Is levomepromazine stable over time?

Levomepromazine (methotrimeprazine) is an anti-psychotic used at low dose for the control of nausea and vomiting. When levomepromazine hydrochloride as Nozinan® is diluted with 0.9% sodium chloride at concentrations ranging from 0.13 to 6.25 mg/ml, and stored in polypropylene syringes, the drug is stable for at least 14 days.

Evaluation of distribution of presbyopic correction through primary healthcare centres in Zanzibar, East Africa

AIM

A pilot scheme was developed to integrate the distribution of ready-made near spectacles into primary eye-care delivery in six primary healthcare facilities in Zanzibar, East Africa. With the aim of scaling it up to national level, the scheme was evaluated in terms of relevance, effectiveness, equality, sustainability and replicability.

METHODS

Six medical officers were trained in ocular anatomy, history taking, blindness definitions, ocular abnormalities, preventable blindness, distance visual acuity, near visual acuity, eye examination, record keeping and referral criteria. Each clinic was supplied with 200 near spectacles. The evaluation team revisited the units 6 months later to assess the scheme.

RESULTS

The evaluation team recommendations included: a structured approach to planning from the outset, facility selection criteria, raising awareness through community meetings, funding through a revolving fund and the introduction of referral monitoring systems. 372 of the 574 patients attending the facilities had eye complaints; 285 eye infections, 29 distance vision problems and 173 near vision problems. 173 near vision spectacles were dispensed, and 74 people were referred. All medical officers and participants recommended continuing with the scheme.

CONCLUSIONS

The project is highly relevant and timely, given that presbyopia is now a priority with the WHO. The scheme could easily be adopted at the national level in Zanzibar and other areas in East Africa.

Childhood blindness and severe visual impairment in Malaysia: a nationwide study

AIM

To determine the causes of childhood blindness and severe visual impairment (BL/SVI) in schools for the blind in Malaysia.

METHODS

All children ≤ 15 years attending 24 schools for the blind throughout the country were examined using the WHO Prevention of Blindness Programme (WHO/PBL) eye examination record for children, and visual loss was classified according to the International Classification of Disease (ICD).

RESULTS

In all, 469 children were examined, of whom 448 (95.6%) had BL/SVI. The major causes of visual loss were retinal disorders (n=148, 33%; mainly retinopathy of prematurity (n=78, 17.4%)), cataract/pseudophakia/aphakia (n=77, 17.2%), and anomalies affecting the whole globe. (n=86, 19.2%). The major underlying etiology was undetermined (n = 193, 43.1%), followed by hereditary factors, 21.7% (mainly retinal dystrophies), and perinatal factors, 20.5%. More than 34 (7.6%) cases were considered potentially preventable and 192 (42.9%) potentially treatable.

CONCLUSION

Diseases of the retina are the major cause of visual impairment, with retinopathy of prematurity being an important avoidable cause. This reflects expansion of neonatal services in Malaysia, and improved survival of very low birth weight and preterm babies. Lens-related causes of visual impairment reflect the need to further improve pediatric ophthalmology services in Malaysia.

Optic neuropathy endemic in secondary school children in Dar es Salaam, Tanzania

AIM

To investigate the prevalence and causes of optic neuropathy, reported as epidemic in 1997, among secondary school students in Dar es Salaam, Tanzania.

PATIENTS AND METHODS

First year students (n = 10,892) from 63 secondary schools located within 30 km from the base hospital were interviewed and had a visual acuity (VA) screening test. Students failing the 6/12-line in either eye were defined as having "poor eyesight" and referred to the base hospital where an optometrist re-tested VA and refracted them. An ophthalmologist examined students with VA of 6/12 or worse in either eye and visual impairment was defined as VA of worse than 6/12 with best correction. Associations between optic neuropathy, socioeconomic status and educational results were investigated.

RESULTS

Students' ages ranged from 12 to 22 (mean 15.2) years; 50.6% were male. The prevalence of optic neuropathy was 0.3 (SD 0.051)%. The condition affected older students and was associated with the family having fewer economic possessions (car, computer, television). Optic neuropathy accounted for 19/33 (58%) of bilateral visual impairment cases. No effect of the disease on educational performance was identified.

CONCLUSION

Optic neuropathy remains a significant problem in this population and can now be termed endemic rather than epidemic. Further research into its causes is required.

What is the efficacy of physical therapeutics for treating neuropathic pain in spinal cord injury patients?

OBJECTIVE

Evaluate the place and level of proof of physical therapeutics for treating neuropathic pain in spinal cord injury (SCI) patients.

METHOD

Literature review from three databases: PubMed, Embase, Pascal. The following keywords were selected: chronic neuropathic pain/non-pharmacological treatment; transcutaneous electrical nerve stimulation, physiotherapy, acupuncture, physical therapy, transcranial magnetic stimulation, heat therapy, ice therapy, cold therapy, massage, ultrasound, alternative treatment, complementary treatment, occupational therapy. The articles were analyzed using the double-reading mode.

RESULTS

Three techniques emerge from the literature: magnetic or electrical transcranial stimulation, transcutaneous electrical nerve stimulation and acupuncture. Even though the first method is not easily accessible on a daily basis it is the one that yields the most promising results validated by Grade B studies. Healthcare professionals remain faithful to pain-relieving transcutaneous neurostimulation for both segmental neuropathic pain and below-level central neuropathic pain. Acupuncture is advocated by Canadian teams and could offer some interesting options; however, to this day, it does not have the methodological support and framework required to validate its efficacy. All other physical therapies are used in a random way. Only below-level massages are advocated by the patients themselves.

CONCLUSION

To this day, no study can validate the integration of physical therapy as part of the array of therapeutics used for treating neuropathic pain in SCI patients. In the future, it will require controlled and randomized therapeutic studies on homogenous groups of SCI patients, to control the various confusion factors.

Measuring cataract surgical services in children: an example from Tanzania

BACKGROUND

Childhood cataract is becoming increasingly recognised as a priority for reducing childhood blindness in developing countries. However, there have been no standard methods to monitor progress in providing this service, besides sporadic reports of surgeries performed.

METHODS

Information on all children receiving surgery for congenital/developmental cataract in the two Child Eye Health Tertiary Facilities (CEHTF) in Tanzania was collected for 2004-6. An annual childhood cataract surgical rate (CCSR) was calculated per region. Male-to-female ratios were also generated by region of residence.

RESULTS

Overall, the CCSR (2006) in Tanzania was 9.9 per million population, ranging from 32.3 for regions where CEHTF are located to 5.4 for regions not adjacent to CEHTF regions. There were, on average, 148 boys for every 100 girls receiving surgery.

CONCLUSION

Practical application of a measure of service delivery for childhood cataract has been useful in identifying gaps in utilisation of existing services by region as well as by gender. Testing in other settings would be helpful. An apparent inequity in use of services by girls requires attention.

Retinopathy of prematurity in South Africa: an assessment of needs, resources and requirements for screening programmes

AIMS

Retinopathy of prematurity (ROP) is a major cause of blindness in children in middle-income countries. In 1995, it accounted for 10.6% of blindness in children in schools for the blind in South Africa. This study was undertaken to estimate the number of premature babies at risk and to investigate policies, practices and screening programmes.

MATERIALS AND METHODS

17 level 1-3 neonatal units were visited in four provinces. Published literature reports were reviewed and staff interviewed.

RESULTS

13,000-15,000 surviving premature babies are at risk of ROP each year. Shortage of equipment precluded continuous oxygen monitoring in public units. Nursing levels were often below recommendations, and most nurses were unaware of target oxygen saturations. Private units were well staffed and adequately equipped. Ophthalmologists were only visiting four units on a regular basis for screening, using the birth weight criterion of <1500 g for ROP screening. ROP needing treatment rates were low (1.6-2.9%), as were rates of follow-up.

CONCLUSIONS

Primary prevention of ROP requires meticulous neonatal care and adequately equipped and staffed units. Secondary prevention requires efficient screening and treatment programmes. Competing demands and limited resources in the public sector in South Africa have precluded prioritizing the prevention of ROP. This should be re-evaluated.

Chromosomal evolution and distribution of telomeric repeats in golden moles (Chrysochloridae, Mammalia)

Golden moles (Chrysochloridae) are small, subterranean mammals endemic to sub-Saharan Africa that together with tenrecs constitute one of six orders in Afrotheria. Here we present a comprehensive karyotypic comparison among six species/subspecies of golden moles based on G-banding and chromosome painting. By expanding the species representation to include a further five species recently published in a companion paper, we were able to map the distribution of telomeric repeats in ten species/subspecies that are representative of six of the nine currently recognized genera. We conclude that: (i) the monophyly of Amblysomus is supported by the amplification of heterochromatin in several pericentric regions and one intrachromosomal rearrangement; (ii) A. hottentotus meesteri groups as sister to a clade that contains A. h. hottentotus, A. h. longiceps, A. h. pondoliae and A. robustus, an association that is underpinned by a shared intrachromosomal rearrangement and the detection of telomeric sequences in the centromeres of all chromosomes of the three A. hottentotus subspecies and A. robustus but, importantly, not in those of A. h. meesteri. These findings indicate an absence of gene flow suggesting that A. h. meesteri should be elevated to specific status. We hypothesize that the lack of gene flow may, in part, reflect hybrid dysgenesis resulting from abnormal meiotic segregation as a consequence of differences in the nature of the centromeric specific satellites; (iii) chromosomes 7 and 13 of Chrysochloris asiatica are fused in both Calcochloris obtusirostris and Eremitalpa granti, but that the position of the centromere in the fused chromosome differs in each species. This suggests that rather than being indicative of common ancestry, the fusion is more likely a convergent character which has arisen independently in each lineage. Furthermore our painting data show two centromeric shifts that are probably autapomorphic for C. obtusirostris. Finally, we conclude that (iv) golden moles are characterized by strong karyotypic conservatism but in marked contrast to the constrained rates of change exhibited by most species, A. robustus is unique in that three autapomorphic fissions define its evolutionary history, and hence the more extensive reshuffling of its genome.

Changing challenges in the control of blindness in children

One cannot address issues of control of blindness in children without first considering the epidemiology, as this allows priorities to be determined and appropriate strategies to be delineated. Control does not occur within a vacuum, and so it is also important to understand the context in which programmes are to be implemented, particularly in relation to development and poverty--the distal risk factors that are powerful determinants of the incidence of disease in populations. Interventions need to be considered from the perspective of patients as well as providers if services are to be acceptable and appropriate.

Risk factors for retinopathy of prematurity in six neonatal intensive care units in Beijing, China

OBJECTIVE

Guidelines on oxygenation policies and on the prevention and treatment of retinopathy of prematurity (ROP) were issued by the Chinese Medical Association in 2004. This study was undertaken to determine the incidence of and risk factors for ROP among preterm infants in Beijing, the capital of China, after implementation of the guidelines.

METHODS

Neonates with birth weights (BW) < or = 2000 g or gestational age (GA) < or = 34 weeks admitted to the six largest neonatal intensive care units in Beijing during 2005 were enrolled. Ophthalmological examinations started 3-4 weeks after birth, and ROP was classified using the revised International Classification. Maternal and perinatal risk factors for type 1 ROP were analysed.

RESULTS

Retinopathy of prematurity was detected in 10.8% of 639 neonates who had complete eye examinations, 23 of whom (3.6%) developed type 1 ROP and were treated. The rate of ROP needing treatment has not declined since 2002. Logistic regression analysis indicated that low BW, apnoea > 20 s, anaemia, hypoxic-ischaemic encephalopathy and placenta abruption were significantly associated with type 1 ROP.

CONCLUSION

In Beijing, rates of ROP needing treatment are high, and affected babies are more mature than in NICUs in high-income countries. More needs to be done to prevent ROP through improved neonatal care.

Prevalence and causes of childhood blindness in camps for displaced persons in Khartoum: results of a household survey

The prevalence and causes of visual impairment and blindness were determined in 29 048 children < 16 years in all households of 5 camps for internally displaced people in Khartoum State, Sudan. After house-to-house visits by trained health care workers, 916 children received further assessment, 2.7% of whom were found to be blind, 1.6% to be severely visually impaired and 5.5% to be visually impaired, according to World Health Organization criteria. The prevalence of blindness in children in the camps was estimated as 1.4 per 1000 children. The leading causes of blindness were found to be corneal opacities (40.0%), mainly due to vitamin A deficiency, followed by amblyopia (32.5%).

Chromosome painting and molecular dating indicate a low rate of chromosomal evolution in golden moles (Mammalia, Chrysochloridae)

Golden moles (Chrysochloridae) are poorly known subterranean mammals endemic to Southern Africa that are part of the superordinal clade Afrotheria. Using G-banding and chromosome painting we provide a comprehensive comparison of the karyotypes of five species representing five of the nine recognized genera: Amblysomus hottentotus, Chrysochloris asiatica, Chrysospalax trevelyani, Cryptochloris zyli and Eremitalpa granti. The species are karyotypically highly conserved. In total, only four changes were detected among them. Eremitalpa granti has the most derived karyotype with 2n = 26 and differs from the remaining species (all of whom have 2n = 30) by one centric and one telomere:telomere fusion. In addition, two intrachromosomal rearrangements were detected in A. hottentotus. The painting probes also suggest the presence of a unique satellite DNA family located on chromosomes 11 and 12 of both C. asiatica and C. zyli. This represents a synapomorphy linking these two sympatric species as sister taxa. A molecular clock was calibrated adopting a relaxed Bayesian approach for multigene data sets comprising publicly available sequences derived from five gene fragments representative of three golden moles and 39 other eutherian species. The data suggest that golden moles diverged from a common ancestor approximately 28.5 mya (95% credibility interval = 21.5-36.5 mya). Based on an inferred chrysochlorid ancestral karyotype of 2n = 30, the estimated rate of 0.7 rearrangements per 10 my (95% Credibility Interval = 0.54-0.93) differs from the 'default rate' of mammalian chromosomal evolution which has been estimated at one change per 10 million years, thus placing the Chrysochloridae among the slower-evolving chromosomal lineages thus far recorded.

[Asthma on the island of Reunion: an analysis of the severity and therapeutic management]

INTRODUCTION

Asthma is a common condition on the island of La Reunion but there are no epidemiological studies that analyse the prevalence, severity and management of the patients.

METHODS

Two studies were undertaken: a CPAM (health insurance) study of 187 patients and an analysis of the data from 253 patients attending a specialist hospital clinic.

RESULTS

In these two studies we found 40% of patients were in GINA group 3 compared with 10% in metropolitan France. Recourse to the emergency department and admission to intensive care were common. There was under-evaluation by the treating physicians who did not classify patients correctly. This under-evaluation also occurred in prescribing with only 1/3 of asthmatics in stages 2 and 3 receiving inhaled corticosteroids. Patient education was poor with 30% receiving a demonstration of inhaler technique and 31% a functional evaluation.

CONCLUSION

These studies show that the severity profile of asthma on La Reunion is comparable to that in other oceanic countries like Australia and New Zealand rather than metropolitan France. A population study is needed to assess the prevalence of asthma on the island of La Reunion.

Changing pattern of childhood blindness in Maharashtra, India

AIM

To determine the causes of severe visual impairment and blindness in children in schools for the blind in Maharashtra, India.

METHODS

Children aged <16 years with a visual acuity of <6/60 in the better eye, attending 35 schools for the blind were examined between 2002 and 2005, and causes were classified using the World Health Organization's system.

RESULTS

1985 students were examined, 1778 of whom fulfilled the eligibility criteria. The major causes of visual loss were congenital anomalies (microphthalmos or anophthalmos; 735, 41.3%), corneal conditions (mainly scarring; 395, 22.2%), cataract or aphakia (n = 107, 6%), and retinal disorders (mainly dystrophies; n = 199, 11.2%). More than one third of children (34.5%) were blind from conditions which could have been prevented or treated, 139 of whom were referred for surgery. Low vision devices improved near-acuity in 79 (4.4%) children, and 72 (4%) benefited from refraction. No variation in causes by sex or region was observed.

CONCLUSIONS

Congenital anomalies accounted for 41% of blindness, which is higher than in a similar study conducted 10 years ago. Corneal scarring seems to be declining in importance, low vision and optical services need to be improved, and research is needed to determine the aetiology of congenital anomalies.