Demography, clinical features, etiology, management and outcomes in acute retinal necrosis: A prospective study

INTRODUCTION: A prospective study of demography, clinical features, etiology, management and outcomes in Acute retinal necrosis(ARN). AIM OF THE STUDY: To Describe the Demographic Profile, Clinical Features, Etiology, Treatment modalities, Visual Outcome and Complications in Acute Retinal Necrosis. OBJECTIVES: 1. Find rate of occurrence of retinal detachment 2. To study the treatment outcome and long term complication in Acute retinal necrosis patients treated with oral and combined antiviral therapy. 3. Incidence Fellow eye involvement following primary ARN in unilateral ARN at presentation. METHODS: Prospective, observational, hospital based case series study of ARN patients reported for 1year and a follow up period of six months. Demographic profile, immune status of the patients recruited was recorded. Relevant history, initial visual acuity, clinical feature documented. Patient was diagnosed to have ARN if had feature as suggested by standard diagnostic criteria proposed by American uveitis society. Few patients underwent vitreous tap for viral DNA analysis through PCR. Patients are treated with oral antiviral as sole antiviral or combined antiviral therapy with intravenous, intravitreal and orally along with corticosteroids and cycloplegics. Occurrence Complication like retinal detachment, secondary glaucoma and fellow eye involvement was documented. Management of complication was also documented. Final visual acuity at the end of six month follow up period was noted. RESULTS: This study enrolled total of 29 patients and 31 eyes. Out of the 29 patients 1 patient died during the follow up period and 1 patient lost follow up. Therefore for end point observations results are calculated with 27 patients and 29 eyes. Minimum age of presentation was 18 years and maximum was 65 years. Mean age was 42.1 years. Totally 5 patients out of 29 patient are immunocompromised. Previous history of viral infection was given by 6 patients (20.7%). The most common viral infection being chicken pox seen 3 patients (50%). Most common symptom found was defective vision (100%). The mean clock hours of retinal necrosis observed was 5.12 clock hours. Vitreous sample of 11 patients was analyzed for herpes family virus through polymerase chain reaction, Varizella zoster was detected in 2 patients (18.18%) and in 9 patients no organism could be detected. Out of total 31 eyes, 17 eyes(55%) treated with sole oral antiviral and 14 eyes (45%) treated with combined antiviral therapy, 34.4% (10 eyes) suffered retinal detachment. Mean time gap of occurrence of retinal detachment was found to be 4.2 weeks. Occurrence of retinal detachment in combined therapy 69.3% (9 eyes out of 16 eyes) and in oral antiviral therapy group was 6.25% ( 1 out of 16 eyes). There exist a statistical significance (P= 0.001) in occurrence of retinal detachment between oral therapy group and combined antiviral group. Re retinal detachment occurred in 28.6% eyes ( 2 eyes) on silicon oil removal. 10% progressed to secondary glaucoma. 2 patients out 29 had fellow eye involvement, with mean time gap of involvement being 2.5 weeks. The over all mean initial acuity in 31 eyes was 0.96LogMar±0.70 (1SD), mean final visual acuity in 29 eyes was 0.69LogMar±0.60 (1SD). On analysis if was found there exist a statistically significant (P=0.002) improvement in vision at the end of six months of treatment. The mean initial visual acuity in oral antiviral therapy group was 0.79LogMAR±0.57 (1SD) and mean final visual acuity was 0.46±0.26 LogMar. A statistically significant (P=0.006) improvement in visual acuity between initial and final vision in oral therapy. No statistical significant (P=0.183) improvement in visual acuity was noted between initial (mean= 1.16LogMar±0.81 (1SD)) and final visual acuity ( mean 0.99±0.76 LogMar) in combined antiviral therapy group. There exists a statistical significant difference (P=0.026) between final vision between oral antiviral and combined antiviral group with oral antiviral therapy group had better final visual acuity. CONCLUSION: Acute retinal necrosis is rare but potential blinding disease, polymerase chain reaction on ocular fluids helps to identify viral DNA and appropriate treatment can be instituted. Oral antiviral and intravitreal antiviral are increasingly used in treatment of ARN. Primary treatment with oral antiviral for indolent ARN is an effective alternate to combined therapy as the later is invasive and requires hospitalization. Prompt diagnosis and good therapeutic approach is a must for better visual recovery. Vision threatening complication like retinal detachment can be prevented with judicious monitoring of ARN patients and prompt treatment. Despite, advances in treatment and diagnostic modalities available like polymerase chain reaction (PCR) to identify virus with intraocular fluid, ARN continues to remain as an ophthalmological emergency with retinal lesion progressing rapidly after the disease onset. Precise understanding about this disease condition by ophthalmologist is at most important for prompt diagnosis and treatment

Numerical Study about Effect of Different Boundary Conditions on Compressive Modulus Coefficient of Bonded and Non-Bonded Cylindrical Isolators

604-609Elastomers (Rubber and rubber-like materials) are widely utilized in many engineering applications due to their specific properties like high elasticity with good static and dynamic behaviors. Rubber blocks are one of the elastomeric components and it is employed in many applications such as vibration isolators, bumpers, shock absorbers, and dampers, etc. Most of the rubber blocks are cylindrical in shape and it can undergo large deformation under different loadings and contact conditions (fixed-fixed, friction-friction and fixed-friction). In this present work, experimentally validated Ogden hyper-elastic material model is adopted in the finite element analysis (FEA). The FE model is validated with other published experimental work. In addition, the following six boundary conditions namely BC1 (Fixed – Fixed), BC2 (Fixed – Friction), BC3 (Friction – Friction), BC4 (Fixed – Cap), BC5 (Cap – Friction) and BC6 (Cap – Cap) boundary conditions are taken for comparative study. The aspect ratio (radius/height) of the rubber isolator also varied as 0.5, 0.75, and 1. From the numerical analysis carried out, it is found that the BC6 (Cap–Cap) with aspect ratio 1 showed better compressive modulus coefficient over other parameters taken for study

Numerical Study about Effect of Different Boundary Conditions on Compressive Modulus Coefficient of Bonded and Non-Bonded Cylindrical Isolators

Elastomers (Rubber and rubber-like materials) are widely utilized in many engineering applications due to their specific properties like high elasticity with good static and dynamic behaviors. Rubber blocks are one of the elastomeric components and it is employed in many applications such as vibration isolators, bumpers, shock absorbers, and dampers, etc. Most of the rubber blocks are cylindrical in shape and it can undergo large deformation under different loadings and contact conditions (fixed-fixed, friction-friction and fixed-friction). In this present work, experimentally validated Ogden hyper-elastic material model is adopted in the finite element analysis (FEA). The FE model is validated with other published experimental work. In addition, the following six boundary conditions namely BC1 (Fixed – Fixed), BC2 (Fixed – Friction), BC3 (Friction – Friction), BC4 (Fixed – Cap), BC5 (Cap – Friction) and BC6 (Cap – Cap) boundary conditions are taken for comparative study. The aspect ratio (radius/height) of the rubber isolator also varied as 0.5, 0.75, and 1. From the numerical analysis carried out, it is found that the BC6 (Cap–Cap) with aspect ratio 1 showed better compressive modulus coefficient over other parameters taken for study

A PROSPECTIVE STUDY FOR THE EVALUATION OF NERVE CONDUCTION ABNORMALITIES IN NEWLY DIAGNOSED TYPE 2 DIABETIC PATIENTS

Objectives: Peripheral neuropathy is the one of the frequently encountered complication of type 2 diabetes mellitus (T2DM). Although, the prevalence of diabetic peripheral neuropathy is associated with the diabetes duration, in some cases, the state of neuropathy is evident at the time of diagnosis. In this backdrop, the present study was carried out to evaluate the nerve conduction abnormalities in newly diagnosed T2DM. Methods: This was a prospective study carried out on 30 newly diagnosed T2DM within a time range of 1 month. The patient symptoms such as weakness, burning and tingling senzation, hyperesthesia, and foot ulcer and gait abnormalities were recorded. Nerve conduction analysis of upper limb and lower limb of non-dominant hand side was done using neuro pack S1 machine. Results: Thirty newly diagnosed T2DM patients were enrolled in the present study. The mean age of the patients was found to be 58.12±15.28 years. Distal motor latencies were elevated in T2DM patients as compared to the controls (p<0.05). Further, there was significant prolongation of F-wave latencies in the upper and Lower limbs of the patients as compared to the controls (p<0.05). In addition, there was a significant decrease in sensory conduction velocities in T2DM patients as that of the controls (p<0.05). Conclusion: The study concludes that newly diagnosed T2DM is susceptible to DPN with high incidence rates. Hence, it is essential to perform the nerve conduction studies in newly diagnosed T2DM patients for the early detection and better management and also to prevent the complications

Plasmodium Secretion Induces Hepatocyte Lysosome Exocytosis and Promotes Parasite Entry.

The invasion of a suitable host hepatocyte by Plasmodium sporozoites is an essential step in malaria infection. We demonstrate that in infected hepatocytes, lysosomes are redistributed away from the nucleus, and surface exposure of lysosome-associated membrane protein 1 (LAMP1) is increased. Lysosome exocytosis in infected cells occurs independently of sporozoite traversal. Instead, a sporozoite-secreted factor is sufficient for the process. Knockdown of SNARE proteins involved in lysosome-plasma membrane fusion reduces lysosome exocytosis and Plasmodium infection. In contrast, promoting fusion between the lysosome and plasma membrane dramatically increases infection. Our work demonstrates parallels between Plasmodium sporozoite entry of hepatocytes and infection by the excavate pathogen Trypanosoma cruzi and raises the question of whether convergent evolution has shaped host cell invasion by divergent pathogens

Mitral paravalvular abscess with left ventriculo-atrial fistula in a patient on dialysis

Background: Infective endocarditis in hemodialysis patients is challenging but is becoming more common recently. Case report: A 64-year-old man with end-stage renal disease on hemodialysis presented with infective endocarditis of mitral valve and coronary artery disease after commencing training for home hemodialysis. During a course of antibiotic treatment the patient developed left ventriculo-atrial fistula due to mitral paravalvular abscess. Abscess debridement followed by reconstruction of the mitral annulus with fresh autologous pericardial patch and mitral valve replacement using a mechanical prosthesis with concomitant coronary artery bypass grafting was performed successfully. Conclusion: Timely diagnosis, proper antibiotic treatment and early surgical intervention including aggressive debridement should improve the outcome of this high-risk disease. © 2009 Kitamura et al; licensee BioMed Central Ltd.Tadashi Kitamura, James Edwards, Suchi Khurana and Robert G Stukli

PREparedness, REsponse and SySTemic transformation (PRE-RE-SyST): a model for disability-inclusive pandemic responses and systemic disparities reduction derived from a scoping review and thematic analysis

Background: People with disabilities (PwD) have been facing multiple health, social, and economic disparities during the COVID-19 pandemic, stemming from structural disparities experienced for long time. This paper aims to present the PREparedness, RESponse and SySTemic transformation (PRE-RE-SyST): a model for a disability-inclusive pandemic responses and systematic disparities reduction. Methods: Scoping review with a thematic analysis was conducted on the literature published up to mid-September 2020, equating to the initial stages of the COVID-19 pandemic. Seven scientific databases and three preprint databases were searched to identify empirical or perspective papers addressing health and socio-economic disparities experienced by PwD as well as reporting actions to address them. Snowballing searches and experts’ consultation were also conducted. Two independent reviewers made eligibility decisions and performed data extractions on any action or recommended action to address disparities. A thematic analysis was then used for the model construction, informed by a systems-thinking approach (i.e., the Iceberg Model). Results: From 1027 unique references, 84 were included in the final analysis. The PRE-RE-SyST model articulates a four-level strategic action to: 1) Respond to prevent or reduce disability disparities during a pandemic crisis; 2) Prepare ahead for pandemic and other crises responses; 3) Design systems and policies for a structural disability-inclusiveness; and 4) Transform society’s cultural assumptions about disability. ‘Simple rules’ and literature-based examples on how these strategies can be deployed are provided. Conclusion: The PRE-RE-SyST model articulates main strategies, ‘simple rules’ and possible means whereby public health authorities, policy-makers, and other stakeholders can address disability disparities in pandemic crises, and beyond. Beyond immediate pandemic responses, disability-inclusiveness is needed to develop everyday equity-oriented policies and practices that can transform societies towards greater resiliency, as a whole, to pandemic and other health and social emergencies

Physical Rehabilitation Needs in the BRICS Nations from 1990 to 2017: Cross-National Analyses Using Data from the Global Burden of Disease Study

Background: This study analyzes the current and evolving physical rehabilitation needs of BRICS nations (Brazil, Russian Federation, India, China, South Africa), a coalition of large emergent economies increasingly important for global health. Methods: Secondary, cross-national analyses of data on Years Lived with Disability (YLDs) were extracted from the Global Burden of Disease Study 2017. Total physical rehabilitation needs, and those stratified per major condition groups are analyzed for the year 2017 (current needs), and for every year since 1990 (evolution over time). ANOVAs are used to detect significant yearly changes. Results: Total physical rehabilitation needs have increased significantly from 1990 to 2017 in each of the BRICS nations, in every metric analyzed (YLD Counts, YLDs per 100,000 people, and percentage of YLDs relevant to physical rehabilitation; all p < 0.01). Musculoskeletal & pain conditions were leading cause of physical rehabilitation needs across the BRICS nations but to varying degrees: from 36% in South Africa to 60% in Brazil. Country-specific trends include: 25% of South African needs were from HIV-related conditions (no other BRICS nation had more than 1%); India had both absolute and relative growths of pediatric rehabilitation needs (p < 0.01); China had an exponential growth in the per-capita needs from neurological and neoplastic conditions (p < 0.01; r2 = 0.97); Brazil had a both absolute and relative growth of needs coming from musculoskeletal & pain conditions (p < 0.01); and the Russian Federation had the highest neurological rehabilitation needs per capita in 2017 (over than three times those of India, South Africa or Brazil). Conclusions: total physical rehabilitation needs have been increasing in each of the BRICS nations, both in absolute and relative values. Apart from the common growing trend, each of the BRICS nations had own patterns for the amount, typology, and evolution of their physical rehabilitation needs, which must be taken into account while planning for health and physical rehabilitation programs, policies and resources