Multimodal Imaging in Dengue-Fever-Associated Maculopathy

Dengue fever can cause ocular complications that may not be easily identified during a regular eye examination. A high degree of suspicion and multimodal imaging will help characterize the lesions during acute stages of the infection.     

Retinal nerve fiber layer and ganglion cell complex thickness analysis in patients having relative afferent pupillary defect

Purpose:To determine the retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) thickness in patients having relative afferent pupillary defect (RAPD) measured by optical coherence tomography (OCT).Methods:This cross-sectional study was conducted on 30 patients with posterior segment disease and glaucoma presenting with RAPD. The control group comprised 30 patients with the aforementioned diseases without RAPD. RAPD was graded using neutral density filters placed over the unaffected eye. Peripapillary RNFL thickness and macular GCC were measured using the Cirrus HD-OCT machine.Results:There were 45 males and 15 females. There was a statistically significant (P < 0.05) difference in the mean of average RNFL thickness in patients having RAPD (64.73 ± 15.16 mm in the affected eyes) as compared to sick control (82.73 ± 11.33 mm in the affected eyes). It was further observed that there was a decrease in RNFL thickness with advancing grades of RAPD. There was a statistically significant (P < 0.05) difference in the mean of average GCC thickness in patients having RAPD (51.57 ± 14.96 mm in the affected eyes) as compared to sick control (76.36 ± 8.06 mm in the affected eyes).Conclusion:Our study suggests that there is a significant reduction in RNFL thickness and GCC thickness in RAPD patients as compared to the sick control group.     

Assessment of the efficacy of teriparatide treatment for osteoporosis on lumbar fusion surgery outcomes: a systematic review and meta-analysis

Neurosurgical Review - Treatment of osteoporosis with medications like teriparatide, a parathyroid hormone, is known to improve bone density and reduce the risk of osteoporotic vertebral fractures....     

The “inadequate doughnut” technique for stapling in rigid rectums

PURPOSE: A technique to achieve sound anastomosis of a stiff irradiated rectum is described. METHOD: After application of the pursestring, manipulation of the rectal stump creates an inadequate doughnut anteriorly after firing the circular stapler, which is conveniently repaired manually. RESULTS: A sound anastomosis is achieved. CONCLUSION: This technique is efficient and reliable for creating a sound anastomosis in the rigid rectum.     

Phage influence on the synthesis of extracellular toxins in group A streptococci.

Phage conversion of group A streptococci to produce streptococcal exotoxins was shown to occur more widely than has been previously reported. Toxigenic conversion was found in 19 newly constructed lysogenic and pseudolysogenic strains resulting in synthesis of exotoxin types A and B. Conversion was accomplished by a positive conversion effector, which was a phage characteristic expressed by the prophage and vegetatively reproducing phage. Exotoxin production was determined by the rabbit skin test and by countercurrent immunoelectrophoresis with type-specific antisera. New lysogens and pseudolysogens were constructed with strains which failed to produce at least one exotoxin type. Phages were obtained from toxigenic strains isolated from cases of scarlet fever. Conversions were consistent and repeatable; loss of the recently introduced phage was accompanied by loss of the newly acquired toxin productivity. Conversion resulted in production of additional exotoxin type or types and never affected existing toxin synthesis. Converting phages were characterized by electron microscopy and negatively stained preparations and were all found to be of morphological class B1. All phage nucleic acid was double-stranded DNA. Though similar in structure, each converting phage had a different host range, and the nine new converting phages identified here did not react with antiserum prepared against the originally reported converting phage.     

Synthesis and evaluation of in vitro antimicrobial activity of novel 2,3-disubstituted-4-thiazolidinones from fatty acid hydrazides

The efficient cyclocondensation reaction of fatty acid hydrazides with thioglycolic acid (TGA)/mercapto acetic acid and Thio lactic acid under anhydrous condition in the presence of catalyst anhydrous ZnCl₂ in dimethyl formamide solvent is described. The synthesis provides the product, substituted thiazolidinone, in appropriate yield. The synthesized compounds were characterized by IR, ¹H NMR, ¹³C NMR, and mass spectra and these compounds were tested for in vitro antibacterial activity against the representative group of Gram-positive and Gram-negative bacteria such as Pseudomonas aeruginosa (ATCC-27853), Escherichia coli (ATCC-25922), Streptococcus pyogenes, and Klebsiella pneumonia (Clinical isolate), Methicillin resistant Staphylococcus aureus (MRSA +ve), and also tested for antifungal activity against Aspergillus fumigates, Trichophyton mentagrophytes, Penicillium marneffei, Candida albicans. Minimum inhibitory concentration, minimum bacterial concentration, and minimum fungicidal concentration were determined for the test compounds along with the reference standards used.     

High-dose humanized anti-IL-2 receptor alpha antibody (daclizumab) for the treatment of active, non-infectious uveitis

PURPOSE: This study was designed to provide preliminary data regarding the safety and efficacy of high-dose humanized anti-IL-2 receptor (daclizumab) therapy for the treatment of active intermediate, posterior or panuveitis. METHODS: Five patients were recruited into this non-randomized, prospective pilot study of high-dose intravenous induction daclizumab therapy given at doses of 8mg/kg at day 0 and 4mg/kg at day 14. Patients who did not meet a safety endpoint at the 3-week follow-up evaluation were given the option of continuing therapy with subcutaneous daclizumab at 2mg/kg every 4weeks for 52weeks. The primary outcome assessed was a two-step decrease in vitreous haze at day 21. Secondary outcomes evaluated included best-corrected visual acuity, retinal thickness as measured by optical coherence tomography, retinal vascular leakage assessed by fluorescein angiography, anterior chamber and vitreous cellular inflammation. RESULTS: Four male patients and one female patient were enrolled. Diagnoses included birdshot retinochoroidopathy (two patients), Vogt-Koyanagi-Harada's disease, bilateral idiopathic panuveitis and bilateral idiopathic intermediate uveitis. By the 4th week, four of five patients demonstrated a two-step decrease in vitreous haze. The other participant did not meet this criterion until week 20, but all five patients maintained stability in vitreous haze grade throughout their follow-up periods. At enrollment, mean visual acuity (10 eyes in 5 patients) was 69.2 ETDRS letters and following treatment was 78.2 letters (p<0.12). Anterior chamber cell, vitreous cell, and vitreous haze also improved in the majority of eyes. Adverse events were generally mild except for one episode of left-lower lobe pneumonia requiring hospitalization and treatment. CONCLUSION: This is the first demonstration that high-dose daclizumab can reduce inflammation in active uveitis. Daclizumab was well tolerated but there may be a potential increased risk of infection associated with immunosuppression. All five patients demonstrated a decrease in vitreous haze and measures of intraocular inflammation at final follow-up. The results of this small, non-randomized pilot study support the consideration of high-dose daclizumab therapy in cases of active posterior uveitis.     

Sleep disorders in Behçet's disease, and their relationship with fatigue and quality of life

Behçet’s disease, a systemic vasculitis, can cause varying degrees of activity limitation, fatigue and quality of life impairment. To date, there have been no studies regarding sleep disturbance and its relationship with fatigue and life quality in Behçet’s disease. We aimed to evaluate sleep disorders and polysomnographic parameters, and to determine their relationship with fatigue and quality of life in Behçet’s disease. Fifty‐one patients with Behçet’s disease without any neurological involvement were interviewed regarding sleep disorders. Twenty‐one subjects with no sleep complaints were included as the control group. Sleep‐related complaints were evaluated in a face‐to‐face interview. Sleep quality, excessive daytime sleepiness, fatigue, depression, anxiety, disease activity/severity, and quality of life questionnaires and an overnight polysomnography were performed. Prevalences of restless legs syndrome (35.3%) and obstructive sleep apnea syndrome with/without other sleep disorders (32.5%) were higher than in the control group and the general population. Fatigue was higher in patients with restless legs syndrome and obstructive sleep apnea syndrome, and in those with lower minimum oxygen saturation; hence, only patients with restless legs syndrome had quality of life impairment. Sleep efficiency index and sleep continuity index were lower, and wake after sleep onset, respiratory disturbance index and apnea–hypopnea index were higher than in controls (P < 0.01). Neither sleep disorders nor polysomnographic parameters were related to disease activity and severity. In conclusion, it is important to question sleep disorder followed by a polysomnography, if necessary, in order to improve quality of life and fatigue in Behçet’s disease.