Solid lipid-based nanoparticulate system for sustained release and enhanced in-vitro cytotoxic effect of 5-fluorouracil on skin Melanoma and squamous cell carcinoma

The present study aimed to prepare solid lipid-based nanoparticles (SLNs) using Precirol® ATO 5 as solid lipid and Poloxamer 188 and Tween 80 as surfactant and co-surfactant respectively, and SLNs-derived gel for sustained delivery, enhanced in-vitro cytotoxicity, enhanced cellular uptake of 5-FU and enhanced permeation of 5-FU across the skin. The 5-FU-loaded SLNs were prepared by the hot melt encapsulation method and converted into SLN-derived gel using a gelling agent (Carbopol 940). The 5-FU-loaded SLNs had a particle size in the range of 76.82±1.48 to 327±4.46 nm, zeta potential between -11.3±2.11 and -28.4±2.40 mV, and entrapment efficiency (%) in range of 63.46±1.13 and 76.08±2.42. The FTIR analysis depicted that there was no chemical interaction between 5-FU and formulation components. Differential scanning calorimetric analysis showed thermal stability of 5-FU in the nanoparticles and powdered X-ray diffraction analysis revealed successful incorporation of 5-FU in nanoparticles. The in-vitro release study of 5-FU-loaded SLNs showed biphasic release behavior with initial burst release followed by sustained release over 48 hr. The 5-FU-loaded SLNs showed a greater cytotoxic effect on skin melanoma (B16F10 cells) and squamous cell carcinoma (A-431 cells) as compared to free 5-FU drug solution after 48 hr. Flow cytometry and fluorescence microscopy displayed enhanced quantitative and qualitative cellular uptake of SLNs. The SLNs formulation showed acceptable safety and biocompatible profile after an acute toxicity study in Wistar rats. Moreover, ex-vivo permeation studies depicted 2.13±0.076 folds enhanced flux of 5-FU-loaded SLN derived gel compared to 5-FU plain gel, and skin retention studies revealed target efficiency (%) 2.54±0.03 of 5-FU-loaded SLN derived gel compared to 5-FU plain gel.

Ionically Cross-Linked Chitosan Nanoparticles for Sustained Delivery of Docetaxel: Fabrication, Post-Formulation and Acute Oral Toxicity Evaluation

Introduction

Polymeric nanoparticles are potential carriers for the efficient delivery of hydrophilic and hydrophobic drugs due to their multifaceted applications. Docetaxel is relatively less hydrophobic and twice as potent as paclitaxel. Like other taxane chemotherapeutic agents, docetaxel is not well tolerated and shows toxicity in the patients. Nanoencapsulation of potent chemotherapeutic agents has been shown to improve tolerability and therapeutic outcome. Therefore, the present study was designed to fabricate chitosan and sodium tripolyphosphate (STPP) based on ionically cross-linked nanoparticles for sustained release of docetaxel.

Methods

Nanoparticles were prepared by the ionic-gelation method by dropwise addition of the STPP solution into the chitosan solution in different ratios. CNPs were characterized for post-formulation parameters like size, zeta potential, scanning electron microscope (SEM), FTIR, DSC/TGA, pXRD, and in-vitro drug release, as well as for acute oral toxicity studies in Wistar rats.

Results and discussion

The optimized docetaxel loaded polymeric nanoparticles were in the size range (172.6nm–479.65 nm), and zeta potential (30.45–35.95 mV) required to achieve enhanced permeation and retention effect. In addition, scanning electron microscopy revealed rough and porous surface, whereas, FTIR revealed the compatible polymeric nanoparticles. Likewise, the thermal stability was ensured through DSC and TG analysis, and powder X-ray diffraction analysis exhibited solid-state stability of the docetaxel loaded nanoparticles. The in-vitro drug release evaluation in phosphate buffer saline (pH 7.4) showed sustained release pattern, i.e. 51.57–69.93% within 24 hrs. The data were fitted to different release kinetic models which showed Fickian diffusion as a predominant release mechanism (R²= 0.9734–0.9786, n= 0.264–0.340). Acceptable tolerability was exhibited by acute oral toxicity in rabbits and no abnormality was noted in growth, behavior, blood biochemistry or histology and function of vital organs.

Conclusion

Ionically cross-linked chitosan nanoparticles are non-toxic and biocompatible drug delivery systems for sustained release of chemotherapeutic agents, such as docetaxel.

Enhancement of Dissolution and Skin Permeability of Pentazocine by Proniosomes and Niosomal Gel

Proniosomes (PN) are the dry water-soluble carrier systems that may enhance the oral bioavailability, stability, and topical permeability of therapeutic agents. The low solubility and low oral bioavailability due to extensive first pass metabolism make Pentazocine as an ideal candidate for oral and topical sustained release delivery. The present study was aimed to formulate the PNs by quick slurry method that are converted to niosomes (liquid dispersion) by hydration, and subsequently formulated to semisolid niosomal gel. The PNs were found in spherical shape in the SEM and stable in the physicochemical and thermal analysis (FTIR, TGA, and XRD). The quick slurry method produced high recovery (> 80% yield) and better flow properties (θ = 28.1-37.4°). After hydration, the niosomes exhibited desirable entrapment efficiency (44.45-76.23%), size (4.98-21.3 μm), and zeta potential (- 9.81 to - 21.53 mV). The in vitro drug release (T_100%) was extended to more than three half-lives (2-4 h) and showed good fit to Fickian diffusion indicated by Korsmeyer-Peppas model (n = 0.136-0.365 and R² = 0.9747-0.9954). The permeation of niosomal gel was significantly enhanced across rabbit skin compared to the pure drug-derived gel. Therefore, the PNs are found promising candidates for oral as dissolution enhancement and sustained release for oral and topical delivery of pentazocine for the management of cancer pain.

Development of Eudragit RS 100 Microparticles Loaded with Ropinirole: Optimization and In Vitro Evaluation Studies

The current study aimed to develop novel pH independent microparticles loaded with ropinirole (ROP) for sustained drug release. Eudragit RS 100 was used as release retardant and microparticles were fabricated by oil-in-oil emulsion solvent evaporation method. A three-factor three-level Box-Behnken design using Design-Expert software was employed to optimize formulation variables. Ropinirole loaded microparticles were evaluated with respect to morphology, particle size, encapsulation efficiency, and in vitro release profile. Optical microscopy and SEM micrographs indicated spherical shape with smooth surface and well-defined boundary. The particle size was in the range of 98.86 to 236.29 μm, being significantly increased with increasing polymer concentration. Higher polymer load also increased the thickness of internal polymer network, which led to reduced drug loss and higher entrapment efficiency (89%). The cumulative in vitro release was found to be in the range of 54.96 to 99.36% during the release studies (12 h) following zero order release kinetics and non-Fickian diffusion pattern. The developed microparticles have the potential to sustain the release of ropinirole, which may lead to a reduction in its adverse effects and improved management of Parkinson's disease.

Medication persistence in older women with osteoporosis: a pilot study

Most osteoporosis patients stop their medications before they should. Side effects are the most common reason patients in this sample stopped their medication before they told their physician. Physicians should use shared decision-making and discuss side effects of osteoporosis medications with their patients and explain the risks of the medications.

INTRODUCTION

The aims of this study were to (a) qualitatively examine reasons for medication non-persistence in osteoporosis, and (b) investigate how medication non-persistence in osteoporosis is associated with outcome expectations, self-efficacy, trust in physicians, and health locus of control.

METHODS

Subjects were recruited from online support groups to answer an anonymous online survey. Subjects were eligible if they (a) were female, (b) were at least 40 years of age, (c) self-identify as having osteoporosis, and (d) have taken at least one medication for osteoporosis. During the survey, subjects completed measures of self-efficacy, outcome expectations, trust in physicians generally, health locus of control, and demographic information.

RESULTS

Thirty-four subjects completed the online survey and had usable data. Approximately 82 % (n = 28) of subjects reported discontinuing an osteoporosis medication without first consulting a physician. The most common reason patients discontinued an osteoporosis medication was adverse effects. Subjects were more likely to discontinue their medications when they had poorer outcome expectations on average (p = 0.01), had lower trust in physicians on average (p < 0.0001), and had more of a doctors-centered locus of control (p = 0.03). Self-efficacy, age, insurance, status, and other measures of locus of control were not associated with medication non-persistence.

CONCLUSIONS

Side effects are a significant concern for women with osteoporosis and may be a cause for medication non-persistence.

Formulation design and characterization of a non-ionic surfactant based vesicular system for the sustained delivery of a new chondroprotective agent

Diacerein is used for symptomatic relief and cartilage regeneration in osteoarthritis. Due to gastrointestinal side effects, poor aqueous solubility and low bioavailability, its clinical usage has been restricted. The objective of the present study was to enhance its dissolution profile and to attain sustained release by designing a novel delivery system based on niosomes. Five niosomal formulations (F1-F5) with non-ionic surfactant (sorbitan monostearate) and cholesterol in varying ratios of 5:5, 6:4, 7:3, 8:2 and 9:1 were developed by the reverse-phase evaporation technique. The size and polydispersivity index (PDI) were found in the range of 0.608 µm to 1.010 µm and 0.409 to 0.781, respectively. Scanning electron microscopy (SEM) of the selected formulation (F3) revealed spherical vesicles, and 79.8% entrapment was achieved with F3 (7:3). Dissolution studies using the dialysis method showed sustained release behaviour for all formulations. The optimized surfactant-to-cholesterol concentration (7:3) in formulation F3sustained the drug-release time (T50%) up to 10 hours. Kinetic modelling exhibited a zero-order release (R2=0.9834) and the release exponent 'n' of the Korsmayer-Peppas model (n=0.90) confirmed non-fickian and anomalous release. The results of this study suggest that diacerein can be successfully entrapped into niosomes using sorbitan monostearate and that these niosomes have the potential to deliver diacerein efficiently at the absorption site.

Solid and liquid lipid-based binary solid lipid nanoparticles of diacerein: in vitro evaluation of sustained release, simultaneous loading of gold nanoparticles, and potential thermoresponsive behavior

Binary fatty acid mixture-based solid lipid nanoparticles (SLNs) were prepared for delivery of diacerein, a novel disease-modifying osteoarthritis drug, with and without simultaneously loaded gold nanoparticles (GNPs). In order to optimize SLNs for temperature-responsive release, lipid mixtures were prepared using different ratios of solid (stearic acid or lauric acid) and liquid (oleic acid) fatty acids. SLNs were prepared by microemulsification (53 nm), hot melt encapsulation (10.4 nm), and a solvent emulsification-evaporation technique (7.8 nm). The physicochemical characteristics of SLNs were studied by Zetasizer, Fourier transform infrared, and X-ray diffraction analysis. High encapsulation of diacerein was achieved with diacerein-loaded and simultaneously GNP-diacerein-loaded SLNs. In vitro dissolution studies revealed a sustained release pattern for diacerein over 72 hours for diacerein-loaded SLNs and 12 hours for GNP-diacerein-loaded SLNs. An increase in diacerein payload increased the release time of diacerein while GNPs decreased it. In addition, rapid release of diacerein over 4 hours was observed at 40°C (melting point of optimized fatty acid mixture), demonstrating that these binary SLNs could be used for thermoresponsive drug delivery. Kinetic modeling indicated that drug release followed zero order and Higuchi diffusion models (R¹⁰>0.9), while the Korsmeyer-Peppas model predicted a diffusion release mechanism (n<0.5).

Efficiency measurement for hospitals owned by the Iranian social security organisation

This study used Data Envelopment Analysis (DEA) to examine the relative efficiency of hospitals owned by the Iranian Social Security Organization, which is the second largest institutional source of hospital care in that country. Using data for the year 2002, 26 of the 53 hospitals were deemed to be efficient. Inefficient hospitals had an average score of 90%, implying a potential reduction in all inputs on average by about 10% with no impact on output levels. In addition to the conventional DEA measurement, efficient hospitals were ranked by calculating super-efficiency scores, by identifying weak efficient hospitals, and by determining the frequency of peers. The study provides useful information for improving hospital management, rationalizing resource allocation, and improving services provided by hospitals.

Community knowledge, attitude and practices regarding sexually transmitted infections in a rural district of Pakistan

OBJECTIVE

To determine knowledge, attitude and practices regarding sexually transmitted infections in district Khairpur, Sindh, Pakistan.

DESIGN AND METHODOLOGY

A needs assessment study employing a community based survey, key informant interviews and focus group discussions was conducted in all seven sub-districts of the district. This paper is based on the results of the key informant interviews and the focus group discussions. Thirty interviews and six group discussions were held with members of the community and with the health care providers.

RESULTS

There was little awareness regarding causes and prevention of sexually transmitted infections in the community. The situation was slightly better among health care providers. While health care providers believed that the prevalence of sexually transmitted infections is high, the community did not consider themselves at risk. The community believed that these diseases are a problem among a sub-population of male adolescents, especially those who have homosexual relations. However, due to social norms, they rarely discussed such health problems with other family members or elders. Adolescents with any sexual health problems visit hakims and quacks. The community was aware about aetiology and some of the risk factors associated with AIDS and hepatitis, most probably due to the recent public health campaigns against both diseases.

CONCLUSION

Considering the suspected high prevalence of sexually transmitted infections and the relative lack of knowledge, it is imperative that a public health intervention be initiated. This must include educating not only the community but also the health workers. The governments' initiative to train community workers in reproductive health is a step in the right direction (JPMA 52:21, 2002).

Prevalence and factors associated with practice of modern contraceptive methods among currently married women in District Naushahro Feroze

OBJECTIVE

To estimate the prevalence and factors associated with practice of modern contraceptive methods among currently married women of reproductive age group (15-49 years) in District Naushahro Feroze.

METHODS

A community based cross-sectional survey was conducted from May to June 2000. We interviewed 420 currently married women of reproductive age group (15-49) years. Information regarding socio-demographic factors, economic condition, their source of information for the message of family planning and reason of using any modern contraceptive method.

RESULTS

The prevalence of modern contraceptive method was 27.9%. Final multiple logistic regression analysis showed that with husband agreement (OR, 5.4; 95% CI 2.2-13.2), women could go alone to a health care provider (OR, 1.4; 95% CI 1.1-2.4) and women employment status (OR, 2.5 95% CI 1.2-5.2) were significantly associated with practice of modern contraceptive methods. Similarly, those women who had 3 or more children were more likely to use any modern contraceptive methods compared to those who have 2 or less children. In addition, husband's education was also found significantly associated with family planning practice.

CONCLUSION

The practice of modern contraceptive method is low. Socio demographic factors of women were significantly associated with use of modern contraceptive methods. Male and female education and small group discussions of various issues related to family planningand reproductive health may be helpful in creating awareness in the district.

Community context of health system development: implications for health sector reform in Pakistan

To describe local sociopolitical and organizational factors that influence health system development in Karachi, Pakistan, we conducted participant observation while working with health providers and communities in one urban district to reorient services towards a primary health care district health system. We found that the community characteristics, particularly the diverse socialpolitical and cultural make-up and organizational complexity that involved multiple levels of government, influenced efforts towards collaboration and shaped the development of the health system. We conclude that for effective implementation of health sector reform there is a need to comprehend fully the community context and complexity of existing health service provision.

Socio-economic factors, personal illness control and infant and child mortality in Pakistan

"The hypothesis of the inverse relationship of socio-economic status of the parents and child infant mortality rates has been retested by introducing 'personal illness control' as an intervening variable. The data obtained in the 1984/1985 Pakistan Contraceptive Prevalence Survey have been used. The infant and child mortality rates have been estimated by using indirect techniques." The author finds that infant and child mortality rates are lower among upper socioeconomic groups, with mother's educational status being particularly important.

Utility of participatory rural appraisal for health needs assessment and planning

BACKGROUND

While poverty and lack of life opportunities are root causes of a high burden of disease and infant and maternal mortality, inadequate health care contributes heavily. Often those who are left without care are those who need it most. Existing health services are managed without taking into account acceptance and need perspectives. This further reduces the effectiveness of and equity in health care. In order to guide the planning of reproductive health services by a national NGO, health needs were assessed in a district in Sindh using a combination of participatory rural appraisal (PRA) and qualitative and quantitative research methods. PRA is considered as a better framework to assess, analyse and develop programs with communities.

OBJECTIVE

The objective of PRA was to initiate community involvement and to understand the needs of health care from a community perspective.

METHODOLOGY

PRA was conducted with groups of men and women from three rural areas in a district of Sindh, Pakistan using a life cycle framework. The community members identified various stages of their life with the associated health issues.

RESULTS

This research was empowering to community members as it facilitated community involvement. The respondents took charge of the process of identification of health needs at PRA sessions. PRA helped identify health problems considered prevalent and important by the community. More importantly, it helped potential service providers and the community to initiate community involvement in planning.

CONCLUSION

PRA is not only an effective tool for assessment and analysis of health issues but also a vehicle to promote community involvement. Additionally, participatory methods contribute to understand the context of quantitative data generated for planning purposes.

Health needs of clients as reported by medical practitioners from two districts of Sindh

OBJECTIVE

To identify the major health and reproductive health problems for which people consult local medical practitioners.

METHODOLOGY

Forty-one practitioners completed a self-administered questionnaire. A startified purposive sample of practitioners was selected by asking the community members from various towns and rural areas to identify practitioners who have most busy practices and are perceived as providing quality care.

RESULTS

Nine of the forty-one practitioners were females. Twenty-two were consulted mainly by women and another seventeen by an equal number of women and men. Practitioners pointed to malnutrition, malaria, gastrointestinal and respiratory tract problems as being the most common ailments. They identified menstrual problems, malnutrition among pregnant women, burning micturition and vaginal discharge as the most common reproductive health problems of their clients. Only 16 medical practitioners said that they diagnosed someone in the last one-month as suffering from sexually transmitted infections.

CONCLUSION

The survey helped in developing an understanding of health issues from provider perspective. Findings indicate a concordance between what has been revealed by previous population based studies in similar situations and to what health problems practitioners pointed as common. While a comprehensive needs-assessment requires surveys and qualitative interviews with communities, consultations with relatively fewer medical practitioners could also provide a quick and fair approximation of priority health problems in the area.

Community knowledge, attitude and practices regarding sexually transmitted infections in a rural district of Pakistan

OBJECTIVE

To determine knowledge, attitude and practices regarding sexually transmitted infections in district Khairpur, Sindh, Pakistan.

DESIGN AND METHODOLOGY

A needs assessment study employing a community based survey, key informant interviews and focus group discussions was conducted in all seven sub-districts of the district. This paper is based on the results of the key informant interviews and the focus group discussions. Thirty interviews and six group discussions were held with members of the community and with the health care providers.

RESULTS

There was little awareness regarding causes and prevention of sexually transmitted infections in the community. The situation was slightly better among health care providers. While health care providers believed that the prevalence of sexually transmitted infections is high, the community did not consider themselves at risk. The community believed that these diseases are a problem among a sub-population of male adolescents, especially those who have homosexual relations. However, due to social norms, they rarely discussed such health problems with other family members or elders. Adolescents with any sexual health problems visit hakims and quacks. The community was aware about aetiology and some of the risk factors associated with AIDS and hepatitis, most probably due to the recent public health campaigns against both diseases.

CONCLUSION

Considering the suspected high prevalence of sexually transmitted infections and the relative lack of knowledge, it is imperative that a public health intervention be initiated. This must include educating not only the community but also the health workers. The governments' initiative to train community workers in reproductive health is a step in the right direction.

Penetrating Keratoplasty vs. Epikeratoplasty for the Surgical Treatment of Keratoconus

PURPOSE

Penetrating keratoplasty and epikeratoplasty have been utilized in the surgical treatment of keratoconus. Comparison of the relative efficacy of each procedure in achieving visual outcomes has not been achieved due to limited numbers of cases and follow-up in previous series.

METHODS

All patients who underwent either penetrating keratoplasty or epikeratoplasty for keratoconus between January 1987 and December 1997, and for whom at least 24 months of postoperative follow-up data for visual acuity was documented in the medical record, were included in this retrospective, nonrandomized, sequential comparative trial. The sole criteria for outcome in each group, as well as for comparison of the two groups, was Snellen visual acuity measured at the time of each follow-up with the presenting optical aid.

RESULTS

Inclusion criteria were met for 443 eyes treated with penetrating keratoplasty and 161 eyes treated with epikeratoplasty. Mean follow-up was 4.3 years for penetrating keratoplasty and 4.5 years for epikeratoplasty. In each group, approximately 50% of the patients chose rehabilitation with optical correction with either spectacles or contact lenses and 50% chose no optical correction. Final median logMAR visual acuity for all patients, irrespective of means of visual rehabilitation, was 0.30 (20/40) for penetrating keratoplasty and 0.40 (20/50) for epikeratoplasty (P < .00005). In 209 penetrating keratoplasty and 77 epikeratoplasty eyes with optical correction, the final median logMAR visual acuity was 0.18 (20/30) for penetrating keratoplasty and 0.40 (20/50) for epikeratoplasty (P < .00005). The final median logMAR visual acuity in 234 penetrating keratoplasty and 84 epikeratoplasty eyes without optical correction was 0.48 (20/60) in both groups (P-value was not statistically significant).

CONCLUSIONS

Although penetrating keratoplasty was statistically superior to epikeratoplasty with respect to visual outcome, results with epikeratoplasty were adequate to recommend its use as a surgical alternative in cases when it is not desirable to perform penetrating keratoplasty.

Sclerokeratitis: an unusual presentation of squamous cell carcinoma of the conjunctiva

OBJECTIVE

To describe three cases of squamous cell carcinoma of the conjunctiva presenting with corneal and scleral inflammation, thinning, and perforation without any tumor formation.

DESIGN

Three case reports.

PARTICIPANTS

Three male subjects aged 76, 66, and 61 years.

INTERVENTION

The subjects had symptoms of external ocular inflammation with focal corneal or scleral thinning and inflammation, as well as interstitial keratitis in two cases. Initial diagnosis of sclerokeratitis with limbal thinning was made in all three in addition to a pterygium in case 2.

MAIN OUTCOME MEASURES

Diagnosis of the carcinoma was delayed for 2 to 24 months in two cases, whereas case 2 was diagnosed on excision of a pterygium from the involved area.

RESULTS

All subjects developed intraocular extension after further scleral thinning and perforation without tumefaction.

CONCLUSIONS

Squamous cell carcinoma of the conjunctiva may be seen without a distinct mass and can masquerade as sclerokeratitis, scleromalacia, or interstitial keratitis. It seems that diffuse growth with inflammation leads to thinning, necrosis, and perforation of the ocular wall with resultant intraocular spread. Squamous cell carcinoma should be considered in the differential diagnosis of corneal and scleral thinning, perforation, and inflammation of unknown cause, especially in the older male subject.

Corneal amyloidosis associated with congenital hereditary endothelial dystrophy

PURPOSE

To report the unusual occurrence of corneal amyloidosis indistinguishable from primary gelatinous drop-like dystrophy in three members of a family with congenital hereditary endothelial dystrophy (CHED).

METHOD

Case study of three patients.

RESULTS

Three patients, a 5-year-old girl, her 21-year-old maternal aunt, and a 16-year-old paternal uncle, presented with bilateral corneal edema and opacification secondary to CHED. All three underwent penetrating keratoplasty, cases 1 and 3 in one eye and case 2 in both eyes. Histopathology confirmed the diagnosis of CHED in all three patients but also revealed multiple subepithelial nodular deposits of amyloid, consistent with the diagnosis of primary gelatinous drop-like dystrophy, in all four specimens. Three other members of the same family underwent penetrating keratoplasty with histologic confirmation of CHED with no deposits of amyloid.

CONCLUSION

To our knowledge, this is the first report of subepithelial corneal amyloid deposits in association with CHED. This may represent the concurrence of two primary dystrophies, although secondary amyloidosis cannot be ruled out. Early manifestation and absence of amyloid in three other family members with CHED lends more weight to a primary etiology.

Penetrating keratoplasty in eyes with keratoconus and vernal keratoconjunctivitis

PURPOSE

To determine the prognosis of penetrating keratoplasty in eyes with keratoconus and vernal keratoconjunctivitis.

METHODS

The medical records of all patients with keratoconus and vernal keratoconjunctivitis who underwent penetrating keratoplasty at King Khaled Eye Specialist Hospital from January 1, 1986 to December 31, 1996 and for whom at least 24 months' follow-up is available were analyzed retrospectively.

RESULTS

Of 85 (61 males, 24 females) patients, 90 eyes met the inclusion criteria. The mean follow-up was 44.7 (range, 26-144) months. At the most recent follow-up visit, 83 (92.2%) grafts were clear. The mean best corrected visual acuity was 20/40. Graft rejection episodes occurred in 12 (13.3%) eyes, with irreversible graft failure occurring in 4 (4.4%) eyes. Bacterial keratitis occurred in 6 (7.7%) eyes, 2 (2.2%) of which developed irreversible graft failure. Herpes simplex keratitis resulted in irreversible graft failure in 1 (1.1%) eye.

CONCLUSION

Penetrating keratoplasty in eyes with keratoconus and vernal keratoconjunctivitis has an excellent visual outcome and a low complication rate.

Congenital sclerocorneal epithelial cyst

PURPOSE

To report a case of congenital intrascleral epithelial cyst.

METHOD

Case report.

RESULTS

A 3-year-old boy presented with a limbal cyst noticed at birth. The cyst enlarged over the next 3 1/2 years and dissected into the cornea, compromising the visual axis. Excision of the cyst improved the patient's best-corrected visual acuity in the left eye from 20/80 to 20/30. Upon histopathology, the cyst wall was lined by conjunctival epithelium.

CONCLUSION

This congenital intrascleral epithelial cyst later enlarged and dissected into the cornea. We believe that the cyst developed secondary to congenital sequestration of conjunctival epithelium.

Detachment of Descemet's membrane

PURPOSE

To determine predisposing factors, best method of treatment, and the final outcome in cases of Descemet's membrane detachment.

SETTING

A tertiary care teaching eye hospital.

METHODS

All cases of Descemet's detachment from January 1986 to May 1994 were retrospectively reviewed. Twelve eyes of 11 patients with partial or total detachment of Descemet's membrane were identified. Patients with small localized detachments at the incision area were excluded.

RESULTS

All but one patient had surgical repair. Ten eyes had successful reattachment after up to four attempts at repair. Methods of repair included intracameral air or sulfur hexafluoride (SF6) 20% gas, with or without corneal sutures. After a followup of 3 to 79 months, eight eyes retained clear corneas, four eyes developed corneal edema and scarring, and two required penetrating keratoplasty. No definite predisposing factor could be identified, although four eyes had preoperative diagnoses of glaucoma and recent corneal edema.

CONCLUSION

Surgical repair with injection of intracameral air or SF6 20% was successful in most cases of Descemet's membrane detachment. A preoperative diagnosis of glaucoma and a recent episode of corneal edema may increase the risk of detachment.

Isolated hepatic mucormycosis in an immunocompetent child

A case of isolated localized hepatic mucormycosis in an immunocompetent 3 1/2-yr-old girl with concomitant acute toxoplasmosis is described. Mucormycosis is rare in immunocompetent patients, and hepatic mucormycosis has so far been described only in the context of disseminated disease. The infection resolved spontaneously without surgical debridement and/or appropriate medical therapy with amphotericen B.

Pyogenic granulomas of the cornea

BACKGROUND

Pyogenic granulomas are vascular inflammatory lesions that represent an aberrant wound healing response. They typically arise from mucous membranes or skin. Pyogenic granulomas primarily involving the cornea have been rarely reported.

METHODS

Between January 1983 and July 1994, 14 patients with histologically proven pyogenic granulomas of the cornea were treated.

RESULTS

The precipitating event was a persistent epithelial defect in nine patients. Ocular surface disease was present in all patients. Predisposing conditions included indolent corneal ulceration, cry eye syndrome, trachoma, trichiasis, alkali burn, multiple topical drug use, previous orbital irradiation, and ocular cicatricial pemphigoid.

CONCLUSIONS

Ophthalmologists should be aware that pyogenic granulomas may involve the cornea and include this entry in the differential diagnosis of tumors involving the limbus or cornea. The typical clinical appearance, rapid growth, minimal staining with rose bengal dye, response to topical steroids, and associated ocular surface disease help to distinguish this lesion from a neoplastic epithelial tumor of the conjunctiva or cornea.

Nephrotic syndrome in 1st year of life and the role of unilateral nephrectomy

The study includes 17 infants with nephrotic syndrome. Their ages at the onset of disease ranged from 10 days to 10 months (median 2 months), and included 10 males and 7 females. Ten patients had consanguineous parents and 4 had a history of similar illness in the sibling. Renal biopsy revealed diffuse mesangial proliferation in 10 patients, diffuse mesangial sclerosis in 3, Finnish microcystic disease in 2, and focal segmental glomerulosclerosis and atypical glomerulopathy in 1 each. Unilateral nephrectomy was performed in 8 patients with intractable proteinuria associated with multiple complications. Five are well after 4-36 months follow-up, 1 died of septicaemia soon after the procedure, 1 needed dialysis and is stable at 26 months and 1 showed no reduction in the degree of proteinuria. We conclude that unilateral nephrectomy is a better alternative to bilateral nephrectomy in some infants with severe nephrotic syndrome.

Peripheral ulcerative keratitis associated with hideradenitis suppurativa

Peripheral ulcerative keratitis (PUK) is a noninfectious inflammation and ulceration of the peripheral cornea. It may be idiopathic--i.e., Mooren's ulcer--or it may be associated with a variety of systemic disorders, including many collagen vascular diseases. We present a patient who had bilateral peripheral infiltrative and ulcerative keratitis in association with severe hideradenitis suppurativa (HS), a suppurative and cicatricial disease of the apocrine glands of the skin. The peripheral ulcerative keratitis was unresponsive to all routine treatment modalities, but it finally responded to immunosuppression by cyclophosphamide, given orally. To the best of our knowledge, there is only one report in the dermatology literature citing the association of hideradenitis suppurativa and interstitial keratitis.

Acute renal failure in non-fulminant hepatitis A infection

A 7-year-old boy developed acute renal failure during the icteric phase of non-fulminant hepatitis A infection. He needed peritoneal dialysis for 3 days, which was followed by a rapid recovery in renal function which was normal when he was discharged 4 weeks later.

Nephrotic syndrome in Saudi children clinicopathological study of 150 cases

The study includes 150 children with primary nephrotic syndrome (NS), aged 16 months to 13 years with a median age of 5 years. The male to female ratio was 2:1 and the familial occurrence was 6%. Amongst 48 biopsied patients, 19 (39%) had focal segmental glomerulosclerosis, 17 (35%) had diffuse mesangial proliferative glomerulonephritis (MesPGN) and 10 (21%) had minimal change nephropathy. About 90% of patients responded to the initial prednisolone therapy. Subsequently 45% of steroid-sensitive patients had frequent relapses, 23% had no relapses, 21% had infrequent relapses and 5% became steroid resistant. Saudi children with primary NS showed no differences as regards age at onset, male predominance and response to initial prednisolone therapy when compared with published data from other countries. However, the higher incidence of familial occurrence, the relatively high frequency of MesPGN, the rarity of infection-related NS and a decreasing incidence of serious infections with improving socio-economic status were all noteworthy.

Pharmacokinetics of aditoprim in goats using a radioassay

A simple, highly sensitive radioassay was developed for the activity of a newly discovered inhibitor of dihydrofolate reductase (DHFR), aditoprim. The procedure is based on the inhibition of binding of [3H]-methotrexate ([3H]MTX) with bacterial dihydrofolate reductase by the antifolate, aditoprim. The analytic sensitivity using this binding inhibition method was less than 5 ng in plasma. The procedure developed requires no extraction of the drug from the plasma. The variation of simultaneous duplicate determinations was 6.3 per cent, whereas the variability of plasma samples assayed on different days was less than 11 per cent. The assay developed was applied to study the pharmacokinetics of aditoprim in the goat. In comparison with trimethoprim (TMP), the new inhibitor of DHFR, aditoprim, had a longer half-life and a larger volume of distribution, suggesting enhanced and prolonged antibacterial activity of aditoprim over TMP.

Herpes zoster ophthalmicus, contralateral hemiplegia, and recurrent ocular toxoplasmosis in a patient with acquired immune deficiency syndrome-related complex

A 42-year-old man presented with herpes zoster ophthalmicus on the right side. He was found to have acquired immune deficiency syndrome-related complex. Two weeks later he developed toxoplasmic retinochoroiditis in the left eye. He also presented later with left hemiplegia, which was probably caused by herpes zoster arteritis. Nine months after the retinal lesion resolved he developed another area of toxoplasmic retinochoroiditis adjacent to the first lesion. Herpes zoster may be the first presentation of acquired immune deficiency syndrome-related complex in a young healthy individual. Ophthalmologists are encountering patients with acquired immune deficiency syndrome who may have multiple organisms as the cause for their ocular infections and this might pose a treatment dilemma. The combination of herpes zoster ophthalmicus and ocular toxoplasmosis in this patient makes this case unusual.

Transient lenticular opacification following trabeculectomy

Permanent lens changes may occur following filtering procedures for glaucoma, most often within a few years after the surgery. We present a case in which transient lenticular opacification occurred two days after trabeculectomy without intraoperative injury to the lens. The patient regained her preoperative vision 2 weeks postoperatively. We postulate that such reversible lenticular opacities may be due to changes in lens metabolism associated with hypotony.

Retinal microangiopathy in pigmented paravenous chorioretinal atrophy

This report describes an atypical case of pigmented paravenous chorioretinal atrophy, associated with focal progressive peripheral retinal microangiopathy, in a 51-year-old black female. The eyes were asymmetrically involved. Although several cases have been reported with typical features of this uncommon entity, none of them have been known to be associated with retinal microangiopathy. The occurrence of such microangiopathy supports the hypothesis that damage to the retinal photoreceptors may induce retinal microangiopathy, as suggested in other clinical and experimental studies.

Complete evulsion of the globe and optic nerve

A 17-year-old boy had an evulsion of globe and optic nerve from an automobile accident. Computed tomography showed a severed optic nerve on the injured side. A visual field defect was demonstrated in the other eye.

Association of rosacea and keratoconjunctivitis sicca

Sixty consecutive patients with active ocular rosacea underwent Schirmer's test without anesthesia. A randomly selected group of 120 patients without rosacea, matched for age and sex, served as controls. The prevalence of dry eyes was significantly greater in the patients with rosacea. The coexistence of keratoconjunctivitis sicca and ocular rosacea probably causes a high level of symptoms that lead patients to examination and recognition.