How to prevent endophthalmitis in cataract surgeries?

Postoperative endophthalmitis is a very devastating complication and every step should be taken to reduce its occurrence. Unattended air conditioning filter systems are often the culprits and regular maintenance of the filters is of paramount importance. Shedders of pathogenic organisms amongst the theater personnel should be identified by regular screening and should be promptly treated. In addition to the use of Povidone iodine 5% solution in the conjunctival sac few minutes prior to surgery, proper construction of wound, injectable intraocular lenses, use of prophylactic intracameral antibiotics or prophylactic subconjunctival antibiotic injection at the conclusion of cataract surgery, placing a patch after the surgery for at least 4 h and initiating topical antibiotics from the same day of surgery helps to lower the frequency of postoperative endophthalmitis. Intraoperative posterior capsule rupture and anterior vitrectomy are risk factors for acute endophthalmitis, and utmost care to prevent posterior capsular rent should be taken while performing cataract surgery. Also, in case of such complication, these patients should be closely monitored for early signs of endophthalmitis in the postoperative period. In the unfortunate event of endophthalmitis the diagnosis should be prompt and treatment must be initiated as early as possible.     

Smokers and marriage: attitude of youth in the United Arab Emirates

Introduction: In order to control the tobacco scourge, an array of measures is required. Among them is focusing on adolescent relationships as it has been shown that being in a close relationship with a smoker or a non smoker will in the long run be a major factor in deciding whether the individual adopts smoking for initial non-smokers or ceases the habit for initial smokers. Objectives: To assess the attitude of youth towards other smokers and towards marrying a smoker. Materials and Methods: A cross-sectional study was carried out among 415 students from five universities in the United Arab Emirates (UAE). Self-administered structured questionnaires were used for data collection. The Chi square test was used to detect significant differences between frequencies. Results: Of the 415 participants who provided their gender information, 99 (24%) were males and 314 (76%) were females. Of all the participants, 83.5% were not willing to marry smokers, while 16.5% were willing. Of those whose parents smoked (106) 68% did not like it when their parents smoked, 13.6% had no opinion, 17.5% did not mind, while the other 1% had other thoughts. Of those whose close friends smoked, 43.4% did not like it, 16.2% did not have any opinion, 36.9% did not mind while 3.5% had other thoughts. Conclusion: Most participants, both males and females are not willing to marry smokers and prefer to have non-smokers as spouses. Also, smokers are seen as less attractive by both genders in contrast to what appears as popular beliefs amongst youngsters and what is depicted in tobacco advertisements. Tobacco control activities can be undertaken in the community and colleges by incorporating students as facilitators.     

Acute effects of dokha smoking on the cardiovascular and respiratory systems among UAE male university students

Background: In the United Arab Emirates (UAE) tobacco use is rampant. A less reported, yet widely used formof smoking native to UAE is midwakh or dhokha. The aim of the study is to assess the acute effects of smokingdokha (Arabian pipe) on the cardiovascular and respiratory systems among male university students in theUAE. Method: A quasi-experimental study was conducted among 97 male volunteers aged more than 17 years.Blood pressure, heart rate and respiratory rate of each participant, were measured before and immediately aftersmoking. A self administered questionnaire was used to collect personal details and data about smoking pattern.Results: Mean increases in systolic blood pressures (12 ± 1 mmHg), heart rates (20 ± 2 bpm) and respiratoryrates (4 ± 1 breaths/min) were observed (p < 0.001). A mean decrease in diastolic blood pressures (1 ± 1 mmHg)was observed (p = 0.483). Conclusion: Smoking dokha has a significant acute effect on systolic blood pressure,heart rate and respiratory rate. Anti smoking campaigns must address the ill effects of this form of smoking.Results from the study warrant further research into this method of smoking which is becoming more popular.     

Molecular targeting agents in cancer therapy: science and society

The inception of targeted agents has revolutionized the cancer therapy paradigm, both for physicians and patients. A large number of molecular targeted agents for cancer therapy are currently available for clinical use today. Many more are in making, but there are issues that remain to be resolved for the scientific as well as social community before the recommendation of their widespread use in may clinical scenarios can be done, one such issue being cost and cost effectiveness, others being resistance and lack of sustained efficacy. With the current knowledge about available targeted agents, the growing knowledge of intricate molecular pathways and unfolding of wider spectrum of molecular targets that can really matter in the disease control, calls for only the just use of the agents available now, drug companies need to make a serious attempt to reduce the cost of the agents. Research should focus on agents that show sustained responses in preclinical data. More needs to be done in laboratories and by the pharmaceutical industries, before we can truly claim to have entered a new era of targeted therapy in cancer care.     

Endophthalmitis after 25-gauge and 20-gauge pars plana vitrectomy: incidence and outcomes

PURPOSE: To compare the rates of endophthalmitis after 20-gauge versus 25-gauge pars plana vitrectomy (PPV) and to investigate clinical features of, and visual acuity outcomes, for patients with endophthalmitis after PPV. METHODS: A computerized database search was performed at each author's institution to identify all patients who underwent PPV by any of the authors between January 1, 2005, and December 31, 2006, and were subsequently treated for endophthalmitis. In addition, all patients who underwent PPV and were subsequently treated for endophthalmitis at Pennsylvania State College of Medicine (Hershey, PA) and Bascom Palmer Eye Institute (Miami, FL) during the study period were included. The medical records of these patients were reviewed to confirm that the endophthalmitis was associated with PPV and to collect clinical data to meet the study objectives. RESULTS: The incidence of endophthalmitis during the study period was 2 cases per 6,375 patients (or 1 case per 3,188 patients; 0.03%) for 20-gauge PPV compared with 11 cases per 1,307 patients (or 1 case per 119 patients; 0.84%) for 25-gauge PPV (P < 0.0001). Of 11 eyes that developed endophthalmitis after 25-gauge PPV, 9 received endophthalmitis prophylaxis with subconjunctival cefazolin after surgery. Median intraocular pressure on postoperative day 1 was 13 mmHg (range, 5-27 mmHg). Median time between PPV and endophthalmitis presentation was 3 days (range, 1-15 days). Presenting vision was hand motions or better in all eyes. Initial treatment included vitreous tap and injection of antibiotics in nine eyes and PPV and injection of antibiotics in two. All patients received intraocular treatment with vancomycin, and 10 received ceftazidime treatment. Eight patients had final visual acuity of >/=20/400, and four had visual acuity of >/=20/63. Cultures were negative in three cases; no culture specimens were obtained in one case. Six of the seven isolates were coagulase-negative staphylococci, and one was enterococcus. Five of six isolates tested for sensitivity to vancomycin were sensitive, and both isolates tested for sensitivity to ceftazidime were sensitive. CONCLUSIONS: The rate of endophthalmitis after 25-gauge PPV was significantly higher than that after 20-gauge PPV. Endophthalmitis after 25-gauge PPV occurred within 15 days of PPV, was usually due to coagulase-negative staphylococci sensitive to vancomycin, and was associated with variable visual outcomes.     

Efficacy and feasibility of teledermatology for paediatric medical education

We evaluated a teledermatology consultation service in the education of medical trainees. The selection of cases for consultation was at the discretion of the trainees, who could contact the study team for advice about obtaining photographs and submitting the case to a web-based system. Asynchronous structured feedback was provided to trainees by an academic paediatric dermatology consultant using a web-based interface. Efficacy was evaluated by examining the trainees' self-reported competency in clinical dermatology skills before and after teleconsultation. A total of 44 trainees (31 residents and 13 medical students) completed 50 consultations. Trainees reported significant improvement (mean improvement 22%, P < 0.002) in competency in five of the six areas assessed. In addition, 88% of trainees were very satisfied with the teaching methodology (> or =5 on a 7-point scale) and 86% were very likely to apply the information in their future practice (> or =5 on a 7-point scale). We believe that teledermatology has great potential in the education of medical trainees.     

Stillbirth in rural Bangladesh: arsenic exposure and other etiological factors: a report from Gonoshasthaya Kendra

Objective

To use data collected by Gonoshasthaya Kendra, a large nongovernmental organization providing health care to some 600 villages, to describe the epidemiological pattern of stillbirth and any additional contribution made by arsenic contamination of hand-pump wells in Bangladesh.

Methods

Completed pregnancies and outcomes (n = 30 984) for two calendar years, together with existing data on 26 socioeconomic and health factors were selected for study. The health care in these villages was administered from 16 geographical centres; information on the average arsenic concentration in each centre was obtained from the National Hydrochemical Survey. After univariate analysis, a multivariate, multilevel, logistic model for stillbirth was developed. The additional effect of arsenic was calculated having adjusted for all potential confounders thus identified.

Findings

The overall stillbirth rate was 3.4% (1056/30 984) and increased with estimated arsenic concentration (2.96% at < 10 µg/l; 3.79% at 10 µg/l to < 50 µg/l; 4.43% at ≥ 50 µg/l). Having adjusted for 17 socioeconomic and health factors, the odds ratios estimated for arsenic (with < 10 µg/l as reference) remained raised: 1.23 (95% confidence interval, CI: 0.87–1.74) at 10 µg/l to < 50 µg/l and 1.80 (95% CI: 1.14–2.86) at 50 µg/l or greater.

Conclusion

An increased risk of stillbirth is associated with arsenic contamination. This risk, substantial enough to be detected by an ecological approach and not readily attributable to unmeasured confounding, is essentially preventable and all efforts must be made to protect women at high risk.     

The frequency of dual TCR-PCR clonality in granulomatous disorders

Background: A granulomatous infiltrate in association with cutaneous T‐cell lymphoma is uncommon. The diagnosis of mycosis fungoides can be difficult in the setting of an exuberant granulomatous infiltrate that obscures the neoplastic lymphoid infiltrate, thereby mimicking a granulomatous dermatitis. Therefore, the clinical context and supplemental molecular analysis, such as the demonstration of a monoclonal T‐cell population, may assist in diagnosis. Monoclonal T‐cell populations have been reported in association with inflammatory conditions and serve as a diagnostic pitfall. The frequency of T‐cell clonality in association with granulomatous dermatitides has not yet been established. Methods: We identified 29 patients with granulomatous dermatitis who had biopsies at two distinct body sites. Results were correlated with clinical follow up and with clonal T‐cell receptor‐gamma chain rearrangement as detected by polymerase chain reaction‐based analysis (dual TCR‐PCR). Results: Clinical follow up was obtained in 17 of 29 cases (58.6%). Twenty‐five of 29 cases of granulomatous dermatitis lacked T‐cell monoclonality. Three cases of granuloma annulare contained a T‐cell clone in one of the two biopsies. One case of necrobiotic xanthogranuloma showed an identical T‐cell clone in multiple biopsies. Conclusions: The use of dual TCR‐PCR analysis, that is, T‐cell clonality analysis in biopsy specimens from two different sites, serves as an adjunct to assist in distinguishing granulomatous inflammatory reactions from granulomatous T‐cell lymphoma, including granulomatous mycosis fungoides. The occasional finding of a T‐cell clone in a granulomatous dermatitis underscores the importance of clinicopathological correlation in daily diagnosis. Dabiri S, Morales A, Ma L, Sundram U, Kim YH, Arber DA, Kim J. The frequency of dual TCR‐PCR clonality in granulomatous disorders.     

Urinary incontinence in the older patient

Over a 7 year period from April 2000 to March 2007 urinary incontinence was managed 802 times for patients aged 45 years and over. Women made up 85% of these encounters. Women had a significantly higher rate of incontinence management than males in all age groups. However, the management rate for men rose significantly among those aged 75 years and over, compared with aged 45-74 years.