Efficacy of topical cyclosporine 0.05% and osmoprotective lubricating eye drops in treating dry eye disease and inflammation

Purpose:To evaluate the effect of topical cyclosporine 0.05% and osmoprotective lubricating eye drops on patients with dry eye disease (DED) with inflammation as measured by raised tear matrix metalloproteinases (MMP-9).Methods:This prospective study included 106 eyes of 53 patients diagnosed with DED based on any of the following DED criteria (Ocular Surface Disease Index [OSDI] score >12, tear film breakup time [TBUT] <10 s, Schirmer’s I test result <10 mm/5 min, ocular surface staining). Ocular surface inflammation was assessed by assessing MMP-9 positivity from tears of the patients in the study (Inflammadry kit Quidel corporation). Patients were prescribed osmoprotective lubricating eye drops (Osmodrops, Cipla Ltd) four times a day and cyclosporine A 0.05% eye drops (Imudrops, Cipla Ltd) twice a day for 6 months. Efficacy of the formulations was evaluated by OSDI scores, Schirmer’s test, TBUT change, reduction in ocular surface staining, and reduction in MMP-9 levels after 6 months of usage. Check P value and add from resultsResults:After 6 months of topical therapy, improvement was observed in OSDI scores (mean pretreatment: 25.7 ± 12.8, and mean posttreatment: 15.2 ± 8.4), P < 0.001. There was also reduction number of patients who were MMP-9 positive. Out of 75 eyes that tested MMP-9 positive, 70.66% showed reduction in MMP-9 levels P < 0.0001). Ocular surface staining also improved.Conclusion:Topical osmoprotective lubricating eye drops and cyclosporine A 0.05% reduce inflammation in cases of DED, which correlates with improvement in OSDI scores, ocular surface staining, and reduction in inflammation as measured by levels of tear MMP-9.     

Segmentation of subtraction images for the measurement of lesion change in multiple sclerosis

BACKGROUND AND PURPOSE: Lesion volume change (LVC) assessment is essential in monitoring MS progression. LVC is usually measured by independently segmenting serial MR imaging examinations. Subtraction imaging has been proposed for improved visualization and characterization of lesion change. We compare segmentation of subtraction images (SSEG) with serial single time-point conventional segmentation (CSEG) by assessing the LVC relationship to brain atrophy and disease duration, as well as scan-rescan reproducibility and annual rates of lesion accrual.MATERIALS AND METHODS: Pairs of scans were acquired 1.5 to 4.7 years apart in 21 patients with multiple sclerosis (MS). Scan-rescan MR images were acquired within 30 minutes in 10 patients with MS. LVC was measured with CSEG and SSEG after coregistration and normalization. Coefficient of variation (COV) and Bland-Altman analyses estimated method reproducibility. Spearman rank correlations probed associations between LVC and other measures.RESULTS: Atrophy rate and net LVC were associated for SSEG (R = −0.446; P < .05) but not when using CSEG (R = −0.180; P = .421). Disease duration did not show an association with net lesion volume change per year measured by CSEG (R = −0.360; P = .11) but showed an inverse correlation with SSEG-derived measurements (R = −0.508; P < .05). Scan-rescan COV was lower for SSEG (0.98% ± 1.55%) than for CSEG (8.64% ± 9.91%).CONCLUSION: SSEG unveiled a relationship between T2 LVC and concomitant brain atrophy and demonstrated significantly higher measurement reproducibility. SSEG, a promising tool providing detailed analysis of subtle alterations in lesion size and intensity, may provide critical outcome measures for clinical trials of novel treatments, and may provide further insight into progression patterns in MS.

MR imaging has evolved as a core paraclinical tool for the diagnosis, longitudinal monitoring, and scientific investigation of multiple sclerosis (MS). Subsequent to documenting disease effects at 1 time point, assessing longitudinal change has evolved as the dominant role of MR imaging. In particular, quantification of MR imaging lesion burden has served an important role in the evaluation of MS progression and treatment effects.^1–5 As the expected average annual change in T2 hyperintense lesion volume has been reported to be only 5%–10%,⁶ the sensitivity of quantitative analysis of lesion burden change is paramount. Established methods for evaluating the change in T2 lesions include manual counting of total, new, enlarging, and resolving lesions⁷ and quantitative segmentation of total lesion load at each time point.^8–17Direct segmentation of lesion change based on subtraction of coregistered serial MR images has not yet been extensively studied. This approach promises to be a more robust and sensitive alternative for measuring disease progression on serial MR imaging scans, because it focuses quantification efforts on the subset of lesions showing change, which frequently represent a very small fraction of all lesions.Subtraction imaging, which cancels stable disease, provides enhanced sensitivity to characterize lesions by separately identifying new, enlarging, and resolving MS lesions.^7,18 The segmentation of subtraction images quantifies the new, enlarging, and resolving MS lesions seen on subtraction imaging.In this article, we assessed the sensitivity of 2 image analysis strategies: conventional segmentation followed by the determination of numeric differences between total lesion volumes at each time point (CSEG) versus the segmentation of subtraction images (SSEG). We compared the average yearly change in MS lesion burden using each of these 2 methods and determined measurement precision. By way of external validation, we related the 2 change measures with changes in brain parenchymal fraction (BPF) and disease duration.     

Clinical validation of an audio-based uroflowmetry application in adult males

IntroductionUroflowmetry is a common test to evaluate lower urinary tract symptoms. Audio-based uroflowmetry is a novel, alternative approach that determines urine flow by measuring sound. Available as a smartphone application, it has potential for screening and monitoring common urological pathologies, particularly in out-of-office environments. This study is the first to evaluate audio-based uroflowmetry in a clinical setting against the gold standard.MethodsAdult male patients (n=44) attending a general urology clinic were recruited. Audio-based uroflowmetry and conventional uroflowmetry were performed concurrently. Pearson correlation and Bland-Altman analysis were used to compare performance with respect to max flow, time to max flow, and total voiding time. Symmetric mean absolute percentage error (SMAPE) was used to compare curve shapes. Repeatability was evaluated separately in three healthy volunteers using repeat measures correlation.ResultsAmong urology clinic patients, the correlation for max flow was 0.12. Correlation for time to max flow was 0.46, with limits of agreement of −120–165%. Correlation for total voiding time was 0.91, with limits of agreement of −41–38%. The SMAPE for curve shape was 32.6%, with corresponding accuracy of 67.4%. Among healthy volunteers, the repeat measures correlation for max flow was 0.72.ConclusionsAudio-based uroflowmetry was inconsistent in evaluating flow rate, attributable to high variability and difficult standardization for acoustic signals. Performance improved with respect to temporal variables, as well as flow curve shape. Further work evaluating intra-patient reliability and pathology-specific performance is required to fully evaluate audio-based uroflowmetry as a screening or monitoring tool.