Factors affecting residual exotropia after two muscle surgery for intermittent exotropia

AIM: To study the factors affecting residual exotropia (>10 PD) at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus (LR) recession or unilateral recess resect procedure]. METHODS: A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia (>10 PD) and successful outcome (within 10 PD of orthotropia) at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount (mm) of muscle surgery done. RESULTS: One hundred and fifty-seven patients with mean age of 14y (range 3-53y) were included. Twenty-seven patients (17.2%) had residual exotropia at 4-6wk postoperative follow up. Age at surgery (P=0.009) and preoperative deviation for distance (P≤0.001) and near (P=0.001) were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done (recess-resect or bilateral LR recession). The effect/dose ratio was more in deviations >40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group (1.36 PD/mm vs 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm vs 2.63 PD/mm in the unilateral recess-resect surgery). CONCLUSION: Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.     

Immunomodulatory Effect of Albizzia Lebbeck

The immunomodulatory effect of the bark of Albizzia lebbeck (Sirisha) was evaluated by studying humoral and cell mediated immune responses. The hot aqueous extract and its butanolic fraction were administered once daily for one week in mice, immunised previously with sheep red blood cells (SRBC). At the dose levels tested (6.25, 12.5 and 25 mg/kg, p.o.), A. lebbeck treated mice developed higher serum antibody titres compared to the vehicle treated group and the effect was comparable to the standard drug muramyl dipeptide (MDP). Delayed type hypersensitivity response was suppressed in SRBC immunised mice treated with A. lebbeck extract. The macrophage migration index remained unaltered in both mice and rats. These results are discussed in the light of possible immunopotentiating effects of A. lebbeck.     

Use of liposomized tetracycline in elimination of Wolbachia endobacterium of human lymphatic filariid Brugia malayi in a rodent model

Wolbachia bacteria, being filarial parasite symbiont have been implicated in a variety of roles, including development, fecundity and the pathogenesis of the filarial infections. Among various strategies used in the treatment of experimental filariasis, the elimination of symbiont Wolbachia seem to offer an efficient means of curing the disease. The antiwolbachial property of tetracycline has been well worked out; however, treatment needs to be continued for a prolonged period of time to achieve complete elimination of Wolbachia from the filarial parasites and their subsequent killing. This results in acute toxicity, thus limiting its practical utility for clinical implementation. In order to increase efficacy of the antibiotic with minimal toxic manifestations, we developed liposomized formulation of the tetracycline. The liposomized tetracycline was found to be significantly more effective when compared to the free form of the drug. In contrast to the 90/120 days oral administration of the drug, the treatment schedule using the liposomized form of the drug was reduced to 12 alternate days with better efficacy of the treatment.     

Synthesis and evaluation of substituted 5-(3-chloro-2-oxo-4-phenylazetidin-1-ylamino)pyrimidine-2,4,6(1H,3H,5H)-triones against pentylenetetrazole-induced convulsant in mice

This study was designed to synthesis of substituted 5-(3-chloro-2-oxo-4-phenylazetidin-1-ylamino)pyrimidine-2,4,6(1H,3H,5H)-triones followed by evaluation against pentylenetetrazole-(PTZ) induced convulsant in mice. The titled compounds were confirmed by IR and ¹H-NMR spectral techniques. Pre-treatment of compound 4c showed significant anticonvulsant activity at 40?mg/kg which was comparable to that of PTZ and sodium valproate pre-treated groups. The results show the importance of barbituric acid derivative (i.e., compound 4c (R?=?p-OH, m-OCH₃) for this anti-convulsant activity. It may be due to its anti-oxidative and neuroprotective potential. Therefore, compound 4c emerged as the most active molecules in the management of convulsive disorder.     

Immunosuppressive activity of hexane and ethanolic extracts of Pterospermum acerifolium seeds in BALB/c mice

The hexane and ethanolic extracts prepared from the seeds of plant Pterospermum acerifolium were evaluated for their immunomodulatory activities by exploiting their effects on the humoral and cellular immune arms of BALB/c mice after oral administration for 14 consecutive days at different log doses. Various immune parameters viz. lymphoproliferative index, oxidative burst in peritoneal macrophages, modulation in T/B cell population and regulation of Th1/Th2 cytokines in mice were monitored to assess the immunomodulatory characteristics of the plant at 3, 10 and 30 mg/kg doses. Both the extracts exerted remarkable dose-dependent immunosuppressive effect with down-regulation of all the immune markers studied. Administration of extracts in immune-stimulated mice (by treatment with levamisole) further validated the immunosuppressive action. The findings are exceedingly encouraging and warrant bioactivity guided fractionation/purification to locate the activity in a single molecule for its future use in autoimmune disorders and organ transplant patients.     

The antiinflammatory potential of phenolic compounds from <Emphasis Type="Italic">Emblica officinalis</Emphasis> L. in rat

Antiinflammatory effects of phenolic compounds from Emblica officinalis were evaluated in carrageenan and cotton pellet induced acute and chronic inflammatory animal model. Fractions of E. officinalis containing free (FPEO) and bounded (BPEO) phenolic compounds were assessed by HPLC technique. The free and bound phenolic compounds were studied for their acute and chronic antiinflammatory activity at dose level of 20 and 40 mg/kg. The carrageenan induced acute inflammation was assessed by measuring rat paw volume at different time of intervals. Further, cotton pellet induced chronic inflammation was assessed by granulomatous tissue mass estimation along with the estimation of tissue biomarker changes (i.e. lipid peroxidation, reduced glutathione, myeloperoxidase and plasma extravasation). The results indicated that in both acute and chronic inflammation, FPEO and BPEO show reduction in the inflammation, but significant effects was observed only at high doses of both fractions which was comparable to diclofenac treated group. In conclusion, phenolic compounds of E. officinalis may serve as potential herbal candidate for amelioration of acute and chronic inflammation due to their modulatory action of free radicals.