Hyaluronidase in sub-Tenon's anesthesia for phacoemulsification, a double-blind randomized clinical trial

AIM: To investigate the effect of hyaluronidase use on the quality of sub-Tenon's anaesthesia for phacoemulsification. METHODS: This was a randomized, double-blind clinical trial which was conducted at Nikookari Eye Hospital for 5 months. Forty-two eyes of candidates for phacoemulsification under sub-Tenon's anaesthesia were randomly allocated to two equal groups and received either 2 mL of lidocaine 2% solution with (LH), or without (L) addition of hyaluronidase (150IU/mL). Akinesia was assessed 15 minutes after sub-Tenon’s injection. Patients and surgeon’s satisfaction, as well as the postoperative pain (the visual analogue scale, VAS) were investigated after operation. The contingency tables (including the Chi-square or Fisher's exact tests, when appropriate) and parametric analysis (the independent samples t test) were used for statistical analysis. RESULTS: Complete akinesia (33.3% vs 4.8%, P=0.04), as well as the patients (85.7% vs 57.1%, P=0.04) and surgeon’s satisfaction (87.5% vs 52.4%, P=0.02) were significantly more frequent in LH than in L group. The mean VAS was significantly lower in the same group (1.90±1.45 vs 3.00±1.55, P=0.04). CONCLUSION: Addition of hyaluronidase to lidocaine solution for sub-Tenon's anesthesia significantly improves the ocular akinesia, enhances the intra-operative patients and surgeons' satisfaction, and attenuates the postoperative pain.     

Hyaluronidase in sub-Tenon's anesthesia for phacoemulsification, a double-blind randomized clinical trial

AIM: To investigate the effect of hyaluronidase use on the quality of sub-Tenon's anaesthesia for phacoemulsification. METHODS: This was a randomized, double-blind clinical trial which was conducted at Nikookari Eye Hospital for 5 months. Forty-two eyes of candidates for phacoemulsification under sub-Tenon's anaesthesia were randomly allocated to two equal groups and received either 2 mL of lidocaine 2% solution with (LH), or without (L) addition of hyaluronidase (150IU/mL). Akinesia was assessed 15 minutes after sub-Tenon’s injection. Patients and surgeon’s satisfaction, as well as the postoperative pain (the visual analogue scale, VAS) were investigated after operation. The contingency tables (including the Chi-square or Fisher's exact tests, when appropriate) and parametric analysis (the independent samples t test) were used for statistical analysis. RESULTS: Complete akinesia (33.3% vs 4.8%, P=0.04), as well as the patients (85.7% vs 57.1%, P=0.04) and surgeon’s satisfaction (87.5% vs 52.4%, P=0.02) were significantly more frequent in LH than in L group. The mean VAS was significantly lower in the same group (1.90±1.45 vs 3.00±1.55, P=0.04). CONCLUSION: Addition of hyaluronidase to lidocaine solution for sub-Tenon's anesthesia significantly improves the ocular akinesia, enhances the intra-operative patients and surgeons' satisfaction, and attenuates the postoperative pain.     

Zonisamide for the treatment of epilepsy

The availability of new antiepileptic drugs with different mechanisms of action has widened our therapeutic choice, allowing better tailoring of treatment regimens to address specific needs. Zonisamide is the latest addition to the pharmacological management of epilepsy in Europe, following extensive clinical experience in Japan and the USA. This article reviews the structure, mechanism of action, pharmacokinetics and drug interactions of zonisamide. The four double-blind, placebo-controlled trials in patients with drug-resistant focal seizures are also presented. They complement pre- and postmarketing studies conducted in Japan and provide clear-cut evidence that the drug has efficacy as an add-on treatment in this indication. Reports on zonisamide monotherapy and on the use of the drug for the control of several types of seizures (typical and atypical absences, tonic and myoclonic) and syndromes in children and adults are also commented on. These were all open-label studies, as is often the case with other antiepileptic drugs, dealing with treatment of epilepsy in children. The Japanese, US and European data provide a large database of safety information suggesting that the drug is well tolerated with mild-to-moderate adverse events (e.g., somnolence and dizziness). Nephrolithiasis appears to have a very low incidence and cutaneous reactions are rare. The available data provide an excellent foundation on which clinicians can build their knowledge on this drug, although the broad-spectrum efficacy of zonisamide needs to be confirmed through randomized trials.     

The effect of fenugreek 4-hydroxyisoleucine on liver function biomarkers and glucose in diabetic and fructose-fed rats

Fenugreek (Trigonella foenum graecum L) is a plant traditionally used for the treatment of diabetes. It contains an unusual amino acid, 4-hydroxyisoleucine, demonstrated to have insulinotropic and antidiabetic properties in animal models. Here we examine the effect of 4-hydroxyisoleucine on liver function and blood glucose in two rat models of insulin resistance, fructose-fed rats and streptozotocin-induced diabetes type 2. In fructose-fed rats, levels of glucose and liver damage marker aspartate transaminase were markedly (84% and 93%, respectively) and significantly elevated compared with controls (p < 0.001 for both). Alanine transaminase was elevated slightly (18%), and all markers were restored to near control values after treatment with 4-hydroxyisoleucine at 50 mg/kg per day for 8 weeks, the effect being significant (p < 0.01) for all markers. This prolonged exposure to 4-hydroxyisoleucine was well tolerated in control animals and did not alter levels of glucose or liver damage markers significantly. In diabetic rats, treatment with 4-hydroxyisoleucine did not affect glucose or liver damage markers, but did improve HDL-cholesterol levels (31% increase, p < 0.05). These findings indicate 4-hydroxyisoleucine as a useful and well-tolerated treatment for insulin resistance, both directly as a hypoglycaemic and also as a protective agent for the liver.     

Metastatic renal cell carcinoma to the nose and ethmoid sinus

We report a rare case of metastatic renal cell carcinoma involving the nose and ethmoid sinus, 17 years after initial nephrectomy and diagnosis of Stage T1N0 clear cell renal cell carcinoma. The patient complained of nasal obstruction and epistaxis. Intensity-modulated radiotherapy (IMRT) was delivered using a higher-than-conventional daily fraction size concurrently with interferon and thalidomide. The patient achieved a complete response both clinically and by magnetic resonance imaging, without any side effects. Late and rare sites of recurrences and treatment options are discussed.     

角膜胶原蛋白交联疗法对人工晶状体大泡性角膜病变的作用

目的：研究核黄素和紫外线（ UVA ）交联疗法对晚期大泡性角膜病的疗效。 方法：15例人工晶状体大泡性角膜病变（ PBK ）患者参与研究。分别于角膜交联前和干预后1,6mo,对患者行裂隙灯检查、视敏度、异物调查表、角膜透明度分级、眼部疼痛度范围、分析仪角膜厚度分析及超声波角膜厚度测量。氯化钠溶液处理1 wk后,去除8 mm直径范围的中央角膜上皮,在角膜上频繁点滴核黄素30min,后行3min紫外线（ UVA）照射交联疗法。 结果：15例患者（5男,10女）,平均年龄为66依13岁。平均随访时间6.2mo。治疗后1mo全眼角膜透明度统计结果明显优于术前（P〈0.05）。6mo时8眼角膜透明度较术前更佳,5眼持平,2眼低于术前（ P=0.218）。70%病患异物感减弱。处理后1mo平均中央角膜厚度（ CCT）减少（ P〈0.05）。6mo时,除3眼外均出现渐进性肿胀,但统计显示CCT明显薄于术前（P=0.006）。统计显示术后1mo平均矫正远视力（ CDVA）明显优于术前（ P=0.010）。6 mo后无显著差异（P=0.130）。1mo痛值统计结果明显优于术前（P=0.007）。但6mo平均痛值较1mo高,较术前无明显差异（P=0.070）。 结论：术后1 mo结果显示角膜胶原交联疗法可显著改善角膜透明度、角膜厚度和眼痛。但是,它对减少PBK患者疼痛和维持角膜透明度方面似乎并无长期持久的效果。这种方法延长了角膜移植的时间间隔,并提高了角膜内皮移植术（ DSAEK）过程的可视化。     

Maintaining human milk bank services throughout the COVID‐19 pandemic: A global response

If maternal milk is unavailable, the World Health Organization recommends that the first alternative should be pasteurised donor human milk (DHM). Human milk banks (HMBs) screen and recruit milk donors, and DHM principally feeds very low birth weight babies, reducing the risk of complications and supporting maternal breastfeeding where used alongside optimal lactation support. The COVID‐19 pandemic has presented a range of challenges to HMBs worldwide. This study aimed to understand the impacts of the pandemic on HMB services and develop initial guidance regarding risk limitation. A Virtual Collaborative Network (VCN) comprising over 80 HMB leaders from 36 countries was formed in March 2020 and included academics and nongovernmental organisations. Individual milk banks, national networks and regional associations submitted data regarding the number of HMBs, volume of DHM produced and number of recipients in each global region. Estimates were calculated in the context of missing or incomplete data. Through open‐ended questioning, the experiences of milk banks from each country in the first 2 months of the pandemic were collected and major themes identified. According to data collected from 446 individual HMBs, more than 800,000 infants receive DHM worldwide each year. Seven pandemic‐related specific vulnerabilities to service provision were identified, including sufficient donors, prescreening disruption, DHM availability, logistics, communication, safe handling and contingency planning, which were highly context‐dependent. The VCN now plans a formal consensus approach to the optimal response of HMBs to new pathogens using crowdsourced data, enabling the benchmarking of future strategies to support DHM access and neonatal health in future emergencies.