Enhanced specific loss power of hematite-chitosan nanohybrid synthesized by hydrothermal method

We used a hydrothermal technique to develop nano-scale α-Fe2O3 particles and functionalized them with chitosan. An X-ray diffraction study revealed α-Fe2O3 nanoparticles were of single-phase, lattice constants were a = 5.07 Å and c = 13.68 Å, and the grain size was 27 nm. The presence of lattice fringes in the HRTEM image confirmed the crystalline nature of the α-Fe2O3. The Mössbauer spectra reveal a mixed relaxation state, which supports the PPMS studies. Zero-field cooled studies revealed the existence of a Morin transition and blocking temperature. The z-average value of the coated particles by DLS was between 218 and 235 nm, PDI ranged from 0.048 to 0.119, and zeta potential was +46.8 mV. We incubated the Vero and HeLa cell lines for 24 h to study the viability of the nanohybrids at different concentrations. Hyperthermia studies revealed the maximum temperature and specific loss power attained by the hematite-chitosan nanohybrid solution of a concentration between 0.25-4 mg ml-1. The Tmax at the lowest and highest concentrations of 0.25 and 4 mg ml-1 were 42.9 and 48.3°C, while the SLP were 501.6 and 35.5 W g-1, which are remarkably high when the maximum magnetization of α-Fe2O3 nanoparticles was as small as 1.98 emu g-1 at 300 K.

Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19

INTRODUCTION

The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities.

METHODS

Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020-October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting.

RESULTS

Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30-60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6-7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03).

CONCLUSION

Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.

Effects of physical therapy intervention in the management of neuromyelitis optica: a case report

Background

Neuromyelitis optica is a rare immune-mediated demyelinating central nervous system disorder affecting the spinal cord and optic nerves. There is no permanent cure for this disease, and its management requires a multidisciplinary approach.

Objective

The objective of this case report is to see the effectiveness of physical therapy in the management of neuromyelitis Optica.

Methods

A case of a 13-year-old female with symptoms of left side weakness, balance, and gait impairments administered a 2-week exercise protocol including progressive resistance training for strength improvements, virtual reality gaming for balance and stability improvements, and modified constraint-induced movement therapy for upper extremity functioning and activities of daily living (ADLs). Pre- and post-outcome measures include manual muscle testing (MMT) scores for strength, ProKin TecnoBody assessment for balance and stability, Functional Independence Measure (FIM), and Capabilities of Upper extremity Questionnaire (CUE-Q) for ADLs.

Results

Results showed a marked improvement in the scores of MMT, FIM, CUE, and ProKin TecnoBody post-intervention.

Conclusion

Physical therapy is effective in the management of neuromyelitis optica.

POS1500-HPR BABS ON A MISSION: AN EXPERIMENTAL STUDY ON THE EFFECTS OF MESSAGE FRAMING AND THE USE OF A PATIENT TESTIMONIAL ON BELIEFS AND INTENTIONS OF OSTEOARTHRITIS PATIENTS

Background

It is important that patients receive appropriate and reliable information that effectively targets beliefs in order for them to adhere to health behaviors. Framing (focusing on either gains or losses; [1]) is one of the most commonly used techniques in health communication to influence beliefs. In addition, the use of a testimonial in educational material might strengthen effects as intentions to adhere to health behaviors seem to rely strongly on testimonies of other patients. However, little is known about the potential of framing and patient testimonies to impact beliefs and change in health behaviors in osteoarthritis (OA).

Objectives

To study the effects of 1) message framing and 2) patient testimonies on beliefs about and intentions to be physically active and use pain medication.

Methods

We conducted an experiment consisting of a 2 (gain-frame vs loss-frame) x 2 (testimonial versus informative message) factorial design. Members of a research panel (n=639) with a self-reported diagnosis of knee OA were invited to participate. Participants were randomized into one of four video messages applying framing and the use of either a testimonial or facts. The messages (mean (SD) words 1073 (129)) were audiotaped by the same female speaker, subtitled, and complemented with images (duration of ~10 minutes). The four different combinations were: informative-loss (“If you are not physically active, this can lead to more pain[…].”), informative-gain (“If you are physically active, this can lead to less pain[…].”), testimonial-loss (“When I wasn’t physically active, I experienced more pain[…].”), testimonial-gain (“When I was physically active, I experienced less pain[…].”). After this video, participants filled out a questionnaire on socio-demographic and disease characteristics, and rated 3 statements concerning beliefs on a 7-point Likert scale (completely disagree – completely agree), and one 7-point Likert scale item on intentions (I do not do this now and am not planning doing this – I am doing this already for more than 6 months) each for both physical activity and pain medication based on the Theory of Planned behavior questionnaire [2]. ANOVA was used to assess the main and interaction effects of framing and the use of a testimonial on mean beliefs and intentions.

Results

A total of 154 respondents completed the questionnaire (Table 1). Framing nor the use of a testimonial impacted beliefs and intentions on physical activity. Loss framing resulted in more positive beliefs about pain medication (mean (SD) 5.5 (1.6)) than gain framing (mean (SD) 4.9 (1.9), p=.04, 95% CI [0.0, 0.1]). Within the loss frame, the patient testimonial scored significantly more positive on pain medication beliefs (mean (SD) 5.0 (1.7)) than the informative message (mean (SD) 6.0 (1.1), p=.02, 95% CI [0.1, 1.6]) (Figure 1).

Table 1.

Characteristics of participants (n=154)

Female, n (%)110 (71)Age (in years), mean (SD)62.3 (7.9)BMI, mean [kg/m2], (SD)27.3 (4.4)Daily functioning (KOOSa; 0-100), mean (SD)64.5 (18.0)Pain VAS (0-10), mean (SD)4.6 (2.2)Symptoms for more than five years, n (%)96 (62.3)Presence of OA in other joints, n (%)85 (55.2)Knee replacement, n (%)32 (20.8)Presence of comorbidities, n (%)111 (72.0)Figure 1.

Interaction of framing and the use of a patient testimonial on beliefs about pain medication

Conclusion

This study showed that stating the disadvantages of nonadherence to pain medication resulted in more positive beliefs about pain medication than stating the advantages of adherence. The use of a patient testimonial within this loss frame strengthened the effect. Our findings indicate that health care providers should be aware of the potential effects of emphasising either gains or losses in educational messages to their patients.

References

[1]Rothman, A.J. and P. Salovey, Shaping perceptions to motivate healthy behavior: the role of message framing. Psychol Bull, 1997. 121(1): p. 3-19.

[2]Ajzen, I., Constructing a Theory of Planned Behavior Questionnaire. 2006. 1-12.

Disclosure of Interests

None declared

Reducing chromium uptake through application of calcium and sodium in spinach

In peri-urban areas, the use of wastewater for crop production is a common practice due to water scarcity. Moreover, in the recent years, large quantity of wastewater generation and discharge as industrial effluent in water resources is another issue for reduction of water quality. The leather industries are significantly contributing chromium (Cr) in effluent, whereas, other industries may have salt and cationic load in their discharges are mixed up. Therefore, it is mandatory to study the interactive effect of different effluent constituents on crop plants. In this connection, a pot culture experiment was conducted at the ICAR-Indian Institute of Soil Science, Bhopal to compute the effect of application of calcium (Ca) and sodium (Na) ions on Cr uptake by spinach crop in Vertisol of central India. Three levels of Cr (0, 50, 100 mg kg^-1), calcium (0, 2, 4 mM), and sodium (0, 40, 80 mM) were applied in combinations. The spinach variety All Green was used as a test crop and harvested at full maturity. Results showed that application of Ca and Na reduced the Cr uptake in spinach crop. The reduction of Cr uptake was more in the root than shoot. Applied calcium acted as an essential plant nutrient and enhanced the crop biomass. Sole applications of Na adversely affected the crop biomass and Cr uptake in both root and shoot of spinach. In conclusion, application of Ca fertilizers reduced the Cr toxicity in spinach and could be used as a strategy for the safe utilization of tannery industrial effluents for crop production.

Effect of a myosin regulatory light chain mutation K104E on actin-myosin interactions

Familial hypertrophic cardiomyopathy (FHC) is the most common cause of sudden cardiac death in young individuals. Molecular mechanisms underlying this disorder are largely unknown; this study aims at revealing how disruptions in actin-myosin interactions can play a role in this disorder. Cross-bridge (XB) kinetics and the degree of order were examined in contracting myofibrils from the ex vivo left ventricles of transgenic (Tg) mice expressing FHC regulatory light chain (RLC) mutation K104E. Because the degree of order and the kinetics are best studied when an individual XB makes a significant contribution to the overall signal, the number of observed XBs in an ex vivo ventricle was minimized to ∼20. Autofluorescence and photobleaching were minimized by labeling the myosin lever arm with a relatively long-lived red-emitting dye containing a chromophore system encapsulated in a cyclic macromolecule. Mutated XBs were significantly better ordered during steady-state contraction and during rigor, but the mutation had no effect on the degree of order in relaxed myofibrils. The K104E mutation increased the rate of XB binding to thin filaments and the rate of execution of the power stroke. The stopped-flow experiments revealed a significantly faster observed dissociation rate in Tg-K104E vs. Tg-wild-type (WT) myosin and a smaller second-order ATP-binding rate for the K104E compared with WT myosin. Collectively, our data indicate that the mutation-induced changes in the interaction of myosin with actin during the contraction-relaxation cycle may contribute to altered contractility and the development of FHC.

Assessment of chromium efficacy on germination, root elongation, and coleoptile growth of wheat (Triticum aestivum L.) at different growth periods

The tannery effluents contain a high concentration of chromium (Cr). It drastically reduces the crop yield when used for irrigation purpose. A huge volume of tannery effluents is available as irrigation for crop production. It is negatively affecting germination as well as yield of the crop. The wheat seeds were exposed to five different concentrations of Cr (0, 20, 40, 80, and 100 ppm). In Petri plates, 100 seeds were placed and the germination percent was recorded after 72 hour (h). Root elongation and coleoptile growth were measured at 72, 120, 168, and 240 h. Results showed that the germination percent of the test crop decreased with increasing Cr levels. It decreased by 6, 14, 30, and 37 % under the Cr concentration of 20, 40, 80, and 100 ppm, respectively. The root elongation was more sensitive than the coleoptile growth. The negative correlation was found between Cr levels and root elongation as well as coleoptile growth. These growth parameters were significantly affected up to 80 ppm of Cr level. The wheat growers using tannery effluent as irrigation should be well treated prior to application.

Moisture sorption studies on vacuum dried coconut presscake

Moisture sorption isotherms of vacuum dried coconut presscake were determined at 25 °C, 30 °C, and 38 °C using a gravimetric technique. Sorption isotherms exhibited Type II behaviour. The effect of temperature on equilibrium moisture content was not significant (p > 0.05). Three models available in the literature viz., GAB, BET, and Halsey models were fitted to the sorption data. Out of the three tested models, Halsey model best fitted the experimental data with a relative deviation percent below 10%. The net isosteric heat of sorption was determined from the equilibrium adsorption data using the Clausius-Clapeyron equation. Isosteric heats of sorption were found to decrease exponentially with increasing moisture content.

Abstract P2-11-07: Endothelial progenitor cells as novel markers of anthracycline induced cardiac injury

Background: Anthracyclines including doxorubicin (DOX) cause myocardial damage that manifests as either subclinical decrements of left ventricular ejection function (LVEF) or overt cardiomyopathy. LVEF changes and cardiac risk factors are insufficient predictors of future DOX cardiotoxicity. Bone marrow derived endothelial progenitor cells (EPCs) are mobilized and are homed to sites of myocardial injury to help with repair of damaged myocardium. We hypothesized that EPC levels would be indicative of early DOX cardiotoxicity. Hence, we prospectively collected serial blood samples to evaluate functional EPCs, Troponin I (Ti) and B-natriuretic peptide (BNP), in patients (pts) receiving DOX-based chemotherapy.

Methods: Eligible pts were initiating adjuvant DOX for early stage breast cancer. Pts underwent cardiac magnetic resonance (CMR), Ti, BNP, and EPC at baseline, after 1 cycle of DOX, and after completion of DOX. CD133+ progenitor cells were isolated from the peripheral blood mononuclear cells (PBMC) using AutoMACS (automated magnetic cell sorting, Miltenyi Biotech). In vitro colony forming unit (CFU) assay was performed for isolated CD133+ progenitor cells on MethoCult (Stemcell Technology). After 8 days of culture, EPC colonies were counted using a two-step image analysis algorithm. Repeated measures analysis of variance modeled changes in cardiac markers over time. Logistic regression was used to correlate variables with abnormal Ti.

Results: Forty two women were enrolled. The average age was 52 years (range 33–68) and stage distribution was I (14%), II (58%) and III (28%). All but one patient received peg-fligrastim after DOX. Thirty six pts had EPC/cardiac biomarkers and twenty nine pts had CMRs at all three time points. LVEF decreased 1.6% following completion of DOX (95% CI: −3.8 to 0.6, p = 0.16). There was a non-linear trend in EPCs over time (p = 0.05), with an initial increase followed by a decrease, with average values of 59 (95% CI: 50–70), 65 (95% CI: 55–75), and 50 (95% CI: 40–60), respectively, across the three time points. By the end of treatment, 54% (95% CI: 0.37–0.71) of women had abnormal troponins (median: 0.03, range: 0.02 to 0.17). Variables associated with abnormal troponins included lower baseline EPCs (p = 0.095), older age (p = 0.075) and initial increase in BNP post cycle 1 (p < 0.03). In a multivariable model, age (p = 0.04) and BNP (p = 0.04) were independent prognostic factors for abnormal troponins, where the odds of abnormal troponins was 65% higher for every 5-year increase in age (OR = 1.65, 95% CI: 1.02–2.66) and 58% higher for every 1.5-fold increase in BNP (OR = 1.58, 95% CI: 1.01–2.46). Baseline EPC did not remain in the final model with p = 0.12.

Conclusions: DOX was well-tolerated with no significant changes in LVEF as measured by serials CMRs. Older age and increased BNP were independent prognostic factors for rise in Ti. We observed an initial increase of EPCs with DOX exposure followed by a decrease after the end of treatment. Although not statistically significant, lower EPCs at baseline, corresponding to lower cardiac reserve, were correlated with abnormal Ti. This is the first study reporting an intriguing association of EPCs with traditional cardiac biomarkers during DOX chemotherapy. Funded by R21 CA143787-02.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-07.

Kruppel-like factor 2 (KLF2) regulates monocyte differentiation and functions in mBSA and IL-1β-induced arthritis

Kruppel-like factor 2 (KLF2) plays an important role in the regulation of a variety of immune cells, including monocytes. We have previously shown that KLF2 inhibits proinflammatory activation of monocytes. However, the role of KLF2 in arthritis is yet to be investigated. In the current study, we show that recruitment of significantly greater numbers of inflammatory subset of CD11b(+)F4/80(+)Ly6C+ monocytes to the inflammatory sites in KLF2 hemizygous mice compared to the wild type littermate controls. In parallel, inflammatory mediators, MCP-1, Cox-2 and PAI-1 were significantly up-regulated in bone marrow-derived monocytes isolated from KLF2 hemizygous mice, in comparison to wild-type controls. Methylated-BSA and IL-1β-induced arthritis was more severe in KLF2 hemizygous mice as compared to the littermate wild type controls. Consistent with this observation, monocytes isolated from KLF2 hemizygous mice showed an increased number of cells matured and differentiated towards osteoclastic lineage, potentially contributing to the severity of cartilage and bone damage in induced arthritic mice. The severity of arthritis was associated with the higher expression of proteins such as HSP60, HSP90 and MMP13 and attenuated levels of pPTEN, p21, p38 and HSP25/27 molecules in bone marrow cells of arthritic KLF2 hemizygous mice compared to littermate wild type controls. The data provide new insights and evidences of KLF2-mediated transcriptional regulation of arthritis via modulation of monocyte differentiation and function.

Aggregation of sensory data using fuzzy logic for sensory quality evaluation of food

A method of sensory evaluation using fuzzy logic has been proposed in this paper. The method was applied for evaluation of sensory quality of tea liquor made out of dried CTC tea. Linguistic data (e.g., excellent, very good, good, satisfactory, fair, not-satisfactory, etc.) on individual tea liquor's quality attributes and the perception of the evaluators (e.g., extremely important, highly important, important, somewhat important, not-at-all important, etc.) for relative importance of these quality attributes were obtained. Sensory score between 0 and 100 for (i) Judges' preference for different quality attributes of tea liquor in general, (ii) Quality attributes ranking of tea liquor and the (ii) Overall quality of tea liquor were estimated. The last one can be utilized for the ranking of the different tea liquors.

Performance evaluation of a double drum dryer for potato flake production

A double drum dryer working under atmospheric pressure was developed for water evaporation rate of 20 kg/h. Potato slurry of 12% solid concentration was dried to obtain potato flakes. Experiments were carried out at drum speed of 5 to 30 rpm, steam pressure 2 to7 kg/cm(2) gauge (saturation temperature 120-164 °C) and liquid level 5 to 10 cm at the nip of drums. The responses obtained were, moisture content of the potato flakes: 1.18-44.15% (db), dry matter output rate: 1.33-2.87 kg dry solid/h and L value of colour: 30.9-66.4. Steam pressure and drum speed were the most influencing parameters affecting all 3 responses. Optimum combination of operating variables for obtaining potato flakes of 8% (db) moisture content, high dry solid output rate and high L value of colour was: drum speed 19.6 rpm, steam pressure 4.3 kg/cm(2) gauge (saturation temperature 145 °C) and liquid level at the drum nip 6.3 cm. At this combination of independent variables, residence time of the product on drum surface would be 2 s, final moisture content of product 8% (db), product output rate 2.4 kg dry solid/h and L value of colour 53.

Effectiveness of intra-operative and post-operative use of 5-fluorouracil in trabeculectomy--a randomized clinical trial

INTRODUCTION

The success rate of trabeculectomy is limited by postoperative scarring.

OBJECTIVE

To evaluate the effectiveness of intra-operative and post-operative use of 5-Fluorouracil (5-FU) in trabeculectomy.

MATERIALS AND METHODS

Thirty consecutive eyes undergoing trabeculectomy were randomized systematically into 3 groups of ten patients each. Group A served as a control; in Group B intraoperative 5-FU was used, whereas Group C received post-operative sub-conjunctival 5-FU. The variables studied were pre- and post-operative intraocular pressure, post-operative bleb characteristics and complications.

STATISTICS

Data were evaluated using the SPSS ver 10.0 program. ANOVA, paired t test and chi2 tests were performed.

RESULTS

The means of age in years of patients in group A, B and C were 49 +/- 9.23, 56.50 +/- 8.39 and 52.10 +/- 8.96 respectively (p = 0.222). The means of pre-operative IOP in groups A, B and C were 37.80 +/- 10 mmHg, 42.00 +/- 11.22 mmHg and 29.40 +/- 12.82 mmHg respectively. The medians of pre-operative anterior chamber depth (ACD) in groups B and C were 3 and 2 in group A according to van Herrick's grading. The mean values of final IOP were 11.90 +/- 3.50, 11.70 +/- 4.24, 11.00 +/- 2.83 mmHg (p = 0.841). The median post-operative anterior chamber depth in all the groups was similar compared to the pre-operative anterior chamber depth (p = 0.510). The final bleb scores in all the groups were similar (p = 0.873).

CONCLUSION

The intra-operative and post-operative use of 5-FU in trabeculectomy is almost equally effective in terms of IOP control and bleb characteristics.

Orbital rhabdomyosarcoma in an adult

INTRODUCTION

Rhabdomyosarcoma is the most common primary orbital malignant tumor in children. Orbital lesions represent about 10 % of all the cases of rhabdomyosarcoma. Rhabdomyosarcoma is a rare cause of proptosis in adults.

OBJECTIVE

To report a case of primary orbital rhabdomyosarcoma in a 45-year-old female.

DESIGN

Interventional case report. The main outcome measures are a rare cause ofproptosis in an adult, discussion on treatment options and prognosis ofrhabdomyosarcoma.

RESULT

The patient underwent total orbital exenteration and was referred for radiotherapy and chemotherapy.

CONCLUSION

Rhabdomyosarcoma is a rare cause of proptosis in adults. It should be suspected in a case of rapidly-progressive proptosis in adults.

Association between pregnancy-induced hypertensive fundus changes and fetal outcomes

BACKGROUND

Ocular involvement in pregnancy-induced hypertension (PIH) is common.

OBJECTIVE

To study the association between pregnancy-induced hypertensive fundus changes and fetal outcomes.

SUBJECTS AND METHODS

A prospective cohort study was carried out including 153 subjects with the diagnosis of PIH. The subjects were evaluated for hypertensive fundus changes. Fetal outcomes were assessed in terms of gestational age, birth weight, 1 minute Apgar score, stillbirth and neonatal death.

STATISTICS

The chi2 test was used to evaluate the association between the various fundus changes and fetal outcomes using SPSS version 10 software program.

RESULTS

Fundus changes were found in 13.7% of the subjects. The means of systolic and diastolic BP of the subjects with hypertensive fundus changes were 182.86 +/- 33.64 and 125.24 +/- 21.36 respectively, whereas those values without fundus changes were 150.72 +/- 12.86 and 100.07 +/- 9.51.Vitreous hemorrhage, serous retinal detachment and macular star were not found in this study. Fetal outcomes in PIH patients with vascular changes alone were similar to those with no fundus changes. Retinal and optic nerve head changes were found to be associated (p = 0.016) with low birth weight (< 2.5 kg). Choroidal changes and optic nerve head changes were associated with low Apgar score.

CONCLUSION

Retinal and optic nerve head changes are associated with low birth weight. Choroidal changes and optic nerve head changes are associated with low Apgar score. Fundus evaluation in patients with PIH is an important procedure to predict adverse fetal outcomes.

The patterns of refractive errors among the school children of rural and urban settings in Nepal

Introduction: The uncorrected refractive error is an important cause of childhood blindness and visual impairment. Objective: To study the patterns of refractive errors among the urban and rural school going children of Nepal. Subjects and methods: A total of 440 school children of urban and rural schools within the age range of 7-15 years were selected for this study using multi-stage randomization technique. Results: The overall prevalance of refractive error in school children was 19.8 %. The commonest refractive error among the students was myopia (59.8 %), followed by hypermetropia (31.0 %). The children of age group 12-15 years had the higher prevalence of myopia as compared to the younger counterparts (42.5 % vs 17.2 %). The prevalence of myopia was 15.5 % among the urban students as compared to 8.2 % among the rural ones (RR = 1.89, 95 % CI = 1.1-3.24). The hypermetropia was more common in urban students than in rural ones (6.4 %) vs 5.9 %, RR = 1.08 (95 % CI: 0.52-2.24). Conclusion: The prevalence of refractive error in the school children of Nepal is 19.8 %. The students from urban settings are more likely to have refractive error than their rural counterparts. DOI: 10.3126/nepjoph.v2i2.3717 Nep J Oph 2010;2(2) 114-120

A randomised clinical trial comparing the outcome of trabeculectomy using triangular versus rectangular scleral flaps

BACKGROUND

trabeculectomy is the standard surgical procedure for management of glaucoma.

OBJECTIVE

to compare the outcome of triangular and rectangular scleral flaps in trabeculectomy.

MATERIALS AND METHODS

this study was carried out in the Department ofOphthalmology, BPKIHS, Dharan, over a period of one year. A total of 22 patients undergoing trabeculectomy were randomized to undergo either trabeculectomy with triangular scleral flap (Group A= 11 eyes) or trabeculectomy with rectangular flap (Group B = 11 eyes).

OUTCOME MEASUREMENT

the parameters studied were intraocular pressure (IOP), anterior chamber depth (ACD), bleb characteristics and surgical complications.

STATISTICS

P value of<0.05 was considered significant. All calculations were executed using SPSS 11.0 software program.

RESULTS

the age ranged between 40 to 76 years with the mean of 56.5 +/- 9.25 years. The most common preoperative diagnosis was angle closure glaucoma. The postoperative percentage of IOP reduction (Group A=68.9%; Group B=66.51%) was statically significant in both the groups (p=0.001). Trabeculectomy was almost equally effective with complete surgical success of 91% in group A, and 82% in group B (p=0.534). Final bleb scores were almost similar in both the groups with 3.27 +/- 1.5 in group A and 3.36 +/- 1.21 in group B (p=0.877). Hypotony with the IOP less than 6 mmHg was found in the first post-operative day in 2 patients in Group A and in 1 in Group B. All of them improved spontaneously within a week.

CONCLUSION

both triangular and rectangular scleral flaps in trabeculectomy are equally effective in terms of post surgical IOP control, bleb characteristics and complications.

Efficacy of lid everting suture in the management of involutional lower eyelid entropion using 4-0 silk versus 4-0 chromic catgut

BACKGROUND

involutional lower eyelid entropion is a common ophthalmic condition requiring surgical correction.

OBJECTIVE

to compare the efficacy of lid everting sutures in the management ofinvolutional lower lid entropion using 4-0 silk versus 4-0 chromic catgut.

MATERIALS AND METHODS

fifty eyes with involutional lower eyelid entropion were enrolled into the study and divided randomly into two groups, A and B. Group A underwent lid everting suture with 4-0 chromic catgut and group B with 4-0 silk. The parameters assessed were pre- and post-operative lower lid excursion (LLE) and horizontal lid laxity (HLL).

STATISTICAL ANALYSIS

data were plotted in the excel spread sheet and analyzed using SPSS 11.0 software program. The difference between the two groups was compared using Chi square test and unpaired t test.

RESULTS

while comparing the pre-operative and post-operative changes of HLL within the two groups separately, there was 63% reduction of HLL in group A(p=0.001) and 68% reduction (p=0.001) in group B. In groupA, there was 48.2% improvement in LLE and in group B 52% postoperatively (p=0.001). The success rate in each group was 92%. The cost of surgery in group A was higher than that in group B (p=0.003).

CONCLUSION

lid everting suture by 4-0 silk is as effective as 4-0 chromic catgut. The cost of lid everting suture by 4-0 catgut is higher than that of 4-0 silk. The silk suture can be recommended for correction of lower lid involutional entropion in a country with low socioeconomic status.

Pattern and determinants of ocular complications in leprosy patients in eastern Nepal

BACKGROUND

odular complications of leprosy can lead to blindness.

OBJECTIVE

to report the pattern and determinants of ocular complications in patients with leprosy from eastern Nepal.

METHODS

a cross-sectional study was carried out analyzing one hundred and eighty six patients of leprosy presenting between Jan 2002-Nov 2004. All the patients were categorized using WHO and Ridley and Jopling classification. After determining bacillary indices in all of them, a detailed ocular examination was carried out. Independent risk factors were determined for ocular involvement.

RESULTS

ocular complications were found in 30.65% of the leprosy patients; lagophthalmos (17.74%) was the most frequent followed by uveitis (8.60%). Most of the patients having visual loss had it due to corneal complications and none of the patients with uveitis had vision <6/18. The patients released from treatment (83.33%) and those currently on treatment (31.63%) had higher occurrence of complications. Risk factors for ocular involvement were higher bacillary index, longer disease duration (p-=0.031, RR=1.109, 95% CI=1.009-01.218) and decreased corneal sensation(p=0.001, RR=3.564; 95 % C I=2.014-6.306). Higher Schirmer values (p=0.012, RR=0.935, 95% CI=0.888-0.985) were found to be protective for ocular complications. STASTICS: SPSS ver 10.0 was used for data analysis. The P value of <0.05 was considered as significant.

CONCLUSIONS

the prevalence of complications is high in patients released from treatment for leprosy. Cornea-related complications are the most important cause of visual disability and blindness. Risk factors for ocular complications are higher bacillary index, longer disease duration and decreased corneal sensation.

Safety of primary intraocular lens insertion in unilateral childhood traumatic cataract

This study analyzes the results of cataract surgery with primary intraocular lens implantation in unilateral childhood traumatic cataract following penetrating trauma and its long term follow up. It is a hospital based study of 114 children (age 3-10 years) with unilateral traumatic cataract who underwent extracapsular cataract extraction/ lens aspiration with implantation of posterior chamber intraocular lens (IOL). Primary posterior capsulotomy (PPC) was performed in 57 eyes and the rest 57 were without PPC (NPPC). The patients were followed up at regular intervals for a period of 3 years. Postoperative inflammation and pupillary capture were two frequent complications seen during postoperative period. Development of posterior capsular opacification (PCO) was 1/57, 4/57 at 8th week and 7/30 and 14/39 at 6 months, in PPC and NPPC group, respectively. Best corrected visual acuity (BCVA)>or=6/18 was achieved in 50% of eyes at 8th week post operatively and the same at 3 years with/without membranectomy/capsulotomy was evident in 73.3% of eyes. Meticulous case selection with insertion of "in the bag IOL" and subjecting the traumatized cataractous eyes to primary posterior capsulotomy are factors responsible for optimal outcome in unilateral traumatic cataract in children.

Safety of Primary Intraocular Lens Insertion in Unilateral Childhood Traumatic Cataract

This study analyzes the results of cataract surgery with primary intraocular lens implantation inunilateral childhood traumatic cataract following penetrating trauma and its long term follow up.It is a hospital based study of 114 children (age 3-10 years) with unilateral traumatic cataract whounderwent extracapsular cataract extraction/ lens aspiration with implantation of posterior chamberintraocular lens (IOL). Primary posterior capsulotomy (PPC) was performed in 57 eyes and the rest57 were without PPC (NPPC). The patients were followed up at regular intervals for a period of 3years.Postoperative inflammation and pupillary capture were two frequent complications seen duringpostoperative period. Development of posterior capsular opacification (PCO) was 1/57, 4/57 at 8thweek and 7/30 and 14/39 at 6 months, in PPC and NPPC group, respectively. Best corrected visualacuity (BCVA) ≥ 6/18 was achieved in 50% of eyes at 8th week post operatively and the same at 3years with/without membranectomy/capsulotomy was evident in 73.3% of eyes.Meticulous case selection with insersion of “in the bag IOL” and subjecting the traumatizedcataractous eyes to primary posterior capsulotomy are factors responsible for optimal outcome inunilateral traumatic cataract in children.Key words: childhood, intraocular lens, Nepal, traumatic cataract

Prevalence of glaucoma in Sunsari district of eastern Nepal

AIMS

To determine prevalence of glaucoma and glaucoma suspect in subjects 40 years and above in Sunsari district of eastern Nepal.

METHODS

A community based cross sectional study examining 1600 selected subjects was carried out. In all subjects best corrected visual acuity was determined. Oblique torch light test was used for anterior chamber depth evaluation. Intraocular pressure (IOP) measurements with Perkins tonometer and fundus examination were carried out in the community. Subjects diagnosed as glaucoma suspect were further evaluated in the hospital using slit lamp examination, gonioscopy and Goldmann perimetry. Glaucoma was defined by characteristic disc and visual field changes irrespective of the level of IOP.

RESULTS

Of 1600 subjects examined, the prevalence of glaucoma was found to be 0.938%. The prevalences of primary open angle glaucoma, primary angle closure glaucoma, secondary glaucoma and ocular hypertension were 0.562%, 0.125%, 0.250% and 0.500% respectively. Lens induced glaucoma accounted for all the cases of secondary glaucoma.

CONCLUSION

The prevalence of glaucoma in the Sunsari District of Nepal is 0.938%, which is lower than that reported in the neighboring regions. Lens induced glaucoma is highly prevalent as a cause of secondary glaucoma.

Striving for the perfect surgery in traumatic cataract following penetrating trauma in a tertiary care hospital at eastern Nepal

This study analyzes the result of traumatic cataract surgery in a tertiary care hospital at eastern Nepal. It is a hospital-based study of 112 patients (age 15-62), who underwent cataract extraction for unilateral traumatic cataracts. The study was carried out to evaluate the surgical outcome of tramatic cataract. Thirty-eight eyes had associated posterior capsular defect. No serious postoperative complications were encountered. Posterior capsular opacification at the end of sixth week was evident only in two eyes. Best corrected visual acuity nof 6/18 or more at the eighth week was achieved in 61 (54%) eyes. Astigmatism of less than 3D was achieved in 82 (73%) eyes. Rational surgical approach in traumatic cataract provides encouraging results. To comment on actual outcome long term follow up is mandatory.

Plasma and aqueous humur ascorbic acid levels in people with cataract from diverse geographical regions of Nepal

Ascorbic acid in aqueous humor of the eye has a role as an antioxidant in delaying cataract formation. In a cross-sectional comparative study, ascorbic acid levels from aqueous humor and venous blood obtained from patients with cataracts in mountainous regions (1,300-2,000 meters) and subtropical lowlands (<100 meters) of Nepal were measured spectrophotometrically with the objective of comparing the levels of aqueous humor ascorbic acid in patients with cataracts from these two diverse geographical regions. Of 131 patients included in the study, 59 were from the mountainous region of Nepal (Group A) and 72 were from the subtropical lowlands (Group B). The mean (+/- SD) plasma ascorbic acid level (mg%) of the subjects in Group A was 0.65 (+/- 0.20) and Group B was 0.85 (+/- 0.31). The aqueous ascorbic acid levels ranged from 12-28 mg % (mean +/-SD = 17.5+/-4.52) and 14-50 mg % (mean +/-SD =23.47+/-8.66) in Groups A and B, respectively. The difference of the plasma and aqueous humor ascorbic acid levels between the two groups was statistically significant (p<0.01). The plasma and aqueous humor ascorbic acid levels in the people with cataracts from the mountainous region of Nepal were significantly lower than those from subtropical lowlands. This may be because of the effect of high altitude and ultraviolet rays on ascorbic acid metabolism.

Indirect traumatic optic neuropathy--retrospective interventional case series from a tertiary care center in eastern Nepal

To report the demography, nature of insult and ocular characteristics in patients presenting with indirect traumatic optic neuropathy and to evaluate the visual outcome with mega dose methylprednisolone therapy. Retrospective hospital data analysis of all patients admitted with indirect traumatic optic neuropathy and treated with mega dose methylprednisolone therapy in the last three years was conducted. Nine patients (M:F= 8:1) were identified with unilateral optic nerve injury. Road traffic injury was the most common cause of injury. Lid ecchymosis and swelling on the same side was the most frequent ocular abnormality noted, followed by loss of consciousness. Time of presentation varied from 3 hours to 11 days. All patients except two had visual acuity of no light perception at presentation. Following therapy there was improvement in visual acuity in two patients who presented within two days of injury. Patients present late with traumatic optic neuropathy in this hospital. Most of the patients are with no light perception. High dose steroids was found to be beneficial only in patients presenting early (<two days).

Effectiveness of combination of permanent and releasable scleral flap sutures in trabeculectomy: a randomized clinical trial

INTRODUCTION

Trabeculectomy is a commonly used surgical treatment for glaucoma.

PURPOSE

To evaluate the effectiveness of combination of permanent and releasable scleral flap sutures to minimize the immediate postoperative complications of trabeculectomy.

MATERIALS AND METHODS

This study was carried out in Department of Ophthalmology, B P Koirala Institute of Health Sciences, Dharan, Nepal. Forty one eyes of 34 patients undergoing trabeculectomy were randomized to undergo either conventional trabeculectomy (Group A= 20 eyes) or trabeculectomy with combination of permanent and releasable scleral flap sutures (Group B =21 eyes). The parameters studied were intraocular pressure (IOP), anterior chamber depth (ACD) and surgical complications over a period of 6 weeks.

RESULTS

Significantly higher number of eyes belonging to group A (14 eyes) had shallower anterior chamber than group B (7 eyes) on first post operative day (p=0.042). Six eyes (30%) in group A had peripheral or central irido-corneal touch in early postoperative period as compared to only one in Group B. Hypotony was noted in 3 eyes in each group. Two patients in group A required reformation of anterior chamber. Other surgical complications in the two groups were similar. Both the groups had a significant drop in IOP following surgery. However, there was no significant difference in the IOP between the two groups after 6 weeks (Group A: 10.95 +/- 3.03 mmHg vs. Group B: 12.29 +/- 4.67 mmHg; p=0.87). There was a significant drop in IOP following removal of sutures (15.19 +/- 6.15 mmHg to 13.19 +/- 6.13 mmHg; p=006) in group B.

CONCLUSION

Use of combination of permanent and releasable scleral flap sutures is a safe technique that significantly reduces the incidence of immediate postoperative shallow anterior chamber after trabeculectomy.

Epidemiology of chronic dacryocystitis and success rate of external dacryocystorhinostomy in Nepal

PURPOSE

To study the epidemiology of chronic dacryocystitis and the success rate of external dacryocystorhinostomy (DCR) in Nepal.

PATIENTS AND METHODS

This is a retrospective descriptive and interventional case series. A total of 662 records of patients with chronic dacryocystitis due to nasolacrimal duct obstruction, who were treated by means of external DCR without bicanalicular silastic tube intubation, were studied.

STATISTICS

Mean for age with standard deviation and confidence intervals were calculated. The significance of the difference in means was calculated using the unpaired t-test.

RESULTS

Of 662 patients, 67.6% were female. The mean age of the patients was 27.4 +/- 13.7 years (SE = 0.53, 95% CI = 26.34-28.46). Chronic dacryocystitis due to nasolacrimal duct obstruction was found in 86 patients (13.0%) from the high hills (mean age = 35.3 +/- 11.4 years, 95% CI = 32.85-37.75), but most patients (576, 87.0%) were from the subtropical lowlands with a monsoon climate (mean age = 26.9 +/- 13.3 years, 95% CI = 25.8-28.0; p = < 0.01). An overall success rate of 88.6% (89.8% for high-hill patients and 87.4% for those from the lowlands) was obtained after DCR.

CONCLUSION

Chronic dacryocystitis is more common in the subtropical plains of Nepal with a monsoon climate than in the high hills. It is predominantly found in pre-menopausal females. External DCR without bicanalicular silastic tube intubation is an effective method for treating chronic dacryocystitis due to NLDO in these patients.

Pattern of intraocular pressure changes following manual small incision cataract surgery

OBJECTIVES

To find out the pattern of changes in intraocular pressure after manual small incision cataract surgery.

METHODS

Consecutive patients (291 eyes of 291 patients) undergoing manual small incision cataract surgery were prospectively evaluated for change in IOP. Patients were further divided into two groups based on whether or not sutures were used to close the scleral tunnel. IOP was serially measured at day 1, 1st, 2nd, 4th, 6th, 8th and 12th week.

RESULTS

The mean post operative IOP in eyes where sutures were not applied (12.59+/- 3.02 mmHg, 12.59+/-2.34mmHg, 12.54+/-2.19mmHg and 12.40+/-2.99 mm Hg at day1, 2week and 4weeks respectively) was lower than that where sutures were used to close the wound (15.57+/- 3.86mmHg, 14.05+/-2.52mmHg, 14.43+/-3.39mmHg at day1, 2weeks and 4 weeks respectively). There was a drop of IOP from the preoperative IOP in both suture (1.15+/-3.29mm Hg) and non suture (3.29+/-3.07mm Hg) group at 3 months of follow up.

CONCLUSION

There is a small drop of IOP following sutureless MSICS during long term follow up. Eyes where sutures are applied are more likely to have higher IOP than those without sutures at the initial post operative period.

Variation of intraocular pressure in patients with leprosy

INTRODUCTION

There are various controversial reports on intraocular pressure (IOP) in patients with leprosy.

PURPOSE

The current study was undertaken to study the level of intraocular pressure in leprosy patients and its association with the risk factors.

MATERIALS AND METHODS

This was a prospective cross sectional comparative study. An ophthalmologist and a dermatologist evaluated consecutive 93 patients with leprosy. The risk factors studied were age, gender, bacillary index, clinical diagnosis, duration of disease and treatment; and ocular complications. The IOP in these patients was compared with healthy age and sex matched controls.

RESULTS

A total of 186 leprosy patients (93) and healthy controls (93) were studied. The mean applanation IOP for the right and left eyes in leprosy patients was 12.87 1.20 mm of Hg and 13.222.70 mm of Hg respectively. This was found to be significantly lesser (p<0.001) than in the controls (RE=15.142.58 and LE=15.412.36 mmHg). The untreated leprosy patients had significantly lower IOP than those with treatment (p<0.001). None of the risk factors were found to be independently associated with the decrease in IOP. The duration of treatment, however, showed a trend towards having a significant association (p=0.057) with the lower level of IOP.

CONCLUSION

The level of IOP is lower in leprosy patients than in the healthy controls. Age, gender, bacillary index and presence of ocular complications due to leprosy are not independently associated with the decrease in IOP. The untreated leprosy patient tends to have a lower IOP. This finding can be used to monitor effectiveness of treatment of leprosy.

Human V gamma 2V delta 2 T cells produce IFN-gamma and TNF-alpha with an on/off/on cycling pattern in response to live bacterial products

Whereas cytokine production in alphabeta T cells is rapidly regulated by exposure to peptide Ag, the mechanisms regulating cytokine production by gammadelta T cells are unknown. In this study, we demonstrate that human Vgamma2Vdelta2 T cells produce IFN-gamma and TNF-alpha as early as 2 h after Ag exposure, and that they produce these cytokines in a dose- and time- dependent manner in response to stimulation with a live bacterial product, iso-butylamine (IBA), but not to dead bacteria or LPS. gammadelta T cells began, ceased, and then resumed IFN-gamma and TNF-alpha generation in an on/off/on cycling pattern, both in vitro and in vivo, depending on the presence or absence of IBA. IFN-gamma and TNF-alpha, whose optimum production was dependent on IBA-stimulated gammadelta T cells, were critical for monocyte-mediated killing of Escherichia coli. By limiting cytokine production to periods of direct contact with live bacteria, gammadelta T cells focus their resources at the site of infection, while limiting systemic immunopathology. Thus, human gammadelta T cells may mediate innate resistance to extracellular bacteria via tightly regulated cytokine production without necessarily expanding in number.

Antibacterial effect of human V gamma 2V delta 2 T cells in vivo

V gamma 2V delta 2 cells, a class of T cells found only in primates, are reactive to nonpeptide organophosphate and alkylamine antigens secreted by bacteria and parasites. These cells make up 2-5% percent of human peripheral blood T cells but expand to make up 8-60% of peripheral blood T cells during bacterial and parasitic infections. We show here, using a chimeric severe combined immunodeficiency (SCID) mouse (hu-SCID) model, that human V gamma 2V delta 2 T cells mediate resistance to extracellular gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli and Morganella morganii) bacteria, as assessed by survival, body weight, bacterial loads, and histopathology. Surprisingly, this bacterial resistance was evident 1 day after infection, and bacteria were cleared well before gamma delta T cell expansion was detected 6 days after infection. Decreased resistance in V delta 2 T cell-depleted hu-SCID mice correlated with decreased serum IFN-gamma titers. Intravenous treatment of infected, reconstituted hu-SCID mice with pamidronate, a human V gamma 2V delta 2 T cell-specific aminobisphosphonate antigen, markedly increased the in vivo antibacterial effect of V gamma 2V delta 2 T cells. Therefore, this large pool of antigen-specific, yet immediately reactive memory human V gamma 2V delta 2 T cells is likely to be an important mediator of resistance against extracellular bacterial infection and may bridge the gap between innate and acquired immunity.

Vgamma2Vdelta2 T-cell receptor-mediated recognition of aminobisphosphonates

Aminobisphosphonates, potent derivatives of bisphosphonates, are frequently used for the treatment of conditions such as osteoporosis and bone metastases that are characterized by excessive osteoclastic bone resorption. Using T-cell receptor (TCR) transfer studies, we show that recognition of antigenic aminobisphosphonates that are known to stimulate human gammadelta T cells in vitro and in vivo (potency: risedronate > alendronate > pamidronate) requires expression of the Vgamma2Vdelta2 TCR and is thus Vgamma2Vdelta2 TCR-dependent. Myeloma cells or monocytes pulsed with risedronate and then washed rendered these target cells sensitive to lysis by a Vgamma2Vdelta2 T-cell clone or cell line. These results suggest that Vgamma2Vdelta2 TCR-dependent recognition leading to direct cytolysis of aminobisphosphonate-sensitized osteoclast or tumor targets may be a mechanism whereby aminobisphosphonate treatment of cancers metastatic to bone decreases osteoclastic activity and tumor burden and also may account for the decreased osteoclastic activity associated with successful treatment of osteoporosis.

Endoscopic sclerotherapy in children with extrahepatic portal venous obstruction

BACKGROUND

Extrahepatic portal vein obstruction (EHPVO) is a common cause of variceal bleeding in children in India. There is paucity of data regarding the results of treatment with endoscopic sclerotherapy.

METHODS

Fifty-nine children (mean age 11 +/- 3.8 years; range 7 months to 12 years; 36 males and 23 females) were studied from February 1990 to September 1999. EHPVO was diagnosed on the basis of portal cavernoma on ultrasonography in 55 patients and on splenoportovenogram in 4 patients. Endoscopic sclerotherapy was caried out at weekly intervals for the first three weeks and at 3 weekly intervals thereafter till complete or near complete thrombosis was achieved. All patients were followed up with check endoscopy every 3-6 months after thrombosis of oesophageal varices.

RESULTS

Over a mean follow up of 25.4 months (range 3 to 87 months) total thrombosis was achieved in 53 (89.8%) of 59 children. The mean number of sclerotherapy sessions required were 7.5 +/- 2.2. The mean number of blood transfusions required per bleeding episode was 3.8 +/- 3.2. Of the 59 children 21 (35.6%) rebled, of which 17 (28.8%) bled during and 4(6.8) after thrombosis of varices. Seven (11.9%) children had more than one episode of bleeding. Once thrombosis of the varices was achieved 15 (26%) of 59 children developed fresh varices on follow up. Gastric varices were detected in 47 (60%) children. In 39 (66%) children it was present at the onset and in 8 (13.5%) children it developed after thrombosis of oesophageal varices. Bleeding from gastric varix occurred in 7(9%) children. Ascites developed in 6(10.6%) children. One child developed oesophageal stricture. There were 3 (5%) deaths. Two died due to upper gastrointestinal bleed while on sclerotherapy schedule and one died due to cerebral abscess.

CONCLUSION

EHPVO is an important and common cause of upper gastrointestinal bleeding in children in Western India. EST is safe and useful in controlling oesophageal variceal bleeding in children.

MICA engagement by human Vgamma2Vdelta2 T cells enhances their antigen-dependent effector function

Vgamma2Vdelta2 T cells comprise 2%-5% of human peripheral blood T cells, recognize ubiquitous nonpeptide antigens, and expand up to 50-fold during microbial infection. It is not clear why these Vgamma2Vdelta2 T cells expand only after microbial infection. We show here that the stress-inducible molecule, MICA, is induced on the surface of dendritic and epithelial cells by infection with M. tuberculosis in vitro and in vivo. MICA engagement by the activating receptor, NKG2D, present on Vgamma2Vdelta2 T cells, resulted in a substantial enhancement of the TCR-dependent Vgamma2Vdelta2 T cell response to nonpeptide antigens and protein superantigens alike. Thus, a MICA-NKG2D interaction may be necessary for an effective innate immune response to microbe-associated antigens that also are constitutively present in vivo.

Role of aprotinin in the management of experimental fungal keratitis

In an experimentally induced Aspergillus fumigatus fungal keratitis in 20 rabbits, aprotinin, an antiplasmin agent, was studied to find out its role as an adjuvant when given along with other established antifungal agents like natamycin and fluconazole. The 20 rabbits included in this study were randomly divided into four equal treatment groups. Once the ulcer was produced after intrastromal injection of 0.03 ml of A. fumigatus (5.5 x 10(4) spores/ml), different drugs/agents in combination were used in a randomized manner. These were natamycin (5%) + placebo, natamycin + aprotinin (40 IU/ml), fluconazole (0.3%) + placebo and fluconazole + aprotinin. The rabbits were followed up every day to note the signs of healing which included subsidence of corneal infiltration, disappearance of stromal abscess and subsidence of corneal oedema till complete healing. Results showed that the average healing time was 28.2, 28.4, 49.8 and 49.0 days for natamycin + placebo, natamycin + aprotinin, fluconazole + placebo and fluconazole + aprotinin, respectively. It suggests that aprotinin as an adjuvant has no definite role in the management of fungal keratitis. The plasminogen activator-plasmin system which is inhibited by aprotinin may not be the pathway through which filamentous fungi like A. fumigatus cause tissue destruction.

Robot-assisted microsurgery: a feasibility study in the rat

OBJECTIVE

Telerobotic surgery is a novel technology that can improve a surgeon's manual dexterity as well as the results achieved with microsurgical procedures.

METHODS

A prototype Robot-Assisted MicroSurgery (RAMS) microdexterity enhancement system developed by the Jet Propulsion Laboratory and MicroDexterity Systems, Inc., was tested in 10 rats. Carotid arteriotomies were created and closed using either the RAMS system or conventional microsurgical techniques. The time required, the technical quality (vessel patency and suture line integrity), the error rate, and subjective difficulty were compared.

RESULTS

All procedures were successfully completed using the RAMS system to manipulate the vessel but not to hold the needle or place the sutures. The precision, technical quality, and error rate of telerobotic surgery were similar to those of conventional techniques. However, the use of the RAMS system was associated with a twofold increase in the length of the procedure.

CONCLUSION

Surgery using a microdexterity enhancement system, or RAMS prototype, is feasible. With further development, such as a stereotelevisualization and haptic feedback system, this system could be used for telerobotic surgery in neurosurgical practice.