An observational comparative study of intraocular pressure changes in post-operative cataract patients treated with dexamethasone and difluprednate

Background: Cataract is the leading cause of blindness worldwide. Treatment of cataract is surgical. Topical corticosteroids are routinely used in the treatment of post-operative inflammation following cataract surgery. This study aims to compare the intraocular pressure changes caused by topical steroids (dexamethasone and difluprednate) and to detect adverse effects.Methods: All patients operated by phacoemulsification in ophthalmology Department of SMIMER Surat were taken as subjects. Depending on topical steroids prescribed after surgery, subjects were separated into 2 groups, group 1 - difluprednate and group 2 - dexamethasone. Changes in intra-ocular pressure (IOP) of patients were collected from the data available pre-operative, 1st ,2nd ,3rd ,4th week after surgery and were analyzed. Other parameters whose data were collected are-adverse effects and compliance of patients.Results: In group 1 preoperative mean IOP was 15.5. At the end of 1st week, the mean IOP was significantly increased to 15.8. There was equal rise in IOP during 3rd week and 4th week which means that after 3rd week IOP remains stable. In group 2 preoperative mean IOP was 15.4. At the end of 1st, 2nd, 3rd and 4th there was significant increase in IOP as compared to preoperative mean IOP. Adverse effects were reported more in group 2.Conclusions: In group 1 there was a rise in IOP up to three weeks but after 3rd week IOP remained stable. In group 2 rise in IOP was seen throughout 4 weeks of treatment. Adverse effects seen more in group 2. Compliance of patients was better in group 1

Self medication among elderly poses challenges in urban settings

Background: Self-medication can be defined as obtaining and consuming one (or more) drug(s) without the advice of a physician. Using over the counter medicine is a common practice in developing countries including India. Studies have shown relatively high rates of self-medication among elderly and suggested awareness programmes among this group. Objectives of current study are to determine the prevalence of self-medication among geriatric population and to educate them about self-medication by an interactive session.Methods This was a cross sectional, questionnaire based study to evaluate the prevalence of self-medication in geriatric population in senior citizen club of Adajan and Ghoddod area of Surat city. Questionnaires were designed and modified from previous studies. Written informed consent was taken from those willing to participate in the study. After filling of pre-questionnaire, an interactive session was arranged and post-questionnaire were given to all participants. Data obtained were subjected to statistical analysis.Results: Number of participants in present study was 100. Self-medication was most common in age group of 65 to 75 years (48%) followed by less than 65 years (33%). 85% participants reported having taken non-prescription drugs. Drugs commonly used for self-medication were analgesics (85) and antacids (80). Side effects due to self-medication were reported by 22 participants. Main reasons for self-medication cited were to save expenses (65) and to save time (62). Post study awareness increased to 98%.Conclusions: Prevalence of self-medication is high in elderly. Interactive session can increase awareness regarding self-medication

An observational comparative study of intraocular pressure changes in post-operative cataract patients treated with dexamethasone, difluprednate and prednisolone in a tertiary care centre

Background: Cataract is opacity of lens which is treated surgically. Topical corticosteroids are routinely used in the treatment of post-operative inflammation following cataract surgery. This study aims to compare the intraocular pressure changes caused by various topical steroids (prednisolone, dexamethasone and difluprednate) in post cataract patients. To compare compliance and to detect any significant adverse effects.Methods: Patients admitted in ophthalmology department for cataract surgery operated by phacoemulsification were taken as subjects. Total number of patients enrolled in the study were 354. Subjects were separated into 3 groups depending on topical steroids which were prescribed after surgery: group 1 - difluprednate, group 2 -dexamethasone and group 3 - prednisolone. Changes in intraocular pressure (IOP) of patients were measured by ophthalmology department preoperatively and postoperatively after 1st, 2nd, 3rd, 4th week of surgery. These data were collected and analysed. Adverse effects, Compliance of patients and number of bottles of drug used after surgery were also noted.Results: On comparing IOP, there was significant variation (p<0.027) between 3 drugs after one week of drug administration. When group 1 was compared with group 2 or group 3 there was no significant difference Average cost of difluprednate is about 3 times higher than the cost of dexamethasone or prednisolone.Conclusions: All the three topical steroids cause a rise in intraocular pressure in post cataract patients. But in group 1 (difluprednate) there was a rise in IOP up to three weeks after surgery but after 3rd week IOP remained stable. Adverse effects were seen more in group 2 and group 3.

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Multi-messenger Observations of a Binary Neutron Star Merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ∼ 1.7 {{s}} with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of {40}-8+8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 {M}ȯ . An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ∼ 40 {{Mpc}}) less than 11 hours after the merger by the One-Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ∼10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ∼ 9 and ∼ 16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC 4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta.</p

Emerging therapeutic targets for cerebral edema

INTRODUCTION: Cerebral edema is a key contributor to death and disability in several forms of brain injury. Current treatment options are limited, reactive, and associated with significant morbidity. Targeted therapies are emerging based on a growing understanding of the molecular underpinnings of cerebral edema. AREAS COVERED: We review the pathophysiology and relationships between different cerebral edema subtypes to provide a foundation for emerging therapies. Mechanisms for promising molecular targets are discussed, with an emphasis on those advancing in clinical trials, including ion and water channels (AQP4, SUR1-TRPM4) and other proteins/lipids involved in edema signaling pathways (AVP, COX2, VEGF, and S1P). Research on novel treatment modalities for cerebral edema [including recombinant proteins and gene therapies] is presented and finally, insights on reducing secondary injury and improving clinical outcome are offered. EXPERT OPINION: Targeted molecular strategies to minimize or prevent cerebral edema are promising. Inhibition of SUR1-TRPM4 (glyburide/glibenclamide) and VEGF (bevacizumab) are currently closest to translation based on advances in clinical trials. However, the latter, tested in glioblastoma multiforme, has not demonstrated survival benefit. Research on recombinant proteins and gene therapies for cerebral edema is in its infancy, but early results are encouraging. These newer modalities may facilitate our understanding of the pathobiology underlying cerebral edema

Assessing Alignment of Patient and Clinician Perspectives on Community Health Resources for Chronic Disease Management

Addressing social determinants of health (SDoH) is associated with improved clinical outcomes for patients with chronic diseases in safety-net settings. This qualitative study supplemented by descriptive quantitative analysis investigates the degree of alignment between patient and clinicians’ perceptions of SDoH resources and referrals in clinics within the public healthcare delivery system in San Francisco. We conducted a qualitative analysis of in-depth interviews, patient-led neighborhood tours, and in-person clinic visit observations with 10 patients and 7 primary care clinicians. Using a convergent parallel mixed methodology, we also completed a descriptive quantitative analysis comparing the categories of neighborhood health resources mentioned by patients or community leaders to the resources integrated into the electronic health record. We found that patients held a wealth of knowledge about neighborhood resources relevant to SDoH that were highly localized and specific to their communities. In addition, multiple stakeholders were involved in conducting SDoH screenings and referrals, including clinicians, system navigators such as case workers, and community-based organizations. Yet, the information flow between these stakeholders and patients lacked systematization, and the prioritization of social needs by patients and clinicians was misaligned, as represented by qualitative themes as well as quantitative differences in resource category distribution analysis (p < 0.001). Our results shed light upon opportunities for strengthening social care delivery in safety-net healthcare settings by improving patient engagement, clinic workflow, EHR engagement, and resource dissemination

Cerebrospinal Fluid Biomarkers for Diagnosis and the Prognostication of Acute Ischemic Stroke: A Systematic Review

Despite the high incidence and burden of stroke, biological biomarkers are not used routinely in clinical practice to diagnose, determine progression, or prognosticate outcomes of acute ischemic stroke (AIS). Because of its direct interface with neural tissue, cerebrospinal fluid (CSF) is a potentially valuable source for biomarker development. This systematic review was conducted using three databases. All trials investigating clinical and preclinical models for CSF biomarkers for AIS diagnosis, prognostication, and severity grading were included, yielding 22 human trials and five animal studies for analysis. In total, 21 biomarkers and other multiomic proteomic markers were identified. S100B, inflammatory markers (including tumor necrosis factor-alpha and interleukin 6), and free fatty acids were the most frequently studied biomarkers. The review showed that CSF is an effective medium for biomarker acquisition for AIS. Although CSF is not routinely clinically obtained, a potential benefit of CSF studies is identifying valuable biomarkers from the pathophysiologic microenvironment that ultimately inform optimization of targeted low-abundance assays from peripheral biofluid samples (e.g., plasma). Several important catabolic and anabolic markers can serve as effective measures of diagnosis, etiology identification, prognostication, and severity grading. Trials with large cohorts studying the efficacy of biomarkers in altering clinical management are still needed