Comparison of Binocular Vision Parameters Pre- and Post-EPILASIK Laser Vision Correction Surgery for Myopia in a Pilot Study – Can Vision Therapy Augment Refractive Results?

Purpose:To analyze the changes in the binocular vision parameters after bilateral Epilasik laser vision correction surgery (LVCS).Setting:Medical Research Foundation, Tamil Nadu, India.Study design:Prospective cohort study.Methods:Subjects with a best corrected visual acuity of ≤ 0.0 Log MAR scale and refractive error: < 6.00DS of myopia, < 0.75D of astigmatism, and < 1D of anisometropia were included in the study. All subjects underwent a comprehensive eye examination, LVCS workup which included corneal topography, tomography, aberrometry, and dry eye assessment prior to binocular vision assessment. Complete Binocular vision assessment which included stereopsis, fusion for distance and near, near point of convergence, phoria measurement, vergence amplitudes and facility, accommodative amplitudes, response, and facility was performed with the best corrected vision prior to LVCS, one month and six months after the surgery.Results:Twenty-five subjects of age 23.8 ± 2.9 years were included. Age ranged from 20 to 32 years. Ten were female and 15 were male. The median spherical power was –2.00DS with an inter quartile range (IQR) of –1.50DS to –3.00DS for both eyes. The median cylindrical power was plano with IQR –0.50DC to –1.00DC for both eyes. There was a statistically significant decrease in monocular and binocular accommodative amplitudes (accounting for age-related changes) as well as positive fusional vergence recovery for near between baseline and one month after surgery (p < 0.05).Conclusion:Though subjects were asymptomatic post LVCS, still there is an indication that myopic LVCS could precipitate or aggravate an existing non-strabismic binocular vision anomaly. Comprehensive binocular vision assessment and appropriate management is recommended before and after LVCS.     

Involvement of histamine receptors in SAPK/JNK phosphorylation

Histamine is a mediator of inflammation in allergic disease and asthma. Stress activated protein kinases/c-jun N-terminal kinases (SAPK/JNK) are involved in asthma. This study examined the role of histamine receptors on the phosphorylation of SAPK/JNK in splenocytes. C57BL/6 mice splenocytes were treated with histamine (10?? M to 10?11 M), and its selective receptor agonists, phorbol 12 myristate 13-acetate (PMA) was used as a positive control, and phosphorylation of SAPK/JNK was determined. Histamine (10?? M-10?? M) inhibited phosphorylation of SAPK/JNK. H1R agonist betahistine (10?? M) decreased SAPK/JNK phosphorylation and H2R agonist amthamine (10?? M) did not show any significant effect. However, H3R agonist methimepip (10?? M) and H4R agonist 4-methyl histamine (10?? M), increased SAPK/JNK phosphorylation. We used TNFα knockout mice to determine if histamine regulated SAPK/JNK phosphorylation via TNFα. While the effects of histamine and H1 agonists were similar to that of wild type mice in inhibiting the phosphorylation of SAPK/JNK, the effects of H3 and H4 agonists differed in TNFα knockout mice splenocytes. Activation of H3 receptors decreased SAPK/JNK phosphorylation in TNFα knockout mice, as opposed to an increase in wild type mice, whereas H4 agonist did not show any significant effect on the phosphorylation of SAPK/JNK. This data showed that histamine acting through H4 receptors caused the phosphorylation of SAPK/JNK via TNFα. The role of H4 receptors in pro-inflammatory response is intriguing.     

Ethnicity and Nonalcoholic Fatty Liver Disease in an Obesity Clinic: The Impact of Triglycerides

Nonalcoholic fatty liver disease (NAFLD) is a growing problem that is associated with the metabolic syndrome. The goal of the present study was to evaluate for ethnic differences in NAFLD and clinical correlates of NAFLD. The study population consisted of 567 patients seen at an urban obesity clinic. Elevated aminotransferase levels were used as a surrogate marker for NAFLD. The prevalence of elevated aminotransferases was highest in Hispanics (39%), followed by Caucasians (28%), and African Americans (12%). In univariate analysis, elevated aminotransferase levels were associated with ethnicity (Hispanic > African American, P < 0.001, and Caucasian > African American P = 0.030), hypertriglyceridemia (P < 0.001), and male gender (P < 0.001). The pattern of results was confirmed in multivariate analysis, except that the differences between Caucasians and African Americans was no longer significant. In conclusion, in an obesity clinic population, elevated aminotransferase levels and hypertriglyceridemia were most common in Hispanics and least common in African Americans.     

Does the mode of administration of the Oral Health Impact Profile-49 affect the outcome score?

Objective

To determine if there are differences in outcome scores if the Oral Health Impact Profile-49 (OHIP-49) is delivered by two different modes of administration (manual-self complete versus telephone interview).

Methods

Patients with chronic periodontitis (n = 83, 54% females and 46% males, mean age 49.1 ± 9.5 years) completed the OHIP-49 using two modes of administration (manual self-complete and telephone interview) in a randomly assigned order, with a minimum washout period of 2 weeks between modes, both episodes occurring prior to any periodontal treatment being provided. To assess convergent validity, after each mode of administration, the patients were additionally asked a global question about their oral health-related quality of life (OHRQoL).

Results

Median OHIP-49 scores recorded by manual self-complete (median 36 [IQR = 20–70]) were significantly higher than those recorded by telephone interview (median 27 [IQR = 11–61]) (p < 0.01). The global question was well correlated to the OHIP domains, but did not reveal any evidence of an order effect such as was seen with OHIP-49 itself (which showed a higher impact on OHRQoL during the first administration in either mode).

Conclusions

The mode of administration (manual-self complete versus telephone interview) did substantially influence the OHIP-49 scores in patients with chronic periodontitis. The OHRQoL differed between the two modes of administration, with significantly higher scores (indicating poorer OHRQoL) when the questionnaire was manually self-completed.

Clinical significance

The mode of administration of quality of life questionnaires such as OHIP-49 could potentially affect the outcome scores derived. This study investigated whether there is a difference in outcome scores if OHIP-49 is delivered via manual self-complete or by telephone interview in patients with chronic periodontitis. We found that there was a significant difference between the two modes: manual self-completion by the patients yielded significantly higher scores than completion by telephone interview. It is therefore important to be consistent in the mode of completion of OHIP-49, as mixing modes could introduce additional error into clinical studies that utilise this instrument.     

Follicular development in a 7-day versus 4-day hormone-free interval with an oral contraceptive containing 20 mcg ethinyl estradiol and 1 mg norethindrone acetate

Background

Combined oral contraceptive (COC) formulations with 20 mcg ethinyl estradiol (EE) have a greater incidence of ovarian hormone production and follicular development, which can be managed by shortening the number of hormone-free days per COC cycle. This study evaluates differences in follicular development during a 7-day versus 4-day hormone-free interval in a COC regimen with 20 mcg EE and 1 mg norethindrone acetate.

Study Design

Forty-one healthy women were randomized in an open-label fashion to this formulation in either a 24/4 or a 21/7 day regimen for three cycles. Estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone and inhibin B were measured daily from Cycle 2, Day 21 to Cycle 3, Day 3 and on Day 7 of Cycle 3. Follicular diameter and Hoogland score were calculated on Cycle 2, Days 21, 24 and 28 and Cycle 3, Days 3 and 7.

Results

Sixty-six percent of subjects in the 21/7 group and 70% of the subjects in the 24/4 group developed a follicle greater than 10 mm diameter. Ovarian steroid hormone levels, Hoogland scores and bleeding patterns were not statistically significant between the groups.

Conclusion

In contrast to prior studies, this analysis suggests no difference in follicle development or bleeding patterns among women receiving a 21/7 or 24/4 regimen of a 20-mcg EE/1-mg norethindrone acetate COC.     

Ocular surface squamous neoplasia in xeroderma pigmentosum: clinical spectrum and outcome

Background  

To study the clinical spectrum and therapeutic outcome of ocular surface squamous neoplasia (OSSN) in patients with xeroderma pigmentosa (XP).     

Heightened motor and sensory (mirror-touch) referral induced by nerve block or topical anesthetic

Mirror neurons allow us to covertly simulate the sensation and movement of others. If mirror neurons are sensory and motor neurons, why do we not actually feel this simulation- like “mirror-touch synesthetes”? Might afferent sensation normally inhibit mirror representations from reaching consciousness? We and others have reported heightened sensory referral to phantom limbs and temporarily anesthetized arms. These patients, however, had experienced illness or injury of the deafferented limb. In the current study we observe heightened sensory and motor referral to the face after unilateral nerve block for routine dental procedures. We also obtain double-blind, quantitative evidence of heightened sensory referral in healthy participants completing a mirror-touch confusion task after topical anesthetic cream is applied. We suggest that sensory and motor feedback exist in dynamic equilibrium with mirror representations; as feedback is reduced, the brain draws more upon visual information to determine- perhaps in a Bayesian manner- what to feel.