Changing trends in the prevalence of blindness and visual impairment in a rural district of India: Systematic observations over a decade

Context : Globally, limited data are available on changing trends of blindness from a single region. Aims : To report the changing trends in the prevalence of blindness, visual impairment (VI), and visual outcomes of cataract surgery in a rural district of Andhra Pradesh, India, over period of one decade. Settings and Design : Rural setting; cross-sectional study. Materials and Methods : Using a validated Rapid Assessment of Cataract Surgical Services (RACSS) method, population-based, cross-sectional survey was done in a rural district in the state of Andhra Pradesh, India. Two-stage sampling procedure was used to select participants ≥50 years of age. Further, a comparative analysis was done with participants ≥50 years from the previously concluded Andhra Pradesh Eye Disease Study (APEDS) study, who belonged to the same district. Statistical Analysis : Done using 11 th version of Stata. Results : Using RACSS, 2160/2300 (93.9%) participants were examined as compared with the APEDS dataset (n=521). Age and sex adjusted prevalence of blindness in RACSS and APEDS was 8% (95% CI, 6.9-9.1%) and 11% (95% CI, 8.3-13.7%), while that of VI was 13.6% (95% CI, 12.2-15.1%) and 40.3% (95% CI, 36.1-44.5%), respectively. Cataract was the major cause of blindness in both the studies. There was a significant reduction in blindness following cataract surgery as observed through RACSS (17.3%; 95% CI, 13.5-21.8%) compared with APEDS (34%; 95% CI, 20.9-49.3%). Conclusion : There was a significant reduction in prevalence of blindness and VI in this rural district of India over a decade.     

肺泡膜弥散和肺毛细血管血量特征在不同级别慢性阻塞性肺病患者的表现

目的:了解不同级别慢性阻塞性肺病患者肺泡毛细血管膜弥散量和肺泡毛细血管血量的特点。方法:收集2006-07/2007-03就诊于四川大学华西医院呼吸科的慢性阻塞性肺病患者154例,依据慢性阻塞性肺病方案分级,0级64例,Ⅰ级38例,Ⅱ级26例,Ⅲ和Ⅳ级共26例。行肺通气功能、肺容量、一氧化碳弥散量、肺泡毛细血管膜弥散量和肺泡毛细血管血量测定。结果:154例患者均进入结果分析。①0级与I级慢性阻塞性肺病患者,无论一氧化碳弥散量、肺泡毛细血管膜弥散量和肺泡毛细血管血量都正常。随着慢性阻塞性肺病程度加重,一氧化碳弥散量、肺泡毛细血管膜弥散量和肺泡毛细血管血量均有不同程度降低。Ⅱ级慢性阻塞性肺病时一氧化碳弥散量和肺泡毛细血管膜弥散量下降明显,肺泡毛细血管血量改变不明显。其中肺泡毛细血管膜弥散量出现异常明显早于一氧化碳弥散量和肺泡毛细血管血量,而且较严重。Ⅲ和Ⅳ级慢性阻塞性肺病的肺泡毛细血管血量下降明显。②一氧化碳弥散量、肺泡毛细血管膜弥散量和肺泡毛细血管血量与慢性阻塞性肺病级别、残气量/肺总量成负相关,与第1秒用力呼气容积/用力肺活量和第1秒用力呼气容积占预计值百分比成正相关,而且,肺泡毛细血管膜弥散量与各指标的相关性最好。结论:随着慢性阻塞性肺病程度的加重,一氧化碳弥散量、肺泡毛细血管膜弥散量和肺泡毛细血管血量均有下降。肺泡毛细血管膜弥散量的异常比一氧化碳弥散量和肺泡毛细血管血量较早出现而且较严重。肺泡毛细血管膜弥散量的测定可以监测疾病发展并早期发现慢性阻塞性肺病气体交换的异常。     

应用干细胞分离仪分离脐血与传统手工分离法的效果比较

目的:脐血处理的关键问题是提高干细胞的回收率及实现处理过程的标准化和可重复化,实验对此进行探讨,比较干细胞分离仪与传统羟乙基淀粉手工法分离脐血的效果。方法:实验于2006-12/2007-05在广州医学院附属市一人民医院完成。①脐血来源:39份脐血采自广州医学院附属市一人命医院妇产科健康顺产新生儿脐带,产妇均知情同意。随机数字表法分为仪器分离组17份、手工分离组22份。②实验方法:仪器分离组收集脐血称质量,计算体积,在开始处理前20min缓慢加入相当于20%脐血体积的60g/L羟乙基淀粉。仪器分离组按仪器要求自动分离,分离终体积20mL。手工分离组50g离心5min,压浆板压出全部血浆以及18mL红细胞移至无菌空袋,500g离心13min,自动压浆板压出血浆,保留20mL终体积样本。③实验评估:采用全自动计数仪进行检测有核细胞(白细胞)、红细胞数量。流式细胞仪分析CD34 含量。结果:采用干细胞分离仪处理浓缩脐血,有核细胞回收率为(89.7±3.4)%,CD34 细胞回收率为(98.8±5.1)%,红细胞去除率为(55.2±16.7)%,均比手工分离组分离效果好,差异有显著性意义(P<0.05或0.01)。同时,仪器分离组有核细胞回收率、CD34 细胞回收率的标准差均明显低于手工分离组(3.4vs.15.3;5.1vs.10.3)。结论:相比传统的羟乙基淀粉手工分离法,干细胞分离仪脐血分离浓缩效果理想,且结果标准误小,数据稳定。     

传统及改良冻存法对人胎肝细胞保护效果的比较

目的:比较传统及改良冻存法对人胎肝细胞保护效果,建立一种适合于人胎肝细胞冷冻保存的方法。方法:实验于2006-07/11在广州医学院进行。①人胎肝组织取自中期终止妊娠胎儿(20周,经胎儿亲属知情同意及医院伦理委员会批准)。冷冻保护液包括A液(DMEM培养液含1.5mol/L乙二醇 体积分数为0.2胎牛血清);B液(A液 0.1mol/L蔗糖)两部分。②传统冻存法:用0.025%Ⅰ型胶原酶消化胎肝组织,分离、收集消化后的胎肝细胞。胎肝细胞在A液、B液中分别渗透平衡20min后,在冷冻保护B液中经液氮蒸汽冷平衡5min后迅速入液氮冻存,1周后复苏培养观察。③改良冻存法:胎肝组织在A液、B液中分别渗透平衡20min后,在冷冻保护液B液中经液氮蒸汽冷平衡5min后迅速入液氮冻存,1周后复苏,入DMEM培养液37℃孵育1h,胶原酶消化胎肝组织,分离、收集消化后的胎肝细胞培养观察。④新鲜分离的胎肝细胞做为对照组。⑤复苏后分离所得胎肝细胞用锥虫兰染色评估细胞活率,并记录贴壁时间,观察集落生长情况。结果:①锥虫兰染色结果显示传统冻存法复温后的胎肝细胞活率为(73.8±2.2)%,明显低于新鲜分离的胎肝细胞活率(89.2±3.6)%及改良冻存法所得胎肝细胞活率(82.5±4.2)%(P<0.01)。②贴壁情况观察发现新鲜胎肝细胞与改良冻存法胎肝细胞于培养24h开始贴壁,而传统冻存法胎肝细胞贴壁时间滞后48h。③新鲜胎肝细胞及改良冻存法胎肝细胞于第3天出现生长集落(细胞数>10为一个集落),传统冻存法胎肝细胞在第5天出现生长集落,集落的数量低于改良冻存法及对照组(P<0.01)。结论:改良冻存法可避免冻存前损伤,提高细胞对冷冻的耐受性和冻存复温后细胞的活率。     

The outcome of surgical fixation of mid shaft clavicle fractures; looking at patient satisfaction and comparing surgical approaches

Introduction:

Clavicle fractures represent 2.5% of fractures in adults and almost 44% of shoulder injuries. The treatment is usually non-surgical with good results; however, significantly displaced fractures can be associated with high non-union rate and therefore many would advocate surgical fixation. This is traditionally carried out by direct approach over the clavicle but an infraclavicular approach has also been used for clavicular fixation. The aim of this study was to identify the main indications for surgical intervention at our unit and patient satisfaction following surgery. We also wanted to compare the direct and the infraclavicular surgical approaches in relation to the outcome of surgical intervention.

Materials and Methods:

Retrospective study looking at all the clavicle fractures managed surgically over 5 years at our department. Information relating to surgical indication, surgical approach, complications, outcome, patient satisfaction, and oxford shoulder score were collected.

Results:

A total of 35 patients were identified, the majority were males (n = 25) and most (n = 29) were working at the time of injury. The commonest indication for surgery was displacement with shortening (n = 16). The infraclavicular approach was used in the majority of patients (n = 21), the rest (n = 14) had direct incision. Evidence of radiological and union was achieved in all patients after an average of 13 (8-24) weeks. There were no major complications but minor complications were reported in 28% and 19% of cases with direct and infraclavicular approaches, respectively. Plates were removed from six symptomatic patients; infraclavicular (n = 2) and direct approach (n = 4). Four asymptomatic plates were removed on patients’ requests. All patients returned to work (after an average 2.6 months), had good oxford shoulder score between 12-20, regardless of the surgical approach used. All patients except one would recommend it to a friend.

Conclusion:

Our study showed excellent surgical outcome for displaced clavicle fractures supported by the high union rate, good oxford shoulder score, high return to work rate, and good patient''s satisfaction. The number of minor complications and symptomatic metal work removal was less in the infraclavicular approach.     

Stability-indicating UPLC method for determination of Valsartan and their degradation products in active pharmaceutical ingredient and pharmaceutical dosage forms

A simple, precise, accurate stability-indicating gradient reverse phase ultra-performance liquid chromatographic (RP-UPLC) method was developed for the quantitative determination of purity of Valsartan drug substance and drug products in bulk samples and pharmaceutical dosage forms in the presence of its impurities and degradation products. The method was developed using Waters Aquity BEH C18 (100 mm × 2.1 mm, 1.7 μm) column with mobile phase containing a gradient mixture of solvents A and B. The eluted compounds were monitored at 225 nm, the run time was within 9.5 min, which Valsartan and its seven impurities were well separated. Valsartan was subjected to the stress conditions of oxidative, acid, base, hydrolytic, thermal and photolytic degradation. Valsartan was found to degrade significantly in acid and oxidative stress conditions and stable in base, hydrolytic and photolytic degradation conditions. The degradation products were well resolved from main peak and its impurities, proving the stability-indicating power of the method. The developed method was validated as per international conference on harmonization (ICH) guidelines with respect to specificity, linearity, limit of detection, limit of quantification, accuracy, precision and robustness. This method was also suitable for the assay determination of Valsartan in pharmaceutical dosage forms.     

Technetium-99m sestamibi scintimammography complements mammography in the detection of breast cancer

Mammography remains the technique of choice for the detection of early breast cancer. The sensitivity of mammography is 85%, but is decreased in patients with dense breasts. Sestamibi scintimammography (SCM) has been suggested as an adjunctive modality to improve the detection of breast cancer. We conducted a study to determine the impact of SCM in patient management. A prospective study was conducted in 95 patients presenting with palpable masses and/or abnormal mammography scheduled for biopsy. Injection of 20-30 mCi of technetium-99m (Tc-99m) sestamibi into a pedal vein was performed. Ten-minute images of the breast and axilla were obtained in multiple projections. The mammography and SCM were correlated with pathology and clinical findings. The median age was 44 years (range 28-86 years). The total number of lesions was 104, as eight patients had bilateral lesions and one patient had two lesions in the same breast. Fifty-nine patients presented with palpable lesions and 45 patients with nonpalpable lesions (42 with abnormal mammography only and 3 with nipple discharge). A comparison of sensitivity, specificity, positive and negative predictive values, and overall accuracy of SCM and mammography were performed. The sensitivity and specificity for SCM were 83% and 83%, respectively, and for mammography were 65%, and 72%, respectively. The sensitivity and specificity for combined SCM and mammography were 87% and 94%, respectively. The p-value for mammography versus combined SCM and mammography was 0.0003 and that for SCM versus SCM and mammography was 0.0098. There were 80 (77%) benign and 24 (23%) malignant lesions. Of the 24 malignancies, SCM missed six (25%), versus eight (33%) by mammography. In two patients (9%) SCM detected malignancy in the breast that was not visualized by mammography or found on clinical examination. Sestamibi SCM improves the sensitivity of mammography and it detects up to 9% of malignancies not detected by mammography or clinical examination. This testing could impact the management of 16,500 patients in the United States every year. More studies are needed to better define its role in breast cancer detection.     

Clinical profile of STD clinic patients seropositive for HIV antibodies

This article provides clinical profiles for HIV seropositive patients discovered at an STD clinic in Tirupati, India. Considering that sexual contact is the most common mode of transmission of HIV, researchers from the SV Medical College at Tirupati conducted a surveillance for HIV infection among patients attending an STD clinic. From January 1988 to April 1989, the researchers collected serum samples from 2320 patients. 11 people were found to be infected with HIV, 1 of whom exhibited the AIDS Related Complex (ARC). 9 out the HIV-infected patients were 20-30 year-old males categorized as heterosexually promiscuous; the remaining 2 seropositive patients were female prostitutes. The seropositivity rate among heterosexually promiscuous males was 0.58%, and 6.7% among female prostitutes (the total seropositivity rate was 0.47%). Among the HIV-infected patients, the most commonly associated STD was syphilis. 5 of the patients had syphilis alone, and 2 others had syphilis and another STD. One of the HIV-infected patients, a 50 year-old heterosexual male with a history of multiple partners, suffered from a nonhealing genital ulcer and inguinal buboes of 1 month duration. A biopsy of the genital ulcer revealed a pattern consistent with that of granuloma venereum. He also developed angular stomatitis which did not respond to B complex therapy. Furthermore, suffering from persistent lymphadenopathy, weight loss, slight thrombo-cytopenia, an opportunistic infection in the form of oral candidosis and persistent seropositivity for HIV antibodies, the patient was deemed to have the AIDS Related Complex. Tirupati's seropositivity rate of .47% was higher that noticed in other parts of the country, leading the authors call for a plan to investigate the problems of HIV-infected people.     

复方烧伤喷雾剂的药效学研究

目的：研究以乙酸乙酯为主要溶媒的复方烧伤喷雾的药效学。方法：用烧伤创面感染常见的金黄色葡萄球菌、绿脓假单胞菌、大肠埃希氏菌、普通变形杆菌做豚鼠烧伤感染模型,并用复方烧伤喷雾剂治疗,结果：复方烧伤喷雾剂可促进豚鼠Ⅱ度烧伤创面的愈合,并具有显著的烧伤创面抗感染作用。结论：乙酸乙酯可作为某些中药有效成分的优良提取溶剂。