First-year experience of chemotherapy for advanced retinoblastoma in Tanzania: disease profile, outcomes, and challenges in 2008.

PURPOSE: To examine the profile of retinoblastoma in a national tertiary referral center in Tanzania and to report first-year outcomes of its treatment using chemotherapy. METHODS: All patients with retinoblastoma referred in 2008 were included. Disease was classified on clinical grounds as ocular, orbital, or metastatic. Those with ocular and orbital disease received chemotherapy. Remission was the main outcome measure and defined as absence of disease at the end of treatment. RESULTS: In 2008, 37 patients (20 males and 17 females) with retinoblastoma were referred to Ocean Road Cancer Institute. The mean delay from the first sign of disease to presentation at hospital was 10.4 ± 8.7 months. Disease was ocular in 32% (12 of 37), orbital in 57% (21 of 37), and metastatic in 11% (4 of 37). Of those with ocular disease, 67% (8 of 12) completed chemotherapy and all (8 of 8) achieved remission. In contrast, 48% (10 of 21) with orbital disease completed chemotherapy and only 50% (5 of 10) achieved remission. The difference in outcome between the groups was statistically significant (P = .001, Fisher exact test). CONCLUSION: The profile of retinoblastoma in Tanzania is skewed toward severe invasive disease. Despite the introduction of chemotherapy, further improvements in mortality and morbidity can only be achieved through emphasis on early detection

Challenges in interpreting allergen microarrays in relation to clinical symptoms: a machine learning approach.

Identifying different patterns of allergens and understanding their predictive ability in relation to asthma and other allergic diseases is crucial for the design of personalized diagnostic tools.Allergen-IgE screening using ImmunoCAP ISAC(®) assay was performed at age 11 yrs in children participating a population-based birth cohort. Logistic regression (LR) and nonlinear statistical learning models, including random forests (RF) and Bayesian networks (BN), coupled with feature selection approaches, were used to identify patterns of allergen responses associated with asthma, rhino-conjunctivitis, wheeze, eczema and airway hyper-reactivity (AHR, positive methacholine challenge). Sensitivity/specificity and area under the receiver operating characteristic (AUROC) were used to assess model performance via repeated validation.Serum sample for IgE measurement was obtained from 461 of 822 (56.1%) participants. Two hundred and thirty-eight of 461 (51.6%) children had at least one of 112 allergen components IgE > 0 ISU. The binary threshold >0.3 ISU performed less well than using continuous IgE values, discretizing data or using other data transformations, but not significantly (p = 0.1). With the exception of eczema (AUROC~0.5), LR, RF and BN achieved comparable AUROC, ranging from 0.76 to 0.82. Dust mite, pollens and pet allergens were highly associated with asthma, whilst pollens and dust mite with rhino-conjunctivitis. Egg/bovine allergens were associated with eczema.After validation, LR, RF and BN demonstrated reasonable discrimination ability for asthma, rhino-conjunctivitis, wheeze and AHR, but not for eczema. However, further improvements in threshold ascertainment and/or value transformation for different components, and better interpretation algorithms are needed to fully capitalize on the potential of the technology

Prevalence of Ocular Morbidity Among School Adolescents of Gandhinagar District, Gujarat

Objective: To study the prevalence of ocular morbidity (abnormal condition) and various factors affecting it among school attending adolescents. Methods: A cross-sectional study was conducted to study abnormal ocular conditions like refractive errors, vitamin A deficiency, conjunctivitis, trachoma, ocular trauma, blephritis, stye, color blindness and pterygium among school adolescents of 10-19 years age in rural and urban areas of Gandhinagar district from January to July, 2009. Systematic sampling was done to select 20 schools having 6th to 12th standard education including 12 schools from rural and 8 from urban areas. Six adolescents from each age year (10-19) were selected randomly to achieve sample size of 60 from each school. In total, 1206 adolescents including 691 boys and 515 girls were selected. Information was collected from selected adolescents by using proforma. Visual acuity was assessed using a Snellen’s chart and all participants underwent an ophthalmic examination carried out by a trained doctor. Results: Prevalence of ocular morbidity among school adolescents was reported 13% (7.8% in boys, 5.6% in girls); with 5.2% have moderate visual impairment. Refractive error was most common ocular morbidity (40%) both among boys and girls. Almost 30% of boys and girls reported vitamin A deficiency in various forms of xerophthalmia. Prevalence of night blindness was 0.91% and of Bitot`s spot 1.74%. Various factors like, illiterate or lower parents’ education, lower socio-economic class and malnutrition were significantly associated with ocular morbidity. Conclusion: Ocular morbidity in adolescents is mainly due to refractive error, moderate visual impairment and xerophthalmia

Full Open Population Capture-Recapture Models with Individual Covariates

Traditional analyses of capture-recapture data are based on likelihood functions that explicitly integrate out all missing data. We use a complete data likelihood (CDL) to show how a wide range of capture-recapture models can be easily fitted using readily available software JAGS/BUGS even when there are individual-specific time-varying covariates. The models we describe extend those that condition on first capture to include abundance parameters, or parameters related to abundance, such as population size, birth rates or lifetime. The use of a CDL means that any missing data, including uncertain individual covariates, can be included in models without the need for customized likelihood functions. This approach also facilitates modeling processes of demographic interest rather than the complexities caused by non-ignorable missing data. We illustrate using two examples, (i) open population modeling in the presence of a censored time-varying individual covariate in a full robust-design, and (ii) full open population multi-state modeling in the presence of a partially observed categorical variable

Microorganisms and Common Ophthalmic Diseases

The human eye is in constant contact to environmental conditions that increase its likelihood in being exposed to a multitude of pathogens. Studies have revealed that the normal microbial flora found around the ocular area contribute to the well-being of ocular health as they play a critical role in inhibiting the proliferation of other pathogenic species and maintaining the homeostatic balance. However an imbalance in this status quo may lead to diseases including dry eye syndrome, meibomian gland dysfunction (MGD), blepharitis, rosacea, allergies, keratitis, conjunctivitis and immunological conditions such as mucous membrane pemphigoid and Sjogren’s syndrome. Thus, it is important to investigate and understand the role of various microorganisms that lead to these ocular diseases, and this knowledge may lead to better future treatments. This review focuses on recent advances and insights of pathogens and related ocular diseases which can help the audience further understand the etiology and the control of these disease

Evaluation of early and late presentation of patients with ocular mucous membrane pemphigoid to two major tertiary referral hospitals in the United Kingdom

PURPOSE: Ocular mucous membrane pemphigoid (OcMMP) is a sight-threatening autoimmune disease in which referral to specialists units for further management is a common practise. This study aims to describe referral patterns, disease phenotype and management strategies in patients who present with either early or established disease to two large tertiary care hospitals in the United Kingdom.\ud \ud PATIENTS AND METHODS: In all, 54 consecutive patients with a documented history of OcMMP were followed for 24 months. Two groups were defined: (i) early-onset disease (EOD:<3 years, n=26, 51 eyes) and (ii) established disease (EstD:>5 years, n=24, 48 eyes). Data were captured at first clinic visit, and at 12 and 24 months follow-up. Information regarding duration, activity and stage of disease, visual acuity (VA), therapeutic strategies and clinical outcome were analysed.\ud \ud RESULTS: Patients with EOD were younger and had more severe conjunctival inflammation (76% of inflamed eyes) than the EstD group, who had poorer VA (26.7%=VA<3/60, P<0.01) and more advanced disease. Although 40% of patients were on existing immunosuppression, 48% required initiation or switch to more potent immunotherapy. In all, 28% (14) were referred back to the originating hospitals for continued care. Although inflammation had resolved in 78% (60/77) at 12 months, persistence of inflammation and progression did not differ between the two phenotypes. Importantly, 42% demonstrated disease progression in the absence of clinically detectable inflammation.\ud \ud CONCLUSIONS: These data highlight that irrespective of OcMMP phenotype, initiation or escalation of potent immunosuppression is required at tertiary hospitals. Moreover, the conjunctival scarring progresses even when the eye remains clinically quiescent. Early referral to tertiary centres is recommended to optimise immunosuppression and limit long-term ocular damage.\ud \u