Physical fitness: a comparative study between students of residential (Sainik) and non-residential schools (aged 12-14 years)

Physical Fitness Index (PFI), of fifty Residential (Sainik) School children (Mean +/- SD, 13.18 +/- 0.48 yrs) and forty four Non-Residential school children (Mean +/- SD, 13.15 +/- 0.66 yrs) of Bijapur, Karnataka, was assessed by Harvard Step Test. Their height (cm), weight (kg), chest circumference (cm), and mid arm circumference (cm) were recorded as physical anthropometry. Body Mass Index (BMI) was also calculated (kg/m2). Results indicated that Non-Residential School children had poor physical anthropometry and showed a less PFI score (Mean +/- SD, 60.56 +/- 13.49), as compared to Residential (Sainik) School children (Mean +/- SD, 85.7 +/- 16.91). Regular physical activity with uniform diet and better physical composition attributed higher physical fitness in the children of Residential (Sainik) school in comparison to their sedentary Non-Residential counter part.     

Phacovitrectomy for primary retinal detachment repair in presbyopes

PURPOSE: To review the results of phacovitrectomy for primary retinal detachment repair in presbyopes. METHODS: The outcome and complications of surgery were examined in a retrospective case series of 93 presbyopic patients who underwent phacoemulsification and vitrectomy for primary rhegmatogenous retinal detachment. RESULTS: Eighty-two patients (88.2%) had reattachment with a single procedure. The final reattachment rate with further procedures was 97.8%. Two patients (2.2%) in whom final reattachment did not occur declined further surgery after the primary repair. All redetachments were due to proliferative vitreoretinopathy. The median Snellen converted logMAR visual acuity improved from 1.00 preoperatively to 0.30 postoperatively (P < 0.001, Wilcoxon test). Postoperative complications included transient intraocular pressure rise (29%), fibrinous uveitis (16.2%), and iris/intraocular lens capture (8.6%). One of the eight patients with iris/intraocular lens capture required surgical reintervention. All cases of fibrinous uveitis and intraocular pressure rise resolved within a few days with medical treatment. Posterior capsular opacification occurred in 23 patients (24.7%). CONCLUSION: Combined surgery with phacoemulsification, lens extraction, and vitrectomy offers significant advantages to both patient and surgeon in the management of primary retinal detachment. We believe that it should be considered for presbyopes even in the absence of significant lens opacity. Fibrinous uveitis and intraocular pressure rise may occur in a few patients in the immediate postoperative period but are transient and resolve with medical treatment. Further prospective studies are required, in particular to examine the rate of postoperative proliferative vitreoretinopathy, which may be higher than with vitrectomy alone.     

Analysis of a comprehensive diabetic retinopathy screening model for rural and urban diabetics in developing countries

AIM: To present an analysis of a screening model for diabetic retinopathy and compare the results of screening between rural and urban populations. METHODS: Between June 2003 and September 2004, 51 diabetic retinopathy screening camps (rural, 25; urban, 26) were conducted in three southern districts of India. The target population, aged 30 years and above, underwent comprehensive eye evaluation and those with referable diabetic retinopathy (proliferative diabetic retinopathy, severe non-proliferative diabetic retinopathy, severe diabetic macular oedema, or a combination of these) were referred to the base hospital for further treatment. RESULTS: Among 7716 diabetic subjects, the age and sex adjusted prevalence of diabetic retinopathy was 18% in the rural areas and 17% in the urban areas. The prevalence of referable retinopathy was 6.8% in rural areas and 4.6% in urban areas (p<0.001). Around 63% of individuals in rural areas and 75% in urban areas had never previously had their eyes examined for diabetic retinopathy. Multivariate analysis revealed the following risk factors for diabetic retinopathy: age more than 50 years, known diabetes, prolonged duration of diabetes, and eyes with moderate or severe visual impairment (p<0.0001). CONCLUSIONS: The study describes a comprehensive diabetic retinopathy screening model which can identify sight threatening retinopathy and provide necessary treatment for rural and urban populations.     

Association Between Periodontal Disease and Chronic Obstructive Pulmonary Disease: A Reality or Just a Dogma?

Background: In the past few years, the association between chronic obstructive pulmonary disease (COPD) and periodontal disease has been promulgated. The present study is aimed at determining the association between these two diseases. Methods: This observational study includes 501 individuals consisting of 102 patients (case group) having COPD and 399 individuals as controls. Individuals in the case group were well‐functioning and ambulatory patients having COPD as determined by their history and their values of forced expiratory volume in 1 second (FEV₁) and forced vital capacity. Periodontal status was evaluated by the following five indices: 1) plaque index; 2) oral hygiene index (OHI); 3) gingival index (GI); 4) probing depth (PD); and 5) clinical attachment level (CAL). Lung function test was performed by all the patients (case group), who were then graded into mild, moderate, severe, and very severe. Results: Preliminary analysis was performed to identify the covariates in this study. Individuals in the case group had significantly higher CAL, PD, and OHI (P <0.0001) compared with the control group after adjusting for covariates. A significant negative correlation was observed between FEV₁ values and CAL, PD, and GI, thus indicating a trend in which severity of lung obstruction increased as these periodontal indices worsened. Conclusion: Although the present study cannot ascertain causal association, it provides substantial evidence that poor periodontal health is associated with obstructive lung disease.     

Relationship Between Behavioral and Physiological Spectral-Ripple Discrimination

Previous studies have found a significant correlation between spectral-ripple discrimination and speech and music perception in cochlear implant (CI) users. This relationship could be of use to clinicians and scientists who are interested in using spectral-ripple stimuli in the assessment and habilitation of CI users. However, previous psychoacoustic tasks used to assess spectral discrimination are not suitable for all populations, and it would be beneficial to develop methods that could be used to test all age ranges, including pediatric implant users. Additionally, it is important to understand how ripple stimuli are processed in the central auditory system and how their neural representation contributes to behavioral performance. For this reason, we developed a single-interval, yes/no paradigm that could potentially be used both behaviorally and electrophysiologically to estimate spectral-ripple threshold. In experiment 1, behavioral thresholds obtained using the single-interval method were compared to thresholds obtained using a previously established three-alternative forced-choice method. A significant correlation was found (r = 0.84, p = 0.0002) in 14 adult CI users. The spectral-ripple threshold obtained using the new method also correlated with speech perception in quiet and noise. In experiment 2, the effect of the number of vocoder-processing channels on the behavioral and physiological threshold in normal-hearing listeners was determined. Behavioral thresholds, using the new single-interval method, as well as cortical P1-N1-P2 responses changed as a function of the number of channels. Better behavioral and physiological performance (i.e., better discrimination ability at higher ripple densities) was observed as more channels added. In experiment 3, the relationship between behavioral and physiological data was examined. Amplitudes of the P1-N1-P2 “change” responses were significantly correlated with d′ values from the single-interval behavioral procedure. Results suggest that the single-interval procedure with spectral-ripple phase inversion in ongoing stimuli is a valid approach for measuring behavioral or physiological spectral resolution.     

Role of transoral CO<Subscript>2</Subscript> laser surgery for severe pediatric laryngomalacia

Controversy exists as to the preferred treatment modality for managing refractory pediatric laryngomalacia (LM). Simultaneous bilateral procedures have been associated with supraglottic stenosis. Unilateral operations have a higher rate of secondary intervention. This prospective study was conceptualized to ascertain a preferred approach. A secondary goal was to correlate the surgical outcome with presenting symptoms and signs. Twenty-two children with severe LM met the criteria for enrollment. Bilateral CO₂ laser-assisted supraglottic laryngoplasties were performed in all cases. The procedure mainly consisted of division of the aryepiglottic fold. Nineteen (86%) patients met our defined success criteria. There were no surgical complications. Bilateral supraglottic laryngoplasty has a role in the management of severe refractory LM.     

Adenovirus Disease after Kidney Transplantation: Course of Infection and Outcome in Relation to Blood Viral Load and Immune Recovery

Information on the clinical spectrum and management of adenovirus infection after kidney transplantation is limited. From April 2007 to April 2010, 17 kidney transplant recipients were diagnosed with adenovirus disease. The median time to infection was 5 (range, 2–300) weeks after transplantation. Of the 17 patients, 13 (76.5%) presented early, within 3 months posttransplant, and four (23.5%) presented late, more than 3 months after transplant. Besides urinary tract, involvement of other organs was common (63.6%) among patients with adenovirus viremia. Despite reduction of immunosuppression, six patients subsequently had a rise in the level of blood viral load, mostly within a week after diagnosis. However, only three (27.3%) patients with early infection developed disease progression. Compared to the late infection group, patients with early infection had significantly lower absolute lymphocyte counts at week 1 (p = 0.01) and 3 (p = 0.002) after diagnosis. Four patients received intravenous cidofovir. At 6‐month follow‐up, 10 (90.9%) patients had reversible graft dysfunction. Only one (5.7%) died from bacterial sepsis. Adenovirus disease is a significant complication following kidney transplantation. Early case recognition with reduction of immunosuppression is critical. Serial blood adenovirus viral loads and assessment of lymphocyte recovery are also useful in monitoring the course of infection.     

Glycoprotein IIb/IIIa antagonism and fibrinolytic therapy for acute myocardial infarction

Fibrinolytic therapy for the treatment of ST-segment elevation myocardial infarction unquestionably reduces mortality when administered within 12 hours of symptom onset. By promptly restoring antegrade perfusion, infarct size is limited, ventricular function is less compromised, and mortality rates are lowered. Although fibrinolytic therapy initially restores antegrade flow in the infarct vessel in the majority of patients, sustained, tissue-level reperfusion occurs in only approximately one fourth of patients. Thrombin and platelets associated with a coronary thrombus are not specifically targeted by fibrinolytic agents, but rather have paradoxically increased activity. These components contribute to the tendency for vessel reocclusion after initially successful reperfusion. Thus, adjunctive therapy with antithrombins and antiplatelet agents are essential in the successful treatment of a coronary thrombus. Although aspirin has been shown to reduce mortality in acute myocardial infarction, it is a weak antiplatelet agent that is pathway specific. Glycoprotein IIb/IIIa inhibitors are potent antiplatelet agents that block the final common pathway for platelet aggregation. Thus, the growing evidence of platelet preeminence in the pathophysiology of failed thrombolysis has lead to the study of combination drug therapy with glycoprotein IIb/IIIa inhibition and reduced dose fibrinolytic agents in the treatment of acute ST-segment elevation myocardial infarction. This article reviews the rationale, results, and clinical implications of the major trials of combination drug therapy in acute myocardial infarction.     

High incidence of bacteriuria in early post-kidney transplantation; results from a randomized controlled study

Since the incidence of bacteriuria in kidney transplant recipients varyes according to the study, we examined it among our cases. Our post hoc analysis of data from a single-center, parallel, randomized, controlled, open label study included 90 patients who underwent kidney transplantation at our hospital from April 2010 to January 2011. Patients were randomized to early ureteric stent removal at 8 days versus routine ureteric stent removal at 15 days after kidney transplantation. We identified the incidence of and causative organism for bacteriuria in the early posttransplant period.Seventy-Four patients (58% living donors) participated in this study. The overall incidence of bacteriuria was 56.7% during the first month after kidney transplantation. In patients who had bacteriuria, 48% showed symptomatic urinary tract infection, 40% asymptomatic bacteriuria and 12% urosepsis. The most common organism was Escherichia coli (40%) follow by Klebsiella pneumoniae (19%). The incidence of an ESBL producing organism was 34%. The incidence of bacteriuria was high during the early post-kidney transplant period, requiring increased awareness and surveillance.