Comparison of the refractive outcome following corneal section phacoemulsification Versus blumenthal technique of manual small incision cataract surgery at 6 weeks

INTRODUCTION: Cataract is one of the leading causes of blindness in India and cataract surgery is the most common and most successful surgery performed by all ophthalmologists which enables millions of people to restore or improve their vision (1)(2). Although cataract surgery has being performed since ancient times, the last half century has seen remarkable refinements of the procedure in order to achieve good and early visual rehabilitation. The procedure of cataract extraction has witnessed enormous evolution over time. Intracapsular cataract extraction was a commonly performed surgery in olden times. Surgical aphakia was corrected with spectacles. But with the advent of intraocular lenses in 1940s extracapsular cataract extraction with rigid intraocular lens implantation became the surgical technique of choice. In late 1960 Charles Kelman came up with the idea of using ultrasonic sound waves to emulsify the lens material and then removing it through a very small incision, a technique referred to as phacoemulsification(3). Today “phacoemulsification” with foldable intraocular lens implantation is state of the art technique of cataract extraction. AIM AND OBJECTIVES: Aim: To compare the refractive outcome following corneal section (CS) Phacoemulsification versus Blumenthal technique of manual small incision cataract surgery (MSICS) at 6 weeks. Objectives: To compare unaided visual acuity following CS-Phacoemulsification versus Blumenthal technique of manual small incision cataract surgery. To compare surgically induced astigmatism (SIA) following CS-Phacoemulsification versus Blumenthal technique of manual small incision cataract surgery. To compare endothelial cell loss after cataract surgery – CS Phacoemulsification versus MSICS (Blumenthal technique). To compare the effect of surgical technique on the central corneal thickness – CS Phacoemulsification vs. MSICS (Blumenthal technique). To assess patient satisfaction in terms of improvement in visual function after cataract surgery – CS Phacoemulsification versus MSICS (Blumenthal technique) MATERIAL AND METHODS: Study design This is a cross sectional observational study conducted in the department of ophthalmology (Schell eye hospital), Christian Medical College, Vellore from March 2012 - December 2012. CONCLUSIONS: 1. 98.3% of patients achieved a BCVA better than 6/18 which is well within the guidelines laid down by WHO. 2. On analyzing the phacoemulsification and the MSICS group separately, BCVA of better than 6/18 was achieved in 100% of the eyes in phacoemulsification group and 96.2% in the MSICS group. However the difference was not statistically significant. 3. Corneal section phacoemulsification was associated with less SIA as compared to MSICS. The difference was statistically significant with a ‘p’ value of 0.003. The mean SIA after phacoemulsification was 1.01 ± 0.49D and after MSICS was 1.29 ± 0.71D. LIMITATIONS OF THE STUDY: 1. The major limitation of our study was the small sample size and a short follow up of six weeks. 2. This was not a randomized controlled trial. Our study is a cohort study where a group of patients were followed up to six weeks. True randomization may not be possible because the choice of surgery and intraocular lens is largely governed by the socioeconomic status of the patient. Thus bias could not be completely avoided. 3. All eyes in the phacoemulsification group had a foldable IOL implanted where as eyes that underwent MSICS had rigid IOL implantation. This difference in the types of IOL used might have influenced postoperative visual function to some extent. 4. In our study no attempt was made to correct the pre-existing cylinder intra-operatively. But in real life practice every surgeon would try to decrease the post operative astigmatism by intraoperative wound modulation

Transvaginal sonography versus saline contrast sonohysterography in evaluation of abnormal uterine bleeding

Background: To evaluate TVS and SCSH as a screening method in case of AUB and to correlate he findings of TVS and SCSH with hysterectomy specimen.Methods: Present study was conducted in department of obstetrics and gynaecology, Kamla Nehru Hospital for mother and child, IGMC, Shimla for a period of one year. A total of 150 patients with AUB were subjected to TVS and SCSH in same sitting irrespective of their phase of menstrual cycle. All the cases were subjected to hysterectomy within 2 weeks and operative findings were noted. Data was collected and findings analysed.Results: Overall sensitivity of SCSH was found to be 97.6% while that of TVS was 95.1%. The overall specificity of SCSH was found to be 99.6% and that of TVS was 98.2%. PPV, NPV and DA for SCSH was more than that of TVS i.e., 98.9% vs 97.4%, 99.7% vs 99.3% and 99.4% vs 98.7%.Conclusions: SCSH represents a new and promising technique for investigation of the uterine cavity. It is safe, minimally invasive, easy, cost effective and reliable method to diagnose the cause of AUB

Comparative analysis of potency of Azole derivatives to target ASL and GPI proteins responsible for pathogenesis of Candida albicans using in silico approach

Candida albicans, a dimorphic fungus which is commensal organism of human gut flora, but due to overgrowth or immune-compromised conditions become pathogenic causing vulvovaginal candidiasis infection which is most common in females. The present study was conducted to determine an effective treatment strategy by making a comparative analysis of potency of azole derivatives such as itraconazole, fluconazole and ketoconazole to target ASL and GPI proteins responsible for pathogenesis of C. albicans using in silico approach. By comparing Gibbs free energy, it becomes clear that itraconazole possess more potency in comparison to fluconazole and ketoconazole to target ALS and GPI macromolecule. The present study clearly indicated that itraconazole can overcome complications of pathogenesis induced by C. albicans inside the host thereby acting as a major drug of interest in comparison to other azole derivatives to treat vulvovaginal candidiasis.  In conclusion, itraconazole exhibits better potential than fluconazole and ketoconazole to target GPI and ALS. This clearly reveals the potency of itracaonazole to target C. albicans, but more research is needed to be carried out to determine the mechanistic approach involved in exhibiting this effect

Role of micronized progesterone in prevention of preterm labour in women with previous history of one or more preterm births: a research study at a tertiary care hospital

Background: According to the WHO, 3 million newborns die each year due to complications related to pregnancy and childbirth and 99% of these deaths occur in the developing countries. Preterm birth is a leading cause of neonatal and infant mortality as well as short and long term disability. The mechanism responsible for preterm labour are not exactly known, may be multifactorial and preventable with timely and appropriate treatment.Methods: This was a prospective double blinded randomized placebo controlled study conducted in the department of Obstetrics and Gynaecology, Kamla Nehru State hospital for mother and child, Shimla. Total 80 patients with asymptomatic high risk singleton pregnancy between 24-28 weeks were included in the study. They were randomly allotted to receive either the progesterone tablet 100 mg intravaginally (Study group) or an identical looking placebo (Control group).Thus both the groups included 40 subjects each. The treatment was continued till 34 weeks of gestation or till PROM/ delivery, whichever was earlier. Method of termination, gestational age at time of delivery, mode and type of delivery, birth weight, apgar score, maternal and perinatal outcome were noted and compared in both groups. All the parameters were statistically analysed by mean + S.D, proportion, frequency, chi-square test. Percentage reduction in the quantitative variables was calculated using the formula of (n-t)/n x100.Results: The incidence of preterm deliveries in the present study was found to be 9.88%. Both the groups were comparable in respect of age, parity, BMI, socioeconomic status, occupation and gestational age at first antenatal visit. There was similarity in both groups in respect to number of previous preterm deliveries and cervical length. The incidence of preterm delivery in the study group was 12.5% and in the control group was 35%.Conclusions: The study concluded that progesterone use was associated with 64.2% reduction in the incidence of preterm delivery (p=0.029).Antenatal administration of progesterone reduces the risk of preterm birth before 37 weeks and 34 weeks as well as the risk of a newborn being born with a birth weight of less than 2500 gms

SFTA2 - a novel secretory peptide highly expressed in the lung - is modulated by lipopolysaccharide but not hyperoxia

Tissue-specific transcripts are likely to be of importance for the corresponding organ. While attempting to define the specific transcriptome of the human lung, we identified the transcript of a yet uncharacterized protein, SFTA2. In silico analyses, biochemical methods, fluorescence imaging and animal challenge experiments were employed to characterize SFTA2. Human SFTA2 is located on Chr. 6p21.33, a disease-susceptibility locus for diffuse panbronchiolitis. RT-PCR verified the abundance of SFTA2-specific transcripts in human and mouse lung. SFTA2 is synthesized as a hydrophilic precursor releasing a 59 amino acid mature peptide after cleavage of an N-terminal secretory signal. SFTA2 has no recognizable homology to other proteins while orthologues are present in all mammals. SFTA2 is a glycosylated protein and specifically expressed in nonciliated bronchiolar epithelium and type II pneumocytes. In accordance with other hydrophilic surfactant proteins, SFTA2 did not colocalize with lamellar bodies but colocalized with golgin97 and clathrin-labelled vesicles, suggesting a classical secretory pathway for its expression and secretion. In the mouse lung, Sfta2 was significantly downregulated after induction of an inflammatory reaction by intratracheal lipopolysaccharides paralleling surfactant proteins B and C but not D. Hyperoxia, however, did not alter SFTA2 mRNA levels. We have characterized SFTA2 and present it as a novel unique secretory peptide highly expressed in the lung

Detection of Landmine Signature using SAW-based Polymer-coated Chemical Sensor

The explosive charge within a landmine is the source for a mixture of chemical vapours that form a distinctive chemical signature indicative of a landmine. The concentrations of these compounds in the air over landmines is extremely low (parts-per-trillion or lower), well below the minimum detection limits of most field-portable chemical sensors. This paper describes a portable  surface acoustic wave-based polymer-coated sensor for the detection of hidden explosives. The sensitivity and selectivity of polymer-based sensors depend on several factors including the chemo-selective coating used, the physical properties of the vapour(s) of interest, the selected transducers, and the operating conditions. The polymer-based sensor was calibrated in the  laboratory using the explosive vapour generator. The preliminary results indicated that the carbowax 1000 could be a very good chemical interface to sense low levels of chemical signature of explosive material. Response for 50 ppb of TNT vapours was observed to be 400 Hz for an exposure of 2 min

Chlamydia pneumoniae heat shock protein 60 is associated with apoptotic signaling pathway in human atheromatous plaques of coronary artery disease patients

SummaryBackgroundChlamydia pneumoniae heat shock protein (HSP) 60 is known to contribute to the activation of inflammation. In addition, there are contradictory reports on C. pneumoniae and their role in activation of pathways (apoptotic/antiapoptotic/necrosis) in coronary artery disease (CAD). Hence, more studies are required to know the actual role of C. pneumoniae in activation of apoptotic/antiapoptotic/necrosis pathways.Methods and resultsIn this study, two sets of patient groups (cHSP60 positive and cHSP60 negative) were included and gene expression was studied by cDNA micro array and real time polymerase chain reaction arrays. Expression of Caspase-3, 8, 9, c-FLIP, PPAR-γ, PGC-1α, and Gsk-3b were also evaluated at protein level by immunoblotting. In cHSP60 positive CAD patients significantly higher (p<0.001) mRNA expression was found for CCL4, CXCL4, CXCL9, IL-8, CD40LG, CD8, TGFβ1, TGFβ2, APOE, EGR1, CTGF, APOB, LDLR, LPA, and LPL, whereas significantly lower (p<0.001) mRNA expression was detected for CD4, IL1F10, IFNA2, and IL-10 as compared to cHSP60 negative CAD patients. Additionally, at protein level expression of Caspase-3 (p=0.027), 8 (p=0.028), and 9 (p=0.037) were higher and c-FLIP (p=0.028) and PPAR-γ (p=0.95) expression were comparable in cHSP60 positive CAD patients compared to cHSP60 negative CAD patients.ConclusionGenes/proteins of pre-apoptotic caspase dependent/independent pathways, chemokines, and inflammatory cytokines receptors were significantly up-regulated in human atheromatous plaques of cHSP60 positive CAD patients suggesting an association of cHSP60 with CAD

The malin-laforin complex suppresses the cellular toxicity of misfolded proteins by promoting their degradation through the ubiquitin-proteasome system

Lafora disease (LD), a progressive form of inherited epilepsy, is associated with widespread neurodegeneration and the formation of polyglucosan bodies in the neurons. Laforin, a protein phosphatase, and malin, an E3 ubiquitin ligase, are two of the proteins that are defective in LD. We have shown recently that laforin and malin (referred together as LD proteins) are recruited to aggresome upon proteasomal blockade, possibly to clear misfolded proteins through the ubiquitin–proteasome system (UPS). Here we test this possibility using a variety of cytotoxic misfolded proteins, including the expanded polyglutamine protein, as potential substrates. Laforin and malin, together with Hsp70 as a functional complex, suppress the cellular toxicity of misfolded proteins, and all the three members of this complex are required for this function. Laforin and malin interact with misfolded proteins and promote their degradation through the UPS. LD proteins are recruited to the polyglutamine aggregates and reduce the frequency of aggregate-positive cells. Taken together, our results suggest that the malin–laforin complex is a novel player in the neuronal response to misfolded proteins and could be potential therapeutic targets for neurodegenerative disorders associated with cytotoxic proteins

Acquired heart block: A possible complication of patent ductus arteriosus in a preterm infant

A large patent ductus arteriosus (PDA) is a frequently encountered clinical problem in extremely low birth weight (ELBW) infants. It leads to an increased pulmonary blood flow and in a decreased or reversed diastolic flow in the systemic circulation, resulting in complications. Here we report a possible complication of PDA not previously published. On day 8 of life, a male ELBW infant (birth weight 650 g) born at a gestational age of 23 weeks and 3 days developed an atrioventricular block (AV block). The heart rate dropped from 168/min to 90/min, and the ECG showed a Wenckebach second-degree AV block and intraventricular conduction disturbances. Echocardiography demonstrated a PDA with a large left-to-right shunt and large left atrium and left ventricle with high contractility. Within several minutes after surgical closure of the PDA, the heart rate increased, and after 30 min the AV block had improved to a 1: 1 conduction ratio. Echocardiography after 2 h revealed a significant decrease of the left ventricular and atrial dimensions. Within 12 h, the AV block completely reversed together with the intraventricular conduction disturbances. We suggest that PDA with a large left-to-right shunt and left ventricular volume overload may lead to an AV block in an ELBW infant. Surgical closure of the PDA may be indicated. Copyright (C) 2007 S. Karger AG, Basel