Effect of proparacaine on central corneal thickness values: an evaluation using noncontact specular microscopy and pentacam

PURPOSE: To study the effect of 1 drop of 0.5% proparacaine on central corneal thickness values monitored by nonspecular microscopy and Pentacam, a corneal topographer with rotating Scheimpflug camera. METHODS: Forty subjects were divided into 2 groups with 1 group measured with a noncontact specular microscope and the other group with Pentacam (Oculus, Inc., Wetzlar, Germany). One eye was randomly selected, and corneal thickness values were monitored every 30 seconds for 10 minutes. Baseline corneal thickness values were defined as the average of all measurements taken over 10 minutes. One drop of 0.5% proparacaine was instilled, and the corneal thickness values were monitored by the same instrument every 30 seconds for another 10 minutes after drug instillation. RESULTS: The 2 groups shared similar age range, refractive error, and baseline corneal thickness values. The spontaneous variation of corneal thickness values was within 3 mum for 10 minutes before drug instillation. There was no obvious trend of corneal thickness value change after the instillation of local anesthetics. The variation of corneal thickness values against the baseline was within 5 mum. CONCLUSION: One drop of 0.5% proparacaine does not produce any significant change in central corneal thickness.     

Differentiation of multiple system atrophy from idiopathic Parkinson's disease using proton magnetic resonance spectroscopy

Proton magnetic resonance spectroscopy, localized to the lentiform nucleus, was carried out in 7 patients with the pure or predominantly striatonigral variant (SND) of multiple system atrophy (MSA), 5 patients with the olivopontocerebellar variant of MSA, 9 patients with a clinical diagnosis of idiopathic Parkinson's disease (IPD), and 9 healthy age-matched controls. The MSA group with predominantly striatonigral involvement showed a significant reduction in the N-acetylaspartate (NAA)/creatine ratio (median, 1.19; range, 0.96–2.0; p < 0.02) compared with the NAA/creatine ratio (median, 1.82; range, 1.19–2.31; p > 0.5). The NAA/creatine ratio was markedly reduced in 6 of the SND patients and in only 1 IPD patient. The choline/creatine ratio was also significantly lower in the SND group (median, 1.02; range, 0.91–1.23; p < 0.04) compared with the control group (median, 1.22; range, 1.05–1.65). The IPD group showed a normal lentiform choline/creatine ratio (median, 1.13; range, 0.89–1.65; p = 0.25) compared with controls. The olivopontocerebellar group also showed a significant reduction in the NAA/creatine ratio from the lentiform nucleus (median, 1.47; range, 1.22–1.68; p < 0.01) compared with the controls as well as a nonsignificant reduction in the choline/creatine ratio (median, 0.93; range, 0.85–1.27; p < 0.4). In vivo quantification of absolute metabolite concentrations was possible in 7 MSA patients and 6 controls and confirmed an absolute reduction of choline-containing compounds and NAA in the MSA group compared with controls with no significant difference in the creatine concentrations between the MSA groups probably reflects neuronal loss, occurring predominantly in the putamen. Proton magnetic resonance spectroscopy is a useful, noninvasive technique to help differentiate MSA from IPD.     

Thyrotropin binding inhibitory immunoglobulin (TBII) and thyroid diseases using ROC analysis

At attempt to detect the auto-immune origin of hyperthyroidism may be made by measuring thyrotropin binding inhibitory immunoglobulin (TBII) which uses the antibodies ability to inhibit labelled TSH binding to the TSH receptor. This study was carried out on 196 patients of which 128 had autoimmune hyperthyroidism and 68 another thyroid disease. Construction of receiver operating characteristic (ROC) curves allowed us to show the quality of the assay. This method, according to the prevalence of the disease, helped to determine the ideal cut-off of the assay. This cut-off was between 13.5 and 7.5% for prevalences ranging between 10 and 80%. For a 9% cut-off, which corresponded to the group studied, we observed 87.5% sensitivity and 87% specificity. Existence of false positives and false negatives was linked to the assay method which only informed us about the occupation of the TSH binding site and not its physiological activity. However, we concluded this easy to perform assay is a good test for the diagnosis of autoimmune hyperthyroidism.     

The prevalence of left ventricular diastolic filling abnormalities in patients with suspected heart failure

AIMS: It is reported that one third of patients with heart failurehave normal left ventricular systolic function, and may or maynot have left ventricular diastolic dysfunction. We sought todefine the prevalence of left ventricular diastolic fillingabnormalities in a large unselected group of patients, unlikethe diagnosis by exclusion in the small highly selected groupsof patients studied previously. METHODS AND RESULT: Patients were referred by general practitioners to an open-accessechocardiography service for assessment of possible heart failure.Echocardiography included a Doppler study of transmitral flowat the tips of the mitral leaflets and calculation of an E/Aratio. Of 534 patients referred and assessed, 371 patients hadnormal systolic function and a measurable E/A ratio. These werecompared with age-adjusted reference ranges to give 9 abovethe reference range and 19 below. This is only 10 more thanwould be expected if our patients were normal. In the same groupof patients we found 96 cases of left ventricular systolic dysfunction,or 52 amongst the 423 with a measurable E/A ratio. CONCLUSIONS: Either left ventricular diastolic filling abnormalities arevery much less common than previously supposed or the E/A ratiois almost useless for their detection.     

Prevalence and predictors of disability for Māori 24 months after injury

Objective: To investigate post‐injury disability prevalence and identify pre‐injury and injury‐related predictors 24 months post‐injury among Māori Prospective Outcomes of Injury Study participants. Methods: Participants were recruited from New Zealand's no‐fault injury insurer. Pre‐injury and injury‐related characteristic information was obtained from participants at three and 24 months post‐injury. The World Health Organization Disability Assessment Schedule was used to measure disability. Multivariable models were developed to estimate relative risks of post‐injury disability. Results: Of 2,856 participants, 566 were Māori. Analyses were restricted to 374 Māori with pre‐injury and 24‐month post‐injury disability data available. Pre‐injury, 9% reported disability compared to 19% 24 months post‐injury. Strong predictors of increased risk of disability 24 months post‐injury were having ≥2 chronic conditions pre‐injury and having trouble accessing healthcare services after injury. Hospitalisation for injury and having inadequate pre‐injury household income were other predictors. Conclusions: Māori experience considerable disability 24 months post‐injury. Pre‐injury socio‐demographic, health and psychosocial, and injury‐related characteristics independently predict post‐injury disability and provide focus for future research and interventions to improve Māori post‐injury outcomes. Implications for public health: Despite having had access to services, injured Māori experienced considerable long‐term disability. Pre‐injury and injury‐related factors predict long‐term disability and should be the focus to reduce the post‐injury disability burden for Māori.     

Two years after injury: prevalence and early post-injury predictors of ongoing injury-related problems

Purpose

To determine, in a cohort with injuries classified anatomically as mainly minor or moderate and for which only 25% were hospitalised acutely, the prevalence of ongoing problems attributed by participants to their injury 2 years prior, and to examine whether three-month post-injury experiences and expectations predict such problems.

Methods

Participants (N?=?2231; 18–64 years at injury) were those in the Prospective Outcomes of Injury Study who completed the initial three-month and final two-year interviews. The outcome measure was whether participants reported ongoing injury-related problems at 2 years. Possible early post-injury predictors were identified from the first interview; pre-injury and injury-related potential confounders from the first interview, insurer records and hospital discharge records. Multivariable models estimated relative risks.

Results

Almost half the participants reported injury-related problems at 2 years. Participants reporting non-recovery at 3 months were more likely than those reporting recovery to have ongoing problems at 2 years, ranging from participants expecting to get better soon [adjusted RR 2.2, 95% CI (1.7,2.8)) to those expecting to never get better (aRR 3.1, 95% CI (2.4,4.0)]. Several three-month post-injury experiences also predicted ongoing problems at 2 years. Participants at highest risk included those with extreme pain [aRR 2.1, 95% CI (1.7,2.5)], and less involvement in usual activities [aRR 1.7, 95% CI (1.5,1.9)].

Conclusions

Findings indicate that early post-injury characteristics predict longer-term recovery among this cohort, most of who were not classified as seriously injured, and provide guidance for future studies on interventions to reduce poor outcome prevalence, particularly focussing on pain management and enabling return to independence and social participation.

     

ECG interference suppressed using a harmonic generator

Non-linear loading of the utilities supply introduced significant electromagnetic field (EMF) interference severe enough to disrupt electrocardiograph (ECG) monitoring and recordings in the new Emergency Department (ED) at the Royal Melbourne Hospital (RMH). This interference was evident even though standard Mu-metal shielding had been installed over the main hospital power feed which runs underneath the department. Investigations revealed that the source of the interference was due to 3^rd harmonic currents flowing in the mains cable. This interference was suppressed by introducing third harmonic current into the main power cable in anti-phase to the interfering signal.     

Transplantation of insulin-producing tissue

A series of new findings have shown that it is possible to prevent rejection of islet allografts and islet xenografts in animals without the continued use of immunosuppressive agents. The survival of allografts of rat islets has been prolonged for more than 100 days by in vitro culture of the islets at 24 °C for seven days prior to transplantation in conjunction with a single injection of rat antilymphocyte serum at the time of transplantation. Xenograft survival of rat islets transplanted into diabetic mice has been prolonged for more than 100 days by the use of culture of rat islets at low temperature, with a single injection of antiserums to mouse and rat lymphocytes at the time of transplantation. Rejection of established islet allografts in rats was induced by the injection of donor peritoneal exudate cells and donor T lymphocytes, whereas the injection of B lymphocytes did not induce rejection. The pretreatment regimens used for prolonging islet allograft and xenograft survival apparently destroy or alter passenger leukocytes in the grafts, and it would appear that these cells are needed for the induction of immune recognition by the recipient. Islet cells in mice express products of the H-2K and H-2D loci, but the cells do not express the I region (Ia) antigens. These new developments in the prevention of immune rejection of the islets raise the question as to whether these approaches may be applicable to the transplantation of islets into human subjects with diabetes.     

Health care providers’ and parents’ attitudes toward administration of new infant vaccines—a multinational survey

The New Vaccinations of Infants in Practice online survey in seven countries evaluated vaccination-related attitudes and concerns of parents of infants and health care providers (HCPs) who provide pediatric medical care. The survey showed that HCPs and parents were open to adding new vaccines to the immunization schedule, even if it requires co-administration with current vaccines or introduction of new office visits. Parental disease awareness campaigns would be helpful to achieve widespread acceptance of changes to vaccination schedules. In addition, HCPs would ideally provide disease education to parents to accompany recommendations for a new vaccine.