Outcome and number of cataract surgeries in India: policy issues for blindness control

Purpose: To assess what impact attention to quality of cataract surgery and postoperative follow up can have on cataract blindness in India, and to estimate the number of surgeries needed to eliminate cataract blindness in India. Methods: In a population‐based sample of 5268 persons in two rural areas in the state of Andhra Pradesh, India, data on the visual outcome of cataract surgery were obtained on 129 eyes of 106 persons operated previously. These were compared with the visual outcome of cataract surgery performed during 1999 in 2394 eyes of 2213 persons at two new rural eye centres set up in these areas that pay particular attention to the quality of eye care. Blindness in an eye was defined as presenting distance visual acuity less than 6/60, and in a person as this acuity level in the better eye. These data were extrapolated to India. Results: In the population‐based sample, of the 129 operated eyes, 51 (39.5%) were blind after surgery, which included 41 (31.8%) from cataract surgery‐related causes. Of the 106 persons in the population sample who had had cataract surgery in one or both eyes, 26 (24.5%) were still blind. In contrast, for the cataract surgery at the two rural eye centres paying attention to quality, 3.1% of the eyes and 1.8% of the persons were blind soon after surgery, but these figures could increase 2.6 times over the lifetime of these persons. The 3.5 million cataract surgeries in India in 2000 are estimated to result in 0.32 million persons having blindness averted over their lifetime. To eliminate cataract blindness in India, an estimated 9 million good‐quality cataract surgeries are needed every year during 2001?2005, increasing to over 14 million surgeries needed every year during 2016?2020 on persons most likely to go blind from cataract. Conclusions: The number of persons in whom blindness is being averted due to cataract surgery in India is currently a very small fraction of the number blind from cataract. If adequate attention is given to the quality of eye care, for the current number of cataract surgeries in India it should be possible to increase by threefold the number in whom blindness can be averted with cataract surgery. In addition to improving quality, the annual number of cataract surgeries has to be at least threefold the current number during 2006?2010 if cataract blindness in India is to be eliminated.     

Biochemical compensation and recovery following temporary inhibition of ornithine decarboxylase during the development of rat cerebellar cortex

Specific inhibition of ornithine decarboxylase selectively in the developing rat cerebellum was achieved within 10 min after intrathecal injection of α-difluoromethylornithine. Twelve hours later the activity started to increase, passed control levels between 2 and 3 days, continued to increase and reached its peak values by day 3 (when animals were 10 days old), 3 days after peak control values. Ornithine decarboxylase activity then declined and attained low adult values simultaneously with controls. Glutamic acid decarboxylase activity, a marker of gabaergic neurons maturation, declined to a nadir at 3 days postinjection, and then was elevated transiently above control levels with a peak at 11 days postinjection. We conclude that after such a temporary insult neuroblasts of the cerebellar cortex are capable of full recovery, which is apparent by a reversible reduction in ornithine decarboxylase and glutamic acid decarboxylase activities followed by a transient compensatory elevation in both enzymes.     

Phosphonoformate inhibits synthesis of epstein-barr virus (EBV) capsid antigen and transformation of human cord blood lymphocytes by EBV

Phosphonoformic acid trisodium salt (PF) and ethyl diethylphosphonoformate (Et-PF) inhibited Epstein—Barr virus (EBV) viral capsid antigen (VCA) synthesis in B.95-8 cells, at concentrations which were nontoxic to cells. PF inhibited 96.7% of VCA synthesis when used at 500 μM whereas Et-PF inhibited only 68.9% of VCA synthesis when used at 2000 μM. The synthesis of EBV nuclear antigen (EBNA) was not inhibited by PF or Et-PF. PF inhibited the transformation of human cord blood lymphocytes (CBL) by EBV as detected by [³H]thymidine uptake. The inhibition of transformation was a function of the dose of PF used. A concentration of 2000 μM PF completely inhibited the transformation; the same concentration of ET-PF had almost no effect.     

Elimination of phenolsulfonphthalein from the cerebrospinal fluid via capillaries in central nervous system in cats by active transport

It was recently proposed that organic anions, such as cerebral acidic metabolites and phenolsulfonphthalein (PSP), are eliminated from cerebrospinal fluid (CSF) by diffusion into the central nervous system (CNS) and further by active transport into capillaries. To test this hypothesis, PSP was injected into cisternal CSF and its distribution into various parts of the CNS was measured 1 and 3 h later in control cats and those pretreated with probenecid, which blocks active transport of organic anions into capillaries. PSP in tissue shows an intensive pink color when exposed to 1 N NaOH. Planimetric analysis of color pictures of coronal CNS slices showed that at the first hour, diffusion and distribution of PSP into the CNS in both groups of animals was similar, while at the third hour, a great reduction of PSP distribution in the CNS in control and only a slight reduction in probenecid pretreated cats was observed. The results support the hypothesis that active transport across the capillary wall in the CNS is the main avenue for elimination of cerebral acidic metabolites from both CSF and CNS and in such a way that central homeostasis is maintained.     

Pemphigus variant associated with penicillin use: a case-cohort study of 363 patients from Israel

OBJECTIVE: To determine whether medication use is associated with the development of a pemphigus variant. DESIGN: Population-based case-cohort study. SETTING: Health maintenance organization in Israel. METHODS: All incident pemphigus variant cases diagnosed from January 1, 1997, through December 31, 2001, among 1.5 million members were identified. A cohort of 150,000 was randomly selected from the health maintenance organization population as the control group. Data on case patients and control subjects, including all medication purchased during the 6 months before the diagnosis, were obtained using the health maintenance organization's central database. RESULTS: We identified a total of 363 case patients diagnosed as having pemphigus during the 5-year study (6,961,853 person-years of follow-up). The mean age at diagnosis was 49.8 (SD, 22.7) years, and 53% of the cases were women. Results of a multivariate analysis showed that increased risk for pemphigus was associated with purchasing penicillin during the 6 months before the diagnosis (odds ratio, 2.03; 95% confidence interval, 1.56-2.64). Compared with individuals with no penicillin purchases, we calculated increased risks of 1.84 (95% CI, 1.36-2.49) and 3.02 (95% CI, 1.41-6.49) in those with 1 and 3 or more purchases, respectively. None of the other examined medications, including cephalosporins, angiotensin-converting enzyme inhibitors, dipyrone, anticonvulsants, and nonsteroidal anti-inflammatory drugs, showed similar risks. CONCLUSIONS: To our knowledge, the present research is one of the largest published epidemiological studies on pemphigus variant. The use of computerized medical and administrative databases allowed the detection of case patients in the community, resulting in a higher calculated incidence rate than previously reported. The findings suggest a relationship between the use of penicillin and pemphigus variant. Further studies to assess the nature of this statistical association are warranted.     

Polymorphisms in four candidate genes in young patients with essential hypertension

Aim: To determine whether four potential genetic factors (polymorphisms in genes for alpha-adducin, beta-adducin, the G-protein beta-3 subunit and nitric oxide synthase) are important for the development of essential hypertension (EH) in Slovenian children and young adults with EH. Methods: Both a nuclear families approach and case-control study have been performed. Genotyping of common polymorphisms in these genes using polymerase chain reaction was carried out in 104 nuclear families (an affected child, both parents) and in 200 control patients. Results: Using the transmission disequilibrium test, no statistically significant differences were found between the frequencies of transmitted and non-transmitted alleles in nuclear families for all four investigated polymorphisms. In addition, the distributions of genotypes and alleles for the four polymorphisms did not differ significantly between our children and 200 healthy control patients. The allele frequencies of all polymorphisms were concordant with those observed in some other Caucasian populations.

Conclusion: We found no association between the investigated gene variants and EH, so we conclude that they do not confer a significantly increased risk of the development of EH in the Slovenian population of hypertensive children.