Management of moderate and severe corneal astigmatism with AcrySof? toric intraocular lens implantation – Our experience

Purpose

Visual performance following toric intraocular lens implantation for cataract with moderate and severe astigmatism.

Setting

Cataract services, Shroff Eye Centre, New Delhi, India.

Design

Case series.

Method

This prospective study included 64 eyes of 40 patients with more than 1.50 dioptre (D) of pre-existing corneal astigmatism undergoing phacoemulsification with implantation of the AcrySof® toric IntraOcular Lens (IOL). The unaided visual acuity (UCVA), best corrected visual acuity (BCVA), residual refractive sphere and refractive cylinders were evaluated. Toric IOL axis and alignment error was measured by slit lamp method and Adobe Photoshop (version 7) method. Patient satisfaction was evaluated using a satisfaction questionnaire at 3 months.

Results

The mean residual refractive astigmatism was 0.57 D at the final follow-up of 3 months. Mean alignment error was 3.44 degrees (SD = 2.60) by slit lamp method and 3.88 degrees (SD = 2.86) by Photoshop method. Forty-six (71.9%) eyes showed misalignment of 5 degrees or less, and 60 (93.8%) eyes showed misalignment of 10 degrees or less. The mean log MAR UCVA at 1st post-op day was 0.172 (SD = 0.02), on 7th post-op day was 0.138 (SD = 0.11), and on 30th post-op day was 0.081 (SD = 0.11). The mean log MAR BCVA at three months was −0.04 (SD = 0.76).

Conclusion

We believe that implantation of AcrySof® toric IOL is an effective, safe and predictable method to correct high amounts of corneal astigmatism during cataract surgery.     

Nux vomica 30 prepared with and without succession shows antialcoholic effect on toads and distinctive molecular association

Adult toads, Bufo melanostictus, were administered Nux vomica (Nux v) 30 prepared with and without succussion on the tongue. The drug was mixed with sterile distilled water at the rate 0.05ml/ml water and given orally 0.05ml/individual. The control consisted of blank ethanol solution. Seeds of Strychnos nuxvomica were ground and extracted with 90% ethanol in the laboratory. Nux v 30 was prepared by successive dilution and succussion in 30 steps, Nux v 30 u was prepared by successive dilution only. Four hours after treatment, toads were given 25% ethanol i.p. at 8g/kg body weight. The duration of ethanol induced sleep time was recorded for each toad. Both Nux v 30 and Nux v 30 u significantly reduced ethanol induced sleep time in toads as compared to their respective controls. Electronic, infra red and nuclear magnetic resonance spectra of Nux v 30, Nux v 30 u and their diluent medium (90% ethanol) show marked differences from each other. These dilutions and ethanol 30 and ethanol 30 u show marked differences from each other with respect to spin-lattice relaxation time (T1) and chemical shift. The difference has been attributed to the variation in intra and inter-molecular association of ethanol and water.     

Epilepsy classification using optimized artificial neural network

ABSTRACT

Objectives: An Electroencephalogram (EEG) is the result of co-operative actions performed by brain cells. In other words, it can be defined as the time course of extracellular field potentials that are generated due to the synchronous action of cells. It is widely used for the analysis and diagnosis of several conditions. But this clinical data use to be multi-dimensional, context-dependent, complex, and it causes a concoction of various computing related research challenges. The objective of this study was to develop a computer-aided diagnosis system for epilepsy detection using EEG signals to ease the diagnosis process.

Materials: In this study, EEG datasets for epilepsy disease detection were taken from a public domain (Bonn University, Germany). These EEG recordings contain 100 single-channel EEG signals with maximum duration of 23.6 seconds. This data set was recorded intra-cranially and extra-cranially with the help of a 128-channel amplifier system using a common reference point.

Results: For a unique set of EEG signal features, the Optimized Artificial Neural Network model for classification and validation was developed with optimum neurons in the hidden layer. Results were tested on the basis of accuracy, sensitivity, precision, and specificity for all classes. The proposed Particle Swarm Optimized Artificial Neural Network provided 99.3% accuracy for EEG signal classification.

Discussion: Our results indicate that artificial neural network has efficiency to provide higher accuracy for epilepsy detection if the statistical features are extracted carefully. It is also possible to improve results for real time diagnosis by using optimization technique for error reduction.

Abbreviations: EEG: Electroencephalogram CAD: Computer-Aided Diagnosis ANN: Artificial Neural Network PSO: Particle Swarm Optimization FIR: Finite Impulse Response IIR: Infinite Impulse Response MSE: Mean Square Error.     

A comparative analysis of surgical outcome in uveitic and non-uveitic steroid–induced glaucoma in children

Purpose:To compare outcomes of surgical management of uveitic glaucoma (UG) and steroid-induced glaucoma (SIG) in children in terms of intraocular pressure (IOP) control, visual acuity, and associations for failure.Methods:This was a retrospective case–control study of consecutive UG (cases) and non-uveitic SIG (controls) in children <18 years of age who underwent surgery between January 2005 and December 2017.Results:Primary trabeculectomy with mitomycin C (MMC) was performed in 12 cases (mean age: 9.2 ± 4.3 years) and 40 controls (mean age: 10.4 ± 3.7 years) (P = 0.33). Primary phaco-trabeculectomy with MMC was performed in 11 cases (mean age: 11.4 ± 4.7 years) and 16 controls (mean age: 10.4 ± 3.4 years) (P = 0.57). IOP control (P = 0.26), visual acuity (P = 0.97), number of glaucoma medications (P = 0.06), and survival rates (49% cases vs. 68% controls at 5 years; P = 0.22) were similar between the two groups following trabeculectomy. Survival rates in the phaco-trabeculectomy group at 5 years were 68% cases vs. 69% controls (P = 0.71). IOP was higher (P = 0.008) and visual acuity was worse (P = 0.02) in cases at the last visit. Associations for failure (univariate analysis) were younger age (OR: 6.29, 95% CL: 1.43, 27.67; P = 0.03) and male gender (OR: 4.79, 95% CL: 1.09, 20.97; P = 0.04). On multivariate analysis, younger age (OR: 11.985, 95% CL: 1.071, 134.153; P = 0.04) remained significant. Preoperative number of uveitic attacks was protective on univariate (OR: 0.75, 95% CL: 0.48, 1.15; P = 0.1) and multivariate analyses (OR: 0.49, 95% CL: 0.24, 0.09; P = 0.04).Conclusion:Outcomes of trabeculectomy between cases and controls were similar in our series. However, phaco-trabeculectomy in pediatric uveitic eye group fared worse than eyes with SIG.     

A contemporary review of Clostridioides difficile infections in patients with haematologic diseases

Clostridioides (Clostridium) difficile (C. difficile) infection is one of the most common causes of increased morbidity and mortality. Approximately 500 000 C. difficile infections (CDIs) occur each year in the United States, and they result in more than 29 000 deaths. Patients with haematologic diseases are at a higher risk for this infection due to frequent hospitalization and exposure to treatment-associated risk factors. Whilst several currently available antimicrobial agents offer resolution, recurrence of infection remains a major concern. Recent advancement in deciphering C. difficile virulence mechanisms and identification of its allies in contributing to the infection has led to the development of alternative treatment strategies. Here, we will provide a contemporary discussion of how major risk factors in haematologic diseases, such as immunosuppression, chemoradiation, use of antibiotic, proton pump inhibitor and opioid, and deficiency in butyrate and antimicrobial peptides contribute to C. difficile infection. Next, we will highlight different approaches to control and mitigate this infection such as antibiotic stewardship and faecal microbiota transplantation. Finally, we will explore several emerging treatments such as use of pre- and probiotics, immunotherapy and microbiome-sparing agents.     

The Dose-Response Effects of Consuming High Fructose Corn Syrup-Sweetened Beverages on Hepatic Lipid Content and Insulin Sensitivity in Young Adults

Increased hepatic lipid content and decreased insulin sensitivity have critical roles in the development of cardiometabolic diseases. Therefore, our objective was to investigate the dose-response effects of consuming high fructose corn syrup (HFCS)-sweetened beverages for two weeks on hepatic lipid content and insulin sensitivity in young (18–40 years) adults (BMI 18–35 kg/m²). In a parallel, double-blinded study, participants consumed three beverages/day providing 0% (aspartame: n = 23), 10% (n = 18), 17.5% (n = 16), or 25% (n = 28) daily energy requirements from HFCS. Magnetic resonance imaging for hepatic lipid content and oral glucose tolerance tests (OGTT) were conducted during 3.5-day inpatient visits at baseline and again at the end of a 15-day intervention. During the 12 intervening outpatient days participants consumed their usual diets with their assigned beverages. Significant linear dose-response effects were observed for increases of hepatic lipid content (p = 0.015) and glucose and insulin AUCs during OGTT (both p = 0.0004), and for decreases in the Matsuda (p = 0.0087) and Predicted M (p = 0.0027) indices of insulin sensitivity. These dose-response effects strengthen the mechanistic evidence implicating consumption of HFCS-sweetened beverages as a contributor to the metabolic dysregulation that increases risk for nonalcoholic fatty liver disease and type 2 diabetes.     

A Study of Erosion–Corrosion Behaviour of Friction Stir-Processed Chromium-Reinforced NiAl Bronze Composite

Corrosion is frequently viewed as a catastrophic and unavoidable disaster in marine applications. Every year, a huge cost is incurred on the maintenance and repair of corrosion-affected equipment and machinery. In the marine environment, as-cast nickel–aluminium bronze (NAB) is susceptible to selective phase corrosion. To solve this problem, chromium-reinforced nickel–aluminium bronze was fabricated using the friction stir process (FSP) with improved microstructures and surface properties. A slurry erosion–corrosion test on as-cast and FSPed composites demonstrated that the developed surfaced composite has lower erosion and corrosion rates than the as-cast NAB alloy. The erosion–corrosion rate increased with a decrease in the impact angle from 90° to 30° for both as-cast NAB and prepared composites, exhibiting a shear mode of erosion. The specimens at impact angle 30° experienced more pitting action and higher mass loss compared with those at impact angle 90°. Due to increases in the mechanical properties, the FS-processed composite showed higher erosion resistance than the as-cast NAB alloy. Furthermore, corrosion behaviour was also studied via the static immersion corrosion test and electrochemical measurements under 3.5 wt.% NaCl solution. In a static immersion corrosion test, the FSPed composite outperformed the as-cast NAB composite by a wide margin. The FSPed composite also demonstrated a reduced electrochemical corrosion rate, as revealed by the polarization curve and electrochemical impedance spectroscopic (EIS) data. This reduced rate is attributed to the formation of a Cr oxide film over its surface in the corrosive environment.