Boston Type 2 keratoprosthesis- mid term outcomes from a tertiary eye care centre in India

To analyse the anatomical and functional outcomes of Boston type II keratoprosthesis at a tertiary eye care centre in South India. Retrospective chart review of 10 patients operated with Boston keratoprosthesis Type 2 between Feb 2013 and June 2017 were analysed. Outcome measures analysed included, visual outcome, device retention and postoperative complications. The most common indication for surgery was SJS in 80% (8 of 10 eyes). Mean follow-up duration was 2.75 years (0.5–5 years, SD?-?1.71, median 32 months) Postoperative visual acuity improved to better than 20/200 in 7 eyes and better than 20/30 in 6 eyes with device retention in 9 eyes at last follow-up. Pre-existing glaucoma was noted in 1 eye. RPM was noted in 1 eye, retinal detachment in 1 eye, endophthalmitis in 1 eye and sterile melt requiring kpro replacement in 1 eye. No progression or development of glaucoma was noted postoperatively in any eye . Boston type 2 keratoprosthesis is a viable option to restore vision in patients with end stage ocular surface disorders. Though the procedure can be associated with complications, early as well as late, our midterm outcome appears to be encouraging.     

Comparison of broadband and monochromatic photopic negative response in eyes of patients with diabetes with no diabetic retinopathy and different stages of diabetic retinopathy

Purpose:To evaluate the change in broadband (W/W), red on blue (R/B), and blue on yellow (B/Y) photopic negative response (PhNR) in patients with diabetes mellitus with no diabetic retinopathy (no DR) and different stages of DR and compare it with age-matched controls. This study was performed to provide a single PhNR protocol that can be used for early diagnosis of DR.Methods:It was a cross-sectional case-control study done in a hospital setup. Patients with diabetes with no DR and different stages of DR with no other associated ocular pathologies were included. Age-matched controls with no retinal pathologies were also included for comparison. All subjects underwent detailed ophthalmic examination and W/W, R/B, and B/Y electroretinography. Fifty control eyes and 52 treatment naïve eyes of 52 patients with diabetes [no DR = 11, mild nonproliferative diabetic retinopathy (NPDR) =11, moderate NPDR = 10, severe NPDR = 9, and proliferative DR = 11] were included in the study.Results:On comparing the ERG responses in patients with diabetes and age-matched controls, a significant reduction (P < 0.05) was noted in the amplitudes of a-wave (39.78 ± 11.34 μV vs. 67.28 ± 12.88 μV), b-wave (116.25 ± 45.25 vs. 134.39 ± 28.78 μV), W/W PhNR (33.86 ± 17.33 vs. 67.18 ± 15.99 μV), R/B PhNR (28.77 ± 15.85 vs. 53.48 ± 14.15 μV), and B/Y PhNR (55.04 ± 32.63 vs. 104.79 ± 24.37 μV). Post hoc analysis revealed that all the eyes in the diabetic group, including those with no DR, had a significantly reduced PhNR amplitude (P < 0.05) when compared with controls. PhNR was found to reduce in amplitude with increasing severity of DR (P < 0.05), with more significance in B/Y. Receiver operating characteristic showed highest area under the curve in B/Y PhNR (94%, P < 0.001), with maximum sensitivity and specificity of 88% and 87%, respectively.Conclusion:Changes in the amplitude and implicit time of ERG can reflect the severity of DR. PhNR amplitudes, especially B/Y PhNR, appear to be significantly reduced even in eyes with no DR.     

Colonic thioguanine pro-drug: Investigation of microbiome and novel host metabolism

Thiopurines are analogues of endogenous purines. They are pro-drugs which require the purine salvage pathway to convert them to the active drug nucleotides (TGN). These drugs are used to maintain clinical remission in patients with inflammatory bowel diseases. In our recent Gut paper, we showed that thioguanine worked quickly to improve colitis in the absence in the host animal of the key guanine salvage enzyme, hypoxanthine-guanine-phosphoribosyltransferase (HPRT). Current evidence favours the proposition that active drug delivery to the host lacking HPRT requires translocation of TGN-loaded bacteria across the inflamed mucosal barrier, and most likely delivery by phagocytosis. Alternatively, the efficacy of thioguanine in treating colitis could be mediated by modulation of the community of the microbiota in the intestine, or there are novel host pathways for conversion of the thioguanine pro-drug to TGN.     

Comparative study of the efficacy of gentamicin-coated intramedullary interlocking nail versus regular intramedullary interlocking nail in Gustilo type I and II open tibia fractures

Purpose: Open tibia fracture is prone to infection, consequently causing significant morbidity and increasing the hospital stay, occupational loss and onset of chronic osteomyelitis. Intramedullary nailing is one choice for treating tibia shaft fractures. To improve the delivery of antibiotics at the tissue-implant interface, many methods have been proposed as a part of prophylaxis against infection. This study was conducted to study the role of gentamicin-impregnated intramedullary interlocking (IMIL) nail in the prevention of infection in Gustilo type I and II open tibia fractures and to compare the results with regular intramedullary nail. Methods: The study included 28 patients with open tibia fractures (Gustilo type 1 or type 2); of them 14 underwent regular IMIL nailing and the other 14 were treated with gentamicin-coated nailing. Randomization was done by alternate allocation of the patients. Follow-up was done postoperatively (day 1), 1 week, 6 weeks, and 6 months for bone union, erythrocyte sedimentation rate (ESR), hemo globin and C-reactive protein (CRP). Statistical significance was tested using unpaired t-test. A p value less than 0.05 was considered significant. Results: There were 4 cases of infection in controls (regular IMIL nail) and no infection among patients treated with gentamicin-coated nail during the follow up (X2 = 4.66, p = 0.031). At 6 months post operatively, CRP (p = 0.031), ESR (p = 0.046) and hemoglobin level (p = 0.016) showed significant dif ference between two groups. The bone healing rate was better with gentamicin-coated nail in comparison to regular IMIL nail at 6 months follow-up (p = 0.016). Conclusion: Gentamicin-coated IMIL nail has a positive role in preventing infection in Gustilo type I and II open tibia fractures.     

Rotary Nickel-Titanium GT and ProTaper Files for Root Canal Shaping by Novice Operators: A Radiographic and Micro–Computed Tomography Evaluation

IntroductionThe purpose of this study was to assess canal preparation outcomes in vitro by novice clinicians after standardized teaching sessions.MethodsAll students received a training session. In experiment 1, twenty canals of mandibular molars were prepared with GT and ProTaper rotaries by 10 students. Standardized radiographs were exposed before and after canal preparation, and canal curvature was measured; canals were assessed for patency and preparation time. In experiment 2, mandibular molars (20 canals) were submitted to microcomputed tomography before and after canal preparation with ProTaper and GT rotaries by 2 dental students. Canals were metrically assessed for changes (volume, surface, cross-sectional shape, transportation) during canal preparation by using software.ResultsIn experiment 1, canal curvature decreased by 7.6° and 7.8° for GT and ProTaper preparations; there were no broken instruments, and 2 canals lost patency. The time for GT preparation was longer than for ProTaper (29.7 ± 6.8 vs 19.4 ± 8.1 minutes, P <.05). In experiment 2, canal volumes and surface areas increased (P < .001), and prepared canals were rounder in cross-section and more tapered. Mean canal transportation ranged between 0.14 ± 0.05 mm and 0.23 ± 0.09 mm for apical and coronal canal thirds. There were no significant differences between the instruments or the operators regarding center of mass shifts; qualitative and quantitative data for canal transportation were similar to earlier studies with experienced operators.ConclusionsBoth rotary instruments performed adequately with inexperienced operators who received a brief structured training session.     

Antiproliferative Effect of Solanum nigrum on Human Leukemic Cell Lines

Solanum nigrum is used in various traditional medical systems for antiproliferative, antiinflammatory, antiseizure and hepatoprotective activities. We have evaluated organic solvent and aqueous extracts obtained from berries of Solanum nigrum for antiproliferative activity on leukemic cell lines, Jurkat and HL-60 (Human promyelocytic leukemia cells). The cell viability after the treatment with Solanum nigrum extract was measured by MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide) assay. Results indicated increased cytotoxicity with increasing extract concentrations. Comparative analysis indicated that 50% inhibitory concentration value of methanol extract is the lowest on both cell lines.     

Smoking adversely affects survival in acute myeloid leukemia patients

Smoking adversely affects hematopoietic stem cell transplantation outcome. We asked whether smoking affected outcome of newly diagnosed acute myeloid leukemia (AML) patients treated with chemotherapy. Data were collected on 280 AML patients treated with high-dose cytarabine and idarubicin-containing regimens at Roswell Park Cancer Institute who had smoking status data at diagnosis. Patients' gender, age, AML presentation (de novo vs. secondary), white blood cell (WBC) count at diagnosis, karyotype and smoking status (never vs. ever) were analyzed. Among the 161 males and 119 females with a median follow-up of 12.9 months, 101 (36.1%) had never smoked and 179 (63.9%) were ever smokers. The proportion of patients between never and ever smokers was similar to respect to age, AML presentation, WBC count at diagnosis or karyotype based on univariate analysis of these categorical variables. Never smokers had a significantly longer overall survival (OS) (60.32 months) compared to ever smokers (30.89; p = 0.005). In multivariate analysis incorporating gender, age, AML presentation, WBC count, karyotype and smoking status as covariates, age, karyotype and smoking status retained prognostic value for OS. In summary, cigarette smoking has a deleterious effect on OS in AML.