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Chowdhury AN, Brahma A. Vulnerable Vagina: A Case of Delusional Parasitosis with Folie-a-Deux: Cultural Variant of Ekbom's Syndrome? Indian J Psychol Med 2024; 46:89-91. [PMID: 38524953 PMCID: PMC10958080 DOI: 10.1177/02537176231198415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Affiliation(s)
- A. N. Chowdhury
- Bradgate Mental Health Unit, Glenfield Hospital, Leicestershire Partnership NHS Trust, Leicester, UK
| | - A. Brahma
- Girindra Sekhar Clinic, Kolkata, West Bengal, India
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Sarathi S, Brahma A, Das PK, Mahapatra A, Behera B. Edwardsiella tarda Causing Fishbone Injury Cellulitis Leading to Sepsis in a Case of Hematological Malignancy-A Rare Report and Review of Literature. J Lab Physicians 2023; 15:602-607. [PMID: 37780878 PMCID: PMC10539073 DOI: 10.1055/s-0043-1770930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/18/2023] [Indexed: 10/03/2023] Open
Abstract
Edwardsiella tarda ( E. tarda ), a gram-negative bacillus, a member of order Enterobacterales , is typically a fish pathogen frequently isolated from fresh and brackish water environments. It is very rarely implicated in human infections such as gastroenteritis (most common), cellulitis, gas gangrene, hepatobiliary infections, peritonitis, empyema, and meningitis. Bacteremia/sepsis caused by E. tarda can be fatal in humans, although very rare (<5%). To date, very few cases of E. tarda sepsis have been reported worldwide including India. We report a rare case of cellulitis caused by E. tarda following fishbone injury in a patient with underlying hematological malignancy leading to sepsis.
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Affiliation(s)
- Sushree Sarathi
- Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Anupam Brahma
- Department of Hematooncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prabodha Kumar Das
- Department of Hematooncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashoka Mahapatra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Wynn T, Marath H, Brahma A, Rajagopal V. An Unusual Case of a Primary Hyperparathyroidism Mimic. Acute Med 2023; 22:261-263. [PMID: 38284639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
A 32-year-old lady with a history of bulimia nervosa was noted to have a raised adjusted calcium of 2.94mmol/L associated with high parathyroid hormone (PTH) 17.2pmol/L. On review, she had an apparent hypercalcaemia for at least three years, and also had a chronic, severe alkalosis with a bicarbonate up to 81.9mEQ/L. Ionised calcium during that time had actually been low, down to 1.03mmol/L. This case highlights the effects of alkalosis on calcium, as more albumin is available for binding to ionised calcium. This results in a low ionised calcium, which triggers PTH release and overall leads to raised adjusted calcium levels. Clinicians may misdiagnose a similar patient with primary hyperparathyroidism and treatment would cause worsening of true hypocalcaemia.
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Affiliation(s)
- T Wynn
- MBBS MClinEd MRCP(UK), West Suffolk Hospital, Bury St Edmunds
| | - H Marath
- FRCP, West Suffolk Hospital, Bury St Edmunds
| | - A Brahma
- FRCP, West Suffolk Hospital, Bury St Edmunds
| | - V Rajagopal
- FRCP, West Suffolk Hospital, Bury St Edmunds
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Chinya A, Pandit S, Baidya S, Brahma A, Jas R. Efficacy of haemolymph of marine gastropod, Telescopium telescopium on Eimeria tenella infection in broiler chicken. EAMR 2022. [DOI: 10.52635/eamr/12.2.205-216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Francis-Emmanuel P, Siddique R, Soong E, Clark J, Majeed J, Wijenaike N, Marath H, Brahma A, Tauni R. SAT-148 Ectopic ACTH Secretion Has Varied Presentation and Requires Individualized Treatment - One Size Does Not Fit All. J Endocr Soc 2020. [PMCID: PMC7209040 DOI: 10.1210/jendso/bvaa046.1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Ectopic ACTH secretion (EAS) presents in myriad ways. We present five cases of EAS to highlight similarities and differences in presentation and treatment. The first woman with known metastatic lung neuroendocrine tumour (NET) for two years presented with facial fullness, proximal weakness, worsening hypertension and hypokalaemia. Random cortisol of 2742nmol/L (99.39mcg/dL), with adrenocorticotrophic hormone (ACTH) of 201ng/L (5-50), was in keeping with EAS. She received medical treatment followed by bilateral adrenalectomy with EAS resolution and development of adrenal insufficiency. She is doing well. The second woman with proximal weakness was evaluated by neurologists. All neurological tests were normal but facial fullness and easy bruising was noted. Random cortisol was 875nmol/L (31.71mcg/dL) and ACTH was 90 ng/L. Imaging revealed metastatic liver disease with unknown primary and biopsy confirmed NET. Cortisol rose despite medical treatment and she died within fifteen months. The third woman with significant smoking history presented with haemoptysis and breathlessness. A right lung mass was suspected on chest X-ray and confirmed with CT. Endobronchial ultrasound-guided biopsy revealed small cell lung cancer (SCLC). She developed generalised weakness and severe hypokalaemia. Random cortisol of 1645nmol/L (59.63mcg/dL) with ACTH of 282ng/L suggested EAS. Despite medical treatment, she died within two weeks. The fourth woman presented with confusion, hypertension and severe hypokalaemia. Morning cortisol of 8557nmol/L (310.19mcg/dL) and random ACTH of 73ng/L were suggestive of EAS. CT demonstrated left lung mass with widespread metastases. She deteriorated and died within 2 weeks. Our only man had incidentally discovered metastatic liver lesions on ultrasound. Further imaging revealed prostatic mass and biopsy showed small cell neuroendocrine cancer. He presented with severe hypokalaemia. Random cortisol was 1065nmol/L (38.61mcg/dL) and ACTH was 188ng/L. He was commenced on medical treatment but declined rapidly and died. All our patients had profound hypokalaemia and metastatic disease at presentation. Many patients do not exhibit classical cushingoid features as EAS tends to develop acutely and underlying malignancy drives weight loss. A high index of suspicion is required to make a diagnosis. EAS should be considered in patients with proximal myopathy, pigmentation, resistant or severe hypokalaemia or hypertension and known or suspected malignancy. Early and quick control of cortisol excess is essential to minimise cardiometabolic abnormalities, severe infections and thromboembolic complications. Prognosis depends upon age, frailty, comorbidity, nature of neoplasm and extent of hypercortisolaemia. Adrenolytics with or without bilateral adrenalectomy, reduction in tumour burden and management of complications are the mainstay of treatment.
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Affiliation(s)
| | - Rana Siddique
- West Suffolk Hospital, Bury St Edmunds, United Kingdom
| | - Elaine Soong
- West Suffolk Hospital, Bury St Edmunds, United Kingdom
| | - John Clark
- West Suffolk Hospital, Bury St Edmunds, United Kingdom
| | - Joohi Majeed
- West Suffolk Hospital, Bury St Edmunds, United Kingdom
| | | | - Haris Marath
- West Suffolk Hospital, Bury St Edmunds, United Kingdom
| | - Anupam Brahma
- West Suffolk Hospital, Bury St Edmunds, United Kingdom
| | - Rahat Tauni
- West Suffolk Hospital, Bury St Edmunds, United Kingdom
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Alzahrani K, Carley F, Brahma A, Mofty H, Biswas S, Lin Y, Morley D, Hillarby C. Corneal haze in juvenile and adult keratoconus patients after corneal cross-linking. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.0s020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K. Alzahrani
- Division of Pharmacy and Optometry- School of Health Sciences; University of Manchester; Manchester UK
| | - F. Carley
- Manchester Royal Eye Hospital, Cornea clinic; Manchester UK
| | - A. Brahma
- Manchester Royal Eye Hospital, Cornea clinic; Manchester UK
| | - H. Mofty
- Division of Pharmacy and Optometry- School of Health Sciences; University of Manchester; Manchester UK
| | - S. Biswas
- Manchester Royal Eye Hospital, Cornea clinic; Manchester UK
| | - Y. Lin
- Division of Pharmacy and Optometry- School of Health Sciences; University of Manchester; Manchester UK
| | - D. Morley
- Manchester Royal Eye Hospital, Cornea clinic; Manchester UK
| | - C. Hillarby
- Division of Pharmacy and Optometry- School of Health Sciences; University of Manchester; Manchester UK
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Alzahrani K, Din N, Brahma A, Carley F, Hillarby M. Corneal clarity measurements in patients with myopia undergoing laser assisted in situ keratomileusis and laser assisted sub-epithelial keratectomy. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.0s034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K. Alzahrani
- Division of Pharmacy and Optometry- School of Health Sciences; University of Manchester; Manchester UK
| | - N. Din
- Division of Pharmacy and Optometry- School of Health Sciences; University of Manchester; Manchester UK
| | - A. Brahma
- Manchester Royal Eye Hospital, Cornea; Manchester UK
| | - F. Carley
- Manchester Royal Eye Hospital, Cornea; Manchester UK
| | - M.C. Hillarby
- Division of Pharmacy and Optometry- School of Health Sciences; University of Manchester; Manchester UK
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Alzahrani K, Carley F, Brahma A, Morley D, Hillarby M. Corneal imaging and densitometry measurements to monitor fuchs progression and treatments outcomes. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sharif MS, Qahwaji R, Shahamatnia E, Alzubaidi R, Ipson S, Brahma A. An efficient intelligent analysis system for confocal corneal endothelium images. Comput Methods Programs Biomed 2015; 122:421-436. [PMID: 26386613 DOI: 10.1016/j.cmpb.2015.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 08/03/2015] [Accepted: 09/01/2015] [Indexed: 06/05/2023]
Abstract
A confocal microscope provides a sequence of images of the corneal layers and structures at different depths from which medical clinicians can extract clinical information on the state of health of the patient's cornea. A hybrid model based on snake and particle swarm optimisation (S-PSO) is proposed in this paper to analyse the confocal endothelium images. The proposed system is able to pre-process images (including quality enhancement and noise reduction), detect cells, measure cell densities and identify abnormalities in the analysed data sets. Three normal corneal data sets acquired using a confocal microscope, and three abnormal confocal endothelium images associated with diseases have been investigated in the proposed system. Promising results are presented and the performance of this system is compared with manual and two morphological based approaches. The average differences between the manual and the automatic cell densities calculated using S-PSO and two other morphological based approaches is 5%, 7% and 13% respectively. The developed system will be deployable as a clinical tool to underpin the expertise of ophthalmologists in analysing confocal corneal images.
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Affiliation(s)
- M S Sharif
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - R Qahwaji
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - E Shahamatnia
- Universidade Nova de Lisboa/FCT-UNINOVA, Caparica 2829-516, Portugal
| | - R Alzubaidi
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - S Ipson
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - A Brahma
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
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Sharif M, Qahwaji R, Ipson S, Brahma A. Medical image classification based on artificial intelligence approaches: A practical study on normal and abnormal confocal corneal images. Appl Soft Comput 2015. [DOI: 10.1016/j.asoc.2015.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Affiliation(s)
- A Brahma
- Elsie Bertram Diabetes Centre, Norfolk & Norwich University Hospital NHS Foundation Trust , Colney Lane, Norwich, Norfolk NR4 7UY , UK
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Chowdhury AN, Banerjee S, Brahma A, Das S, Sarker P, Biswas MK, Sanyal D, Hazra A. A prospective study of suicidal behaviour in Sundarban Delta, West Bengal, India. Natl Med J India 2010; 23:201-205. [PMID: 21192512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Deliberate self-harm is a challenging public health issue but there is a paucity of data on non-fatal deliberate self-harm in the literature. We aimed to understand the behaviour of deliberate self-harm, both fatal and nonfatal, in a primary care setting. METHODS A year-long prospective study of all admitted patients of deliberate self-harm at 13 block primary health centres of the Sundarban region was done to examine the sociodemographic profile and clinical outcome of suicidal behaviour. Data were collected by using an especially devised deliberate self-harm register. Each subject was administered a 20-item case history sheet by trained medical officers and nursing staff. RESULTS A total of 1614 deliberate self-harm subjects (619 men, 995 women) were admitted during the year, of whom 143 (62 men, 81 women) died. Although women, especially in the younger age groups, constituted the majority of subjects (61.6%), the fatality trend was higher among men than among women (10% v. 8.1%). Poisoning was the commonest (98.4%) method of self-harm, particularly using pesticide. Easy availability of pesticides was a risk factor. Psychosocial stressors, such as conflict with spouse, guardian or in-laws, failed love affairs and economic distress, were the common underlying reasons. The majority of acts of deliberate self-harm (92.6%) were committed inside the home, especially by women. Only a small proportion of subjects had a past or family history of attempt at deliberate self-harm. The overall incidence of fatal and non-fatal deliberate self-harm was 5.98 and 61.51 per 100 000 population, respectively. CONCLUSION Both fatal and non-fatal pesticide-related deliberate self-harm is a major public health issue in the Sundarban region. An intersectoral approach involving primary health, administration and agriculture may help in developing an effective preventive programme to reduce the morbidity and mortality from deliberate self-harm.
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Affiliation(s)
- A N Chowdhury
- Institute of Psychiatry, Kolkata, West Bengal, India.
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Chowdhury AN, Brahma A, Banerjee S, Biswas MK. Deliberate self-harm prevention in the Sundarbans region need immediate public health attention. J Indian Med Assoc 2009; 107:88-93. [PMID: 19585816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Deliberate self-harm is a major public health problem. This study is aimed to examine the sociodemographic characteristics of both non-fatal and fatal deliberate self-harm cases admitted at the 13 block primary health centres of the Sundarbans region under South 24 Parganas district, West Bengal. Retrospective deliberate self-harm data from the admission registers of 13 block primary health centres was collected for the year 1999. A total of 1850 deliberate self-harm cases (639 males and 1211 females) were admitted at the 13 block primary health centres, of which 159 (60 males, 99 females) were fatal (completed suicide). A higher fatality rate for male than female (9.4% compared to 8.2%) was observed. Women (65.5%), especially of younger age groups constituted the major cases. Poisoning (96.9%) was the commonest method of self-harm. Easy availability of pesticides was a common factor. Marital status and seasonal trend (March-April) had important contribution in self-harm incidents. Planned psychosocial intervention as a part of community mental health programme may help to reduce the deliberate self-harm morbidity and mortality at this primary care level.
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Rahman I, Carley F, Hillarby C, Brahma A, Tullo AB. Penetrating keratoplasty: indications, outcomes, and complications. Eye (Lond) 2008; 23:1288-94. [PMID: 18949010 DOI: 10.1038/eye.2008.305] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Chowdhury AN, Banerjee S, Brahma A, Biswas MK. A study on mortality and morbidity pattern of acute childhood poisoning cases admitted in block primary health centres of Sundarban, West Bengal. Indian J Public Health 2008; 52:40-42. [PMID: 18700721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
A hospital - record based study was conducted in Sundarban of West Bengal to explore the profile of mortality and morbidity pattern of acute accidental poisoning among children. Sundarban is an underdeveloped coastal region of West Bengal. Three years retrospective (1999 - 2001) data of childhood accidental poisoning cases were collected from the indoor admission registers and case history sheets of 11 Block Primary Health Centers (BPHC) of the region. A total of 1056 children with accidental poisoning were admitted during those three years of which 58% were males. Mean age of males was slightly higher than females in all the three years. Organophosphorus pesticide poisoning was the commonest.
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Chowdhury AN, Brahma A, Banerjee S, Biswas MK. Media influenced imitative hanging: a report from West Bengal. Indian J Public Health 2007; 51:222-224. [PMID: 18232161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Media influences behaviour, especially of the young children and adolescents in various ways. The present study examined the media coverage of a judicial hanging and its immediate social effect. In a qualitative study the media coverage of a case of a judicial hanging was thoroughly discussed and the media influence, for over a period of ten weeks of the incident, in terms of suicide and copying of hanging among children, was collected and analysed. Eighteen cases were reported as an aftermath of this hanging: 1 suicide and 17 imitative hanging in children with 5 deaths. This report calls for attention that media should be cautious and responsible in presenting the news items that have potential social impact.
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Abstract
This is a report of an outbreak of mass hysteria, attributed to an unknown infectious disease, in a small village near Baruipur, South 24 Parganas district of West Bengal. The epidemic was triggered following the death of 2 persons of the same family on the same day. Thereafter, several other family members and villagers became ill and complained of similar symptoms. They were hospitalized for observation and all were discharged after a couple of days. We report the detailed sequence of events and the management of this mini epidemic.
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Affiliation(s)
- A N Chowdhury
- Professor and Head, Institute of Psychiatry, 7 D.L. Khan Road, Kolkata 700025
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Affiliation(s)
- C N McGhee
- Discipline of Ophthalmology, University of Auckland, New Zealand
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Chakrabarti HS, Craig JP, Brahma A, Malik TY, McGhee CN. Comparison of corneal thickness measurements using ultrasound and Orbscan slit-scanning topography in normal and post-LASIK eyes. J Cataract Refract Surg 2001; 27:1823-8. [PMID: 11709257 DOI: 10.1016/s0886-3350(01)01089-6] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare corneal thickness measurements made by ultrasonic and slit-scanning techniques in normal eyes and in eyes after laser in situ keratomileusis (LASIK). SETTING Corneal Diseases and Excimer Laser Research Unit, University of Dundee, Dundee, Scotland. METHODS Central corneal thickness (CCT) was measured in 101 eyes of 59 normal subjects and in 30 eyes of 21 post-LASIK patients. Measurements were made with an Orbscan slit-scanning elevation topographer and immediately afterward with an ultrasound pachymeter. RESULTS The difference in mean CCT between ultrasound (538.0 microm +/- 36.7 [SD]) and Orbscan (566.6 +/- 40.7 microm) pachymetry was statistically significant (P <.001) in the normal eyes; the Orbscan measurement was approximately 28 microm higher than that of the ultrasound pachymeter. The difference in mean CCT between the ultrasound and the slit-scanning techniques was also statistically significant in the post-LASIK eyes (mean values 475.3 +/- 50.3 microm and 461.9 +/- 74.2 microm, respectively; P <.0001). Differences in CCT in individual subjects were much more variable in the post-LASIK eyes than in the normal eyes. The Bland and Altman method for assessing clinical agreement between 2 instruments showed that in 95% of cases, the CCT measurements with both instruments would be within 65 microm in normal eyes and 150 microm in post-LASIK eyes. CONCLUSION Central corneal thickness measurements were, on average, 28 microm higher with the Orbscan than with the ultrasound pachymeter in normal eyes and 13 microm lower in post-LASIK eyes. The degree of variability within each group indicated that these 2 techniques are not clinically comparable, precluding interchangeable use of their data in planning or assessing corneal surgery.
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Affiliation(s)
- H S Chakrabarti
- Department of Ophthalmology, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
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Brahma A, McGhee CN, Craig JP, Brown AD, Weed KH, McGhee J, Brown R. Safety and predictability of laser in situ keratomileusis enhancement by flap reelevation in high myopia. J Cataract Refract Surg 2001; 27:593-603. [PMID: 11311630 DOI: 10.1016/s0886-3350(01)00765-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the safety and predictability of laser in situ keratomileusis (LASIK) retreatment following primary procedures for high myopia and astigmatism. SETTING Corneal Diseases and Excimer Laser Research Unit, Department of Ophthalmology, University of Dundee, Dundee, United Kingdom. METHODS This prospective observational study of retreatment comprised a cohort of 109 eyes having primary LASIK for high myopia and astigmatism with a spherical equivalent (SE) of -9.70 diopters (D) +/- 4.06 (SD). Twenty-four eyes (22%) with an initial myopic SE of -9.83 +/- 3.50 D, a comparable subset of the entire group (P < .05), had retreatment for residual myopia (-3.02 +/- 2.17 D) to improve uncorrected visual acuity (UCVA) by reelevating the corneal flap and ablating the stromal bed. RESULTS The mean follow-up after retreatment was 12.8 +/- 5.1 months (range 1.5 to 24 months; 19 eyes >/=6 months, 13 eyes > or = 12 months). The mean myopic SE was reduced to +0.53 +/- 0.62 D at 1 week, +0.05 +/- 0.50 D at 1 month, +0.30 +/- 0.50 D at 6 months, and +0.18 +/- 0.42 D at the latest follow-up, 12.8 months. At the latest review, 62% of eyes were within +/-0.50 D of emmetropia and 100% were within +/-1.00 D. The mean refraction did not alter statistically between 1 week and subsequent times. The mean UCVA improved from 6/30 prior to retreatment to 6/9 at the latest follow-up. Uncorrected visual acuity of 6/6 or better, 6/9 or better, and 6/12 or better was achieved by 33.0%, 75.0%, and 95.8% of eyes, respectively. No significant complications that led to a loss of best corrected visual acuity were encountered, although retreatment procedures were more uncomfortable than primary procedures and self-limiting; epithelial ingrowth that did not threaten vision was common, and 2 patients complained of nighttime visual symptoms. CONCLUSIONS Retreatment of residual myopia by reelevating the flap was relatively safe and predictable, with a low risk of sight-threatening complications. However, longer term studies may be required to detect late complications.
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Affiliation(s)
- A Brahma
- Corneal Diseases and Excimer Laser Research Unit, University of Dundee, Dundee, United Kingdom
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Abstract
PURPOSE A retrospective study to ascertain the management of pellucid marginal corneal degeneration (PMCD). METHOD AND RESULTS Sixteen patients (average age 42.6 years) presented with PMCD. PMCD was bilateral in 13 and unilateral in 3 patients. Eight eyes underwent surgery. Nineteen eyes were managed non-surgically. Surgery involved corneal wedge excision (WE) (6 eyes), penetrating keratoplasty (PK) (3 eyes) and lamellar thermo-keratoplasty (LTK) (1 eye). Immediate pre-operative average visual acuity (VA) was 6/24, 6/10 and 6/60 with an average pre-operative astigmatism of 11.40 D, 9.75 D and 20.5 D for WE, PK and LTK respectively. After an average post-operative follow-up of 57 months, 66 months and 1 year, the average astigmatism was 8.90 D, 4.63 D and 6.00 D with an average final VA of 6/19, 6/15 and 6/6 for WE, PK and LTK respectively. In the nonsurgical group, at presentation, 40% of eyes had a VA of 6/12 or better. After an average follow-up period of 32.3 months, 80% of eyes had a visual acuity of 6/12 or better. Optical correction was achieved with spectacles and or contact lenses. CONCLUSIONS Surgical correction for PMCD provides poor long-term reduction of astigmatism. Patients with PMCD may be adequately corrected in the long term by the use of scleral fitted gas-permeable contact lenses.
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Affiliation(s)
- S Biswas
- Royal Eye Hospital, Manchester, UK
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McGhee C, Brahma A. Surgical correction of refractive error. J R Soc Med 2000; 93:333-4. [PMID: 10911836 PMCID: PMC1298044 DOI: 10.1177/014107680009300618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
PURPOSE To develop and evaluate a new method to quantify centration of the trephined donor cornea relative to the limbus. METHODS After human donor corneas were trephined for penetrating keratoplasty, the remaining corneoscleral discs were stained and subjected to image analysis. The centration of the excised donor cornea relative to the limbus was calculated by measuring their centroids from the "captured" images. RESULTS Fifty-two corneoscleral discs were analyzed. The average deviation from the centre was 0.32 mm (SD, 0.18 mm). Neither surgeon nor the type of trephine significantly influenced the mean centroid deviation. CONCLUSION We have developed and evaluated a method to quantify centration of human donor cornea. In a small series, decentration did not correlate significantly with either the surgeon or the trephine.
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Affiliation(s)
- A Brahma
- School of Biological Sciences, Manchester University, Royal Eye Hospital, UK
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Affiliation(s)
- A Brahma
- Department of Ophthalmology, University of Dundee, Ninewells Hospital, Scotland, UK
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Abstract
PURPOSE To review the clinical presentation, treatment and outcome in four cases of severe anterior segment infection by Pseudomonas aeruginosa unrelated to contact lens wear. METHODS Four cases presenting over an 18 month period were reviewed. RESULTS The cases had variable presenting features and outcomes. Complications such as persistent infection, corneal thinning and phthisis bulbi were noted. Possible factors influencing adherence and tissue disruption are discussed. CONCLUSIONS Suspicion of infection by P. aeruginosa and prompt isolation of the organism is needed early in the course of disease. Intensive and prolonged treatment with parenteral and topical antibiotics combined with judicious use of topical steroid gives the best chance of a favourable outcome.
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Affiliation(s)
- R Radford
- Department of Ophthalmology, Royal Eye Hospital, Manchester, UK
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Brahma A, Ennis F, Harper R, Ridgway A, Tullo A. Visual function after penetrating keratoplasty for keratoconus: a prospective longitudinal evaluation. Br J Ophthalmol 2000; 84:60-6. [PMID: 10611101 PMCID: PMC1723235 DOI: 10.1136/bjo.84.1.60] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate visual function and vision specific health status in patients undergoing penetrating keratoplasty for keratoconus. METHODS A prospective longitudinal study measuring logMAR visual acuity, contrast sensitivity, disability glare, binocular visual field, stereoacuity, and subjective visual function (VF-14) was conducted on 18 patients with keratoconus undergoing penetrating keratoplasty (PK), including six patients who had already had PK in the fellow eye. Data were collected preoperatively and at 3, 9, and 18 months after surgery. RESULTS Within 3 months of surgery there was significant improvement in aided visual acuity, contrast sensitivity, and stereoacuity (p<0.05); disability glare (p<0.05) no longer had a significant detrimental effect on these variables. VF-14 score improved significantly throughout the postoperative period (p<0.05). There was significant correlation of the VF-14 score with aided visual acuity, binocular visual field, and stereoacuity. Postoperative astigmatism (<4D v >4D) did not affect the VF-14 score significantly. CONCLUSIONS There is substantial and rapid improvement in visual function and vision specific health status in keratoconic patients as a result of uncomplicated penetrating keratoplasty.
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Affiliation(s)
- A Brahma
- Department of Ophthalmology, Manchester University and the Royal Eye Hospital, Manchester
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Goodall KL, Brahma A, Bates A, Leatherbarrow B. Lateral canthotomy and inferior cantholysis: an effective method of urgent orbital decompression for sight threatening acute retrobulbar haemorrhage. Injury 1999; 30:485-90. [PMID: 10707216 DOI: 10.1016/s0020-1383(99)00137-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Retrobulbar haemorrhage (RBH) occurs in a variety of situations. It can complicate facial fractures, orbital surgery and retrobulbar injections and can occur spontaneously. It is relatively uncommon and sight-threatening RBH is even less common. If not detected early enough it can lead to devastating loss of vision. We have collected five cases of acute RBH, following trauma, associated with a profound reduction in vision. In each case a permanent loss of vision was avoided using a lateral canthotomy and inferior cantholysis approach to obtain urgent orbital decompression.
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