A lateral approach to lower eyelid entropion repair

The authors describe a simple technique that highlights the use of the sagittal anatomy of the lower eyelid to aid identification of the retractors during involutional entropion repair. This anatomy is exposed following lateral canthotomy and inferior cantholysis. The orbital septum is seen to enclose the fat pad and fuse with the retractors above it prior to insertion into the tarsus. The septum, orbicularis, and skin are incised from the lateral approach, allowing exposure of the retractors for tarsal reattachment, and the procedure is completed with a lateral tarsal strip. Forty-eight procedures in 42 patients with involutional entropion were performed using this technique and 90% and 89% of primary and recurrent entropion, respectively, were successfully repaired. Mean operating time was 30 minutes. The lateral approach to a standard procedure for entropion repair can reduce operating time and technical difficulty.     

Treatment of proliferative diabetic retinopathy with anti‐VEGF agents

Proliferative diabetic retinopathy (PDR) is the most common cause of severe visual loss in people with diabetes. Although panretinal photocoagulation (PRP) remains the gold standard of care to date, several combinations of new treatment modalities have emerged. These approaches can be used to increase the extent of treatment, expedite the effect of laser treatment and provide alternate measures when laser delivery is difficult or impossible, especially in patients with vitreous haemorrhage. Currently, most of the research in this field is focussed on inhibitors of vascular endothelial growth factor (VEGF), referred to herein as anti‐VEGF agents. Although limited by their short‐lived effects and a lack of established protocols, anti‐VEGF agents are widely available, especially for the treatment of aggressive PDR. This review analyses published studies using anti‐VEGF agents alone or as an adjunct to other therapies in the treatment of PDR.     

Asymptomatic bacteriuria in pregnant mothers: a valid and cost-effective screening test in Bangladesh

In Bangladesh, a number of screening tests for asymptomatic bacteriuria in pregnancy are in practice. The objective of this study was to assess the validity and cost-effectiveness of these screening tests. A total of 600 apparently healthy pregnant mothers were included in this study. The validity of the screening tests was calculated against the urine culture as 'gold standard'. Incremental cost-effective ratio between the screening test methods and the least costly method (microscopic urine analysis) was calculated. Bacterial count/oil-immersion field in Gram-stained smear of urine was the most sensitive (91.7%) and specific (97.2%). Incremental cost per additional positive cases of bacterial count, leukocyte esterase and combination of leukocyte esterase and nitrite were US$3, US$25 and US$23, respectively. Gram staining may be the alternative approach to traditional routine urinalysis for the screening of asymptomatic bacteriuria during pregnancy in clinical practice in Bangladesh, as well as other developing countries.     

Lymphocyte‐Bound Complement Activation Products as Biomarkers for Diagnosis of Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is frequently misdiagnosed due to the lack of definitive diagnostic tests. The purpose of this study was to determine specifically whether complement activation products (CAP) are deposited on lymphocytes of SLE patients and whether lymphocyte‐bound CAP (LB‐CAP) may serve as novel biomarkers for the diagnosis of SLE. We conducted a cross‐sectional study of 224 patients with SLE, 179 patients with other diseases, and 114 healthy controls. LB‐CAP on peripheral blood lymphocytes was measured by flow cytometry. Diagnostic utility of LB‐CAP was determined by receiver operating characteristic (ROC) analysis. Significantly elevated levels of C4d and C3d were detected specifically on T and B lymphocytes (designated T‐C4d, T‐C3d, B‐C4d, and B‐C3d) of SLE patients. As diagnostic tools, T‐C4d and B‐C4d, respectively, were 56% sensitive/80% specific and 60% sensitive/82% specific in differentiating SLE from other diseases. Moreover, compared with measurement of anti‐dsDNA, serum C3, or serum C4, measurement of T‐C4d/B‐C4d was significantly more sensitive in identifying SLE patients during a single clinic visit. This is the first investigation of lymphocytes bearing complement activation products in human disease. T‐C4d and B‐C4d have high diagnostic sensitivity and specificity for SLE and may have added value to current laboratory tests for SLE diagnosis.     

Young children non-immunized against measles: characteristics and programmatic implications

AIM: To examine the presenting characteristics, including nutritional status, of young children without measles immunization and to suggest appropriate public health measures to improve immunization status. METHODS: In this retrospective case-control analysis, we studied 4075 children aged 12-23 mo of either sex, who attended ICDDR,B's Dhaka hospital during 1994-2003. Cases included children who reported to this facility without receiving measles vaccine, and the control children were those who received the vaccine. RESULTS: 3181 of 4075 (78%) children, including 1227 (39%) girls and 1954 (61%) boys, received measles immunization. The proportion of vaccinated children increased from 74% in 1997 to 82% in 2001. Some non-specific effects of measles immunization were observed. Fifty-one per cent of the children without measles immunization were stunted, 76% were underweight, and 48% were wasted. The non-immunized children were twice as likely to be stunted, underweight, and wasted than the immunized children; they were more often dehydrated (some or severe dehydration) (28% vs 22%, p<0.001), required longer duration (>72 h) of hospitalization (15% vs 10%, p<0.001), did not receive vitamin A capsule in the previous 6 mo (56% vs 36%, p<0.001), and had more frequent abnormal lung auscultation indicative of acute lower respiratory tract infections (8% vs 5%, p<0.001). Female children, illiterate mother, lack of vitamin A supplementation, and history of measles were significantly associated with non-immunization against measles after controlling for co-variables. Results were similar when different nutritional indicators (underweight, stunting, or wasting) were added separately to logistic regression models. CONCLUSION: Intervention strategies to enhance immunization coverage in infants should target illiterate mothers and their children, particularly the females and malnourished ones, provide them with measles immunization and vitamin A capsule, and encourage their periodic follow-up visits as part of a preventive nutritional programme.     

Drug-eluting coronary stents

The introduction and widespread use of coronary stents have been the most important advancement in the percutaneous treatment of coronary artery disease since the introduction of balloon angioplasty. Coronary artery stents reduce the rate of angiographic and clinical restenosis compared to balloon angioplasty. This angiographic restenosis was further reduced with the introduction of drug-eluting stents and hence further reduction in the frequency of major adverse cardiac events. Herein we present a comprehensive and up-to-date review about the use of drug-eluting stents in the treatment of coronary artery disease.     

Role of Toll-like receptors in host responses to a virulence antigen of Streptococcus mutans expressed by a recombinant,attenuated Salmonella vector vaccine

In the present study, we investigated the role of Toll-like receptors (TLRs) in host responses to the saliva-binding region (SBR) of Streptococcus mutans expressed by a recombinant, attenuated Salmonella vaccine. C57BL/6 wild type (wt), TLR2^−/−, TLR4^−/− and MyD88^−/− mice were immunized by the intranasal route on days 0, 18 and boosted on day 98 with Salmonella typhimurium BRD 509 containing a plasmid encoding SBR. Serum and saliva samples were collected throughout the experiment and assessed for antibody activity by ELISA. Evidence is provided that the induction of a serum IgG2a (Th1-type) anti-SBR antibody response involved TLR2 signaling, whereas the anti-Salmonella response involved signaling through TLR4. The adaptor molecule MyD88 was not essential for the induction of a primary Th1-type response to SBR or Salmonella, but was necessary for a secondary response to SBR. Furthermore, the absence of TLR2, TLR4 or MyD88 resulted in enhanced Th2-type serum IgG1 anti-SBR and anti-Salmonella responses. Mucosal IgA responses to SBR were TLR2-, TLR4- and MyD88-dependent, while IgA responses to Salmonella were TLR4- and MyD88-dependent.     

The incidence and severity of injury in children hospitalised for traumatic brain injury in Kashmir

A large number of people experience traumatic brain injury each year, often with severe consequences. This is a public health problem that requires ongoing surveillance to follow trends in the incidence, risk factors, causes, and outcomes of these injuries. In 2003, a prospective study of all children below 15 years admitted to hospitals with a diagnosis of head injury was conducted in the Accident & Emergency Department of Sher-e-Kashmir Institute of Medical Sciences, Srinagar (India) to determine the incidence and severity of accidental head injury among children and the circumstances of injury. The highest incidence of head injury was seen at ages 6-10 years. Head injury rates were higher in males than in females. The leading causes include falls and motor vehicle accidents. More than 50% falls occurred in the age group of 4-6 years. Ninety per cent patients, who recovered, were discharged within 16-24 h after admission. Lack of supervision, non-implementation of safety measures and poor implementation of traffic rules leads to many injuries. The ability of the health care system to deal with increasing trauma in Jammu & Kashmir is limited. Nevertheless, prevention can be low cost strategy to overcome this problem. The results of epidemiological studies are affected by factors like demography, geographic region and socioeconomic status. This study emphasizes the need for intensified effort for prevention, minimising risk factors, strict legislative measures, observing traffic rules, implementation of safety measures, establishing appropriate trauma care at district level, adult supervision, and creating awareness.