Brucellosis in pregnant women

Brucella species occasionally cause spontaneous human abortion, but theories regarding whether they do so more frequently than do other infectious pathogens remain controversial. We reviewed 92 pregnant women who presented with acute brucellosis at a Saudi Arabian hospital. From 1983 through 1995, the cumulative incidence of pregnancy and brucellosis was 1.3 cases per 1000 delivered obstetrical discharges. The incidence of spontaneous abortion in the first and second trimesters was 43%, and the incidence of intrauterine fetal death in the third trimester was 2%. Antepartum antimicrobial therapy with cotrimoxazole or cotrimoxazole/rifampin was protective against spontaneous abortion (relative risk, 0.14; 95% confidence interval, 0.06--0.37; P<.0001). The beneficial effect of treatment occurred in women with febrile illness; vaginal bleeding at presentation usually led to spontaneous abortion. This study demonstrated that the incidence of spontaneous abortion among pregnant women with brucellosis is high and that these women should receive prompt therapy with antimicrobial agents when they present for medical care.

Diagnostic value of Brucella ELISA IgG and IgM in bacteremic and non-bacteremic patients with brucellosis

The diagnostic value of Brucella ELISA IgG and IgM has been evaluated in patients with brucellosis. Serum samples and blood cultures were collected from 83 patients with brucellosis. The sera were tested by Brucella ELISA for Brucella IgM and IgG antibodies. All 44 controls were negative for IgG and IgM. Brucella melitensis was isolated from blood cultures of 30/83 (36.1%) patients. Among the 30 bacteremic patients, 24 (80%) had an increased IgM titer of > or = 200. Of the 53 non-bacteremic patients, 41 had IgM titer > or = 200, while 22 had IgG titer of > or = 1,600. The ELISA IgM and IgG tests achieved a specificity and sensitivity of 100% and 96% respectively, while the positive and negative predictive values were 100% and 94% respectively. The Brucella ELISA is a reliable and sensitive test in the diagnosis of brucellosis. The test is rapid, easy to perform and can be automated.

Telomere attrition of the human abdominal aorta: relationships with age and atherosclerosis

Little is known about the turnover rate (i.e. the rate of replication and death) of cells in the intima and media of human arteries as a function of age and atherosclerosis. One indicator of the replicative history of cells is telomere length. In this work we explored the rate of telomere attrition as a function of age and atherosclerosis in cells of the human abdominal aorta. Telomere length, measured by the terminal restriction fragment using Southern analysis, was determined in the intima and media of the distal (infrarenal) versus proximal (suprarenal) segments of the abdominal aorta. Telomere length was then correlated with age and atherosclerotic grade. The rate of age-dependent telomere attrition was higher in both the intima and media of the distal versus proximal abdominal aorta. In addition, telomere length was negatively correlated with atherosclerotic grade. However, after adjustment for age, this relationship was not statistically significant. The high rate of age-dependent telomere attrition in the distal abdominal aorta probably reflects enhanced cellular turnover rate due to local factors such as an increase in shear wall stress in this vascular segment.

Audit of a diabetic health education program at a large Primary Health Care Center in Asir region

OBJECTIVE

To evaluate the health education program in a large Primary Health Care Center, to find out the problems faced by the staff and to suggest the practical and relevant solutions.

METHODS

This study was carried out at Wasat Abha Primary Health Care Center, Asir region during 1997. The files of diabetics who attended the center were evaluated for health education topics by using a checklist. The essential structure of diabetic health education program was assessed by using another check list designed by the investigators. Data entry and analysis was carried out through SPSS package. Chi-square test was applied wherever necessary.

RESULTS

The total number of diabetics who attended Wasat Abha Primary Health Care Center was 198. The duration of diabetes mellitus was 7.7+5.8 years. Ninety percent of these were married, 50.5% were educated and 79% were employed. Compliance to appointment was good in 60% and poor in 30% of diabetics. About 73% of the diabetics received at least one health education topic while 27% did not receive any health education at all. Only 33% of diabetic patients had adequate health education. Ninety one percent were provided with diabetic identification cards, 80% were explained about diabetes and 77% were educated about the role of diet. Essential structure for diabetes education program was found to be unsatisfactory.

CONCLUSION

Effective diabetic health education program needs the availability of all essential structures, community participation and integration of the government and private sectors. The deficiencies in the structures and the process of health education programs in our practice are almost universal to other Primary Health Care Centers in the Asir region. Providing the Primary Health Care Centers with all essential structures and annual auditing are complimentary to a successful diabetic health education program.

Clinico-diagnostic experience with tuberculous lymphadenitis in Saudi Arabia

OBJECTIVES

To describe the diagnosis and outcomes of tuberculous lymphadenitis in a low HIV-seroprevalence population at a hospital in Riyadh, Saudi Arabia.

METHODS

Retrospective case series of tuberculous lymphadenitis from 1983 to 1998 were examined.

RESULTS

There were 99 cases with a median age of 38 years and a female preponderance (female/male ratio of 1.3 : 1). Eighty per cent had cervical involvement and 36% had systemic symptoms. Eighty-nine per cent had their lymphadenopathy for more than 1 month. The diagnostic yield of tuberculin skin testing was 83%, of chest X-ray was 27%, of fine-needle aspiration was 46%, and of excisional lymph node biopsy was 97%. Only one-third of patients received a tuberculin test. There was no significant difference in outcome between 6 and 9 months of chemotherapy, and paradoxical enlargement of nodes occurred in only 6%.

CONCLUSIONS

Tuberculous lymphadenitis in our study population was predominantly cervical in location. The diagnostic yield of FNA was lower than that reported in the literature, and might be improved by more frequent tuberculin skin testing, multiple aspirations of lymph nodes, or use of excisional biopsy as the initial diagnostic procedure. Most patients responded well to chemotherapy, with few complications.

Measles antibody titre in children up to 5 years of age in rural areas of Aligarh District, India

OBJECTIVE

To determine the pattern of decline of maternal antibodies in 0-9 month old infants and to study the prevalence of measle antibodies and their levels in 9 month to 5 year old children, regardless of their immunization status.

METHODS

A cross-sectional study covering 456 children in the 0-5 year age group residing in 9 registered villages in a rural area of Aligarh District was conducted. The study included the interview of parents, clinical examination of children, and Hemagglutination Inhibition Test for Measles Antibody Titre.

RESULTS

There was rapid decline in seropositivity from 100% in the 0-3 month age group to 18% in the 6-9 month age group. There was a positive correlation (r = 0.77) between decline of seropositivity and age. Measle immunization coverage rate was 64.5%. In 202 children where immunization was confirmed by availability of card, sero-conversion was 96.5%. Of the 118 unvaccinated children, 9% were sero-positive. Of the 71 children who had a history of measles infection, 75% were seropositive indicating correct identification of measle infection by the parents.

The changing spectrum of Group B streptococcal (GBS) infection in infants of Saudi Arabia

This study describes the incidence, clinical presentation and outcome of neonatal Group B streptococcal (GBS) infection in a Saudi Arabian Hospital. Charts of all neonates with GBS infection admitted to our hospital during a 5-year period (1990-1994) were reviewed retrospectively. Of the 29,601 live births, 23 neonates had GBS infection, giving an overall incidence rate of 0.8 per 1000 live births. The incidence rate appeared to increase from 0.2 per 1000 live births in 1990 to 1.2 per 1000 live births in 1994 (not statistically significant (P=0.07)). Of the 23 neonates with GBS infection, 16 (70%) were full term infants (gestation > or = 37 weeks). In contrast, 7 (30%) were preterm infants (gestation < 37 weeks). Ten (44%) mothers had premature rupture of membrane. Intrapartum fever and/or urinary tract infection was observed in 9% of the mothers. Nineteen (82%) of the neonates had early onset GBS infection, whereas only 4 infants (18%) had late-onset infection. Blood and CSF cultures were positive in 21 (91%) and 5 (21%), respectively. Complications of GBS infection were as follows: sepsis without focus of infection 15 (65%); meningitis 5 (22%); pneumonia 3 (13%); urinary tract infection 2 (9%). None of these complications had any significant association with the onset of infection (P>0.1). The overall case-fatality rate was 9%. The incidence of GBS infection appears to be increasing in Saudi neonates and measures to prevent perinatal transmission need to emphasized and implemented.

Brucella bacteraemia: clinical and laboratory observations in 160 patients

OBJECTIVES

To describe the clinical, serological, and prognostic features of bacteraemic brucellosis in an endemic region.

METHODS

Retrospective case series of 160 patients admitted from 1983 to 1995 to a hospital providing secondary and tertiary level medical care in Saudi Arabia. All patients had positive blood cultures for Brucella species, predominantly Brucella melitensis.

RESULTS

Bacteraemia was documented in 38% of 545 cases of brucellosis admitted to our institution during the study period. The main clinical syndromes were febrile illness alone (44%) or fever with arthritis (42%). Of 68 isolates that were speciated, 93% were Brucella melitensis. Initial agglutinating antibody titre was > or =1:320 in 96% of the patients. Antimicrobial resistance of B.melitensis isolates was: co-trimoxazole, 29%; rifampicin, 3.5%; streptomycin, 0.6%; and tetracycline, 0.6%. No increase in resistance was noted over the 13-year study period. Commonly used antimicrobial regimens consisted of streptomycin plus tetracycline or rifampicin plus doxycycline given for 6 weeks. Seven patients (5%) had relapse of their symptoms after antimicrobial therapy. Three of these had infective endocarditis with repeated bacteraemia. These patients required aortic valve replacement and recovered after surgery. The remaining four patients responded to a second course of therapy.

CONCLUSIONS

Brucella bacteraemia is an acute febrile disease often associated with rheumatologic complaints. Most patients have an agglutinating antibody titre > or =1:320 and respond well to standard chemotherapy regimens with low mortality.

The need for traditional birth attendants (dayas) in Saudi Arabia

Preferences of women living in remote areas regarding delivery place and attendant were surveyed, opinions of primary health care (PHC) doctors about traditional birth attendants' (TBA) maternal care were assessed and training needs for TBAs were identified using questionnaires and a focus group discussion. Home deliveries and TBAs were preferred by approximately 24% and 38% of the women respectively. The fact that they were women and psychological comfort were the main reasons for preferring TBAs. TBAs disclosed many harmful practices. No PHC centre help was sought by 75% of TBAs. Lack of cooperation between PHC centres and TBAs was a concern of most of the doctors. Training and links to PHC services for TBAs are needed.

Effect of extracapsular cataract extraction and phacoemulsification performed after trabeculectomy on intraocular pressure

PURPOSE

To determine whether there is a difference in intraocular pressure (IOP) control between extracapsular cataract extraction (ECCE) and phacoemulsification performed after successful trabeculectomy.

SETTING

Eye Unit, St. Woolos Hospital, Newport, United Kingdom.

METHODS

This retrospective study comprised 55 patients with glaucoma who had had trabeculectomy and subsequently had cataract surgery. Extracapsular cataract extraction was performed in 34 eyes and phacoemulsification in 21. The IOP before cataract surgery was used as a baseline for comparison with the IOP at 6 and 12 months and at the last follow-up visit (mean 44.26 months in the ECCE group and 15.09 months in the phacoemulsification group). At the 3 postoperative examinations, the IOP was recorded before and after institution of medical treatment.

RESULTS

In the ECCE group, the IOP exceeded the target pressure in 7 eyes and required medical treatment; it remained uncontrolled in 1 eye at the final visit. In the phacoemulsification group, the IOP was less than 18 mm Hg without any medication and within the target pressure in all 21 eyes. The IOP increase after ECCE was statistically significant (mean IOP was 13.61 mm Hg before and 15.53 mm Hg after ECCE; P = .0297). After treatment was instituted, there was no statistically significant difference in the IOP compared with the preoperative value (P = .0796 at 6 months, .677 at 1 year, and .4419 at the final visit in the ECCE group and .0703, .2220, and .1035, respectively, in the phacoemulsification group).

CONCLUSION

The findings indicated that IOP was better controlled by phacoemulsification than by ECCE in patients who had had filtration surgery.

Compliance and control of diabetes in a family practice setting, Saudi Arabia

This study aimed to identify some determinants of compliance with diet, anti-diabetic drugs and the appointment system amongst diabetic patients (n = 294) attending a family practice setting. The results showed that good compliance with diet was significantly higher among males (P = 0.01) and those with good diabetic control (P = 0.01), while good compliance with appointment systems was significantly associated with type II diabetes (P < 0.01) and good care (P < 0.01). Compliance with drugs showed no significant association with any of the studied determinants (P > 0.05). When multiple regression analysis was applied, the degree of control of diabetes, its duration and the total score of care were the only predictors of the three aspects of compliance (P < 0.05).

Efficiency of utilisation of energy from maize- and broken rice-based diets in old White Leghorn and Rhode Island Red laying hens

1. The efficiency of utilisation of metabolisable energy (ME) for maintenance (k(m)) from diets containing maize and broken rice (BR) at 500 g/kg was studied in old White Leghorn (WL) and Rhode Island Red (RIR) laying hens using the respiration calorimetry technique. The maize-based diet contained 180.8 g crude protein (CP)/kg and 16.4 MJ gross energy (GE)/kg while the BR-based diet contained 173.2 g CP/kg and 16.3 MJ GE/kg. Diets were fed for 10 d, while an energy and nitrogen metabolism study was conducted during 3 d on an ad libitum-fed diet followed by another 3 d on two-thirds of the ad libitum-fed quantity. 2. ME values for the maize- and BR-based diets for WL hens were 73.3% and 77.6% of the GE, whereas for the RIR hens these were 77.7% and 80.0%, respectively. 3. Fasting heat productions, determined at the end of 24 h fast for WL and RIR hens were 473.2 and 366.1 kJ/kg W0.75/d, respectively. During fasting WL and RIR hens utilised body energy reserves with efficiencies of 84.9% and 73.7%, respectively. 4. The k(m) of maize- and BR-based diets for the WL hens were 81.6% and 79.6%, whereas for the RIR hens these were 74.2% and 76.0%, respectively. 5. ME for maintenance of WL and RIR hens were 589 and 499.6 kJ/kg W0.75/d, respectively. 6. It is concluded that although WL and RIR hens differ significantly in energy metabolism, their efficiency of utilisation of energy from maize- and BR-based diets are similar.

Kaposi's sarcoma in a liver transplant series

At our center one hundred eighteen patients have received liver transplants between July 1, 1991 and December 10, 1997. We describe the only one of them to our knowledge who developed Kaposi's sarcoma. It was disseminated, involving the gastrointestinal tract, lungs, multiple lymph nodes and peripancreatic soft tissues. She had no cutaneous Kaposi's sarcoma. Her massive gut involvement was not apparent clinically, even by colonoscopic examination with multiple biopsy specimens. She was diagnosed at postmortem examination.

Evolution of brain tuberculomas under standard antituberculous treatment

The treatment of brain tuberculomas is primarily medical. Surgery, excision or biopsy, is generally performed when the diagnosis is in doubt or there is no response to medical therapy. The aim of this study was to determine the radiological evolution of intracranial tuberculomas under standard anti-tuberculous drug therapy and to establish guidelines for better management of these patients. Eighteen patients were studied retrospectively. None of them had surgical intervention and all were treated by standard antituberculous drugs and had serial computed tomography (CT) scans until disappearance or stabilization of brain lesions. The regression of lesions' size and number was slow in the first month (mean -7.3%) then became rapid after this (-15% to -20% per month). A paradoxical increase in size was noted in three patients in the first month. All three had associated meningitis. All tuberculomas disappeared on CT scan after 12 months of therapy. Most of the edema images disappeared by 6 months. This study would suggest that a long treatment regimen of 15-18 months may not be necessary in most intracranial tuberculomas occurring in non-immunocompromised patients. It also demonstrates that medical trial in well tolerated suspected cases should last for at least 2 months before considering other etiologies or surgical exploration.

On the tissue/species dependence of cathepsin B isozymes

Characterization of cathepsin B from buffalo kidney and goat spleen showed the presence of isozymes in case of the goat spleen (GSCB-I and GSCB-II) whereas cathepsin B from buffalo kidney exhibited only one form (BKCB). The molecular weights determined by SDS-PAGE for GSCB-I, GSCB-II, and BKCB were 25.7, 26.6 and 25.5 kDa respectively. The kinetic parameters (Km and Vmax) of GSCB-I showed close similarities with BKCB against alpha-N-benzoyl-DL-arginine-2-napthylamide whereas GSCB-II was closer to the buffalo enzyme with regards to its activity against Z-Arg-Arg-MCA and Z-Phe-Arg-MCA. All the three enzymes had similar sensitivities towards urea, antipain and leupeptin. However, clear differences were observed in the inhibition patterns of the enzyme with iodoacetic acid and iodoacetamide. Differences in the kinetic, immunogenic and some catalytic properties of GSCB-I and II, which had similarities with regard to most of their physico-chemical properties, were considered to be due to the existence of two isozyme forms in goat spleen cathepsin B preparations. Absence of such a multiplicity in forms of the enzyme from buffalo kidney was accordingly attributed to the absence of cathepsin B isozymes in this species. These observations taken together therefore, indicate a probable species/tissue dependence of cathepsin B.

Sublingual lorazepam as premedication in peribulbar anesthesia

PURPOSE

To assess the efficacy of sublingual lorazepam in inducing amnesia when used as a premedication for peribulbar anesthesia.

SETTING

Department of Ophthalmology in a large district general hospital.

METHODS

Following local ethical committee approval, a prospective, randomized, placebo-controlled, double-blind study of patients having routine cataract or glaucoma surgery under local anesthetic was undertaken. Patients older than 90 years of age or who were frail, confused, or unfit for surgery were excluded, as were those who weighed less than 50 kg, swallowed the tablet, or had missing data. Sixty volunteer patients were randomly given 1 mg of lorazepam or a placebo tablet by sublingual route 1 hour preoperatively. All patients were assessed for sedation, akinesia, intraoperative analgesia, and patient response including amnesia.

RESULTS

There was no significant difference between groups in sedation, analgesia, or akinesia. Overall patient response was better in the lorazepam group (P = .05). Patient-reported incidence of amnesia was significantly higher in the lorazepam than in the placebo group (P < .05).

CONCLUSIONS

Sublingual lorazepam improved patient comfort by inducing amnesia, and in the low dose used in this study, did not adversely affect surgery by undue heavy sedation.

Purification and tissue/species dependence of the specificity of buffalo kidney cathepsin B

A simple purification scheme was developed for isolation and purification of cathepsin B from buffalo kidney. The use of CM-Sephadex and chromatofocusing helped in better and simultaneous separation of cathepsin B, H and L. As judged by PAGE and SDS-PAGE studies, the enzyme was found to be pure on the basis of charge and had a molecular mass of 25.5 kDa. The amino acid composition, number of free sulfhydryl groups and other major physico-chemical properties of the purified enzyme were similar to the properties reported for cathepsin B from other sources/tissues. However, the NH2-terminal amino acid residue of the enzyme was found to be Ala as against Leu reported from other tissues/species. The total carbohydrate content was also found to be significantly lower (3.6%) as compared to 7.0-7.6% reported for the enzyme from other sources. Thiol reducing compounds activated the enzyme whereas thiol blocking compounds inhibited it. The buffalo kidney enzyme hydrolyzed Z-Phe-Arg-MCA (Vmax/K(m) = 17.1) as the most efficient substrate followed by Z-Arg-Arg-MCA, BANA and BAPNA. Among the protein substrates, goat hemoglobin (Vmax/K(m) = 874) was found to be the most preferred. Rabbit muscle aldolase, usually considered to be a good substrate for cathepsin B, proved to be a poor substrate for this enzyme; only 25-30% inactivation of aldolase was observed. Antibodies raised against the enzyme recognised only cathepsin B and did not have any cross reactivity with cathepsin H or L from the same or different sources. These differences in the properties of the buffalo kidney enzyme vis-a-vis the same enzyme from other tissue/species have been attributed to specialized function of cathepsin B in diversified tissues.

Molecular biology of opioid receptors: recent advances

Endogenous opioid peptides and opiates like morphine produce their pharmacological effects through the membrane bound opioid receptors. These receptors belong to a superfamily of G-protein-coupled receptors, all of which possess seven membrane-spanning regions. Structure-activity relationship studies of opioids opened up new avenues for the pharmacological characterization of the opioid receptors. As a further advancement in this direction, molecular cloning has led to the identification of three different types of opioid receptors -- OP1 (delta), OP2 (kappa) and OP3 (mu) -- thereby supporting the results of earlier pharmacological studies which postulated their existence. The three opioid receptors are highly homologous. Consequent to the development of highly specific and selective agonists and antagonists, it was proposed that the three types of opioid receptors could be further categorized into different subtypes. However, the molecular biology data generated so far do not support the presence of the various subtypes of the three well-characterized opioid receptors. Recent strides towards the advancement of our knowledge relating to the molecular biology of these receptors have been reviewed in this article.

Catalytic and physico-chemical characteristics of goat spleen cathepsin B

To improve the level of purity of cathepsin B, we have modified the published procedure [Agarwal, S.K. and Khan, M.Y. (1987) Biochem. Int. 15,785-792] by incorporating CM-Sephadex ion exchange chromatography and chromatofocusing. The enzyme thus isolated could be resolved into one 26 kDa major and a minor 27 kDa protein bands on SDS-PAGE. The two components, however, could not be separated by gel filtration and they eluted, in a single peak corresponding to a molecular mass of 28.1 kDa. Among the various substrates tested, Z-Phe-Arg-MCA with a Km of 0.058 mM and hemoglobin with a Km of 1.449 microM were the most preferred synthetic and protein substrates respectively. It was found to be a glycoprotein with an acidic pI of 4.8. The enzyme was activated by various thiol-reducing reagents and inhibited by cysteine proteinase inhibitors, divalent cations, lysyl group modifiers, anti-inflammatory drug and denaturing agents. The hydrodynamic behaviour of cathepsin B suggested a compact and globular conformation. Immunodiffusion studies with anti-goat cathepsin B indicated a tissue/ species dependence.

Interaction of the NH2-terminal domain of fibronectin with heparin. Role of the omega-loops of the type I modules

Determinants of the interaction of the 29-kDa NH2-terminal domain of fibronectin with heparin were explored by analysis of normal and mutant recombinant NH2-terminal fibronectin fragments produced in an insect cell Baculovirus host vector system. A genomic/cDNA clone was constructed that specified a secretable human fibronectin NH2 fragment. With the use of site-directed mutagenesis a set of 29 kDa fragments was obtained that contained glycine or glutamic acid residues in place of basic residues at various candidate sites for heparin binding in the five type I modules that make up the domain. The recombinant fragment containing the wild type sequence had a nearly normal circular dichroic spectra and a melting profile, as assayed by loss of ellipticity at 228 nm, that was indistinguishable from that of the native fragment obtained by trypsinization of plasma fibronectin. A substantial proportion of the wild type recombinant fragment bound to heparin-Sepharose, where it was eluted at the same NaCl concentration as the native fragment. The wild type fragment was capable of promoting matrix-driven translocation, a morphogenetic effect in artificial extracellular matrices that depends on the interaction of the fibronectin NH2 terminus with heparin-like molecules on the surfaces of particles. Mutant fragments in which arginines predicted to be most exposed in the folded fragment were converted to glycines retained the same affinity for heparin as the wild type fragment. In contrast, a mutant fragment in which the single basic residue (Arg99) in the minor loop ("Omega-loop") of the second type I module was converted to a glycine had an essentially normal melting profile but exhibited no binding to heparin and failed to promote matrix-driven translocation. A mutant fragment in which the single basic residue (Arg52) of the first type I module was converted to a glycine also completely lacked heparin binding activity, but one in which the single basic residue (Arg191) the fourth type I module was converted to a glycine retained the ability to bind heparin. A mutant fragment in which the single basic residue (Lys143) in the Omega-loop of the third type I module was converted to a glutamic acid lacked heparin binding activity but had a CD spectrum similar to the heparin-liganded native protein and was capable of promoting matrix-driven translocation. The results indicate that multiple residues in the Omega-loops of the fibronectin NH2-terminal domain participate in its interactions with heparin. In addition, the conformation of one of the nonbinding mutants may mimic the heparin-induced structural alteration in this fibronectin domain required for certain morphogenetic events.

Re-evaluation of hyaluronidase in peribulbar anaesthesia

AIMS/BACKGROUND

Hyaluronidase can augment the actions of local anaesthetics in peribulbar anaesthesia. However, evidence suggests satisfactory anaesthesia can be achieved using mixtures without hyaluronidase. A randomised double blind study was conducted on 50 patients, undergoing peribulbar anaesthesia, to validate this observation.

METHODS

Patients received a standard mixture of local anaesthetic (0.5% bupivacaine and 2% lignocaine in a 1:1 ratio) with or without hyaluronidase (25 IU/ml of mixture), pH values 5.16 and 5.24 respectively. Time taken to establish satisfactory anaesthesia to allow surgery was noted.

RESULTS

The onset time to globe akinesia in the control group ranged from 2 to 15 minutes (mean 5.64 and median 4 minutes) and in the hyaluronidase group from 2 to 12 minutes (mean 4.64 and median 4 minutes). The volume of local anaesthetic injected to achieve satisfactory anaesthesia ranged from 8 to 16 ml (mean 10.96, SD 1.95) in the control group and 10 to 18 ml (mean 11.64, SD 2.8) in the hyaluronidase group. A Mann-Whitney test to compare onset times to globe akinesia between groups gave a p value = 0.6 and 95% confidence interval (-1 to 2 minutes).

CONCLUSION

Addition of 25 IU/ml of hyaluronidase to a standard pH unadjusted local anaesthetic mixture does not significantly reduce the time to the onset of satisfactory globe akinesia.