Long term outcomes of bilateral congenital and developmental cataracts operated in Maharashtra,India. Miraj pediatric cataract study III

Aim:

To study long term outcome of bilateral congenital and developmental cataract surgery.

Subjects:

258 pediatric cataract operated eyes of 129 children.

Materials and Methods:

Children who underwent pediatric cataract surgery in 2004-8 were traced and examined prospectively in 2010-11. Demographic and clinical factors were noted from retrospective chart readings. All children underwent visual acuity estimation and comprehensive ocular examination in a standardized manner. L. V. Prasad Child Vision Function scores (LVP-CVF) were noted for before and after surgery.

Statistics:

Statistical analysis was done with SPSS version 16 including multi-variate analysis.

Results:

Children aged 9.1 years (std dev 4.6, range 7 weeks-15 years) at the time of surgery. 74/129 (57.4%) were boys. The average duration of follow-up was 4.4 years (stddev 1.6, range 3-8 years). 177 (68.6%) eyes had vision <3/60 before surgery, while 109 (42.2%) had best corrected visual acuity (BCVA) >6/18 and 157 (60.9%) had BCVA >6/60 3-8 years after surgery. 48 (37.2%) had binocular stereoacuity <480 sec of arc by TNO test. Visual outcome depended on type of cataract (P = 0.004), type of cataract surgery (P < 0.001), type of intra-ocular lens (P = 0.05), age at surgery (P = 0.004), absence of post-operative uveitis (P = 0.01) and pre-operative vision (P < 0.001), but did not depend on delay (0.612) between diagnosis and surgery. There was a statistically significant improvement for all the 20 questions of the LVP-CVF scale (P < 0.001).

Conclusion:

Pediatric cataract surgery improved the children''s visual acuity, stereo acuity and vision function. Developmental cataract, use of phacoemulsification, older children and those with better pre-operative vision had betterlong-termoutcomes.     

Barriers to follow-up for pediatric cataract surgery in Maharashtra,India: How regular follow-up is important for good outcome. The Miraj Pediatric Cataract Study II

Background:

Regular follow up and amblyopia treatment are essential for good outcomes after pediatric cataract surgery.

Aim:

To study the regularity of follow-up after cataract surgery in children and to gauge the causes of poor compliance to follow up.

Subjects:

262 children (393 cataracts) who underwent cataract surgery in 2004-8.

Materials and Methods:

The children were identified and examined in their homes and a “barriers to follow-up” questionnaire completed. Demographic data collected, visual acuity estimated, and ocular examination performed.

Statistical Analysis:

SPSS version 19.

Results:

Of the 262 children, only 53 (20.6%) had been regularly following up with any hospital, 209 (79.4%) had not. A total of 150 (57.3%) were boys and the average age was 13.23 years (Std Dev 5 yrs). Poor follow up was associated with the older age group (P < 0.001), less education of mother (P = 0.012), father''s occupation (P = 0.031), how much money spent on travel (P = 0.033) and was it paid or free surgery (P = 0.001). It was not related to gender, numbers of children in family, ordinal status of child, and social strata. Distance and cost were major barriers, as was the inability of the eye care center to communicate the importance of follow up. A prospective follow-up visit showed that 93 children needed Nd: YAG LASER capsulotomy, 5 needed low vision aids, 4 contact lens, and 162 a change of spectacles. The average visual acuity improved in 150 (38.8%) eyes >1 line with regular follow-up.

Conclusion:

Regular follow-up is important and improves vision; eye care practitioners need to take special efforts to ensure better follow-up.     

Prevalence of gram negative anaerobic bacilli in routine clinical specimens

A total of 206 gram negative anaerobic bacilli were isolated from 2591 routine clinical specimens. Majority of them (78.2%) were part of a mixed flora. A high incidence of gram negative anaerobic bacilli was found in post-operative wound infections and diabetic foot infections (30.1%), followed by necrotizing fasciitis and crush injuries (18%), pus of empyema and lung abscesses (14.5%) and aspirates from other deep abscesses (10.7%). Bacteroides fragilis was the most frequently recognized species (42.2%), followed by Fusobacterium sp. (17.4%), Prevotella sp. (15.1%) and Porphyromonas sp. (11.2%). Neomycin blood agar plate yielded the maximum number (72.8%) of strains in pure culture. Gram negative anaerobic bacilli in infective processes are significantly on the rise and so suspected cultures should be processed for both aerobic and anaerobic organisms.     

Ribosome-Lamella Complexes in the Perineurial Cells of Neurofibromatosis

Ribosome-lamella complexes are occasionally seen in neoplastic disorders of the hematopoietic system, particularly in hairy cell leukemia. However, these structures are rare in epithelial and mesenchymal cells. In this report three tumors from a patient with neuro-fibromatosis (von Recklinghausen's disease) are examined by electron microscopy. Ribosome-lamella complexes were seen in the perineurial cells. This may be the first report of these complexes in nerve sheath tumors.     

Malignant Mesenchymoma of the Prostate: Immunohistochemical and Ultrastructural Observations

A case of malignant mesenchymoma of the prostate is reported. Immunohistochemical and ultrastructural examination revealed malignant chondro-osteoblastic and rhabdomyoblastic features. A separate incidental prostatic adenocarcinoma was also seen. These lesions should be differentiated from carcinosarcoma in which adenocarcinoma is intermingled with malignant mesenchymal components.     

Advances in cardiac pacing and defibrillation

Introduction: There have been many evolutionary milestones in cardiac implantable electronic device (CIED) therapy over the past few decades. These advancements have created new challenges. Right ventricular pacing was the original (late 1950s) breakthrough, however the risk of pacing induced dyssynchrony has become evident. Biventricular pacing provided a viable way to mitigate dyssynchrony, but only benefits certain patients (primarily left bundle branch block and QRS duration ≥150 ms with depressed left ventricular (LV) function).

Areas covered: Recent advances have made His Bundle pacing an option that may provide physiological pacing for a wider patient population. Traditional CIED systems utilize transvenous endocardial leads. Unfortunately, leads have been CIEDs’ weakest link. Lead-related vascular occlusion, infection and malfunction have spurred the need for percutaneous lead extraction, and development of subcutaneous ICDs and leadless pacing. These options are important for individuals with limited vascular access and those at risk for blood borne infection. Subcutaneous ICDs have been proposed as optimal for younger patients. This recommendation is controversial.

Expert commentary: We review recent advances including His bundle pacing, percutaneous lead extraction, leadless pacing and subcutaneous ICDs as well as their potential use in combination. Additional technological evolution promises to make the future of CIEDs exciting.     

Convection-enhanced selective excitotoxic ablation of the neurons of the globus pallidus internus for treatment of parkinsonism in nonhuman primates.

OBJECT: Selective treatment of central nervous system (CNS) structures holds therapeutic promise for many neurological disorders, including Parkinson's disease (PD). The ability to inhibit or augment specific neuronal populations within the CNS reliably by using present therapeutic techniques is limited. To overcome this problem, the authors modeled and developed a method in which convection was used to deliver compounds to deep brain nuclei in a reproducible, homogeneous, and targeted manner. To determine the feasibility and clinical efficacy of convective drug delivery for treatment of a neurological disorder, the investigators selectively ablated globus pallidus internus (GPi) neurons with quinolinic acid (QA), an excitotoxin, in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced model of primate parkinsonism. METHODS: After the parameters of convective distribution to the GPi were confirmed by infusion of biotinylated albumin into the GPi of a primate (Macaca mulatta), seven adult monkeys of this species were rendered either fully parkinsonian by intravenous injections of MPTP (five animals) or hemiparkinsonian by a right-sided intracarotid injection of this agent (two monkeys). Using convection-enhanced delivery to the GPi, animals were infused with either QA (three fully parkinsonian, two hemiparkinsonian) or saline (two fully parkinsonian). The three fully parkinsonian animals that underwent GPi lesioning with QA had substantial improvement of PD symptoms, manifested by a marked increase in activity (34 +/- 2.5%; mean +/- standard deviation) and dramatic improvement of parkinsonian clinical scores. In contrast, the control animals did not improve (activity monitor change = -1.5 +/- 0.5%). The two hemiparkinsonian animals that underwent QA lesioning of the GPi had dramatic recovery of extremity use. Histological examination revealed selective neural ablation of GPi neurons (mean loss 87%) with sparing of surrounding gray and white matter structures. No animal developed worsening signs of PD or neurological deficits after infusion. CONCLUSIONS: Convection-enhanced delivery of QA permits selective, region-specific (GPi), and safe lesioning of neuronal subpopulations, resulting in dramatic improvement in parkinsonian symptomatology. The properties of convection-enhanced delivery indicate that this method could be used for chemical neurosurgery for medically refractory PD and that it may be ideal for cell-specific therapeutic ablation or trophic treatment of other targeted structures associated with CNS disorders.     

Collaborative Problem Solving (CPS) as a Primary Method of Addressing Acute Pediatric Pathological Aggression Along with Other Modalities

The answer for treating pathologic aggression (PA) in children on inpatient psychiatry units (based on various factors like severity of aggression and co-morbidities) is less likely to be restrictive interventions or sedating the patient. Using seclusion and restraints or medications to calm down the aggression is not free of adverse consequences. A protocol is needed to safely and effectively address aggressive and violent children and adolescents seen very commonly in psychiatry inpatient units.