper motion enable a separation of the system component masses: we obtain a pulsar mass of [Formula: see text] and a companion mass of [Formula: see text]. This raises the possibility that the companion is also a neutron star. Searches for radio pulsations from the companion have thus far been unsuccessful; hence, we cannot confirm the latter hypothesis. The low mass of this millisecond pulsar - one of the lowest ever measured for such objects - clearly indicates that the recycling process can be achieved with a relatively small amount of mass transfer.

A lifestyle intervention programme for the prevention of Type 2 diabetes mellitus among South Asian women with gestational diabetes mellitus [LIVING study]: protocol for a randomized trial

AIM

This study aims to determine whether a resource- and culturally appropriate lifestyle intervention programme in South Asian countries, provided to women with gestational diabetes (GDM) after childbirth, will reduce the incidence of worsening of glycaemic status in a manner that is affordable, acceptable and scalable.

METHODS

Women with GDM (diagnosed by oral glucose tolerance test using the International Association of the Diabetes and Pregnancy Study Groups criteria) will be recruited from 16 hospitals in India, Sri Lanka and Bangladesh. Participants will undergo a repeat oral glucose tolerance test at 6 ± 3 months postpartum and those without Type 2 diabetes, a total sample size of 1414, will be randomly allocated to the intervention or usual care. The intervention will consist of four group sessions, 84 SMS or voice messages and review phone calls over the first year. Participants requiring intensification of the intervention will receive two additional individual sessions over the latter half of the first year. Median follow-up will be 2 years. The primary outcome is the proportion of women with a change in glycaemic category, using the American Diabetes Association criteria: (i) normal glucose tolerance to impaired fasting glucose, or impaired glucose tolerance, or Type 2 diabetes; or (ii) impaired fasting glucose or impaired glucose tolerance to Type 2 diabetes. Process evaluation will explore barriers and facilitators of implementation of the intervention in each local context, while trial-based and modelled economic evaluations will assess cost-effectiveness.

DISCUSSION

The study will generate important new evidence about a potential strategy to address the long-term sequelae of GDM, a major and growing problem among women in South Asia. (Clinical Trials Registry of India No: CTRI/2017/06/008744; Sri Lanka Clinical Trials Registry No: SLCTR/2017/001; and ClinicalTrials.gov Identifier No: NCT03305939).

Similar glycaemic control with less nocturnal hypoglycaemia in a 38-week trial comparing the IDegAsp co-formulation with insulin glargine U100 and insulin aspart in basal insulin-treated subjects with type 2 diabetes mellitus

AIMS

To confirm non-inferiority of insulin degludec/insulin aspart (IDegAsp) once-daily (OD) versus insulin glargine (IGlar) U100 OD + insulin aspart (IAsp) OD for HbA_1c after 26 weeks, and compare efficacy and safety between groups at W26 + W38.

METHODS

A 38-week, randomised, open-label, treat-to-target (HbA_1c < 7.0%) trial in adults with type 2 diabetes mellitus (on basal insulin ± oral antidiabetic drugs; HbA_1c 7.0-10.0%). Randomisation (1:1): IDegAsp or IGlar U100 + IAsp. Intensification to IDegAsp twice daily (BID) was permitted at W26 + W32, or with additional IAsp injections at W26 (maximum IAsp BID) or W32 (maximum IAsp three-times daily).

RESULTS

For W0-W26, mean percentage-change (standard deviation) HbA_1c was: IDegAsp, -1.1 (0.9); IGlar U100 + IAsp, -1.1 (0.8); estimated treatment difference: 0.07% (95% confidence interval [CI]: -0.06; 0.21) confirmed non-inferiority. At W26 and W38, target HbA_1c achievement, and mean fasting and postprandial glucose were similar across groups. At W38, more subjects achieved target HbA_1c without hypoglycaemia with IDegAsp (22.5%) than with IGlar U100 + IAsp (21.1%), with significantly fewer nocturnal episodes (W0-W38, estimated rate ratio: 0.61 [95% CI: 0.40; 0.93]). Safety profiles were similar across treatment groups throughout.

CONCLUSIONS

IDegAsp OD/BID are effective treatment intensification options versus multiple injection basal-bolus therapies, achieving similar glycaemic control, with significantly less nocturnal hypoglycaemia.

Role of nebivolol in the control and management of central aortic blood pressure in hypertensive patients

Measurement of blood pressure (BP) using a brachial cuff sphygmomanometer is universally accepted for the diagnosis of hypertension and prediction of cardiovascular diseases. However, brachial systolic BP does not represent actual systolic BP in the central arteries which encounter cardiac load directly. Due to wave amplification from central to peripheral arteries, a significant difference exists between the two. Central BP measurements also account for arterial stiffness, vessel branching and vascular mechanics, unlike brachial BP. Emerging data suggests that hypertension can be diagnosed more accurately by central pressure indices as compared to brachial BP. Various non-invasive techniques are now available to measure central BP indices owing to recent technological advances. Recently, it has been reported that different classes of anti-hypertensive drugs display differential effects on brachial and central BPs. Nebivolol is a cardio-selective beta-blocker which targets central systolic BP and reduces it significantly along with brachial BP. In this article, we will review the current literature to evaluate the role of central BP to diagnose hypertension in detail. We will also assess the clinical evidence to evaluate the role of nebivolol in the management of elevated central systolic BP. Central BP indices offer better estimation of BP in central arteries and should be considered in routine clinical practice. Nebivolol has shown significant reduction in aortic pressure and wave reflection and improvements in endothelial dysfunction and arterial stiffness in hypertensive patients.

Conversion of gestational diabetes mellitus to future Type 2 diabetes mellitus and the predictive value of HbA1c in an Indian cohort

AIM

To investigate the distribution of and risk factors for dysglycaemia (Type 2 diabetes and prediabetes) in women with previous gestational diabetes mellitus in India.

METHODS

All women (n = 989) from two obstetric units in New Delhi and Hyderabad with a history of gestational diabetes were invited to participate, of whom 366 (37%) agreed. Sociodemographic, medical and anthropometric data were collected and 75-g oral glucose tolerance test were carried out.

RESULTS

Within 5 years (median 14 months) of the pregnancy in which they were diagnosed with gestational diabetes, 263 (72%) women were dysglycaemic, including 119 (32%) and 144 (40%) with Type 2 diabetes and prediabetes, respectively. A higher BMI [odds ratio 1.16 per 1-kg/m² greater BMI (95% CI 1.10, 1.28)], presence of acanthosis nigricans [odds ratio 3.10, 95% CI (1.64, 5.87)], postpartum screening interval [odds ratio 1.02 per 1 month greater screening interval 95% CI (1.01, 1.04)] and age [odds ratio 1.10 per 1-year older age 95% CI (1.04, 1.16)] had a higher likelihood of having dysglycaemia. The American Diabetes Association-recommended threshold HbA_1c value of ≥ 48 mmol/mol (6.5%) had a sensitivity and specificity of 81.4 and 90.7%, respectively, for determining the presence of Type 2 diabetes postpartum.

CONCLUSION

The high post-pregnancy conversion rates of gestational diabetes to diabetes reported in the present study reinforce the need for mandatory postpartum screening and identification of strategies for preventing progression to Type 2 diabetes. Use of the American Diabetes Association-recommended HbA_1c threshold for diabetes may lead to significant under-diagnosis.

Length of Stay of Orthopaedic Inpatients at a Teaching Hospital in Eastern Part of Nepal

INTRODUCTION

This study aimed to analyze the average length of stay of all inpatients in the department of Orthopaedics and to compare the variations in hospital stay between age, gender, traumatic and non-traumatic co-morbidities and modality of payment.

METHODS

This hospital based retrospective descriptive epidemiological study was based on patients discharged from a tertiary level health care center of eastern Nepal. Registry data of 1 year was used to calculate length of stay and analyze the variations.

RESULTS

Average length of stay was 10.5 days. It was 10.7 days for males and 10.1 days for females. It was 10.12 days for patients paying themselves for their treatment whereas 14.98 days for patients receiving reimbursement (third party payment).

CONCLUSIONS

Average length of stay was more in elderly and patients of trauma (longest in pelvis injury). It was 1.5 times longer for patients receiving reimbursement for treatment.

Nasal Endoscopy Versus Other Diagnostic Tools in Sinonasal Diseases

Sinonasal endoscopy is an essential part of the rhinologic examination performed by otolaryngologists in the evaluation of sinonasal disease. The use of the endoscopes has been popularized with the advent of endoscopic sinus surgery. To evaluate the role of nasal endoscopy as primary examination in the early and accurate diagnosis of sinonasal diseases in comparison to other diagnostic tools in rhinology. A retrospective and prospective study was carried out on 200 patients with clinical evidence of sinonasal diseases. They were evaluated with anterior rhinoscopy, nasal endoscopy and CT paranasal sinus. The level of agreement between anterior rhinoscopy and nasal endoscopy was substantial for deviated nasal septum, inferior turbinate hypertrophy and polyp (0.735, 0.712 and 0.709, respectively), but moderate for middle turbinate hypertrophy (0.418). The results of endoscopy and CT comparison among 80 patients, whose symptoms warranted CT, indicated that although for most of the findings, there was almost perfect to substantial level of agreement between the results of the two methods, five patients had normal CT imaging report, while they demonstrated early polyps during endoscopic evaluation. Also, CT missed 4 cases of deviated nasal septum. Diagnostic nasal endoscopy proved a better technique to detect various sinonasal pathologies as well as anatomical variations, which are otherwise missed on Computed Tomography or inaccessible on anterior rhinoscopy especially in the key area comprising the ostiomeatal complex. We reinforce the fact that it should be viewed as an essential part of a complete examination of the nose and sinuses.

Long term effects of anti-VEGF agents: patho-physiological perspectives

Monoclonal antibodies directed against different targets have become a new tool for the treatment of various disorders. More than 20 monoclonal antibody-based therapies have been approved in the USA and hundreds more are in development. Some of these therapies are finding applications in ocular disorders. The role of anti-VEGF in the treatment of wet ARMD is now well known. Anti-VEGF, which were initially discovered to treat carcinomas like bevacizumab in metastatic colorectal carcinoma, have now found place in ophthalmology to treat disorders where neovascularization/angiogenesis leads to blindnes. Nepal J Ophthalmol 2013; 5(9):100-105 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7834

School eye survey in rural population in UP, India

OBJECTIVE

To find out the prevalence of refractive errors and pattern of ocular morbidity amongst the school children of a rural village.

MATERIALS AND METHODS

A cross sectional study was carried out in children of age group 3 - 12 years in a rural village of Hathras, Uttar Pradesh, India. All the children were examined including visual acuity measurement using Snellen's E chart, retinoscopy and refraction under cycloplegia. Examination of the anterior segment, media, and fundii was also done. Myopia was defined as spherical/cylindrical equivalent refractive error of at least -0.50 D and hypermetropia as +0.50 D or more (Dandona et al 2002).

RESULTS

In the survey 220 eyes of 110 children were examined, majority of them were in 5-10 year age group. The prevalence of uncorrected visual acuity of 6/6 was 85.40%. Refractive error was the cause in 6.81% of eyes with vision impairment, out of which myopia and hypermetropia were present in 26.67% of eyes. Blepharo-conjunctivitis was present in 15.45% of children and Bitot's spots were present in 0.90% of them. Colour blindness was found in one child.

CONCLUSION

The prevalence of refractive error in rural school is 6.81 %. Blepharitis is the commonest cause of ocular morbidity.

Concha bullosa: Frequency and appearances on sinonasal CT

Aeration of the middle turbinate, termed "Concha bullosa", is one of the most common, obstructive, anatomic variants seen in patients with sinusitis. The present study was carried out on 150 patients of chronic sinusitis, who underwent CT scan paranasal sinuses, coronal section prior to Functional Endoscopic Sinus Surgery (FESS). The CT Scans were evaluated to detect the incidence of Concha bullosa and its types, the significance of Concha bullosa in genesis of osteomeatal complex disease and relation between type of Concha bullosa and osteomeatal complex disease. Later the patients were subjected to FESS. In this study we found that the overall incidence of inflammatory disease in the osteomeatal complex in these symptomatic patients was no different between with and without Concha bullosa and osteomeatal complex disease is found to be more frequent if peumatization is localized to inferior part of middle turbinate. Concha bullosa requires specific endoscopic surgical techniques.

Accommodation: its relation to refractive errors, amblyopia and biometric parameters

AIM

To study accommodation in relation to different refractive errors, amblyopia and to measure the anatomical changes in the accommodating eye

MATERIALS AND METHODS

We studied the amplitude of accommodation (AA) in 150 patients in the age group 11 ± 30 years which included emmetropes, myopes, hypermetropes and hypermetropic amblyopes using the Royal Air Force (RAF) rule. The anterior chamber depth (ACD), axial length (AxL) and lens thickness (LT) changes during accommodation were measured using an A-scan. Myopes and hypermetropes were further divided based on the amount of refractive error : less than 2D, 2 -4D and greater than 4D.

RESULTS

Corrected low myopes had the highest accommodation amplitude (p less than 0.05) followed by emmetropes. Corrected hypermetropes were found to have the lowest amplitude of accommodation (p less than 0.05). The amblyopic eye had a significantly low AA compared to the non-amblyopic eye (p less than 0.05). ACD decreased (p less than 0.05) and LT increased (p less than 0.05) during accommodation. The AxL increase was maximum in myopes (p less than 0.05) followed by hypermetropes but the change was not significant in hypermetropes (p greater than 0.05).

CONCLUSION

The amblyopic eye has low amplitudes of accommodation proving the benefit of near adds in amblyopic patients. Prolonged near work might induce myopia in susceptible eyes by increasing the axial length.

Presbyopia and its anatomical and physiological variants

AIM

To study the various ocular anatomical and physiological parameters in presbyopia.

MATERIALS AND METHODS

We studied the various ocular anatomical and physiological parameters like corneal curvature (keratometry readings: K1 and K2), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT) and axial length (AL) in 100 presbyopic patients between 35 - 55 years of age. The patients were divided into two age groups: I (35 ± 44 years) and II (45-55 yrs). ACD, AL and LT were measured using an Ascan. CCT was measured with ultrasonic pachymetry.

RESULTS

The CCT decreased (BE), LT increased and ACD decreased (RE) significantly with increasing age (p less than 0.05). There was no significant difference in males and females. Nearly 3/4th of the total increase in lens thickness was responsible for the decrease in the anterior chamber depth and the rest, 1/4th , goes posteriorly. Corneal curvature and AL showed no significant change with age.

CONCLUSIONS

The mean of CCT decreased significantly with advancing age. As age increased, the mean value of lens thickness increased and anterior chamber depth decreased. Nearly 3/4th of total increase in LT was anteriorly, decreasing the ACD. Corneal curvature and AL has no relation with age.

Association between helicobacter pylori and open angle glaucoma: current perspective

Helicobacter pylori is a Gram negative, spiral-shaped, strictly micro-aerophilic and flagellate human pathogen that can inhabit many areas of stomach. H. pylori infection leads to the generation of oxygen free radicals. H. pylori infection might also aggravate the course of glaucoma by increasing the levels of nitric oxide, endothelin-1 and free radicals indirectly. This article briefly reviews the current perspectives on this issue.

Xerosis meter-an electro-physiological device for quick screening of dry eyes

AIM

to study the role of'Xerosis Meter' in screening of dry eye cases in a large population and compare its results with Schirmer's test and tear break-up time.

MATERIALS AND METHOD

in a cross sectional study with a control group dry eye was evaluated with Xerosis Meter, Schirmer test and tear film break-up time (TBUT). Cases included in the study were divided into two groups. Group I (Control Group) comprised of asymptomatic patients while Group II (Test Group) had patients showing symptoms and signs of dry eye. The Group II was further divided into two subgroups. Group IIa had cases showing positive result with either of the two tests Schirmer test or TBUT. Group IIb had cases which showed positive results with Xerosis Meter but normal results with the other two tests.

STATISTICS

all the observations were statistically analyzed using SPSS version 11.5 software. The results obtained were compared statistically using unpaired t-test and chi-square test. The p value of < 0.05 was considered as significant.

RESULTS

There was a statistically significant difference between the means of Xerosis Meter, Schirmer test and TBUT of the two groups: Group I and Group IIa (p value < 0.001). On comparing Group I and Group IIb the difference was found to be statistically significant with Xerosis Meter (p value <0.001). The sensitivity and specificity ofXerosis Meter were 85.7% and 80.2% respectively. This was higher than that of the Schirmer's test (81.3% and 74.9%) and TBUT (73.2% and 68.7%).

CONCLUSION

the "Xerosis Meter" is an effective alternate in screening of dry eye cases. It is more effective than the TBUT and as effective as the Schirmer's test in detecting both the normal and dry eye patients.

An electro-physiological device to assess status of vitreous transparency

INTRODUCTION

Evaluation of optical media is important in ophthalmic practice.

OBJECTIVE

to design and tryout an electro-physiological device in order to assess the transparency of the vitreous.

MATERIALS AND METHODS

A media-meter was designed where a light sensitive sensor was placed on the cornea and adjoining sclera during the process of trans-illumination. The trans-corneal (TC) and trans-scleral (TS) light transmittance were recorded objectively. By standardizing these readings on normal eyes, it was possible to suspect any cause of vitreous turbidity in eyes where the transmittance of light was observed to be less than the normal readings.

STATISTICS

Media-meter values were compared using Student's unpaired t- test for comparison between both the groups. Pearson or Spearman correlation coefficients were calculated for pooled media-meter values obtained from patients with endophthalmitis.

RESULTS

The readings were obtained by TC and TS media-metry with white light in 20 eyes that served to standardize the device. The mean values for the intensity recorded on the media-meter were 206 to 74 Lux and after log-values conversion were 2.14 (range 2.36 to 1.87) and 45 to 31 Lux and after log conversion 1.60 (range 1.66 to 1.49) for TC and TS media-meter respectively. There was a highly significant difference between normal eye readings and the corresponding values obtained for TC and TS media-meter values in eyes with endophthalmitis.

CONCLUSION

The media-meter can be used to evaluate vitreous transparency.

Physiological disproportions between un-corrected vision and degree of myopia

INTRODUCTION

Anomalies of the refractive state of the eye are the commonest cause of defective vision.

PURPOSE

To study the relationship between uncorrected visual acuity and refractive error in myopia in children, the prevalence of disparity between them and to find out the possible explanation for it.

MATERIALS AND METHODS

100 eyes of 50 myopic children were studied and analyzed to study relationship between the uncorrected visual acuity (UCVA) and its refractive status. 42 cases were chosen to study disparity, either in the form of uncorrected visual acuity or refractive error. To study these disparities, Keratometery for anterior corneal curvature and A-scan for axial length and anterior chamber depth were also done.

STATISTICS

The results were analyzed statistically using student t-test while the relationship between uncorrected visual acuity (UCVA) and refractive error in myopia was obtained with Spearman's correlation coefficient (R).

RESULTS

The strength of association of uncorrected visual acuity and myopia as indicated by the correlation coefficient (0.897, p less than 0.001) is a significant one. Out of 42 cases taken to study disparity, 24 (57 %) cases showed discrepancy either in the form of uncorrected visual acuity or refractive error. The reason for this disparity as proven statistically in our study is increased axial length (p value less than 0.001).

CONCLUSIONS

There exists a linear relationship between UCVA and myopia, yet an accurate prediction of uncorrected visual acuity cannot be made on the basis of the refractive error or vice-versa for any single individual, as there exists a disparity either in form of UCVA or refractive error in myopia.

A rare case of persistent pupillary membrane associated with high myopia and amblyopia

PURPOSE

To present the management of a rare case of persistent pupillary membrane (PPM) associated with high myopia and amblyopia.

CASE

A 12-year-old boy presented with progressive diminution of vision in the right eye since childhood. Examination (OD) showed several fine strands of iris attached to the collarette and to the anterior lens capsule with a clump of iris pigment adherent over it. Some of these strands even wrinkled on pupillary contraction. The patient was also examined on slit-lamp.The patient was operated for lens extraction with PCIOL implantation.

RESULTS

The patient regained useful vision after surgery.

CONCLUSION

This is a rare case of persistent pupillary membrane associated with high axial myopia.

British Rhinological Society audit of the role of antibiotics in complications of acute rhinosinusitis: a national prospective audit

OBJECTIVE

Acute rhinosinusitis (ARS) is one of the most common presenting conditions to Primary Care physicians. Over-prescription of antibiotics has led to wide debate and divided expert opinion regarding the resulting increasing bacterial resistance or the merits of prevention of more serious complications of ARS. A national prospective audit was undertaken in the UK to evaluate use of antibiotics for ARS in Primary Care.

METHODS AND MATERIALS

British Rhinological Society members were asked to contribute patients admitted with complications of ARS, between Feb 2008–Feb 2009 to a national prospective audit via an on-line survey.

RESULTS

Seventy-eight patients were admitted with complications of ARS. The majority of patients were started on antibiotics (59%) prior to admission, with penicillin/amoxicillin being most frequently (64%) prescribed. Similar complication rates were seen in patients treated with and without prior antibiotics.

CONCLUSION

Despite prior antibiotic treatment, complications of ARS seem to occur sporadically. Our study has shown that the complications which require surgical treatment are similar in both the prior antibiotic treated group and the no prior antibiotic group, suggesting limited benefit of oral antibiotics in the Primary Care setting. Early recognition with CT scanning and appropriate hospital management is essential to reduce any subsequent morbidity or mortality.

Methotrexate bearing calcium pectinate microspheres: a platform to achieve colon-specific drug release

In the present work calcium pectinate (Ca-pectinate) microspheres were prepared to deliver methotrexate in the environment of colon. Calcium pectinate microspheres were prepared by modified emulsification method using calcium chloride as cross linker. All the formulations were evaluated for various physicochemical parameters. Particle size of the microspheres was determined using laser diffraction particle size analyzer. Encapsulation efficiency was determined by digesting with enzyme pectinase for 24 hours and swellability by equilibrium swelling in simulated gastrointestinal fluid. The in vitro drug release studies were performed in simulated gastric fluid for 2 hours and simulated intestinal fluid for 3 hours. In vitro release rate studies were also carried out in simulated colonic fluid in presence of rat caecal contents. Moreover, release rate studies were also carried out after enzyme induction by treating the rats with 1 ml of 1% w/v aqueous dispersion of pectin for 7 days. Mean particle size of the microspheres was found to be in the range of 20.82+/-1.34 to 32.26+/-1.59 microm whereas the entrapment efficiency varied from 52.28+/-0.32 to 74.01+/-3.32%. The in vitro drug release studies in simulated gastric fluid and simulated intestinal fluid showed that only 8.15+/-0.49% drug was released in 5 hours whereas most of the loaded drug was released in simulated colonic fluid containing pectinase. In vitro release rate study showed release of 69.94+/-3.46% of drug in presence of 3% rat caecal contents, which was further increased to 94.43+/-4.48% when enzyme induction was carried out for 7 days. Thus, it is concluded that calcium pectinate microspheres can be used to effectively localize the release of drug in the physiological environment of colon.

Design and development of a mucoadhesive buccal film bearing progesterone

The purpose of this research was to develop and evaluate mucoadhesive films for buccal administration of progesterone using film-forming and mucoadhesive polymers. Buccal films of chitosan bearing progesterone were prepared by solvent casting technique. The films have been evaluated in terms of film weight, thickness, density, surface pH, FT-IR, X-ray diffraction analysis, bioadhesion, swelling properties, in vitro drug release and in vivo studies. It was found that the film formulations of 2 cm2 size having weight in the range of 239 +/- 0.32 to 290 +/- 3.23 mg and film thickness were in the range of 0.49 +/- 0.21 to 0.60 +/- 0.26 mm. Density of the films was found to be 0.108 to 0.139 g/mL. Drug content was found to be uniform in a range of 9.21 +/- 0.051 to 9.67 +/- 0.086 mg/cm2 for formulation F1 to F4. Maximum bioadhesion force was recorded for PVP buccal films (formulation F2) i.e. 0.45 +/- 0.53 N as compared to other films. In vitro residence time was in range of 1.85 +/- 0.08 to 8.94 +/- 0.08 h. The drug release studies revealed that formulations follows non-fickian diffusion. In vivo residence time data confirmed that none of the polymers detached from the oral mucosa over the study period, which indicated that the bioadhesion values of all polymers were satisfactory to retain the film on the buccal mucosa. These mucoadhesive formulations could offer many advantages in comparison to traditional treatments and their efficacy as an effective contraception is assessed.

P-glycoprotein expression is associated with sestamibi washout in primary hyperparathyroidism

Background

The detection of parathyroid adenomas by 99mTc-labelled hexakis 2-methoxyisobutyl isonitrile (sestamibi) scintigraphy is influenced by several factors, including tumour size and serum level of parathyroid hormone (PTH). This study examined the relationship between sestamibi accumulation and multidrug resistance (MDR)-related P-glycoprotein (P-gp) expression in a large series of surgically excised parathyroid tumours.

Methods

Seventy-eight patients underwent dual-phase sestamibi imaging before parathyroidectomy. Expression of P-gp within tumour cells was assessed by immunohistochemistry. Tumour size was measured and the ellipsoid volume calculated. Scan results were analysed in relation to preoperative serum levels of calcium and PTH, P-gp expression and tumour volume.

Results

Sixty-four of the 78 sestamibi scans were positive and 14 negative. Smaller adenomas (less than 0·5 cm3) were more likely to be sestamibi negative than larger lesions (P = 0·006). Ten of 14 adenomas with negative imaging showed strong P-gp membrane positivity and 45 of 64 lesions with a positive scan did not show P-gp membrane expression, indicating a significant association between high P-gp membrane immunoreactivity and negative sestamibi result (P = 0·006).

Conclusion

These data suggest an association between P-gp membrane expression and false-negative sestamibi scan result. Inhibition of the P-gp transmembrane pump using MDR modulators may therefore improve the sensitivity of sestamibi scintigraphy.

Solid lipid nanoparticles bearing flurbiprofen for transdermal delivery

Topical application of the drugs at the pathological sites offer potential advantages of delivering the drug directly to the site of action and thus producing high tissue concentrations of the drug. The solid lipid nanoparticles (SLN) bearing flurbiprofen were prepared by microemulsion method by dispersing o/w microemulsion in a cold aqueous surfactant medium under mechanical stirring. The SLN gel was prepared by adding SLN dispersion to polyacrylamide gel prepared by using polyacrylamide (0.5%), glycerol (10%), and water (69.5%). Shape and surface morphology was determined by scanning electron microscopy that revealed fairly spherical shape of the formulation. Percent drug entrapment was higher in SLN dispersion in comparison to SLN gel formulations. In vitro drug release, determined using cellophane membrane, showed that SLN dispersion exhibited higher drug release compared with SLN gel formulations. Both the SLN dispersion and SLN-gel formulation possessed a sustained drug release over a 24-hr period, but this sustained effect was more pronounced with SLN-gel formulations. The percent inhibition of edema after 8 hr was 55.51 +/- 0.26% in case of SLN-T4-gel, whereas flurbiprofen and SLN-T4 dispersion exhibited 28.81 +/- 0.46 and 31.89 +/- 0.82 inhibition of edema. The SLN-T4-gel not only decreased the inflammation to larger magnitude, but also sustained its effect.

Mesiodens: a retrospective study of fifty teeth

A retrospective study of 30 cases of mesiodens is presented. male preponderance of 1.5:1. was 64% mesiodens were impacted and 36% erupted. Inverted impacted mesiodens was seen in 62.5% of the impacted mesiodens. 66.6% cases had 2 mesiodens per case. The harmful effects on the dentition were mostly crowding, rotation, diastema and impacted permanent incisor.

A survey on refractive error and strabismus among children in a school at Aligarh

An ophthalmic survey of 310 school going children in the age group of 4-12 years was done. 41 children (13.2%) were found to have a vision of less than 6/6 in one or both eyes. Myopia of 0.5 D or more and hyperopia of +2 D or more or astigmatism of 1 D or more in one or both eyes were seen in 74 children (22.9%). There was a tendency for a decrease in hyperopia and an increase in myopia with advancing age. Astigmatic error of 1 D or less was seen in 12 eyes (1.93%) and anisometropia of more than 1 D was present in 11 cases (3.5%). Hypertropia was more in female children whereas myopia had a nearly equal distribution in both sexes. There was heterophoria and manifest strabismus which showed a gradual increase with advancing age. This study was compared to few other studies undertaken in the past.

Brush cytology and its comparison with histopathological examination in cases of diseases of the nose

Nasal cytology is a simple, easy, bloodless and quite reliable investigation. Although its utility was recognized as early as 1927 by Eyerman, it has not yet gained much popularity. Here, an attempt is made to assess its efficacy for the diagnosis of various inflammatory, benign and malignant conditions in 151 cases of common rhinological problems in the M.Y. Group of Hospitals, Indore MP, India. This method can be used as an adjuvant to clinical diagnosis and histopathological diagnosis as an outpatient department (OPD) procedure with the help of a nasal endoscope, as it was found to be a simple, reliable and time-saving procedure for further management. It can also be used as a screening test for the detection of symptomless patients particularly in precancerous lesions.

Oral submucous fibrosis in paediatric age group

Oral submucous fibrosis is common in the Indian subcontinent, but only a few cases have been reported in the paediatric age group. An interesting case of submucous fibrosis in a child aged 8 years is reported . A brief review of literature and management of the patient are discussed.