Clinical effects of Lactobacillus reuteri probiotic in chronic periodontitis - a systematic review

OBJECTIVE

This systematic review examines the effectiveness of Lactobacillus reuteri as an adjunct to scaling and root planing in the treatment of chronic periodontitis.

MATERIALS AND METHODS

Scopus, PubMed, and Web of Science databases were searched according to specific inclusion and exclusion criteria in October 2022. Randomized control trials that evaluated the effects of Lactobacillus reuteri in patients with periodontitis were included. The primary outcome was pocket depth and clinical attachment levels, while the secondary outcome considered was bleeding on probing, microbial levels, and gingival index score. Study quality was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions and the ROB2 tool.

RESULTS

A total of eleven studies that examined 369 subjects were included in the review. Adults in the age group of 18-70 years of age suffering from chronic periodontitis were evaluated. Eight out of the eleven studies reported statistically significant improvement in the intergroup pocket depths, whereas seven studies showed a statistically significant reduction in the clinical attachment levels in the probiotic group. Three studies showed no significant improvement in the pocket depth levels in the probiotic group as compared to the controls. Four studies showed no significant reduction in clinical attachment levels between the two groups. The overall risk of bias was high in four studies, while seven studies reported some concerns about the risk of bias.

CONCLUSIONS

Based on the limited evidence available, the adjunctive use of Lactobacillus reuteri to scaling and root planing may provide some additional benefit in improving periodontal parameters.

High prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibodies among unvaccinated children of Chandigarh, Northwest India, in a household-based paediatric serosurvey post-second wave of pandemic (June to July 2021)

OBJECTIVE

Current national severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination policy covers children aged >12 years. Unvaccinated, uninfected children remain susceptible to SARS-CoV-2 and play a role in community transmission, as paediatric infection is mostly mild or asymptomatic. To estimate the proportion of susceptible children in a community for public health measures, there is a need to assess the extent of natural infection.

STUDY DESIGN

We performed a cross-sectional household serosurvey of SARS-CoV-2 antibodies in unvaccinated children aged between 6 and 18 years after the second COVID-19 wave.

METHODS

Anti-SARS-CoV-2 immunoglobin G (IgG) testing in serum was done using chemiluminescence immunoassay. We used a logistic regression model to investigate predicted factors of seropositivity.

RESULTS

We observed a high prevalence (weighted average: 68.3%) of anti-SARS-CoV-2 IgG in 2700 enrolled children. Logistic regression for predictors of IgG seropositivity showed lower odds in households with completely vaccinated adults (adjusted odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.26-0.71, P = 0.0011) compared with households with unvaccinated adults. Other factors for low seropositivity included frontline workers as family members (adjusted OR: 0.69, 95% CI: 0.52-0.91, P = 0.0091) and non-crowded households (adjusted OR: 0.74, 95% CI: 0.61-0.89, P = 0.0019).

CONCLUSION

A high SARS-CoV-2 IgG prevalence in unvaccinated children was indicative of previous exposure to potentially infected contacts. This implies in-person academic activities for children can be continued during future community transmission. Comparatively lower seropositivity in children of completely vaccinated households or frontline workers suggests decreased transmission due to vaccination-induced immunity of family members. Vaccination will still be required in these children to maintain protective IgG levels, particularly in low seroprevalence groups.

Ocular infection caused by Hormographiella aspergillata: A case report and review of literature

Hormographiella aspergillata, a basidiomycete is a rare cause of human infection. We report a case of 70-year-old female with corneal ulcer and endophthalmitis caused by this agent. The patient had an intraocular implantation of lens following a cataract surgery. Corneal tissue obtained during therapeutic penetrating keratoplasty showed presence of septate hyphae on microscopy and culture grew H. aspergillata which was confirmed by sequencing of ITS region. Patient was started on systemic voriconazole and topical natamycin, however the eye could not be salvaged. To our knowledge, this is the first report of ocular infection caused Hormographiella aspergillata in an immunocompetent patient.

Incidence of Type 2 Diabetes is Higher among Men with Persistent Impaired Glucose Tolerance than in Transient Impaired Glucose Tolerance - A 5 year Follow up Study

OBJECTIVE

This was a 5 year comparative analysis of the incidence of type 2 diabetes in men who had persistent impaired glucose tolerance (P-IGT) versus transient impaired glucose tolerance (T-IGT). P-IGT (positive IGT on two oral glucose tolerance tests (OGTT), T-IGT (IGT in first OGTT and normal glucose tolerance (NGT) in the 2nd OGTT).

METHODS

The samples were collected from a randomized controlled diabetes prevention study. The prevention study was done using lifestyle modification (LSM) promoted by use of mobile short message services (SMS) for 2 years. The control group of the randomized study who received advice on LSM at only the baseline formed the P-IGT group for the 3 years follow up study (n=236). T-IGT (n=569) were available from those who had NGT on the 2nd OGTT while screening for the prevention study. The total diabetes incidence at 5 years in the study groups were compared using standard OGTT (WHO criteria).

RESULTS

The conversion rate to diabetes in 5 years was significantly lower among T-IGT than among P-IGT, OR=0.202 (95% CI, 0.145-0.296,p< 0.0001). P-IGT had higher rate of risk factors for diabetes than T-IGT.

CONCLUSION

The risk of conversion to diabetes was 80 percent lower in T-IGT than in P-IGT. Identification of P-IGT will help in selecting persons who require early intervention for diabetes.

The post-trial analysis of the Indian SMS diabetes prevention study shows persistent beneficial effects of lifestyle intervention

AIMS

We had shown that mobile phone based text messaging was an effective tool to deliver lifestyle changes among Asian Indian men with a 36% relative risk reduction in incident diabetes over two years. The present analysis investigated whether beneficial effects of intervention on diabetes prevention persisted for an additional three years after withdrawal of active intervention.

METHODS

The primary two year randomized controlled trial (2010-2012) compared lifestyle changes with use of automated text messaging reminders in the intervention (n = 271) versus standard care advice (n = 266) at baseline. At the end of the study, both groups received additional advice on lifestyle changes by a trained dietician. Participants free of diabetes (n = 394) were invited three years later to ascertain the sustained effect of intervention. The primary outcome was incidence of type 2 diabetes. This trial is registered with ClinicalTrials.gov,number NCT02848547.

RESULTS

During the mean follow-up of 5 years, 346 out of 394 (87.8%) men were reviewed. Incidence of diabetes was reduced by 30% in the intervention group, with declining gap between-group differences over time (Kaplan-Meier analysis). Significant improvement in dietary adherence occurred in the intervention group at 2nd and 5th year follow up (trend χ2 = 21.35, p < 0.0001). Cox regression analysis showed that the 5th year incidence of diabetes was significantly reduced in the intervention group. Higher body mass index and 2 h plasma glucose at 24 months increased the incidence of diabetes.

CONCLUSIONS

Sustained reduction in incident diabetes was apparent after cessation of active lifestyle intervention. This was possibly associated with continuing practice of improved lifestyle.

Impact of lifestyle intervention in primary prevention of Type 2 diabetes did not differ by baseline age and BMI among Asian-Indian people with impaired glucose tolerance

AIM

To investigate whether the effectiveness of lifestyle interventions on the incidence of diabetes was influenced by the baseline age and BMI of the Asian-Indian participants with prediabetes.

METHODS

Pooled data, obtained from two of our Indian Diabetes Prevention Programmes (2006, n=236 and 2013, n=473; total N=709) which had similar baseline characteristics and intervention principles, were analysed. For the present secondary analysis we dichotomously categorized the participants' baseline age (<45 and ≥45 years) and BMI (<25.0 and ≥ 25.0 kg/m² ). Glycaemic status was ascertained at 6-monthly intervals by oral glucose tolerance tests. The incidence rates of diabetes and relative risk reduction in both the intervention and the control group were calculated for categories of baseline age and BMI. Interactions between the intervention and baseline age and BMI on diabetes risk were also analysed.

RESULTS

Incident diabetes was diagnosed in 227 of the total 709 participants (32.0%) [control group 139 participants (38.8%) vs intervention group 88 participants (24.2%)] during the median follow-up period of 2 years. The overall relative risk reduction was 35.4% (95% CI 19.3-48.3). Lifestyle intervention was equally effective in both age groups [relative risk reduction in those aged <45 years: 43.7% (95% CI 19.8-60.5) and in those aged ≥ 45 years: 28.9% (95% CI 5.3-46.6) P for interaction = 0.52] and in categories of BMI [BMI <25 kg/m² : 36.1% (95% CI 9.5-54.9); and BMI ≥ 25 kg/m² : 34.8% (95% CI 12.9-51.2); P for interaction = 0.95].

CONCLUSIONS

In Asian-Indian individuals with prediabetes, the effectiveness of lifestyle intervention was not modified by baseline age and BMI.

Baseline level of 30-min plasma glucose is an independent predictor of incident diabetes among Asian Indians: analysis of two diabetes prevention programmes

BACKGROUND

The objective was to study the ability of the 30-min plasma glucose (30-min PG) during an oral glucose tolerance test to predict the future risk of type 2 diabetes among Asian Indians with impaired glucose tolerance.

METHODS

For the present analyses, we utilized data from 753 participants from two diabetes primary prevention studies, having complete data at the end of the study periods, including 236 from Indian Diabetes Prevention Programme-1 and 517 from the 2013 study. Baseline 30-min PG values were divided into tertiles: T1 < 9.1 mmol/L (<163.0 mg/dL); T2 9.2-10.4 mmol/L (164.0-187.0 mg/dL) and T3 ≥ 10.4 mmol/L (≥188 mg/dL). The predictive values of tertiles of 30-min PG for incident diabetes were assessed using Cox regression analyses RESULTS: At the end of the studies, 230 (30.5%) participants developed diabetes. Participants with higher levels of 30-min PG were more likely to have increased fasting, 2-h PG and HbA_1c levels, increased prevalence of impaired fasting glucose and decreased beta cell function. The progression rate of diabetes increased with increasing tertiles of 30-min PG. Cox's regression analysis showed that 30-min PG was an independent predictor of incident diabetes after adjustment for an array of covariates [Hazard Ratio (HR):1.44 (1.01-2.06)] CONCLUSIONS: This prospective analysis demonstrates, for the first time, an independent association between an elevated 30-min PG level and incident diabetes among Asian Indians with impaired glucose tolerance. Predictive utility of glycemic thresholds at various time points other than the traditional fasting and 2-h PG values should therefore merit further consideration. Copyright © 2016 John Wiley & Sons, Ltd.

Use of Scheimpflug imaging in the management of intra-lenticular foreign body

INTRODUCTION

Asymptomatic traumatic intra-lenticular foreign body is very uncommon and few case reports have been published.

OBJECTIVE

To report a case of post-traumatic intra-lenticular foreign body and use of Scheimpflug imaging in its management.

CASE

A 41-year-old male with history of injury to right eye during hammering a chisel 1 year back presented with decreased vision since 6 months. An intra-lenticular foreign body was found on slit lamp bio-microscopy and was confrmed by Scheimpflug imaging. Posterior capsule was intact on Scheimpflug imaging. Thus, Scheimpflug imaging helps in exact localization of the foreign body in the intralenticular space or behind the iris. We ruled out other foreign bodies by x-ray and ultrasonography of the orbit. The foreign body with post-traumatic cataract was removed using phacoemulsification and three piece foldable intraocular lens was implanted in the bag.

CONCLUSION

An intra- lenticular foreign body may remain asymptomatic for months. Scheimpflug imaging can be useful in its localization. It can be removed during phacoemulsification.

The oral disposition index is a strong predictor of incident diabetes in Asian Indian prediabetic men

AIMS

In this analysis, we sought to examine the prospective association of the disposition index (DIo) derived from oral glucose tolerance test with incident diabetes in Asian Indian men with impaired glucose tolerance (IGT).

METHODS

These post hoc analyses used data from a 2-year prospective study in primary prevention of diabetes using lifestyle intervention among 517 men with IGT. All the participants received standard lifestyle advice at baseline. The surrogate insulin sensitivity and insulin secretion measures were tested for their hyperbolic relationship. Predictive associations of various surrogate measures with incident diabetes were determined using receiver operating characteristic curves.

RESULTS

The combination of total area under the curve of insulin-to-glucose ratio (AUCinsulin/glucose) and Matsuda's insulin sensitivity index was the best equation to depict DIo [β: -0.954 (95 % CI -1.015 to -0.893)] compared to other measures tested in this cohort. There was an inverse association between change in DIo at the final follow-up and development of incident diabetes. Among the surrogate insulin measures studied, DIo [AUC (0.717 (95 % CI 0.675-0.756))] as a composite measure was superior than other surrogate indices.

CONCLUSIONS

Among the surrogate indices studied, DIo was the best measure associated with incident diabetes.

Adiponectin, leptin, interleukin-6 and HbA1c in the prediction of incident type 2 diabetes: A nested case-control study in Asian Indian men with impaired glucose tolerance

AIMS

The aims of this study were: (1) to assess the association of adiponectin, leptin and interleukin-6 (IL-6) with incidence of type 2 diabetes (T2DM) in Asian Indian men with impaired glucose tolerance (IGT) and (2) to evaluate the additional contribution of these with the well-established glycaemic marker HbA1c.

METHODS

This is an ancillary analyses of a nested case-control study derived from a prospective, prevention trial in India. All the participants had IGT at baseline. For this subanalysis a total of 147 (T2DM: 71; nondiabetic: 76) participants were selected based on the final glycemic outcomes. Association of these selected adipokines with T2DM were assessed using logistic regression analyses. Clinical usefulness of adding adipokine markers with HbA1c on prediction of T2DM was assessed using the area under the curve (AUC) of the receiver operating characteristics.

RESULTS

Baseline levels of adiponectin were lower and the levels of IL-6 were higher in T2DM cases when compared with non-diabetic cases (P<0.05). Levels of leptin were similar in both groups. In fully adjusted models, adiponectin (odds ratio (OR): 0.55 [95%CI: 0.33-0.91]; P=0.019) and IL-6 (OR: 2.27 [95%CI: 1.40-3.691]; P=0.001) were associated with diabetes. Addition of adiponectin to HbA1c improved the AUC (ΔAUC: 0.0619; P=0.0251), whereas addition of IL-6 did not improve the predictive power of HbA1c alone.

CONCLUSIONS

Adiponectin and IL-6 are independently associated with incident diabetes. However, they are unlikely to serve as simple tools to predict future risk of diabetes but may have a role in understanding the pathogenesis.

Retinol binding protein-4 predicts incident diabetes in Asian Indian men with prediabetes

The association of retinol binding protein-4 (RBP4) with incident type 2 diabetes (T2DM) in Asian Indian middle-aged men with impaired glucose tolerance (IGT) was studied. This was an ancillary analysis of a subsample from a cohort of participants with IGT in a 2 year prospective diabetes prevention program in India. For this analysis, 71 incident T2DM and 76 non-diabetic cases (non-progressors) based on the final glycemic outcome were selected. Baseline serum RBP4 was measured using competitive enzyme immunoassay. Correlations of RBP4 with relevant anthropometric and biochemical variables and also its association with diabetes were assessed using appropriate statistical analyses. Participants who developed T2DM had higher levels of serum RBP4 (21.3 [IQR: 17.7-24.9] µg/mL) compared with non-progressors (17.3 [IQR: 13.1-21.0] µg/mL; P = 0.001). Levels of RBP4 were lower than in Caucasians. Stepwise linear regression analysis showed that body mass index (BMI), systolic blood pressure, triglycerides, and HbA1c had independent associations with RBP4 levels. Multiple logistic regression analyses showed that RBP4 was independently associated with incident diabetes (odds ratio [OR] [95%confidence interval (CI)]: 1.69 [1.18-2.41]; P = 0.004). Adjustment for study group, age, BMI, waist circumference, 2 H plasma glucose, triglycerides, gamma glutamyl transferase, and insulin resistance weakened the significance of its association (OR [95%CI]: 1.65 [1.03-2.66]; P = 0.038).The results of this preliminary analyses showed that baseline serum RBP4 levels were independently associated with incident diabetes in Asian Indian men with IGT. It may be used as an additional predictor of future diabetes.

Improvement in diet habits, independent of physical activity helps to reduce incident diabetes among prediabetic Asian Indian men

AIMS

To assess the beneficial effects of the components of lifestyle intervention in reducing incidence of diabetes in Asian Indian men with impaired glucose tolerance (IGT) in India.

METHODS

This analysis was based on a 2 year prospective, randomized controlled primary prevention trial in a cohort of Asian Indian men with IGT (n=537) (Clinical Trial No: NCT00819455). Intervention and control groups were given standard care advice at baseline. Additionally, the intervention group received frequent, mobile phone based text message reminders on healthy lifestyle principles. Dietary intake and physical activity habits were recorded by validated questionnaires. The lifestyle goals were: reductions in consumption of carbohydrates, oil, portion size and body mass index of at least 1 unit (1 kg/m(2)) from baseline and maintenance of good physical activity. The association between diabetes and lifestyle goals achieved was assessed using multiple logistic regression analyses. Changes in insulin sensitivity (Matsuda's insulin sensitivity index) and oral disposition index during the follow-up were assessed.

RESULTS

At the end of the study, 123 (23.8%) participants developed diabetes. The mean lifestyle score was higher in the intervention group compared with control (2.59 ± 1.13 vs. 2.28 ± 1.17; P=0.002). Among the 5 lifestyle variables, significant improvements in the 3 dietary goal were seen with intervention. Concomitant improvement in insulin sensitivity and oral disposition index was noted. Higher lifestyle score was associated with lower risk of developing diabetes (odds ratio: 0.54 [95% CI: 0.44-0.70]; P<0.0001).

CONCLUSIONS

Beneficial effects of intervention were associated with increased compliance to lifestyle goals. The plausible mechanism is through improvement in insulin sensitivity and beta cell preservation.

Hypertriglyceridaemic waist phenotype as a simple predictive marker of incident diabetes in Asian-Indian men with prediabetes

AIM

To determine prospectively the association of baseline hypertriglyceridaemic waist phenotype with incident diabetes in Asian-Indian men with impaired glucose tolerance.

METHODS

In a randomized 2-year diabetes prevention trial in 517 men with impaired glucose tolerance, 123 (23.8%) developed diabetes. Baseline anthropometric, metabolic and clinical variables were estimated. Associations of hypertriglyceridaemic waist phenotype (waist circumference ≥ 90cm and a serum triglyceride level of ≥ 1.7 mmol/l) with insulin resistance and incident diabetes were assessed using multiple linear regression and Cox's proportional hazard models, respectively.

RESULTS

Men with an isolated enlarged waistline and hypertriglyceridaemic waist phenotype had significantly higher BMI and percentage of total body fat compared with the group with normal waistline and triglyceride levels and the group with isolated hypertriglyceridaemia. The men with hypertriglyceridaemic waist phenotype had higher insulin resistance (mean ± sd homeostasis model assessment of insulin resistance value: 3.6 ± 1.5) compared with those in the isolated enlarged waistline, the isolated hypertriglyceridaemia or the normal waistline and triglyceride level groups (3.1 ± 1.4, 2.7 ± 1.0 and 2.5 ± 1.1, respectively, all P < 0.05 compared with hypertriglyceridaemic waist phenotype). Multiple linear regression analyses showed that hypertriglyceridaemic waist phenotype was significantly associated with insulin resistance after adjusting for age, BMI, family history, percentage of total body fat, smoking, alcohol intake, 2-h plasma glucose and HDL cholesterol level. Hypertriglyceridaemic waist phenotype was independently associated with incident diabetes after adjusting for the above confounders and gamma-glutamyl transferase (hazard ratio 1.49, 95% CI 1.01-2.21; P = 0.047). The association of hypertriglyceridaemic waist phenotype with incident diabetes was abolished when insulin resistance was introduced into the model (hazard ratio 1.39, 95% CI 0.092-2.10; P=0.12).

CONCLUSIONS

Hypertriglyceridaemic waist phenotype is a simple clinical proxy measurement for insulin resistance and is strongly associated with incident diabetes in Asian-Indian men with impaired glucose tolerance.

Early improvement predicts reduced risk of incident diabetes and improved cardiovascular risk in prediabetic Asian Indian men participating in a 2-year lifestyle intervention program

OBJECTIVE

Objectives of this ancillary analysis of a prospective, prevention study among Asian Indians with impaired glucose tolerance (IGT) were a) to quantify the reduction in incident diabetes at 24 months in participants who achieved normal glucose tolerance (NGT) at 6 months (NGT-6 m) compared with the other participants, b) the factors influencing the reversal to NGT at the end of the study at 24 months (NGT-24 m), and c) to assess changes in cardiometabolic risk factors in different categories of dysglycemia at 24 months.

RESEARCH DESIGN AND METHODS

Data from a 2-year primary prevention trial were used. Effect of reversion to NGT-6 m on incidence of type 2 diabetes mellitus (T2DM) was analyzed using the Cox proportional hazards model. Predictive variables for reversal to NGT were identified using multiple logistic regression analysis. Changes in cardiometabolic risk factors were estimated according to the final glycemic status using fixed-effect, mixed-linear regression modeling.

RESULTS

The risk of T2DM in 2 years was lower by 75% in NGT-6 m group (hazard ratio 0.25 [95% CI 0.12-0.52]). Predictive variables for reversal to NGT-24 m were good baseline β-cell function (odds ratio [OR] 2.79 [95% CI 2.30-3.40]) and its further improvement (OR 5.70 [95% CI 4.58-7.08]), and NGT-6 m (OR 2.10 [95% CI 1.14-3.83]). BMI decreased in those who reverted to NGT. Deterioration to T2DM was associated with an increase in the levels of cardiometabolic risk factors.

CONCLUSIONS

Early reversion to NGT by lifestyle intervention in prediabetic men was associated with a significant reduction in subsequent incidence of diabetes. Good baseline β-cell function and its further improvement and NGT-6 m were associated with reversion to NGT-24 months. Reversion to NGT was associated with modest improvements, whereas conversion to T2DM was associated with significant worsening of the cardiometabolic risk profile.

Effectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India: a prospective, parallel-group, randomised controlled trial

BACKGROUND

Type 2 diabetes can often be prevented by lifestyle modification; however, successful lifestyle intervention programmes are labour intensive. Mobile phone messaging is an inexpensive alternative way to deliver educational and motivational advice about lifestyle modification. We aimed to assess whether mobile phone messaging that encouraged lifestyle change could reduce incident type 2 diabetes in Indian Asian men with impaired glucose tolerance.

METHODS

We did a prospective, parallel-group, randomised controlled trial between Aug 10, 2009, and Nov 30, 2012, at ten sites in southeast India. Working Indian men (aged 35-55 years) with impaired glucose tolerance were randomly assigned (1:1) with a computer-generated randomisation sequence to a mobile phone messaging intervention or standard care (control group). Participants in the intervention group received frequent mobile phone messages compared with controls who received standard lifestyle modification advice at baseline only. Field staff and participants were, by necessity, not masked to study group assignment, but allocation was concealed from laboratory personnel as well as principal and co-investigators. The primary outcome was incidence of type 2 diabetes, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00819455.

RESULTS

We assessed 8741 participants for eligibility. 537 patients were randomly assigned to either the mobile phone messaging intervention (n=271) or standard care (n=266). The cumulative incidence of type 2 diabetes was lower in those who received mobile phone messages than in controls: 50 (18%) participants in the intervention group developed type 2 diabetes compared with 73 (27%) in the control group (hazard ratio 0·64, 95% CI 0·45-0·92; p=0·015). The number needed to treat to prevent one case of type 2 diabetes was 11 (95% CI 6-55). One patient in the control group died suddenly at the end of the first year. We recorded no other serious adverse events.

INTERPRETATION

Mobile phone messaging is an effective and acceptable method to deliver advice and support towards lifestyle modification to prevent type 2 diabetes in men at high risk.

FUNDING

The UK India Education and Research Initiative, the World Diabetes Foundation.

Effects of Clonidine on Recovery after Sevoflurane Anaesthesia in Children Undergoing Cataract Surgery

This trial assessed the effects of two doses of clonidine compared with placebo on the quality and speed of recovery in children premedicated with oral midazolam and anaesthetised with sevoflurane for cataract surgery.

One hundred and twenty American Society of Anesthesiologists physical status I to II children (aged one to six years), premedicated with oral midazolam 0.5 mg/kg and undergoing elective unilateral cataract surgery with sevoflurane anaesthesia were studied. Children were randomised to intravenous clonidine 1 μg/kg (group C1, n=39), 2 μg/kg (group C2, n=41) or normal saline (group NS, n=40). Clinically successful sub-Tenon local anaesthesia block was required for a patient to be included in the analysis.

The primary outcome was the incidence of postoperative agitation. Postoperative agitation was defined as a Pain Discomfort Score of ≥3 using items 3 to 5 only, which was assessed 15 minutely until discharge. Agitation was observed in 11/40 (27.5%) children in the NS group compared to 2/39 (5.1%) in group C1 and none in group C2 (P <0.001). Rescue medication to treat severe agitation was required in 5/40 (12.5%) in the NS group, 1/39 (2.6%) in group C1 and none in group C2 (P=0.025). Time to meet discharge criteria was significantly shorter in group C1 compared to the other two groups (48.4±14.0 minutes compared to C2 79.5±12.8 minutes and NS 73.1±20.4 minutes, P <0.001). There were no significant effects on blood pressure and heart rate.

Intravenous clonidine 1 μg/kg is effective for reducing agitation after sevoflurane anaesthesia and midazolam premedication in children undergoing cataract surgery. Intravenous clonidine 2 μg/kg was also effective and for a longer period, but was associated with a longer time to discharge.

Type II lepra reaction: an unusual presentation

Ulcers with maculo-papular rash are an unusual presenting feature of leprosy. They occur as result of neuropathy, type-2 lepra reaction or Lucio's phenomenon. The hall mark of type-2 reaction is erythema nodosum. Very rarely it manifests as ulcerative skin lesions. We describe one such unusual case of a young male who presented with multiple ulcers and maculo-papular rash over the legs, chest and abdomen. In addition to this, he had fever, heart murmur, pulmonary infiltrates, neuropathy, and deranged liver function. A clinical differential diagnosis of infective endocarditis and systemic nectrozing vasculitis was made. Skin biopsy showed dense inflammation with lepra bacilli consistent with type-2 lepra reaction.

Modulatory influence of Adhatoda vasica Nees leaf extract against gamma irradiation in Swiss albino mice

The radiomodulatory influence of ethanolic extract of Adhatoda vasica Nees leaf extract against radiation-induced hematological alterations in peripheral blood of Swiss albino mice was studied at various post-irradiation intervals between 6 h to 30 days. Oral administration of A. vasica leaf extract (800 mg/kg body weight) prior to whole body irradiation showed a significant protection in terms of survival percentage and hematological parameters. Mice exposed to radiation (8.0 Gy) without A. vasica leaf extract pre-treatment exhibited signs of radiation sickness like anorexia, lethargicity, ruffled hairs and diarrhoea and such animals died within 25 days post-irradiation. The dose reduction factor (DRF = 1.6) for A. vasica leaf extract was calculated from LD50/30 values. A significant decline in hematological constituents (RBCs, WBCs, Hb and Hct) was evident till day 15 and no animal could survive beyond day 25. Conversely, animals pre-treated with A. vasica leaf extract showed 81.25% survival till 30 days after exposure and a gradual recovery was noted in the hematological values. However, these hematological values remained significantly below the normal even till day 30. A significant decrease in blood reduced glutathione (GSH) content and increase in lipid peroxidation (LPO) level was observed in control animals (Radiation alone). However, A. vasica leaf extract pretreated irradiated animals exhibited a significant increase in GSH content and decrease in LPO level. A significant increase in the serum alkaline phosphatase activity and decrease in acid phosphatase activity was observed in A. vasica leaf extract pretreated irradiated animals during the entire period of study.

Neuroprotection in glaucoma

Currently, glaucoma is recognised as an optic neuropathy. Selective death of retinal ganglion cells (RGC) is the hallmark of glaucoma, which is also associated with structural changes in the optic nerve head. The process of RGC death is thought to be biphasic: a primary injury responsible for initiation of damage that is followed by a slower secondary degeneration related to noxious environment surrounding the degenerating cells. For example, retinal ishaemia may establish a cascade of changes that ultimately result in cell death: hypoxia leads to excitotoxic levels of glutamate, which cause a rise in intra-cellular calcium, which in turn, leads to neuronal death due to apoptosis or necrosis. Neuroprotection is a process that attempts to preserve the cells that were spared during the initial insult, but are still vulnerable to damage. Although not yet available, a neuroprotective agent would be of great use in arresting the progression of glaucoma. There is evidence that neuroprotection can be achieved both pharmacologically and immunologically. Pharmacological intervention aims at neutralising some of the effects of the nerve-derived toxic factors, thereby increasing the ability of the spared neurons to cope with stressful conditions. On the other hand, immunological interventions boost the body's own repair mechanisms for counteracting the toxic effects of various chemicals generated during the cascade. This review, based on a literature search using MEDLINE, focuses on diverse cellular events associated with glaucomatous neurodegeneration, and discusses some pharmacological agents believed to have a neuroprotective role in glaucoma.

Frequency doubled Nd:YAG (532 nm) laser photocoagulation in corneal vascularisation: efficacy and time sequenced changes

PURPOSE

To evaluate the efficacy of frequency-doubled Nd:YAG (532 nm) laser treatment in quiescent corneal vascularisation, and to record the sequential changes in lasered vessels and complications in eyes with one and two quadrant vascularisation.

METHODS

Thirty eyes (30 patients)--15 eyes (15 patients) with one-quadrant and 15 eyes (15 patients) with two-quadrant corneal vascularisation were treated. Frequency-doubled Nd:YAG laser (532 nm) was used at laser setting of 120-480 mw power, 50-150 mm spot size and 0.05 sec pulse duration. The area of corneal vascularisation, status of treated corneal vessels, area of corneal opacity and visual acuity were recorded before treatment, at one week after treatment and thereafter at monthly intervals up to three months.

RESULTS

The mean area of corneal vascularisation decreased from 20.09% to 8.31% of the total corneal area in group I (p<0.01) and from 44.34% to 20.67% of the total corneal area in group II (p<0.01) at 3 months' follow-up. The mean reduction in the area of corneal vascularisation was 58.64% in group I and 53.38% in group II (p>0.05). Of 148 corneal vessels treated, 60 (44.6%) were totally occluded, 44 (30%) partially occluded, 37 (28%) recanalized and there was one shunt vessel at one week following laser treatment. At three months' follow-up, 80 (54.15%) vessels were totally occluded, 14 (9%) partially occluded, 52 (35.14%) recanalised and two shunt vessels appeared. Thus, at three months' follow-up, the number of totally occluded vessels increased and partially occluded vessels decreased. Superficial corneal haemorrhage was observed in 4 (14%) patients.

CONCLUSION

Frequency-doubled Nd:YAG (532 nm) laser photocoagulation appears a safe and effective means of reducing the area of corneal vascularisation in quiescent eyes with vascularised corneal opacities.

Retrieval of a dropped corneal button from a vitrectomized eye

A successful retrieval of a dropped corneal button from an aphakic vitrectomized eye during penetrating keratoplasty is reported. A 52-year-old female patient underwent penetrating keratoplasty for aphakic corneal edema in a vitrectomized eye. The donor button inadvertently dropped into the vitreous cavity and was retrieved successfully. The dropped corneal button was visualized after focusing the operating microscope on the retina. The visualization significantly improved after aspiration of the fluid from the vitrectomized eye. The donor button was picked up by McPherson's forceps and subsequently sutured to the recipient's cornea. Corneal surgeons need to be aware of this rare complication in aphakic vitrectomized eyes and its retrieval after accurate visualization.

Molecular theory of elastic constants of liquid crystals. III. Application to smectic phases with tilted orientational order

Using the density-functional formalism we derive an expression for the distortion free energy of systems with continuous broken symmetry and use it to derive an expression for the elastic constants of smectic phases in which the director is tilted with respect to the smectic layer normal. As in the previous papers of this series [Y. Singh, S. Singh, and K. Rajesh, Phys. Rev. A 45, 974 (1992); Y. Singh, K. Rajesh, V. J. Menon, and S. Singh, Phys. Rev. E 49, 501 (1994)], the expressions for the elastic constants are written in terms of order and structural parameters. The structural parameters involve the generalized spherical harmonic coefficients of the direct pair correlation function of an effective isotropic liquid. The density of this effective isotropic liquid depends on the nature and amount of ordering present in the system and is evaluated self-consistently. We estimate the value of elastic constants using reasonable guesses for the order and structural parameters.

Fungal endophthalmitis following cataract surgery: clinical presentation, microbiological spectrum, and outcome

PURPOSE

To determine the clinical presentation, microbiological spectrum, and outcome in cases of fungal endophthalmitis following cataract surgery.

DESIGN

Observational case series.

METHODS

SETTING

Tertiary referral hospital.

PATIENTS

Retrospective analysis of 27 cases of smear- and culture-proven fungal endophthalmitis.

INTERVENTION

Pars plana vitrectomy in 18 eyes, where the corneal condition did not preclude the same. All eyes received intravitreal amphotericin B and dexamethasone along with systemic antifungal agents.

MAIN OUTCOME MEASURES

Functional success: Final visual acuity of 3/60 or better with attached retina. Anatomical success: Final visual acuity of better than light perception with preserved anatomy of globe.

RESULTS

The majority of the eyes (22 of the 27) had early onset and diffuse presentation (that is, anterior segment as well as posterior vitreous exudates). Substantial corneal involvement was seen in 14 eyes (51.85%). Aspergillus sp. was the most common isolate. Multivariate analysis using forward stepwise logistic regression showed corneal involvement as the single most important risk factor in determining final visual outcome (P =.0429).

CONCLUSIONS

Early onset and diffuse presentation, which mimics bacterial endophthalmitis, stresses the importance of both bacterial and fungal cultures from intraocular fluids to reach a diagnosis apart from the clinical judgment. Corneal involvement was the most important predictor of outcome in cases of fungal endophthalmitis.

Intracameral amphotericin B: initial experience in severe keratomycosis

PURPOSE

Fungal keratitis is a significant cause of ocular morbidity in India. The most commonly implicated fungi are Aspergillus spp. Patients often present with hypopyon, which usually contains fungal elements. The treatment is difficult owing to poor intraocular penetration of most available antifungal agents. This study evaluated the results of intracameral injection of amphotericin B in natamycin resistant cases of severe keratomycosis.

METHODS

Three patients of culture proven Aspergillus flavus corneal ulcer with hypopyon not responding to topical natamycin 5%, amphotericin B 0.15%, and oral itraconazole were administered intracameral amphotericin B. The first case received 7.5 microg in 0.1 mL followed by two subsequent injections of 10 microg in 0.1 mL each, the second case received two injections of 10 microg in 0.1 mL, and the third patient received a single dose of 10 microg in 0.1 mL. Culture of the aqueous sample also grew A. flavus in all three cases.

RESULTS

All three cases responded favorably, with the ulcer and hypopyon clearing completely. There was no clinical evidence of corneal or lenticular toxicity in any patient.

CONCLUSIONS

Intracameral amphotericin B may be a useful modality in the treatment of severe keratomycosis not responding to topical natamycin. It ensures adequate drug delivery into the anterior chamber and may be especially useful to avoid surgical intervention in the acute stage of the disease.

Neodymium:YAG capsulotomy rates following phacoemulsification with implantation of PMMA, silicone, and acrylic intraocular lenses

BACKGROUND AND OBJECTIVE

Posterior capsular opacification (PCO) is the most common visually disabling sequela of modern cataract surgery. Methods of reducing its incidence include the development of newer surgical techniques and intraocular lens (IOL) materials and designs. The aim of this study was to compare the incidence and time interval of development of PCO, and the requirement of laser capsulotomy in patients implanted with a polymethylmethacrylate (PMMA), silicone, or acrylic IOL.

PATIENTS AND METHODS

The data of 340 consecutive patients who underwent phacoemulsification and implantation ofa PMMA, silicone, or acrylic intraocular lens were analyzed. The aim of this study was to compare the incidence and time interval of development of PCO, and the requirement of laser capsulotomy in patients implanted with a PMMA, silicone, or acrylic IOL.

RESULTS

The incidence of PCO was found to be significantly less in the acrylic group (6.5% as compared to 21.74% and 26.6% in the PMMA and silicone groups, respectively; P = 0.01297 and 0.0039). Most patients (65%) exhibiting PCO in the PMMA group developed it within the first six months. In the silicone group, development of PCO was delayed. In 60% of patients, it appeared 18 months after surgery. Neodymium:YAG capsulotomy was required in 45% and 60% of patients developing PCO in the PMMA and silicone groups, respectively, while it was required in only 1 of the 4 patients developing PCO in the acrylic group.

CONCLUSION

This study indicates that implantation of an acrylic IOL helps reduce the incidence of PCO as well as the need for Nd:YAG capsulotomy. PMMA IOLs require Nd:YAG capsulotomy earlier in the postoperative period as compared to silicone IOLs.

Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification

PURPOSE

To compare the incidence of posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) and phacoemulsification and to evaluate the role of posterior chamber intraocular lens (PC IOL) haptic fixation and biomaterial/design in reducing the incidence.

SETTING

Postgraduate Institute of Medical Education and Research, Chandigarh, India; Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.

METHODS

This study comprised 278 eyes of 263 patients having ECCE and 318 eyes of 297 patients having phacoemulsification with PC IOL implantation. Posterior capsule opacification leading to a decrease in Snellen visual acuity of 2 or more lines was considered visually significant. The presence of PCO and IOL haptic fixation were evaluated postoperatively using slitlamp biomicroscopy. Haptic position was noted as in-the-bag (B-B), 1 haptic in the bag and 1 in the sulcus (bag-sulcus [B-S]), or both haptics out of the bag (sulcus-sulcus [S-S]). In addition, the rate of visually significant PCO was compared among 3 IOL biomaterials: poly(methyl methacrylate), silicone, and hydrophobic acrylic.

RESULTS

Visually significant PCO occurred in 42.45% of eyes having ECCE and 19.18% of eyes having phacoemulsification (P <.001, chi-square test) after a mean follow-up of 2.4 years +/- 0.7 (SD). In both groups, visually significant PCO was significantly less in eyes with B-B fixation than in those with B-S or S-S fixation (P <.001). The rate of visually significant PCO in all eyes in the phacoemulsification group with B-B fixation was low (11.90%) and was significantly lower in eyes with a hydrophobic acrylic IOL (2.22%; P <.05, chi-square test).

CONCLUSIONS

In-the-bag PC IOL fixation is required to consistently reduce the incidence of PCO. Thorough removal of lens substance, including hydrodissection-assisted cortical cleanup, and in-the-bag PC IOL fixation seem to be the most important factors in reducing PCO, regardless of surgical procedure or IOL type used. Intraocular lens biomaterial and design also help prevent PCO.