Observation of Seven Astrophysical Tau Neutrino Candidates with IceCube

We report on a measurement of astrophysical tau neutrinos with 9.7 yr of IceCube data. Using convolutional neural networks trained on images derived from simulated events, seven candidate ν_{τ} events were found with visible energies ranging from roughly 20 TeV to 1 PeV and a median expected parent ν_{τ} energy of about 200 TeV. Considering backgrounds from astrophysical and atmospheric neutrinos, and muons from π^{±}/K^{±} decays in atmospheric air showers, we obtain a total estimated background of about 0.5 events, dominated by non-ν_{τ} astrophysical neutrinos. Thus, we rule out the absence of astrophysical ν_{τ} at the 5σ level. The measured astrophysical ν_{τ} flux is consistent with expectations based on previously published IceCube astrophysical neutrino flux measurements and neutrino oscillations.

POS1167 REVIEW OF THE IMPACT OF COVID-19 PANDEMIC ON RHEUMATOLOGY SERVICES AT A LARGE TERTIARY CARE CENTRE IN WALES, UK

Background:

COVID-19 pandemic had an unprecedented impact on the delivery of patient care. Rheumatology services had to rapidly adapt to virtual consultations at the onset of the pandemic. However, providing a high quality and effective service in a virtual setting can be challenging and therefore its prudent to do a formal review and gain patient feedback to ensure that these clinics are fit for purpose.

Objectives:

To evaluate the impact of first wave of COVID-19 pandemic on patients with autoimmune rheumatic conditions, assess delivery of rheumatology outpatient care and record patient feedback.

Methods:

This study included patients on the Rheumatology clinic lists between 3rd and 31st August 2020. An electronic survey questionnaire was developed and the survey link was sent to patients via a text message using secure IT platform. Data was collected on patient demographics, diagnosis, comorbidities, treatments, clinical/ laboratory confirmed COVID-19 diagnosis, treatment interruption, impact on work, personal protective measures taken and views on virtual consultations.

Results:

307 patients responded with 287 complete responses. 73.1%(223) were female and 32.4% (99) were >65 years of age. Rheumatoid arthritis was the most common diagnosis 41.6%(127). Hypertension was the commonest comorbidity 21.4%(64) followed by Chronic lung disease 17.3%(52). 28.8%(85) were on Hydroxychloroquine, 26.7%(79) Methotrexate, 14.2%(42) Sulfasalazine and 13.2%(39) on Prednisolone. 22.3%(66) were on Biologics: Anti TNF 12.8%(38), Tocilizumab 3.7%(11) and Rituximab 3%(9). 52.6%(161) shielded, 16.9%(55) self-isolated and 30.3%(93) only maintained social distance. 197 patients self reported as being vulnerable but based on their treatment,only 167 patiemts met the clinically extremely vulnerable (CEV) criteria and all of those received government shielding letter.

3.6%(11) had lab confirmed COVID-19, 3.2%(10) had clinically suspected COVID-19 infection. 14.3% (43) had their treatment interrupted. 4.6%(14) were unable to work from home or maintain social distancing at work. 59.8%(182) had face-to-face consultation changed to virtual. 63.2%(189) were satisfied, 28%(84) neutral and 8.7%(26) reported dissatisfaction with their consultation. 50.5%(153) were happy to continue with virtual consultation but with an option of face to face only if necessary.For consultations post COVID-19, 59.4%(182) preferred a mixture of face to face and virtual appointments.

Conclusion:

Majority of our patients seem happy with virtual consultations as long as they are assured of a face-to-face consultation if needed. A minority(8.7%) however, were dissatisfied. Some of the suggestions were, use of video consultations and improvement in communication before the virtual appointments. Our survey also shows that our patients have adapted well to virtual consultations and many are keen to have virtual consultation in the longer term. In our survey, only 6.8%(21) patients reported definite or clinically suspected COVID-19. Possible explanations for this include strict compliance with government advice on social distancing/shielding and limited testing at the onset of the pandemic. More patients assumed themselves to be clinically CEV than those who were actually CEV based on their treatment which is not surprising because of high level of anxiety among patients due to rapidly spreading pandemic and multiple sources of information.

This feedback provides useful data which will help us to plan the delivery of rheumatology services post COVID-19 pandemic. While face-to-face patient contact is needed for comprehensive disease assessment, teaching and training, a model for the future is likely to include a combination of face-to-face and virtual consultations. This could allow a greater capacity to see new patients and reduce waiting lists. Patients with uncomplicated and stable disease could be followed up in virtual clinics. There is also a need to formally incorportate the virtual consultations into the curriculum for Rheumatology trainees.

Disclosure of Interests:

None declared.

Combination of capsular tension ring and capsular tension segment for the management of lens coloboma >4 clock hours

Lens colobomas extending more than 4 clock hours and causing visual impairment require lens extraction along with capsular support devices with scleral fixation for adequate centration of the capsular bag and for prevention of capsular fornix aspiration with inadvertent extension of zonular dialysis intraoperatively. In this case series, we describe a technique for the management of isolated lens colobomas involving 4–5 clock hours by clear lens extraction and intraocular lens implantation using a combination of a capsular tension ring with a capsular tension segment (CTS) for the centration and stability of the capsular bag. Hoffman's corneoscleral pocket and half-bow sliding knot technique were used for scleral fixation of the CTS.

Long-Term Ophthalmic Outcomes in Pediatric Orbital Cellulitis: A Prospective, Multidisciplinary Study From a Tertiary-Care Referral Institute

PURPOSE

To analyze the clinical profile, radiological features, and ophthalmic outcomes of the multidisciplinary management of children with pediatric orbital cellulitis.

METHODS

A prospective, interventional study of patients diagnosed as having pediatric orbital cellulitis was conducted. A complete history, clinical examination, laboratory work-up, radiology (computed tomography [CT]), multidisciplinary consultations (otolaryngology, pediatrics, and microbiology), and treatment plan were obtained for all children. The patients were admitted to the hospital and administered intravenous broad-spectrum antibiotics. Orbital and subperiosteal abscesses were drained via an endonasal or external route. Functional endoscopic sinus surgery was performed when necessary. After a minimum follow-up of 12 months, visual acuity, pupillary reaction, extraocular movements, and proptosis were evaluated as the outcome measures.

RESULTS

Forty patients (male = 28, 70%) had unilateral presentation of pediatric orbital cellulitis at a mean age of 7.5 years (range: 4 to 12 years). At presentation, all patients had eyelid edema, conjunctival congestion, and chemosis: 38 (95%) had proptosis, 36 (90%) had decreased extraocular movements and pain, 16 (40%) had a relative afferent pupillary defect, and 6 (15%) had exposure keratitis and optic disc edema. CT scans showed sinusitis in 30 (75%) patients, orbital abscess in 14 (35%) patients, and subperiosteal abscess in 5 (12.5%) patients. At a mean follow-up of 15 months, 30 (75%) patients had complete success, 8 (20%) patients had partial success, and the treatment failed in 2 (5%) patients. No patient had any life-threatening complications.

CONCLUSIONS

The multidisciplinary management of pediatric orbital cellulitis provides satisfactory long-term ophthalmic outcomes. Ethmoidal sinusitis is the most common etiology of pediatric orbital cellulitis, and endoscopic abscess drainage and functional endoscopic sinus surgery are minimally invasive and provide rapid relief in children. [J Pediatr Ophthalmol Strabismus. 2019;56(5):333-339.].

Immune keratitis: An unusual primary presentation of neuro-Behçet’s disease

A 19-year-old Nepalese male presented with complaints of bilateral ocular discomfort, photophobia, watering, and redness for 1 week. Visual acuity was 6/12 and 6/60 in the right and left eye, respectively. On biomicroscopic examination, presence of peripheral stromal infiltrates with conjunctival follicles was noted; infiltrates progressed to involve central cornea with further decrease in vision over next few days. After ruling out infectious keratitis, detailed systemic examination and laboratory investigations were diagnostic of neuro-Behçet’s disease. Patient responded to systemic steroidal and immunosuppressive therapy characterized by corneal healing and visual acuity improvement to 6/6 and 6/9. Although rare, but neuro-Behçet’s disease can primarily present as bilateral immune keratitis and every case of bilateral keratitis needs early systemic evaluation after ruling out infective etiologies.

Establishing a sample-to cut-off ratio for lab-diagnosis of hepatitis C virus in Indian context

INTRODUCTION

Lab-diagnosis of hepatitis C virus (HCV) is based on detecting specific antibodies by enzyme immuno-assay (EIA) or chemiluminescence immuno-assay (CIA). Center for Disease Control reported that signal-to-cut-off (s/co) ratios in anti-HCV antibody tests like EIA/CIA can be used to predict the probable result of supplemental test; above a certain s/co value it is most likely to be true-HCV positive result and below that certain s/co it is most likely to be false-positive result. A prospective study was undertaken in patients in tertiary care setting for establishing this "certain" s/co value.

MATERIALS AND METHODS

The study was carried out in consecutive patients requiring HCV testing for screening/diagnosis and medical management. These samples were tested for anti-HCV on CIA (VITROS(®) Anti-HCV assay, Ortho-Clinical Diagnostics, New Jersey) for calculating s/co value. The supplemental nucleic acid test used was polymerase chain reaction (PCR) (Abbott). PCR test results were used to define true negatives, false negatives, true positives, and false positives. Performance of different putative s/co ratios versus PCR was measured using sensitivity, specificity, positive predictive value and negative predictive value and most appropriate s/co was considered on basis of highest specificity at sensitivity of at least 95%.

RESULTS

An s/co ratio of ≥6 worked out to be over 95% sensitive and almost 92% specific in 438 consecutive patient samples tested.

CONCLUSION

The s/co ratio of six can be used for lab-diagnosis of HCV infection; those with s/co higher than six can be diagnosed to have HCV infection without any need for supplemental assays.

Enhanced hepatitis B virus (HBV) pre-genomic RNA levels and higher transcription efficiency of defective HBV genomes

Defective hepatitis B virus (dHBV) particles contain genomes corresponding to singly spliced HBV RNA. A limited number of studies show that dHBV is present in all chronically HBV-infected patients. Clinical studies have linked dHBV and dHBV gene products to high virus loads and liver damage. The replication characteristics of dHBV genomes remain poorly understood. We found that the splice donor/acceptor sites critical for the formation of dHBV genomes are conserved across HBV genotypes. We report a novel method to create dHBV constructs from corresponding wild-type (WT) HBV constructs. We assessed the transcriptional characteristics of the dHBV constructs with those of the corresponding WT construct using a cell culture model. Interestingly, dHBV constructs had higher pre-genomic RNA levels, transcription efficiency, HBV e antigen levels and intracellular HBV core antigen levels compared with the corresponding WT HBV constructs. Our findings highlight previously unrecognized fundamental molecular characteristics of dHBV genomes and their potential role in the pathogenesis of HBV infection.

Association study of genetic variants on chromosome 7q31 with susceptibility to normal tension glaucoma in a Japanese population

The caveolin 1 to caveolin 2 (CAV1-CAV2) gene region on chromosome 7q31 has been reported to be associated with susceptibility to primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) in previous studies. We investigated whether genetic variants in the CAV1-CAV2 region are associated with NTG in Japanese patients. Two hundred and ninety-two Japanese patients with NTG and 352 Japanese healthy controls were recruited. We genotyped three single-nucleotide polymorphisms; that is, rs1052990, rs4236601, and rs7795356, in the CAV1-CAV2 gene region and assessed the allelic diversity among cases and controls. The frequency of the minor allele (G) of rs1052990 was significantly decreased in NTG cases compared with controls (P=0.014, OR=0.71), whereas NTG or POAG cases had a significantly higher frequency of the allele than controls in previous studies. Conversely, rs7795356 did not show any significant association with NTG cases, and rs4236601 was monomorphic in the Japanese study population. Our findings did not correspond with previous positive results, suggesting that CAV1-CAV2 variants studied in the present study are not important risk factors for NTG susceptibility in all populations. Further studies are needed to elucidate the possible contribution of the CAV1-CAV2 region to the development of glaucoma.

Etiology and survival of aplastic anemia: a study based on clinical investigation

BACKGROUND

Management of aplastic anemia is etiology driven, whether constitutional or acquired. Age, gender, and severity of disease also play crucial role in the survival of aplastic anemia. Since, inadequate data are available from India, the present study was conducted with the aim to evaluate the etiology and survival of aplastic anemia.

METHODS

Three hundred patients were enrolled between May 2007 and April 2010. Severity analysis and chromosomal breakage study was performed and patients were followed up to calculate the survival rate.

RESULTS

Only 9.4% of the cases demonstrated the evidence of constitutional disease. Patients with acquired disease showed a significantly higher odd ratio for hepatitis. Overall survival was found to be independent of the gender and inherited etiology. Phenotype resembling to constitutional disease was present in only 22.22% (6/27) of patients. Similar ratio of the constitutional and acquired disease in both the age groups was observed.

CONCLUSION

Irrespective of the age and phenotype, chromosomal breakage study should be mandatory for all patients with aplastic anemia. Hepatitis as a preceding event may be associated with the cause of aplastic anemia. Young age and less severe disease were strongly associated with better survival. Lack of tertiary care facility in the country, time lag between diagnosis and treatment, and unaffordability to abide the treatment cost could be the major contributory factors for poorer survival.

Endodontic management of mandibular central incisor fused to a supernumerary tooth associated with a talon cusp: a case report

AIM

To report the successful non-surgical endodontic management of a mandibular central incisor fused to a supernumerary tooth associated with a talon cusp.

SUMMARY

Fusion and gemination are developmental anomalies of teeth that may require endodontic treatment. In this article, a case of successful endodontic management of a permanent mandibular right central incisor fused to its supernumerary counterpart associated with a talon cusp is reported. The incidence of fusion in mandibular anteriors is rare. A search of the literature failed to reveal any reports on the fusion of a permanent mandibular central incisor with its supernumerary counterpart associated with a talon cusp. Successful non-surgical endodontic management of a case is reported.

KEY LEARNING POINTS

•  Fused and geminated teeth requiring endodontic treatment present diagnostic and technical challenges. • An exact differentiation between fusion and gemination may not be critically important for treatment. • The use of an operating microscope for detection of additional root canal orifices in complicated cases is recommended.

Inhibitory effects of maternal smoking on the development of severe retinopathy of prematurity

PURPOSE

In this study, the effects of maternal smoking along with other clinical risk factors in developing severe retinopathy of prematurity (ROP) were evaluated.

DESIGN

A case-control study.

METHODS

Records of newborn infants with an estimated postmenstrual age of 32 weeks or less (n=86) were reviewed. ROP grading was evaluated in accordance with the International Classification of Retinopathy of Prematurity. Severe ROP was diagnosed when it progressed to stage 3 with plus disease. The factors were first evaluated using a univariate logistic regression analysis between the groups of severe and non-severe ROP, followed by a multivariate logistic regression analysis using STATA version 10 and R version 2.71.

RESULTS

A low birth weight, a long duration of artificial ventilation and oxygen supplementation, presence of chronic lung disease, and absence of maternal smoking were found to be significantly associated with severe ROP in the univariate logistic regression analysis. In the multivariate logistic regression analysis, maternal smoking was revealed as a significant factor independently associated with the incidence of severe ROP.

CONCLUSIONS

An inhibitory effect of maternal smoking against developing severe ROP is suggested. The mechanism by which smoking may reduce the incidence of severe ROP needs to be further investigated.

Investigation of the association between the GLC3A locus and normal tension glaucoma in Japanese patients by microsatellite analysis

Purpose:

To investigate whether the GLC3A locus harboring the CYP1B1 gene is associated with normal tension glaucoma (NTG) in Japanese patients.

Materials and Methods:

One hundred forty-two Japanese patients with NTG and 101 Japanese healthy controls were recruited. Patients exhibiting a comparatively early onset were selected as this suggests that genetic factors may show stronger involvement. Genotyping and assessment of allelic diversity was performed on 13 highly polymorphic microsatellite markers in and around the GLC3A locus.

Results:

There were decreased frequencies of the 444 allele of D2S0416i and the 258 allele of D2S0425i in cases compared to controls (P = 0.022 and P = 0.034, respectively). However, this statistical significance disappeared when corrected (Pc > 0.05). We did not find any significant association between the remaining 11 microsatellite markers, including D2S177, which may be associated with CYP1B1, and NTG (P > 0.05).

Conclusions:

Our study showed no association between the GLCA3 locus and NTG, suggesting that the CYP1B1 gene, which is reportedly involved in a range of glaucoma phenotypes, may not be an associated factor in the pathogenesis of NTG.

Retrospective analysis and chemotherapy results in extra-nodal NHL patients in a large super-speciality hospital in North India

e19566

Background: We retrospectively analysed records of the Patients visiting the pathology department of Sir Ganga Ram Hospital, New Delhi a super-speciality hospital, between February 2007- February 2008. Out of a total of 16,500 cases, NHL was reported in 154 (0.93%)cases. The median age was 52 yrs and the no. of male patients were 104 and female were 50 making M:F = 2:1. The type of NHL was B-Cell type (CD-20+ve) in 132(85%) and T-Cell type (CD 3+ve) in 22 (15%) cases. Out of 154 patients, 77 were nodal and 77 were extra nodal. Additional features - HIV positivity in 2 patients, autoimmune haemolytic disease in 1 patient and thalessemia major in 1 patient. In extra-nodal group of NHL patients the no. Of male and female patients were 55 & 22 respectively (M:F=2.5:1). Out of 77 extra-nodal cases, 31(20%) were GIT NHL (Stomach -16, Colon-8, Ileum-4, and Duodenum-3) and out of the rest 46 extra-nodal cases the site of origin was - head & neck-14, skin n soft tissues -8, primary CNS-6, testicular-4, para-spinal- 3, breast mass-3, perinephric-2, bones-2 and 1 each in cervix, lung mass, liver and cervical plexus. Methods: A detailed analysis of 31 GIT NHL cases was carried out. 28 out of 31 were B-Cell type and 3 were T-Cell type. 26 out of 31 were diffuse large cell variety, 2 were mixed small & large cell variety and 1 MALT variety. In 2 patients the type of lymphoma could not be ascertained. Bone marrow infiltration was present in 2 out of 31 cases of GIT Lymphoma. Surgery was carried out in 15 of 31 GIT NHL cases and these were arising from Colon, Ileum and Duodenum. No surgery was performed in patients with stomach lymphoma. Results: Of all the extra-nodal cases chemotherapy was given to 39 patients - R-CHOP = 20 patients, CHOP = 13 patients, high dose MTX in primary CNS NHL = 6 patients. CR was achieved 16 out of 20 R-CHOP patients (80%), 8 out of 13 CHOP Patients (61 %) and 4 out of 6 high dose MTX patients (66%).

No significant financial relationships to disclose.

Alkaptonuria and intramedullary calcification

Alkaptonuria is a rare disorder of metabolism caused by deficiency of homogentisic acid oxidase enzyme and characterized by triad of homogentisic aciduria (dark urine), relentlessly progressive arthritis and ochronosis. We have documented a case with typical features of alkaptonuria along with intramedullary calcification which has not been reported in the literature before.

Preferable use of intravitreal bevacizumab as a pretreatment of vitrectomy for severe proliferative diabetic retinopathy

PURPOSE

To evaluate the safety and efficacy of intravitreal injection of bevacizumab advanced to vitrectomy for severe proliferative diabetic retinopathy.

METHODS

Eight eyes of six patients (33-64 years old, all male patients) with severe proliferative diabetic retinopathy were investigated. An intravitreal injection of 1.25 mg bevacizumab was performed 3-30 days prior to planned vitrectomy.

RESULTS

All cases showed minimum bleeding during surgical dissection of fibrovascular membrane. Two cases receiving bevacizumab 7 days before the surgery showed strong fibrosis and adhesion of fibrovascular membrane, resulted in some surgical complications. The cases having intravitreal bevacizumab for shorter time did not show extensive fibrosis.

CONCLUSIONS

The pretreatment of bevacizumab is likely effective in the vitrectomy for severe PDR. The appropriate timing of vitrectomy after bevacizumab injection should be further evaluated.

Efficacy of oxaliplatin, 5 FU and gemcitabine in advanced pancreato-biliary cancer

15182

Background: The treatment of advanced pancreato-biliary cancer remains an unmet need. The drugs known to be effective are oxaliplatin, gemcitabine. Method: The records of twenty patients suffering with cancers of advanced gall bladder (10), common bile duct (3), ampulle of vater (3) and pancreas (4) were analysed. Twenty patients were treated in the year 2006. Median age was 52 years. The common sites of metastatis were liver (12), lymphnodes (10), peritoneum (4), lungs (1). The patients with normal bilirubin & LFT (< 3 times upper limit of normal) were included. The chemotherapy protocol was given as: oxaliplatin 50 mg, leucovorin 30 mg, and 5FU 500 mg/m2 on day 1, 2, & 3. Gemcitabine was given 800 mg/m2 on day 2, 9, and 16. The cycle was repeated every 4 weeks. Response: The regimen was well tolerated. Pancytopenia requiring G-CSF, delays in drug administration occurred in 70% cases. The response was as follows-partial response 6/20 (30%), stable disease 5/20 (25%), progressive disease 9/20 (45%). The median survival was 5.5 months, four patients completed six cycles of chemotherapy and survival for at least 12 months. Conclusion: Oxaliplatin, 5 FU, gemcitabine and leucovorin is an effective chemo-protocol in advanced pancreato-biliary cancer. However, there is a need to improve upon the existing results.

No significant financial relationships to disclose.

The −174G/C interleukin-6 promoter polymorphism influences the development of macular oedema following uncomplicated phacoemulsification surgery

AIM

To determine whether the functional -174 G/C interleukin-6 gene polymorphism is a risk factor for the development of cystoid macular oedema (CMO) following routine uncomplicated phacoemulsification surgery in patients with no established risk factors.

METHODS

A total of 40 patients who underwent routine phacoemulsification surgery as part of a randomised controlled trial comparing the use of postoperative steroid drops against a single sub-tenon injection of triamcinolone were genotyped for the IL-6 -174G/C polymorphism. All patients underwent fluorescein angiography at 30 days and anterior chamber flare measurements pre-operatively and at day 1, 7, and 30.

RESULTS

Angiographic CMO developed in 14 patients of the 40 studied. 9 out of the 14 patients carried the GG genotype (Fisher's exact test P=0.05, Hazard ratio for GG genotype; 4.05 (1.02-16.00)). There was no difference in flare measurements between the GG and Non-GG (GC/CC) group. The two groups were otherwise well matched in terms of age, sex, phacoemulsification energy used intraoperatively, and proportion of patients receiving postoperative triamcinolone or steroid drops.

CONCLUSION

The -174G/C interleukin-6 promoter gene variant appears to modulate the response to phacoemulsification surgery and to influence the development of postoperative CMO. These data suggest a genetic predisposition to this complication.

Different transitions of multifocal electroretinogram recordings between patients with age-related macular degeneration and polypoidal choroidal vasculopathy after photodynamic therapy

AIM

To compare and evaluate the transitions in retinal function after photodynamic therapy (PDT) between age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) using multifocal electroretinograms (mfERGs).

METHODS

10 eyes with choroidal neovascularisation (CNV) secondary to AMD and 11 eyes with CNV secondary to PCV were included in the study. mfERGs were recorded before PDT, and 1 week and 3 months after PDT. mfERG recordings were acquired by a Veris system (V.3.1.3) using a 103 hexagon stimulus. The first-order kernel was used to calculate amplitudes and latencies. Mean amplitudes and latencies from two central rings rated 0-4 degrees of visual angle were analysed and compared with each disease.

RESULTS

In AMD, the mean first negative peak (N1) amplitudes tended to decrease, and the mean first positive peak (N1P1) amplitudes reduced to significant levels (p = 0.047) 1 week after PDT. 3 months after PDT, there were no significant differences in the mean N1 and N1P1 amplitudes compared with pre-PDT values. In PCV, there were no significant changes in the mean N1 and N1P1 amplitudes 1 week after treatment. However, 3 months after PDT, mean amplitudes showed significant increases in N1 (p = 0.008) and N1P1 (p = 0.006) amplitudes compared with pre-PDT values.

CONCLUSIONS

mfERG recording transitions are different between patients with AMD and those with PCV. In patients with AMD, these results may show transient impairments in retinal function 1 week after PDT, but in those with PCV, the efficacy of PDT is superior to the impairment after PDT.

Role of CT angiography in pulmonary embolism and its comparative evaluation with conventional pulmonary angiography

OBJECTIVES : The purpose of this study is to assess the role of spiral CT angiography in suspected cases of pulmonary embolism and to do comparative evaluation of CT angiography with conventional pulmonary angiography. MATERIAL AND METHODS : Twenty five patients of suspected pulmonary embolism (PE) underwent spiral CT angiography from the level of arch of aorta to the dome of diaphragm .Scanning was done with collimation of 5mm and an interval of 5mm at 130 mA and 120 kV. 100 cc of contrast containing 300 mg I/ ml, diluted with 60cc of normal saline in ratio 5:3 was injected at a flow rate of 3ml/sec with a scan delay of 20 seconds. Retro - reconstruction was done at 3mm interval. RESULTS : Spiral CTA showed a sensitivity of 80 % and a specificity of 85.7% for the diagnosis of pulmonary embolism. It also provided ancillary findings in the form of parenchymal and mediastinal structural information. CONCLUSION : CTA is an effective alternative to PA in diagnosis of suspected cases of PE. With its non- invasive nature, low cost, over and above high sensitivity and specificity, it may be used as the first line of investigation in the diagnosis of PE.

Intravitreal triamcinolone will cause posterior subcapsular cataract in most eyes with diabetic maculopathy within 2 years

PURPOSE

To determine the incidence of cataract following intravitreal triamcinolone (IVTA) for diabetic macular oedema.

METHODS

Prospective, non-randomised, interventional cohort case series. A total of 27 eyes of 27 patients with diabetic macular oedema received an intravitreal injection of 4 mg (0.1 ml) of triamcinolone acetonide inferotemporally through the pars plana under direct vision. In 20 patients the fellow eye served as control, whereas seven patients had both eyes injected (not simultaneously). Seven patients had a repeat (second) injection in the same eye. The main outcome measures were cataract and intraocular pressure (IOP) rise of at least 5 mmHg (IOP responder).

RESULTS

The mean follow-up time was 18.9 months (range 13-29 months). A total of 22 (81%) of 27 eyes developed cataract during the follow-up period, of which 20 (74%) were posterior subcapsular in nature. None of the 20 uninjected fellow eyes developed posterior subcapsular cataract. Mean time to cataract formation was 16.2 months. In the seven patients who had both eyes injected, mean time to cataract formation was 16.5 and 17.1 months in the first and second eye, respectively. Mean time to cataract formation in seven eyes receiving a repeat second injection was 17.9 months. There was no significant difference in cataract formation between IOP responders (85%) and non-responders (79%) (P=1.00, Fisher's exact test). Uneventful cataract surgery was performed in six eyes of five patients.

CONCLUSION

This study demonstrates that given appropriate long-term follow-up, the majority of patients, even after a single IVTA injection, will go on to develop cataract, of which posterior subcapsular will be by far the most common.

Macular thickness reduction in eyes with unilateral optic atrophy detected with optical coherence tomography

AIMS

To assess the changes in macular and peripapillary retinal nerve fibre layer (RNFL) thickness in eyes with unilateral optic atrophy and to evaluate the relationship between retinal thickness and visual function.

METHODS

Enrolled were 22 patients with unilateral optic atrophy. Macular thickness at the divided nine areas and peripapillary RNFL thickness in quadrantic sections were measured by optical coherence tomography. Thickness values in the affected eyes were compared with those in the contralateral unaffected eyes. The correlation of foveal thickness with best-corrected visual acuity (BCVA) was evaluated. The correlation between retinal thickness and the remaining visual field area circumscribed with I-4-e isopter in superior and inferior hemifield was assessed.

RESULTS

Macular thinning was observed in all areas (P < 0.001 in each area) other than the fovea (P = 0.068). Peripapillary RNFL thickness decreased in all quadrantic sections (P < 0.001 in each section). The affected to unaffected eye ratio of retinal thickness was more than 0.6 in each area. BCVA did not correlate with foveal thickness (correlation coefficient = 0.094, P = 0.668). Although not statistically significant (P = 0.281, superior hemifield; P = 0.053, inferior hemifield), there was a tendency that eyes with severe visual field loss show more marked retinal thinning.

CONCLUSIONS

Macular thinning with the preserved foveal thickness is a hallmark of eyes with optic atrophy. Together with no correlation between foveal thickness and BCVA, this finding would help in differential diagnosis of macular and optic nerve diseases.

Improved visual acuity and macular thickness 1 week after intravitreal triamcinolone for diabetic macular oedema

PURPOSE

To evaluate the clinical and volumetric improvement 1 week after an injection of intravitreal triamcinolone acetonide in eyes with diabetic macular oedema.

METHODS

Seven phakic eyes of seven diabetic patients diagnosed with clinically significant macular oedema were treated with a single 4-mg intravitreal injection of triamcinolone acetonide (0.1 ml). LogMAR best corrected visual acuity (logMAR BCVA), best corrected reading ability (RA), and central macular thickness (CMT) with optical coherence tomography (OCT) were assessed prior and 1 week subsequent to treatment.

RESULTS

Mean improvement in logMAR BCVA was 0.146 (P=0.03). Mean reduction in CMT was 150.9 mum (P=0.02, Wilcoxon signed-rank test). Mean improvement in RA was 3 lines.

CONCLUSION

Reduction in macular oedema was demonstrated on OCT at 1 week, in most cases associated with improvement in central visual function, in particular, reading ability. Total resolution of diabetic macular oedema may occur at 1 week following intravitreal steroid injection.

Is poor life expectancy a predictive factor in the progression of primary open angle glaucoma?

AIM

To investigate the disease progression and final visual outcome of glaucoma patients with poor life expectancy, compared to matched patients with a longer life expectancy.

METHOD

Visual fields at diagnosis and at the last ophthalmic appointment before death were analysed for glaucoma patients referred between 1991 and 1995, and deceased before the end of 2001. These patients were matched to the patients living beyond 2001. Functional vision was also assessed, and classified as better than the NHS partial sighted criteria.

RESULTS

A total of 61 deceased patients were identified, resulting in 40 matched pairs. In all, 6.5% of the patients with poor life expectancy progressed from functional vision to beyond partial sighted criteria, and none of the matched patients progressed to this extent. At final assessment an association between poor life expectancy and progression beyond functional vision was found existing (P = 0.02), with a lesser association at diagnosis (P = 0.06). Visual field scores of the matched pairs who had test results available for both initial and final assessment (n = 23 pairs) showed no statistically significant difference between the two groups at diagnosis (P = 0.52); However, a significant difference at final the assessment did exist (P = 0.042). No difference between the initial (off medication) intraocular pressures (IOPs) was found (P = 0.82). At the final assessment a significant difference existed (P = 0.025), with the surviving group having a higher final mean pressure (15.9 mmHg, SD 2.8, vs 18.3 mmHg, SD 4.9).

CONCLUSION

Patients with poor life expectancy progressed more than the matched surviving patients, when measured from an initially similar position, despite better IOP control.

N-(2-Chloroethyl)-N-ethyl-2-bromobenzylamine reduces intracellular calcium response to noradrenaline in rat visual cortex

Using the fluorescent indicator Fura-2, we investigated the effects of N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine (DSP-4), a noradrenergic neurotoxin, on intracellular calcium responses to noradrenaline, N-methyl-D-aspartate, and carbamylcholine chloride in brain slices of the rat visual cortex. Noradrenergic depletion in the visual cortex of young rats was induced by DSP-4, and its selectivity was confirmed by two different methods, i.e., immunostaining with anti-dopamine-beta-hydroxylase antibody and biochemical analysis by high-performance liquid chromatography. The treatment with DSP-4 (25 mg/kg i.p., x2) caused disruption of noradrenergic fibers throughout all cortical layers, and reduced the content of noradrenaline to 6.4% of that in the normal control. In the normal cortex, bath-applied noradrenaline (100 microM) increased the intracellular calcium to 123% of the control in terms of the F(340)/F(380) ratio of Fura-2 fluorescence. Quantitative analysis of the F(340)/F(380) ratio was performed in layers II to IV, since the increase was mainly observed in these layers. The intracellular calcium response to noradrenaline was significantly (P<0.0001) reduced in the DSP-4-treated animals to 63.2% of that in the normal control. The response to N-methyl-D-aspartate (100 microM) was also reduced, whereas the response to carbamylcholine chloride, a muscarinic cholinergic agonist (100 microM), was not affected by the DSP-4 treatment. From these findings we suggest that noradrenergic denervation by DSP-4 reduces the intracellular calcium response to noradrenaline through changes in the intracellular signal transduction.

Matrix metalloproteinases induction by pseudomonal virulence factors and inflammatory cytokines in vitro

The pathogenesis of pseudomonal keratitis was investigated by focusing on induction and activation of matrix metalloproteinases (MMPs) by pseudomonal virulence factors and proinflammatory cytokines. Corneal lesions and MMP induction in vivo were evaluated in rabbit corneas infected with a clinical isolate of Pseudomonas aeruginosa. Effects of pseudomonal virulence factors [elastase, alkaline protease, exotoxin A and lipopolysaccharide (LPS)], tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta on MMP induction and activation were further examined in vitro in rabbit corneal fibroblasts (RCF) and human fibrosarcoma (HT1080) cells using reverse transcriptase-polymerase chain reaction (RT-PCR), zymography and immunoblotting. Corneal ulcers with typical ring abscesses were observed 12-24 h after infection, and MMPs, particularly MMP-9, were upregulated in infected corneas. Pseudomonal elastase caused the most extensive damage to both cell types. RCF treated with pseudomonal exoproteases or LPS expressed and secreted MMP-9. Exotoxin A had no effect on MMP expression. Both IL-1beta and TNF-alpha augmented MMP-9 expression in HT1080 cells. Pseudomonal elastase proteolytically activated MMP-2 and MMP-9 released from the cells. In conclusion, corneal destruction seen with P. aeruginosa infections may result from enhanced expression of MMPs by corneal stromal cells stimulated with pseudomonal exoproteases and proinflammatory cytokines and the proteolytic activation of MMPs by pseudomonal elastase.