Role of prophylactic use of timolol maleate (0.5%) in preventing rise of intraocular pressure (iop) post Neodymium: Yttrium Aluminum Garnet (Nd: Yag) capsulotomy

Purpose: To evaluate the role of prophylactic use of Timolol maleate (0.5%) eye drop in preventing rise of intraocular pressure (IOP) post Nd: YAG capsulotomy.Materials and Methods: A randomized, single-blinded, parallel group study conducted in 220 eyes, over a period of 18 months. Precapsulotomy baseline IOP, Slitlamp examination and grading of PCO was done. After instilling the test medication Nd: YAG laser capsulotomy performed. Post capsulotomy patients were assessed immediately, after 1 hour and 3 hours for IOP.Result: Precapsulotomy, mean IOP in Group I (use of placebo) was 15.30 ± 2.83 mm Hg as compared to 16.15 ± 2.48 mmHg in Group II (use of Timolol eyedrop), Group II mean IOP was significantly higher (P = 0.019). However, immediately after the procedure mean IOP in Group I was 14.55 ± 2.87 mmHg as compared to 13.16 ± 3.72 mmHg in Group II thus showing mean IOP in Group II to be significantly lower (P = 0.002). One hour and 3 hours after the procedure too, mean IOP in Group II was significantly lower as compared to that in Group I (P < 0.001). With increasing grade of PCO reduction in post-procedure IOP was lower and reduction in IOP was maximum in patients requiring <30 milliJoules of total energy.Conclusion: A judicious control over energy use and post laser IOP monitoring can influence the trend of IOP rise in a positive manner. Whenever anticipated that >60 mJ of laser energy is required as in higher grades and younger age, prophylactically Timolol maleate 0.5% eye drop should be instilled before Nd: YAG capsulotomy while all other patients in which Timolol is not used, should be kept under observation after laser capsulotomy.Keywords: Capsulotomy, grade of posterior capsular opacification, intra ocular pressure, Nd: YAG laser, Timolol maleat

Unregulated Sale of Nimesulide in India

IntroductionNimesulide has been withdrawn from a number of countries. However it continues to be available over the counter in India.MethodsA survey of 1460 drug stores and 1531 families in India on their perceptions of the potential side effects of Nimesulide.Results A high proportion (78.96%) of the drug stores sold the drug without prescription from a licensed physician. More than one in four families (26.95%) preferred Nimesulide to other drugs. A relatively small proportion drug store owners and families (12.14% and 9.6% respectively) were aware of the potential adverse effects of this drug. DiscussionThere is an urgent need to tighten regulation of dangerous drugs freely available to Indian consumers. Further research to increase public awareness about drug side effects is required in order to reduce the potential for harm from under regulation

Radiation-induced spinal cord hemorrhage (hematomyelia)

Intraspinal hemorrhage is very rare and intramedullary hemorrhage, also called <em>hematomyelia</em>, is the rarest form of intraspinal hemorrhage, usually related to trauma. Spinal vascular malformations such intradural arteriovenous malformations are the most common cause of atraumatic hematomyelia. Other considerations include warfarin or heparin anticoagulation, bleeding disorders, spinal cord tumors. Radiation-induced hematomyelia of the cord is exceedingly rare with only one case in literature to date. We report the case of an 8 year old girl with Ewing’s sarcoma of the thoracic vertebra, under radiation therapy, presenting with hematomyelia. We describe the clinical course, the findings on imaging studies and the available information in the literature. Recognition of the clinical pattern of spinal cord injury should lead clinicians to perform imaging studies to evaluate for compressive etiologies

Sensitivity of 3D gradient recalled echo susceptibility-weighted imaging technique compared to computed tomography angiography for detection of middle cerebral artery thrombus in acute stroke

We aimed at comparing the sensitivity of magnetic resonance (MR) susceptibility-weighted imaging (SWI) with computed tomography angiography (CTA) in the detection of middle cerebral artery (MCA) thrombus in acute stroke. Seventy-nine patients with acute MCA stroke was selected using our search engine software; only the ones showing restricted diffusion in the MCA territory on diffusion-weighted images were included. We finally selected 35 patients who had done both MRI (including SWI) and CTA. Twenty random subjects with completely normal MRI (including SWI) exam were selected as control. Two neuroradiologists (blinded to the presence or absence of stroke) reviewed the SW images and then compared the findings with CT angiogram (in patients with stroke). The number of MCA segments showing thrombus in each patient was tabulated to estimate the thrombus burden. Thrombus was detected on SWI in one or more MCA segments in 30 out of 35 patients, on the first review. Of the 30, SWI showed thrombus in more than one MCA segments in 7 patients. CTA depicted branch occlusion in 31 cases. Thrombus was seen on both SWI and CTA in 28 patients. Thrombus was noted in two patients on SWI only, with no corresponding abnormality seen on CTA. Two patients with acute MCA showed no vascular occlusion or thrombus on either CTA or SWI. Only two case of false-positive thrombus was reported in normal control subjects. Susceptibility-weighted images had sensitivity and specificity of 86% and 90% respectively, with positive predictive value 94%. Sensitivity was 86% for SWI, compared with 89% for CTA, and this difference was statistically insignificant (P&gt;0.05). Of all the positive cases on CTA (31) corresponding thrombus was seen on SWI in 90% of subjects (28 of 31). Susceptibility-weighted imaging has high sensitivity for detection of thrombus in acute MCA stroke. Moreover, SWI is a powerful technique for estimation of thrombus burden, which can be challenging on CTA

Prioritising the eradication of invasive species from island archipelagos with high reinvasion risk

Eradicating invasive species from islands is a proven method for safeguarding threatened and endangered species from extinction. Island eradications can deliver lasting benefits, but require large up-front expenditure of limited conservation resources. The choice of islands must therefore be prioritised. Numerous tools have been developed to prioritise island eradications, but none fully account for the risk of those eradicated species later returning to the island: reinvasion. In this paper, we develop a prioritisation method for island eradications that accounts for the complexity of the reinvasion process. By merging spatially explicit metapopulation modelling with stochastic dynamic optimisation techniques, we construct a decision-support tool that optimises conservation outcomes in the presence of reinvasion risk. We applied this tool to two different case studies—rat (Rattus rattus) invasions in the Seaforth archipelago in New Zealand, and cane toad (Rhinella marina) invasions in the Dampier archipelago in Australia—to illustrate how state-dependent optimal policies can maximise expected conservation gains. In both case studies, incorporating reinvasion risk dramatically altered the optimal order of island eradications, and improved the potential conservation benefits. The increase in benefits was larger in Dampier than Seaforth (42% improvement versus 6%), as a consequence of both the characteristics of the invasive species, and the arrangement of the islands. Synthesis and applications. Our results illustrate the potential consequences of ignoring reinvasion risk. We recommend that reinvasion risk be explicitly included in any island eradication prioritisation involving an archipelago, particularly when some islands are close to the mainland.</p