Urinalysis and culture results of free-catch urine samples in dogs: a randomised controlled trial

OBJECTIVES

To evaluate the prevalence of bacterial presence in free-catch urine samples preceded by either a standardised prepped ("clean-catch") protocol versus unprepped (non-cleaned) voiding.

MATERIALS AND METHODS

The study was a single-centre prospective single-blinded randomised controlled trial. Urine samples were obtained from 100 client-owned dogs presenting for routine evaluation. Dogs were randomly assigned to either the prepped group (preputial or peri-vulvar area cleaned with sterile saline before collection) or the unprepped group (no preliminary cleansing) stratified by sex. Urinalysis and urine culture (blood and MacConkey agar) were performed on all samples. Significant bacterial presence on urine culture was defined as >104 colony forming units (CFU)/mL.

RESULTS

There were no statistically significant associations between prepped versus unprepped collection method or sex with a urinalysis positive for bacteriuria. However, on culture, significant bacterial growth was almost five times more likely to be associated with males relative to females (odds ratio 4.59, 95% confidence interval 1.61 to 13.10). The probability of finding a positive culture was not statistically associated with prep method (odds ratio 1.43, 95% confidence interval 0.50 to 4.08).

CLINICAL SIGNIFICANCE

For the majority of dogs without clinical signs of urinary tract infection, free-catch urine collection does not result in significant bacteriuria found on analysis or culture. The presence of bacteria found in free-catch samples may be secondary to sample contamination or subclinical bacteriuria. Sample contamination or subclinical bacteriuria may be more prevalent in male dogs.

Accurate determination of CRISPR-mediated gene fitness in transplantable tumours

Assessing tumour gene fitness in physiologically-relevant model systems is challenging due to biological features of in vivo tumour regeneration, including extreme variations in single cell lineage progeny. Here we develop a reproducible, quantitative approach to pooled genetic perturbation in patient-derived xenografts (PDXs), by encoding single cell output from transplanted CRISPR-transduced cells in combination with a Bayesian hierarchical model. We apply this to 181 PDX transplants from 21 breast cancer patients. We show that uncertainty in fitness estimates depends critically on the number of transplant cell clones and the variability in clone sizes. We use a pathway-directed allelic series to characterize Notch signaling, and quantify TP53 / MDM2 drug-gene conditional fitness in outlier patients. We show that fitness outlier identification can be mirrored by pharmacological perturbation. Overall, we demonstrate that the gene fitness landscape in breast PDXs is dominated by inter-patient differences.

Results of the phase I CCTG IND.231 trial of CX-5461 in patients with advanced solid tumors enriched for DNA-repair deficiencies

CX-5461 is a G-quadruplex stabilizer that exhibits synthetic lethality in homologous recombination-deficient models. In this multicentre phase I trial in patients with solid tumors, 40 patients are treated across 10 dose levels (50–650 mg/m²) to determine the recommended phase II dose (primary outcome), and evaluate safety, tolerability, pharmacokinetics (secondary outcomes). Defective homologous recombination is explored as a predictive biomarker of response. CX-5461 is generally well tolerated, with a recommended phase II dose of 475 mg/m² days 1, 8 and 15 every 4 weeks, and dose limiting phototoxicity. Responses are observed in 14% of patients, primarily in patients with defective homologous recombination. Reversion mutations in PALB2 and BRCA2 are detected on progression following initial response in germline carriers, confirming the underlying synthetic lethal mechanism. In vitro characterization of UV sensitization shows this toxicity is related to the CX-5461 chemotype, independent of G-quadruplex synthetic lethality. These results establish clinical proof-of-concept for this G-quadruplex stabilizer. Clinicaltrials.gov NCT02719977.

G-quadruplex stabilizers, including CX-5461, exhibit synthetic lethality with loss of BRCA1/2 in preclinical models. Here the authors report the results of a phase I study of CX-5461 in patients with solid tumors enriched for DNA-repair deficiencies.

Single-cell genomic variation induced by mutational processes in cancer

How cell-to-cell copy number alterations that underpin genomic instability¹ in human cancers drive genomic and phenotypic variation, and consequently the evolution of cancer², remains understudied. Here, by applying scaled single-cell whole-genome sequencing³ to wild-type, TP53-deficient and TP53-deficient;BRCA1-deficient or TP53-deficient;BRCA2-deficient mammary epithelial cells (13,818 genomes), and to primary triple-negative breast cancer (TNBC) and high-grade serous ovarian cancer (HGSC) cells (22,057 genomes), we identify three distinct 'foreground' mutational patterns that are defined by cell-to-cell structural variation. Cell- and clone-specific high-level amplifications, parallel haplotype-specific copy number alterations and copy number segment length variation (serrate structural variations) had measurable phenotypic and evolutionary consequences. In TNBC and HGSC, clone-specific high-level amplifications in known oncogenes were highly prevalent in tumours bearing fold-back inversions, relative to tumours with homologous recombination deficiency, and were associated with increased clone-to-clone phenotypic variation. Parallel haplotype-specific alterations were also commonly observed, leading to phylogenetic evolutionary diversity and clone-specific mono-allelic expression. Serrate variants were increased in tumours with fold-back inversions and were highly correlated with increased genomic diversity of cellular populations. Together, our findings show that cell-to-cell structural variation contributes to the origins of phenotypic and evolutionary diversity in TNBC and HGSC, and provide insight into the genomic and mutational states of individual cancer cells.

Visual Immunoprecipitate Assay (VIP) for Listeria monocytogenes and Related Listeria Species Detection in Selected Foods: Collaborative Study

Six foods representing a variety of food products were analyzed by the Assurance Listeria polyclonal enzyme immunoassay (EIA) and by either the Bacteriological Analytical Manual or the U.S. Department of Agriculture culture method for detecting Listeria monocytogenes and related Listeria species. Samples of each food type, at each inoculation level, were analyzed simultaneously by both methods. A total of 19 laboratories representing federal government agencies and private industry in the United States and Canada participated. Food types were inoculated with Listeria species including L. monocytogenes, with the exception of 3 lots of green beans, which were naturally contaminated. During this study, 1764 samples and controls were analyzed and confirmed, of which 492 were positive and 947 were negative by both methods. There were 159 samples that were positive by culture method but negative by the EIA and 188 that were negative by culture method but positive by EIA. Twenty-two samples were negative by EIA and by culture method but confirmed positive when Assurance selective enrichment broths were subcultured to selective agar. The Assurance polyclonal EIA for detecting L. monocytogenes and related Listeria species in foods has been adopted first action by AOAC INTERNATIONAL.

Assurance Enzyme Immunoassay for Detection of Enterohemorrhagic Escherichia coli 0157:H7 in Selected Foods: Collaborative Study

Five foods types were analyzed by the Assurance EHEC (Escherichia coli 0157:H7) enzyme immunoassay (EIA) and by the Bacteriological Analytical Manual (BAM) culture method. Each sample of each food type at each inoculation level was simultaneously analyzed by both methods. A total of 21 laboratories representing state and federal government agencies and private industry in the United States and Canada participated. Samples were inoculated with E. coli 0157:H7, except for one lot of poultry that was naturally contaminated. A total of 1304 samples and controls were analyzed and confirmed, of which 473 were positive and 818 were negative by both methods. Thirteen samples were positive by BAM but negative by EIA. Because of the study design, it was not possible for the BAM method to produce false-negative or falsepositive results. The Assurance method for detection of E. coli OI57:H7 in selected foods has been adopted first action by AOAC INTERNATIONAL.

Visual Immunoprecipitate Assay (VIP) for Detection of Enterohemorrhagic Escherichia coli (EHEC) 0157:H7 in Selected Foods: Collaborative Study

Five foods representative of a variety of food products were analyzed by the Visual Immunoprecipitate Assay (VIP) and the Bacteriological Analytical Manual (BAM) culture method for the presence of Escherichia coli 0157: H7. A total of 21 laboratories representing state and federal government agencies, as well as private industry, in the United States and Canada participated. Food types were inoculated with strains of E. coli 0157:H7, with the exception of one lot of poultry, which was naturally contaminated. During this study, a total of 1377 samples and controls were analyzed and confirmed, of which 508 were positive and 867 were negative by both methods. Two samples were positive by BAM and negative by VIP. Because of the study design, it was not possible for the BAM method to produce false-negative or false-positive results. The VIP assay for detection of EHEC in selected foods has been adopted first action by AOAC INTERNATIONAL.

Assurance Polyclonal Enzyme Immunoassay for Detection of Listeria monocytogenes and Related Listeria Species in Selected Foods: Collaborative Study

Six foods representing a variety of food products were analyzed by the Assurance Listeria polyclonal enzyme immunoassay (EIA) and by either the Bacteriological Analytical Manual or the U.S. Department of Agriculture culture method for detecting Listeria monocytogenes and related Listeria species. Samples of each food type, at each inoculation level, were analyzed simultaneously by both methods. A total of 19 laboratories representing federal government agencies and private industry in the United States and Canada participated. Food types were inoculated with Listeria species including L. monocytogenes, with the exception of 3 lots of green beans, which were naturally contaminated. During this study, 1764 samples and controls were analyzed and confirmed, of which 492 were positive and 947 were negative by both methods. There were 159 samples that were positive by culture method but negative by the EIA and 188 that were negative by culture method but positive by EIA. Twenty-two samples were negative by EIA and by culture method but confirmed positive when Assurance selective enrichment broths were subcultured to selective agar. The Assurance polyclonal EIA for detecting L. monocytogenes and related Listeria species in foods has been adopted first action by AOAC INTERNATIONAL.

3M™ Petrifilm™ Enterobacteriaceae Count Plate Method for Enumeration of Enterobacteriaceae in Selected Foods: Collaborative Study

The practice of detecting and enumerating all oxidase-negative, glucose-fermenting-Gram-negative rods (i.e., the family Enterobacteriaceae) isused to indicate unsanitary or inadequate food processing conditions. The objective of this interlaboratory collaborative study was to evaluate and compare the methods described in Standard Methods for the Examination of Dairy Products (SMEDP) and the Compendium of Methods for the Microbiological Examination of Foods (Compendium) with a commercial product, the 3M™ Petrifilm™ Enterobacteriaceae Count Plate, for the recovery of Enterobacteriaceae in foods. Six foods—cheddar cheese, milk, flour, frozen prepared meals, frozen broccoli, and nut pieces—were analyzed for Enterobacteriaceae by 12 collaborating laboratories. For each food tested, the collaborators received 8 blind test portions consisting of a control test portion and 3 levels of inoculated test portion, each in duplicate. Each test portion was tested by the Petrifilm Enterobacteriaceae Count Plate method as well as the SMEDP or Compendium methods. The precision estimates (repeat-ability or within-laboratory variation, and reproducibility or between-laboratory variation) were calculated with standard statistical techniques.

TECRA® Unique™ Test for Rapid Detection of Salmonella in Food: Collaborative Study

The TECRA® Unique™ Salmonella test uses the principle of immunoenrichment to allow rapid detection of Salmonellae in food. A collaborative study was conducted to compare the TECRA Salmonella Unique test with the reference culture method given in the U.S. Food and Drug Administration's Bacteriological Analytical Manual. Three food types (milk powder, pepper, and soy flour) were analyzed in Australia and 2 food types (milk chocolate and dried egg) were analyzed in the United States. Forty-one collaborators participated in the study. For each of the 5 foods at each of the 3 levels, a comparison showed no significant differences (p ≥ 0.05) in the proportion of positive test samples for Unique and that for the reference method using the Chi-square test for independence with continuity correction.

Petrifilm™ Rapid S. aureus Count Plate Method for Rapid Enumeration of Staphylococcus aureus in Selected Foods: Collaborative Study

A rehydratable dry-film plating method for Staphylococcus aureusin foods, the 3M™ Petrifilm™ Rapid S. aureus Count Plate method, was compared with AOAC® Official MethodSM 975.55 (Staphylococcus aureus in Foods). Nine foods—instant nonfat dried milk, dry seasoned vegetable coating, frozen hash browns, frozen cooked chicken patty, frozen ground raw pork, shredded cheddar cheese, fresh green beans, pasta filled with beef and cheese, and egg custard—were analyzed for S. aureus by 13 collaborating laboratories. For each food tested, the collaborators received 8 blind test samples consisting of a control sample and 3 levels of inoculated test sample, each in duplicate. The mean log counts for the methods were comparable for pasta filled with beef and cheese; frozen hash browns; cooked chicken patty; egg custard; frozen ground raw pork; and instant nonfat dried milk. The repeatability and reproducibility variances of the Petrifilm Rapid S. aureus Count Plate method were similar to those of the standard method.

Equivalence of Assurance® Gold Enzyme Immunoassay for Visual or Instrumental Detection of Motile and Nonmotile Salmonella in All Foods to AOAC Culture Method: Collaborative Study

Six foods representative of a wide variety of processed, dried powder processed, and raw food types were analyzed by the Assurance® Gold Salmonella Enzyme Immunoassay (EIA) and AOAC INTERNATIONAL culture method. Paired samples of each food type were simultaneously analyzed; one sample by the Assurance method and one by the AOAC culture method. The results for Assurance method were read visually and instrumentally with a microplate reader. A total of 24 laboratories representing federal government agencies and private industry, in the United States and Canada, participated in this collaborative study. Food types were inoculated with species of Salmonella with the exception of raw ground chicken, which was naturally contaminated. No statistical differences (p < 0.05) were observed between Assurance Gold Salmonella EIA with either visual or instrumental interpretation and the AOAC culture method for any inoculation level of any food type or naturally contaminated food. The Assurance visual and instrumental options of reading sample reactions produced the same results for 1277 of the 1296 sample and controls analyzed.

Iron- and Hepcidin-Independent Downregulation of the Iron Exporter Ferroportin in Macrophages during Salmonella Infection

Retention of iron in tissue macrophages via upregulation of hepcidin (HAMP) and downregulation of the iron exporter ferroportin (FPN) is thought to participate in the establishment of anemia of inflammation after infection. However, an upregulation of FPN has been proposed to limit macrophages iron access to intracellular pathogens. Therefore, we studied the iron homeostasis and in particular the regulation of FPN after infection with Salmonella enterica serovar Typhimurium in mice presenting tissue macrophages with high iron (AcB61), basal iron (A/J and wild-type mice), or low iron (Hamp knock out, Hamp^-/-) levels. The presence of iron in AcB61 macrophages due to extravascular hemolysis and strong erythrophagocytosis activity favored the proliferation of Salmonella in the spleen and liver with a concomitant decrease of FPN protein expression. Despite systemic iron overload, no or slight increase in Salmonella burden was observed in Hamp^-/- mice compared to controls. Importantly, FPN expression at both mRNA and protein levels was strongly decreased during Salmonella infection in Hamp^-/- mice. The repression of Fpn mRNA was also observed in Salmonella-infected cultured macrophages. In addition, the downregulation of FPN was associated with decreased iron stores in both the liver and spleen in infected mice. Our findings show that during Salmonella infection, FPN is repressed through an iron and hepcidin-independent mechanism. Such regulation likely provides the cellular iron indispensable for the growth of Salmonella inside the macrophages.

Non-Dietary Correlates and Determinants of Plasma Lutein and Zeaxanthin Concentrations in the Irish Population

OBJECTIVE

To investigate non-dietary correlates and determinants of plasma lutein (L) and zeaxanthin (Z) concentrations in The Irish Longitudinal Study on Ageing (TILDA) sample.

DESIGN

Cross-sectional study.

SETTING

Community dwelling adults in the Republic of Ireland (ROI).

PARTICIPANTS

3,681 participants aged 50 years and older.

MEASUREMENTS

TILDA is a nationally representative prospective cohort study of community dwelling adults aged 50 years and over in the ROI. Demographic and health variables were collected during a face-to-face interview carried out in the home (n=8175), and a substantial proportion of these (n=5035; 62%) also attended a study visit in a health assessment centre. Blood samples collected at baseline (wave 1, the subject of the current study), were analysed for plasma concentrations of L and Z by reversed-phase high performance liquid chromatography, and macular pigment (MP) optical density was also measured (using customized heterochromatic flicker photometry).

RESULTS

After excluding participants with eye disease, data from 3,681 participants were available for analysis. For this group of participants, plasma L and Z were inversely and significantly associated with body mass index (BMI), and were positively and significantly associated with MP, total cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) (p<0.001, for all). Plasma L and Z were significantly lower in males, current smokers, participants reporting less physical exercise, and participants reporting lower levels of education (p<0.05, for all). Plasma L was significantly higher in participants reporting a family history of age-related macular degeneration (AMD) (p=0.001), and in the group of ≥75 years old (p<0.05). For each of these variables, the significant associations remained after controlling for other potential confounding variables.

CONCLUSION

The findings of this large study indicate that plasma concentrations of L and Z were lower in association with indicators of a poor lifestyle (high BMI, tobacco use, and less physical exercise) and in association with lower education, indicating that modifying lifestyle in a positive way is likely to be reflected in higher concentrations of plasma carotenoids, with consequential and putative health benefits.

The evidence informing the surgeon's selection of intraocular lens on the basis of light transmittance properties

In recent years, manufacturers and distributors have promoted commercially available intraocular lenses (IOLs) with transmittance properties that filter visible short-wavelength (blue) light on the basis of a putative photoprotective effect. Systematic literature review. Out of 21 studies reporting on outcomes following implantation of blue-light-filtering IOLs (involving 8914 patients and 12 919 study eyes undergoing cataract surgery), the primary outcome was vision, sleep pattern, and photoprotection in 9 (42.9%), 9 (42.9%), and 3 (14.2%) respectively, and, of these, only 7 (33.3%) can be classed as high as level 2b (individual cohort study/low-quality randomized controlled trials), all other studies being classed as level 3b or lower. Of the level 2b studies, only one (14.3%) found in favor of blue-light-filtering IOLs vs ultraviolet (UV)-only filtering IOLs on the basis of an association between better post-operative contrast sensitivity (CS) at select frequencies with the former; however, that study did not measure or report CS preoperatively in either group, and the finding may simply reflect better preoperative CS in the eyes scheduled to be implanted with the blue-light-filtering IOL; moreover, that study failed to measure macular pigment, a natural preceptoral filter of blue-light, augmentation of which is now known to improve CS. In terms of photoprotection, there is no level 2b (or higher) evidence in support of blue filtering IOLs vs UV-only filtering IOLs. On the basis of currently available evidence, one cannot advocate for the use of blue-light-filtering IOLs over UV-only filtering IOLs.

Complex genetics architecture contributes to Salmonella resistance in AcB60 mice

Human infection with Salmonella is of global public health concern. In low- and middle-income countries, Salmonella infection is a major source of disease in terms of both mortality and morbidity, while in high-income nations, the pathogen is an ongoing threat to food security. The outcome of infection with Salmonella enterica serovar Typhimurium (Salmonella Typhimurium) in mouse models is dependent upon a coordinated and complex immune response. A panel of recombinant congenic strains (RCS) derived from the reciprocal double backcross of A/J and C57BL/6J mice has been screened for their susceptibility to Salmonella infection, and the RCS AcB60 was identified to be the most resistant strain to Salmonella infection, more resistant than the parental strain A/J. These mice are known to carry resistant alleles at three well-defined Salmonella susceptibility loci, Slc11a1 ^Ity (solute carrier family 11 member 1; Immunity to Typhimurium locus), Pklr ^Ity4 (pyruvate kinase liver and red blood cell; Ity4 locus), and Ity5. In the current study, we used interval mapping to validate a locus on Chr 15, named Ity8, linked to Salmonella resistance in AcB60 mice. Global gene expression analysis during infection identified AcB60-specific expression of genes involved in Ccr7 signaling, including downstream effector Mapk11 (mitogen-activated protein kinase 11), located within the Ity8 interval, and representing a potential positional candidate gene. An additional region on Chr 18 of C57BL/6J descent was shown to be associated with increase resistance in AcB60. These observations provide an opportunity to achieve new insight into the complex genetics of resistance to Salmonella infection in the context of mouse models of human infection with Salmonella Typhimurium.

Bringing meaning to user involvement in mental health care planning: a qualitative exploration of service user perspectives

BACKGROUND

Service users wish to be involved in care planning but typically feel marginalized in this process. Qualitative explorations of the barriers and enablers of user involvement in mental health care planning are limited.

QUESTION

How is user involvement in care planning conceptualized by service users and how can meaningful involvement be instilled in the care planning process?

METHODS

In 2013, we conducted five focus groups (n = 27) and 23 individual interviews with current or recent adult users of secondary care mental health services (n = 27) in England. Eight users participated in both. Data were analysed using Framework Analysis. Results Ten themes emerged from the data: these themes encompassed procedural elements (connection; contribution; currency; care consolidation; and consequence), service user characteristics (capacity and confidence) and professional enablers (consultation; choice; and clarity of expression). Procedural elements were discussed most frequently in service user discourse.

DISCUSSION

The process of care planning, centred on the user-clinician relationship, is key to user involvement.

IMPLICATIONS FOR PRACTICE

Users describe a common model of meaningful involvement in care planning. Their requests, summarized through a 10C framework of care planning involvement, provide clear direction for improving service users satisfaction with care planning and enhancing the culture of services.

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Background

Evidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.

Aim and objectives

Our aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.

Methods and results

Examination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.

Conclusions

Further research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.

Study registration

Current Controlled Trials ISRCTN68572159.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

What is meso-zeaxanthin, and where does it come from?

The carotenoids lutein (L), zeaxanthin (Z), and meso-zeaxanthin (MZ) accumulate in the central retina, where they are collectively known as macular pigment (MP). Each of these three compounds exhibit a regional dominance, with MZ, Z, and L being the dominant carotenoids at the epicentre, mid-periphery, and periphery of the macula, respectively. There is a growing and evidence-based consensus that MP is important for optimal visual performance, because of its blue light-filtering properties and consequential attenuation of chromatic aberration, veiling luminance, and blue haze. It has also been hypothesised that MP may protect against age-related macular degeneration because of the same optical properties and also because of the antioxidant capacity of the three macular carotenoids. Challenges inherent in the separation and quantification of MZ have resulted in a paucity of data on the content of this carotenoid in foodstuffs, and have rendered the study of tissue concentrations of this compound problematic. As a consequence, the few studies that have investigated MZ have, perhaps, been disproportionately influential in the ongoing debate about the origins of this macular carotenoid. Certainly, the narrative that retinal MZ is derived wholly and solely from retinal L needs to be revisited.

The effectiveness of self-care support interventions for children and young people with long-term conditions: a systematic review

Children's health policy has highlighted the need to develop self-care programmes. However, there is a lack of evidence on which to base the development of such programmes. This paper reviews the published research on the effectiveness of self-care support interventions for children and young people with asthma, cystic fibrosis and diabetes. A systematic search was conducted of a range of electronic databases, supplemented by searching the reference lists of retrieved papers and published reviews. Retrieved studies were assessed against quality and eligibility criteria by two independent reviewers. The results were narratively synthesized to examine the effectiveness of self-care support interventions on health status, psycho-social well-being, condition-related knowledge, health service use and participant satisfaction. The search strategy identified 4261 papers which were screened against the review inclusion criteria. A total of 194 papers were assessed as being potentially eligible for inclusion with 15 papers being judged as adequate to include in the review. There is strong evidence of the effectiveness of interventions that target children/young people; use e-health or group-based methods; that are delivered in community settings. There is no evidence that interventions that focus on parents alone or are delivered only in hospital settings are effective. While there is some evidence to inform the development of self-care support programmes, there is a need for well-designed trials of interventions that are feasible to transfer into real-life settings and which involve parents and children in their development.

Psychophysical impact and optical and morphological characteristics of symptomatic non-advanced cataract

PURPOSE

To investigate whether psychophysical, morphological, and/or optical characteristics of symptomatic non-advanced cataract are complementary to, or more appropriate than, visual acuity (VA) for the purposes of recording visual data that reflect subjective visual difficulty in patients with cataract that exhibit relative sparing of high contrast acuity (0.4 logarithm of minimal angle of resolution (logMAR) scale or better).

METHODS

Eighty-two patients with symptomatic non-advanced cataract and no other ocular pathology were asked to complete a validated questionnaire, and to perform a series of visual function assessments including: corrected distance VA (CDVA); photopic and mesopic contrast sensitivity; photopic and mesopic glare disability (GD); reading acuity and reading speed; stereoacuity; and retinal sensitivity. Optical and morphological characteristics of the cataract were evaluated by lens optical density and by the Lens Opacities Classification System III, respectively. Correlations between questionnaire score and each of these measures were calculated.

RESULTS

Statistically significant negative correlations were observed between the Rasch-scaled questionnaire score and mesopic GD (at 3 and 6 cycles per degree (cpd); r=-0.396 (P<0.01) and -0.451 (P<0.05), respectively) and between the Rasch-scaled questionnaire score and photopic GD (at 3 and 6 cpd; r=-0.328 (P<0.01) and -0.440 (P<0.01), respectively).

CONCLUSION

Symptomatic non-advanced cataract, in the presence of good CDVA, is associated with measurable subjective visual difficulty, best reflected in a decrease in mesopic and photopic GD (at medium spatial frequencies). CDVA does not reflect the patient's visual dissatisfaction in such cases.

An assessment of lifestyle video education for people newly diagnosed with type 2 diabetes

BACKGROUND

Education plays a key role in the development of self-management skills for people with type 2 diabetes, although there is limited evidence for the use of video education.

AIMS

To develop a video-based lifestyle education programme for people newly diagnosed with type 2 diabetes and to evaluate changes in knowledge, biomedical indices and quality of life.

METHODS

Forty-two newly diagnosed type 2 diabetic subjects were recruited and randomly allocated to either a video education or control group. Data were collected at baseline and 6 months after the intervention. Subjects (43% male) had a mean (SD) age of 60.8 (9.6) years, weight 89.5 (15.5) kg, BMI 31.3 (5.1) kg m(2), glycated haemoglobin (A1c) 7.4 (1.7)%, total cholesterol 4.7 (1.2) mmol L(-1), high-density lipoprotein cholesterol 1.15 (0.34) mmol L(-1), triglycerides 1.8 (1.0) mmol L(-1), low-density lipoprotein cholesterol 2.8 (1.0) mmol L(-1), pedometer reading 5721 (3446) steps per day. There were 63.7% correct answers given to the ADKnowl questionnaire and the WHO-5 Well-Being score was 65.8%.

RESULTS

At 6 months, the intervention group showed increased knowledge compared to controls (74.3% versus 56.4% correct answers, P < or = 0.0001). Although there were no significant differences in changes over 6 months between the two groups, the intervention group showed improvements in A1c (-0.7%, P = 0.024), total cholesterol (-0.5 mmol L(-1), P = 0.017), low-density lipoprotein cholesterol (-0.5, P = 0.018) and increased physical activity measured by pedometer (1266 steps per day, P = 0.043) from baseline, with no significant changes in the control group.

CONCLUSIONS

A brief video intervention increased diabetes knowledge amongst those newly diagnosed with type 2 diabetes and may comprise an effective way of directing education to such individuals.

Issues raised by a case of orbital metastatic disease

The clinical, radiological and histopathological findings in an 81-year-old man presenting with lung carcinoma metastatic to the orbit are described. Orbital biopsy was complicated by postoperative visual loss and failed to contribute significantly to the final diagnosis. The authors believe that in cases of possible orbital metastases a primary neoplasm should be excluded by means of a complete oncological assessment before proceeding to biopsy.

Correlation between gross anatomical topography, sectional sheet plastination, microscopic anatomy and endoanal sonography of the anal sphincter complex in human males

This study elucidates the structure of the anal sphincter complex (ASC) and correlates the individual layers, namely the external anal sphincter (EAS), conjoint longitudinal muscle (CLM) and internal anal sphincter (IAS), with their ultrasonographic images. Eighteen male cadavers, with an average age of 72 years (range 62-82 years), were used in this study. Multiple methods were used including gross dissection, coronal and axial sheet plastination, different histological staining techniques and endoanal sonography. The EAS was a continuous layer but with different relations, an upper part (corresponding to the deep and superficial parts in the traditional description) and a lower (subcutaneous) part that was located distal to the IAS, and was the only muscle encircling the anal orifice below the IAS. The CLM was a fibro-fatty-muscular layer occupying the intersphincteric space and was continuous superiorly with the longitudinal muscle layer of the rectum. In its middle and lower parts it consisted of collagen and elastic fibres with fatty tissue filling the spaces between the fibrous septa. The IAS was a markedly thickened extension of the terminal circular smooth muscle layer of the rectum and it terminated proximal to the lower part of the EAS. On endoanal sonography, the EAS appeared as an irregular hyperechoic band; CLM was poorly represented by a thin irregular hyperechoic line and IAS was represented by a hypoechoic band. Data on the measurements of the thickness of the ASC layers are presented and vary between dissection and sonographic imaging. The layers of the ASC were precisely identified in situ, in sections, in isolated dissected specimens and the same structures were correlated with their sonographic appearance. The results of the measurements of ASC components in this study on male cadavers were variable, suggesting that these should be used with caution in diagnostic and management settings.

The rationale and evidence base for a protective role of macular pigment in age-related maculopathy

Age-related maculopathy (ARM) remains the most common cause of blind registration in people aged 50 years or over in the developed world, and its prevalence continues to rise. Although effective new treatments have become available in the recent past, these are expensive and cumbersome to the healthcare provider and to the patient, and many cases remain resistant to such therapy. There is a biologically plausible rationale whereby macular pigment, which is entirely of dietary origin, may prevent or delay the onset, or ameliorate the clinical course, of ARM. In this article, we review this rationale, and critically appraise the current evidence base germane to the use of supplements containing the macular carotenoids in patients with, or at risk of developing, ARM.

Endogenous endophthalmitis following ipsilateral carotid endarterectomy

We report a case involving a 75-year-old lady who presented to our department of ophthalmology complaining of a 1 day history of ocular pain and reduced vision in the right eye, associated with rigors and diarrhoea. This patient, who had undergone a right carotid endarterectomy (CEA) 4 days previously, was subsequently confirmed to have developed endogenous endophthalmitis. To our knowledge, endogenous endopthalmitis has not previously been described as a postoperative complication of CEA, and should be considered in patients presenting with ocular complaints after this type of surgery.

A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects

BACKGROUND

Low-carbohydrate diets are effective for weight reduction in people without diabetes, but there is limited evidence for people with Type 2 diabetes. Aims To assess the impact of a low-carbohydrate diet on body weight, glycated haemoglobin (HbA(1c)), ketone and lipid levels in diabetic and non-diabetic subjects.

METHODS

Thirteen Type 2 diabetic subjects (on diet or metformin) and 13 non-diabetic subjects were randomly allocated to either a low-carbohydrate diet (< or = 40 g carbohydrate/day) or a healthy-eating diet following Diabetes UK nutritional recommendations and were seen monthly for 3 months. Subjects (25% male) were (mean +/- sd) age 52 +/- 9 years, weight 96.3 +/- 16.6 kg, body mass index 35.1 kg/m(2), HbA(1c) 6.6 +/- 1.1%, total cholesterol 5.1 +/- 1.1 mmol/l, high-density lipoprotein cholesterol 1.3 +/- 0.4 mmol/l, low-density lipoprotein cholesterol 3.1 +/- 0.9 mmol/l, triglycerides (geometric mean) 1.55 (1.10, 2.35) mmol/l and ketones range 0.0-0.2 mmol/l.

RESULTS

Analysis was by intention to treat with last observation carried forward. Twenty-two of the participants (85%) completed the study. Weight loss was greater (6.9 vs. 2.1 kg, P = 0.003) in the low-carbohydrate group, with no difference in changes in HbA(1c), ketone or lipid levels.

CONCLUSIONS

The diet was equally effective in those with and without diabetes.

Disulfiram-induced transient optic and peripheral neuropathy: a case report

AIM

To report a case of optic and peripheral neuropathy after chronic use of disulfiram for alcohol dependence management.

MATERIALS AND METHODS

A case report.

RESULTS

A 57-year-old male presented with gradual loss of vision in both eyes with intermittent headaches for 2 months. He also complained of paraesthesia with numbness in both feet. His vision was 6/15 and 2/60 in the right and left eyes, respectively. Fundoscopy revealed bilaterally swollen optic nerve heads. Visual field testing confirmed bilateral central-caecal scotomata. He had been taking disulfiram for alcohol dependence for the preceding 3 years. Disulfiram discontinuation lead to an immediate symptomatic improvement.

CONCLUSION

Physicians initiating long-term disulfiram therapy should be aware of these adverse effects. They should recommend annual ophthalmic reviews with visual field testing. Patients should be reassured with respect to the reversibility of these adverse effects.

Plain X-ray and computed tomography of the orbit in cases and suspected cases of intraocular foreign body

AIM

To evaluate the roles of plain X-ray and computed tomography (CT) orbital imaging in cases and suspected cases of intraocular foreign body (IOFB).

METHODS

Retrospective review of clinical and radiological data relating to 204 consecutive cases and suspected cases of IOFB.SettingRoyal Victoria Eye and Ear Hospital, Dublin, Ireland.

RESULTS

Plain X-rays were performed in the absence of clinically evident ocular penetration in 177 (87%) cases, and no IOFB was demonstrated in any of these radiographs. Twenty-seven (13%) plain X-ray radiographs were obtained in the presence of clinically evident ocular penetration, and an IOFB was clinically visible in 19 (70%) of these cases. CT scans were undertaken in 21 (10%) of the 204 patients. Of these CT images, 9 (43%) and 12 (57%) were undertaken in the absence and presence of clinically evident ocular penetration, respectively. None (0%) and all (100%) of the CT scans obtained in the absence and presence of clinically evident ocular penetration demonstrated an IOFB, respectively.

CONCLUSION

Plain X-ray and CT orbital imaging are non-contributory in the absence of clinically evident ocular penetration. In the presence of clinically evident ocular penetration, and where an IOFB is clinically visible, plain X-ray orbital radiography may have a role in excluding multiple IOFBs. In the presence of clinically evident ocular penetration, but where an IOFB is not clinically visible, CT orbital imaging remains the investigation of choice, and the role of pre-CT plain X-ray orbital radiography, as recommended by the guidelines of the Royal College of Radiologists, merits re-evaluation.

Buckle-related complications following surgical repair of retinal dialysis

AIM

To describe buckle-related complications following surgical repair of retinal dialysis.

METHODS

A retrospective study of 28 consecutive cryobuckle procedures for retinal detachments secondary to retinal dialysis is reported, with particular attention directed towards postoperative complications relating to the buckle. Stata 8 statistical software and Fisher's exact test were used to analyse the data.

RESULTS

Of the 28 cases, anatomic success was achieved with a single procedure in 26 cases (92.9%). Postoperative complications were seen in 20 cases (71.4%), with complications attributable to the buckle noted in 19 (67.9%). Buckle-related complications included exposure (7; 25%), strabismus (5; 17.9%), and infection (3; 10.7%). Surgical removal of the buckle was indicated in 13 cases (46.4%), typically within the first 6 postoperative months. Of these, the retina remained flat following removal of buckle in 12 cases (92.3%), whereas the retina redetached in one case (7.7%).

CONCLUSION

Cryotherapy with explant is an effective primary procedure for the surgical repair of retinal detachment secondary to retinal dialysis. However, there is a high rate of postoperative complications relating to the buckle following this surgical approach, although the buckle can be safely removed without compromising the anatomic success of the primary surgery in the vast majority of cases.

The impact of new regulations on the incidence and severity of ocular injury sustained in hurling

AIM

To prospectively evaluate, and compare, the incidence of hurling-related eye injuries in the South East of Ireland before and after implementation of new rules rendering the use of protective head gear and face masks compulsory for players aged 18 years or under.

METHODS

Details relating to patients attending the regional ophthalmic department with injuries sustained during hurling were prospectively recorded between 1 October 2003 and 31 March 2006.

RESULTS

Sixty players attended with hurling-related ocular injuries during the study period. Of these, 43 (71.6%) and 17 (28.3%) sustained the ocular injuries during the 15-month period before, and after implementation of the new rules (1 January 2005), respectively. Restricting our analysis to players aged 18 years or under, and, for statistical validity, to the 12-month period immediately before and immediately after implementation of the new rules, a statistically significant reduction in the number of hurling-related injuries was seen (1 January 2004 to 31 December 2004: 11; 1 January 2005 to 31 December 2005: 2; chi(2) test P<0.05) in this age group. A permanent visual deficit was seen in 11 (18.3%) patients. Of these, one (9%) was aged 18 years or under, and this injury was sustained before the new regulations.

CONCLUSION

New rules rendering the use of protective eye wear compulsory for players aged 18 years or under have resulted in a significant reduction in the incidence and severity of hurling-related eye injuries in this age group.

Transconjunctival sutureless vitrectomy: initial experience and surgical tips

OBJECTIVES

We report the operative details and surgical outcomes of 39 consecutive transconjunctival sutureless vitrectomies using the TSV 25 system.

METHODS

We retrospectively reviewed the medical records of 35 patients (39 eyes) who underwent surgery using TSV 25 at the Department of Ophthalmology, Waterford Regional Hospital between March 2003 and February 2005. Preoperative, intraoperative and postoperative details were recorded and analysed. We also performed a systematic review of our surgical technique.

RESULTS

Mean (+/-SD; range) duration of surgery was 32.85 (17.54; 5-85) min. Methods of anaesthesia included retrobulbar anaesthesia (31; 79.5%) and general anaesthesia (8; 20.5%). The mean (+/-SD; range) length of stay was 1.53 (1.25; 0-4) days. Mean (+/-SD; range) visual acuities (logMAR) were -1.335 (1.15; 0.0 to -3.0) and -0.803 (1.03; 0.1 to -3.0) preoperatively and postoperatively, respectively. The mean (+/-SD) intraocular pressures were 14.69 (4.64) mmHg and 11.56 (9.03) mmHg preoperatively and at the first dressing, respectively. Intraoperative complications included blockage of the TSV cutter tip during attempted clearance of organized intragel haemorrhage, thus requiring conversion to conventional trans pars plana vitrectomy (1; 2.6%). No other intraoperative complication arose. Complications in the postoperative period included: reactivation of dormant chorioretinal toxoplasmosis (1; 2.6%); postoperative posterior segment haemorrhage (3; 7.7%); hyphaema (1; 2.6%); transient postoperative hypotony (10; 25.6%).

CONCLUSIONS

With appropriate case selection, and with appreciation of this technique's limitations, transconjunctival sutureless vitrectomy is a safe procedure.

Age and sex profile of patients having cataract surgery between 1986 and 2003

PURPOSE

To investigate the age and sex profile of patients having cataract surgery by 2 consulting ophthalmic surgeons over an 18-year period.

SETTING

Waterford Regional Hospital, Waterford, Republic of Ireland.

METHODS

Operating theater logbooks were reviewed, and all patients having cataract surgery between January 1986 and December 2003 in Waterford Regional Hospital were identified. The following data were recorded for each patient: age, sex, and type of cataract surgery. Patients having cataract surgery were categorized according to the date of the procedure as follows: Group 1: 1986-1991; Group 2: 1992-1997; Group 3: 1998-2003.

RESULTS

Eight thousand two hundred fifty-seven patients who had cataract surgery during the study period were identified. The mean age of patients was 72.32 years +/- 12.21 (SD) and 74.89 +/- 11.03 years of men and women, respectively. The age profile of patients having cataract surgery was statistically comparable in Groups 1, 2, and 3 (mean age; Group 1: 72.33 +/- 13.03 years; Group 2: 73.72 +/- 11.78 years; Group 3: 74.57 +/- 10.69 years), indicating that the age profile of patients did not change significantly with the passage of time (analysis of variance, F<1). The proportion of women having cataract surgery rose significantly over the duration of the study period (1986-1991: 55.13%; 1992-1997: 57.68%; 1998-2003: 59.43% (chi-square test, P<.01)).

CONCLUSIONS

The age profile of 8257 patients having cataract surgery did not change over the 18-year study period. A small but significant increase in the proportion of women having cataract surgery was noted in latter years. This data is useful to those involved in health care planning.

Macular pigment levels following successful macular hole surgery

AIM

Macular pigment (MP) is composed of two hydroxycarotenoids contained within the photoreceptors and the axons of the central neurosensory retina, with peak concentrations in the Henle layer. A full thickness macular hole (FTMH) is characterised by absence of all retinal layers in an area centred at the former centre of the fovea. The authors report the results of a study designed to investigate MP levels in patients following successful FTMH surgery, using Raman spectroscopy, and to correlate these findings with functional and topographic outcomes.

METHODS

The following details were recorded for 12 eyes of 12 patients following successful closure of a FTMH: best corrected visual acuity; macula threshold test, fixation, fundus photography, and macular pigment levels using Raman spectroscopy. High resolution imaging of the retina using optical coherence tomography (OCT) was performed in nine of the 12 study eyes.

RESULTS

Mean (SD) best corrected visual acuity was 0.6 (0.4) and improved significantly from preoperative levels. On macula threshold testing of the operated eye, a central scotoma was detectable in one eye only (8.3%). MP levels were demonstrable in 10 of the 12 study eyes following successful FTMH surgery. MP levels were higher in three study eyes, and lower in seven study eyes, when compared with the fellow eye. Of the three pairs of eyes where MP levels were greater in the study eye, macular pathology was present in two fellow eyes.

CONCLUSIONS

The presence of MP was confirmed in the neurosensory retina of an anatomically closed FTMH in 10 of 12 study eyes, although the levels were lower than the fellow normal macula in nine of 10 cases. This suggests a good degree of physiological recovery of photoreceptors and their axons following successful FTMH surgery.

Ocular injury in hurling

OBJECTIVES

To describe the clinical characteristics of ocular injuries sustained in hurling in the south of Ireland and to investigate reasons for non-use of protective headgear and eye wear.

METHODS

Retrospective review of the case notes of 310 patients who attended Cork University Hospital or Waterford Regional Hospital between 1 January 1994 and 31 December 2002 with ocular injuries sustained during a hurling match. A confidential questionnaire on reasons for non-use of protective headgear and eye wear was completed by 130 players.

RESULTS

Hurling related eye injuries occurred most commonly in young men. Fifty two patients (17%) required hospital admission, with hyphaema accounting for 71% of admissions. Ten injuries required intraocular surgical

INTERVENTION

retinal detachment repair (5); macular hole surgery (1); repair of partial thickness corneal laceration (1); repair of globe perforation (1); enucleation (1); trabeculectomy for post-traumatic glaucoma (1). Fourteen eyes (4.5%) had a final best corrected visual acuity (BCVA) of <6/12 and six (2%) had BCVA <3/60. In the survey, 63 players (48.5%) reported wearing no protective facemask while playing hurling. Impairment of vision was the most common reason cited for non-use.

CONCLUSIONS

Hurling related injury is a significant, and preventable, cause of ocular morbidity in young men in Ireland. The routine use of appropriate protective headgear and faceguards would result in a dramatic reduction in the incidence and severity of these injuries, and should be mandatory.

Refractive lens exchange in high myopia: long term follow up

AIM

To establish long term outcomes and incidence of complications following refractive lens exchange (RLE) for the correction of high myopia.

METHODS

Operative and postoperative records of 62 cases of small incision phacoemulsification RLE performed in 37 patients over an 11 year period, by a single surgeon, were reviewed. In addition, patients were recalled for a follow up examination, which included dilated retinal examination with scleral indentation.

RESULTS

Two cases (3.2%) of retinal detachment occurred at intervals of 2 months and 5 months following uncomplicated RLE procedures. A posterior chamber intraocular lens was inserted in 46 eyes (74%). YAG laser posterior capsulotomy was performed in 38 of 62 eyes (61%) and did not represent a risk for retinal detachment.

CONCLUSION

Refractive lens exchange results in rapid and predictable improvement in unaided vision in patients with high myopia. However, the risks of sight threatening complications inherent in any intraocular procedure underlie the need for appropriate patient selection.