Congenital nasolacrimal duct obstruction update study (CUP study): paper I—role and outcomes of Crigler’s lacrimal sac compression

PurposeTo assess the exclusive role and outcomes of Crigler’s lacrimal sac compression in the management of congenital nasolacrimal duct obstruction (CNLDO).MethodsRetrospective interventional case-series was performed on patients diagnosed with CNLDO and who were advised Crigler’s lacrimal sac compression (CLSC) at a tertiary care Dacryology Institute from Jan 2016 to June 2019. CNLDO patients who were practicing incorrect techniques of lacrimal sac compression at presentation were separately assessed. All the patients were assigned to four groups (Gr 1: 0–3 months, Gr 2: >3 & <6 months, Gr 3: >6 & <9 months and Gr 4: >9 and <12 months) based on the age at which the CLSC was initiated and followed up quarterly or as needed till at least 1 year of age. The parameters studied include patient demographics, clinical presentation, age of initiation of CLSC, success rate with CLSC, and need for additional interventions. Success was defined as the subjective resolution of epiphora and discharge with objective measures of normal tear meniscus height and dye clearance on fluorescein dye disappearance test.ResultsA total number of 1240 patients with CNLDO were assessed. Of these, 1037 patients were advised correct techniques of CLSC from the beginning, and the remaining 203 patients were referred but performing it incorrectly at presentation. Of the 1037 patients, 236 were lost to follow-up; hence, a total of 1004 patients (801 + 203) were included for final analysis. CLSC was found to be an effective conservative strategy in the management of CNLDO. The rate of resolution of CNLDO in Gr 1 to Gr 4 was 87.3%, 78.9%, 77.9%, and 76.8%, respectively. There were no statistically significant differences in the outcomes based on the age of CLSC initiation. The referred patients whose techniques were rectified following the initial incorrect techniques showed a resolution of 61.2% (79/129). The correct techniques of CLSC appeared to influence the outcomes. However, the age of its initiation did not substantially impact the outcomes. Significantly high resolution was noted even beyond nine months of age and encouraging results beyond 12 months of age.ConclusionsIt is crucial to initiate the correct techniques of Crigler’s lacrimal sac compression to achieve favourable outcomes. Age of initiation of CLSC in infancy does not appear to influence the outcomes. The resolution rate continued to be significantly high up to 1 year of age. There is a need to assess the role of CLSC beyond 12 months of age.Subject terms: Lacrimal apparatus diseases, Respiratory tract diseases     

Effects of structural modifications upon the accumulation in planta of replicons derived from beet necrotic yellow vein virus RNA 3

Summary. Beet necrotic yellow vein virus (BNYVV) RNA 3 from which all but the 3′ and 5′‘core’ replication origins (promotors) have been deleted replicates when coinoculated to Chenopodium quinoa with viral RNAs 1 and 2. The resulting ‘replicon’ can be used to express inserted heterologous sequences in planta. The effects of alterations of replicon structure on its efficiency of accumulation in planta were examined. Inclusion of up to ∼240 nucleotides of sequence from the region immediately upstream of the core 3′-promoter sequence increased replicon accumulation, suggesting that this region contains specific replication enhancer elements. Insertion of non-viral ‘spacer’ sequences between the core promoters also increased replicon accumulation, provided that no strong secondary structure was present. The highly homologous 3′-terminal core promoters of BNYVV RNAs 1, 2 and 4 could substitute for the RNA 3 core promoter but were generally somewhat less effective. Co-inoculation of full-length RNA 3 but not RNA 4 interfered with accumulation of the RNA 3-based replicons. Received December 7, 1998 Accepted February 11, 1999     

Accuracy and cross-sensitivity of 10 different anesthetic gas monitors

Objective. The objective of this study was to test the accuracy and cross-sensitivity of commercially available anesthetic gas monitors.Methods. Using gas chromatography (GC) as a reference method, the accuracy, cross-sensitivity, and ability to recognize an erroneously selected agent were determined in the following 10 monitors for volatile anesthetics: Datex Capnomac Ultima-S, Datex Capnomac, Ohmeda 5330 agent monitor, Iris Dräger, Andros Dräger PM 8020 (all monochromatic, infrared analyzers), Nellcor N-2500E, Criticare POET II, Irina Dräger (all polychromatic, infrared analyzers), Siemens Servo Gas Monitor 120 (a piezoelectric analyzer), and Brüel & Kjaer Type 1304 (a photoacoustic analyzer). Accuracy was determined at 0.5, 1, 2, and 4 times the minimal alveolar concentration (MAC) of either halothane or isoflurane in oxygen (O₂). The cross-sensitivity tests were performed with 70 vol% nitrous oxide in O₂, 5 vol% carbon dioxide in O₂, 0.032 vol% alcohol in O₂, and 70% water vapor in O₂. The photoacoustic analyzer showed a higher accuracy for isoflurane than the polychromatic infrared monitors. The greatest inaccuracy with isoflurane was found in the Iris Dräger monitor, which had a maximal bias percentage by volume (vol%) of 0.09 at 0.5 MAC. (This bias was within the manufacturer's specified tolerance of ±0.1 vol% or 10% relative difference of reading, whichever is greater.) Irina Dräger was the most accurate analyzer with halothane (mean % bias [relative %] ± SD, 0.9 ± 2.0%). The greatest bias with halothane was found in the monochromatic infrared analyzers, with a maximal % bias at 0.5 MAC of 50.3% of the GC reading (12.4% with a new inner Nafion tube) found in the Datex Ultima monitor. The Siemens gas monitor showed a cross-sensitivity for water vapor (–0.248 vol%). The monochromatic infrared analyzers showed a small sensitivity to alcohol (additional deviation of 0.011 to 0.147 vol% at 2 MAC isoflurane) but no sensitivity to nitrous oxide. No cross-sensitivity was found in the polychromatic infrared and photoacoustic analyzers. An incorrect selection of anesthetic agent when using a monochromatic infrared analyzer can be fatal; for example, when using halothane and selecting isoflurane the values measured by the Datex Capnomac monitor were nearly 6 times below the actual value (i.e., 1 vol% isoflurane on the display = 6 vol% halothane in reality).Conclusions. The photoacoustic measurement principle is more accurate than the other methods, although the polychromatic infrared analyzers are safer because they detect erroneously selected agents.

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Abstrakt Zielsetzung. Ziel der Untersuchung war es, die Genauigkeit und Kreuzempfindlichkeit kommerziell erhältlicher Narkosegasmonitore zu überprüfen. Ein Gaschromatograph (GC) wurde als Referenz verwendet, um die Genauigkeit, Kreuzempfindlichkeit und die Fähigkeit fälschlich gewhlter Narkosegase zu erkennen, an 10 verschiedenen Monitoren überprüft: Datex Capnomac® Ultima -S, Datex Capnomac®, Ohmreda 5330® Nakosegasmonitor, Iris® Dräger, Andros® Dräger PM8020 (alle monochromatische Infrarotanalysesysteme), Nellcor® N-2500E, Criticare® POET II, Irina® Dräger (alle polychromatische Infrarotanalysesysteme), Siemens Servo® Gasmonitor 1320 (ein piezoelektrisches System) und das Brüel & Kjaer® Typ 1304 ein photakustische Analysesystem. Die Genauigkeit wurde bei der 0.5–1–2 und 4fachen minimalen alveolären Konzenztration (MAC) in entweder Halothan oder Isofluran in Sauerstoff bestimmt. Eine Kreuzempfindlichkeit wurde mit 70 Vol% Lachgas in Sauerstoff, 5 Vol% Kohlendioxyd in Sauerstoff, 0.032 Vol% Alkohol in Sauerstoff und 70 Vol% Wasserdampf in Sauerstoff untersucht.Ergebnisse. Das photoakustische System wies grssere Genauigkeit für Isofluran auf als alle polychromatischen Infrarotgasmonitore Die grösste ungenauigheit wurde beim Dräger Iris® Monitor für Isofluran gefunden, der eine prozentuale Abweichung von 0.09 Vol% bei 0.5 MAC aufwies. Diese Abweichung lag innerhalb der vom Hersteller angegebenen Toleranzgrenze von ± 0.1 Vol% bzw. relative10%. Der Irina® Drägermonitor war der genauste für Halothan (mittlere % Abweichung [relative %] ± Stabdardabweichung, 0.9 Vol% ± 2.0%). Die größte Abweichung für Halothan wurde bei den monochromatischen Systemen gefunden; bei 0.5 MAC wurde eine maximale % Abweichung für den Datex Ultima® Monitor von 50.3% (12.4% mit dem neuen Nafionschlauch) von dem am Gaschromatographen gemessenen Wert gefunden. Der Siemens Gasmonitor wies eine Kreuzempfindlichkeit für Wasserdampf auf (–0.248 Vol%). Die monochromatischen Infrarotsysteme wiesen alle eine geringe Kreuzempfindlichkeit für Alkohol (zusätzliche Abweichung von 0.011 bis 0.147 Vol% bei 2 MAC Isofluran) jedoch keine Kreuzempfindlichkeit für Lachgas auf. Keine Kreuzempfindlichkeit wurde bei den polychromatischen Infrarot- und photoakustischen Systemen nachgewiesen. Eine fehlerhafte Auswahl zum verwendeten Narkosegas kann bei einem monochromatischen Infrarot-Narkosegasmonitor fatale Folgen haben, wenn z.B. beim Gebrauch von Halothan und der Wahleinstellung Isofluran, die mit dem Datex Capnomat® gemessenen Werte bis zum 6fachen unterhalb der eigentlichen Konzentration liegen (i.e. 1 Vol% Isofluran in der Anzeige bei eigentlichen 6 Vol% Halothan).Schlußfolgerung. Das photoakustische Messprinzip ist genauer als alle anderen Methoden, obgleich das polychromatischen System sicherer ist, da hiermit fälschlicherweise Narkosegase gewählte entdeckt werden können.

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Resumen Objetivo. El objetivo de este estudio fue determinar la precisión y sensibilidad cruzada de monitores de gases anestésicos disponibles en el comercio.Metodos. Usando cromatografía de gases (GC) como método de referencia, se determinó la precisión, sensibilidad cruzada, y capacidad de reconocer un agente seleccionado en forma errónea, de los siguientes diez monitores de agentes anestésicos volátiles: Datex Capnomac Ultima S, Datex Capnomac, Ohmeda 5330, Iris Drager, Andros Drager PM 8020 (todos analizadores infrarrojos monocromáticos), Nellcor N 2500E, Criticare POET II, Irina Drager (todos analizadores infrarrojos policromáticos), Siemens Servo Gas Monitor 120 (analizador piezoeléctrico), y el Bruel & Kjaer Tipo 1304 (analizador fotoacústico). La precisión fue determinada a 0.5, 1, 2, y 4 veces la concentración alveolar mínima (MAC) de halothane o isoflurane en oxígeno (O2). Las pruebas de sensibilidad cruzada fueron realizadas con 70 vol% de óxido nitroso en O2, 5 vol% de CO2 en O2, 0.032 vol% alcohol in O2 y 70% vapor de agua en O2. El analizador fotoacústico mostró mayor precisión para el isofluorano que los monitores infrarrojos policromáticos. La mayor falta de precisión para el isoflurane se observó en el monitor Iris Drager, cuyo sesgo máximo en porcentaje por volumen (vol%) fue 0.09 at 0.5 MAC. (Este sesgo estaba dentro de la tolerancia especificada por el fabricante, de ±0.1 vol% o 10% diferencia relativa de lectura, lo que resultare mayor). El analizador Irina Drager fue el más preciso con halothane (sesgo % medio [% relativo] ± SD, 0.9 ± 2.0%). El mayor sesgo con halothane se observó en los analizadores infrarrojos monocromáticos, con un sesgo máximo a 0.5 MAC de 50.3% de la lectura del GC (12.4% con un tubo interior de Nafion nuevo) en el monitor Datex Ultima. El monitor de gases Siemens demostró sensibilidad cruzada para el vapor de agua (0.248 vol%). Los analizadores infrarrojos monocromáticos mostraron escasa sensibilidad al alcohol (desviación adicional de 0.011 a 0.147 vol% a 2 MAC isoflurane), pero no sensibilidad al óxido nitroso. No se detectó sensibilidad cruzada a los analizadores infrarrojos policromáticos ni fotoacústico. Una selección incorrecta de agente anestésico, usando un analizador infrarrojo monocromático, puede ser fatal: Por ejemplo, al usar halothano y seleccionar isofluorano los valores medidos por el monitor Datex Capnomac eran casi 6 veces por debajo del valor real (i.e., 1 vol% isoflurane en el display = 6 vol% halothane en la realidad).Conclusiones. El principio fotoacústico de medición es más preciso que los otros métodos, si bien los analizadores infrarrojos policromáticos son más seguros porque detectan selección errónea de agente anestésico.

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Résumé Objectifs. Le but de cette étude était deverifier l'exactitude et la sensibilité croisée des moniteurs de gaz anesthésiques disponibles sur le marché.Méthodes. En choisissant la chromatographie gazeuse (CG) comme méthode de référence, nous avons déterminé l'exactitude, la sensibilité croisée, et la capacité de reconnaissance d'un agent sélectionné par erreur, chez les 10 moniteurs d'anesthésiques volatils suivants: Datex Capnomac Ultima-S, Datex Capnomac, Ohmeda 5330, Iris Drager, Andros Drager PM 8020 (analyseurs infra-rouges monochromatiques); Nelicor N-2500E, Criticare POET II, Irina Drager (analyseurs infra-rouges polychromatiques), Siemens Servo Gas Monitor 120 (analyseur piezoélectrique), et Bruel & Kjaer Type 1304 (analyseur photoacoustique). L'exactitude a été déterminée à respectivement 0,5; 1; 2; 4 fois la concentration alvéolaire minimale (MAC) soit d'halothane, soit d'isoflurane sous oxygène. Les tests de sensibilité croisée ont été réalisés avec un mélange gazeux contenant de l'oxygène et, respectivement, 70% de protoxyde d'azote, 5% de dioxyde de carbone, 0,032% d'alcool, et 70% de vapeur d'eau. L'analyseur photoacoustique s'est révèlé d'une plus grande exactitude pour l'isoflurane que les moniteurs infra-rouges polychromatiques. La plus grande inexactitude avec l'isoflurane était obtenue avec le moniteur Iris Drager, qui présentait l'erreur maximale en pourcentage de volume (vol %) de 0,09 à 0,5 MAC. Cette erreur était située dans l'intervalle de tolérance spécifié par le constructeur de 0,1 vol% en valeur absolue ou de 10% d'erreur relative. Irina Drager était l'analyseur le plus précis avec l'halothane (erreur moyenne ± écart-type de 0,9 ± 2,0 %). L'erreur la plus importante avec l'halothane était obtenue avec les analyseurs infra-rouges monochromatiques, avec une erreur relative maximale 0,5 MAC de 50.3% des résultats de la CG (12,4% avec le nouveau tube Nafion) obtenue avec le moniteur Ultima de Datex. Le moniteur Siemens a montré une sensibilité croisée pour la vapeur d'eau (–0,248 vol%). Les analyseurs infra-rouges monochromatiques ont montré une petite sensibilité à l'alcool (déviation de 0,011 à 0,147 vol% à 2 MAC d'isoflurane) mais aucune sensibilité au protoxyde d'azote. Aucune sensibilité croisée n'était obtenue chez les analyseurs polychromatiques infrarouges et photo-acoustiques. Une sélection incorrecte d'agent anesthésique d'un agent anesthésique lors de l'utilisation d'un analyseur monochromatique infra-rouge peut être fatal; par exemple, en cas d'utilisation d'halothane et de sélection de l'isoflurane, les valeurs mesurées par le moniteur Capnomac de Datex étaient près de 6 fois inférieures aux valeurs réelles (c'est-à-dire: 1 vol% d' isoflurane affiché = 6 vol% d'halothane en réalité).Conclusions. Le principe de mesure photoacoustique est plus exacte que les autres méthodes, bien que les analyseurs infra-rouges polychromatiques sont plus srs puisqu'ils détectent les agents sélectionnés par erreur.

     

Predictors of outcomes in managing breast abscesses—A large retrospective single‐center analysis

We have retrospectively examined a wide range of clinical characteristics, sonographic features, microbiology, and antibiotic regimens in patients with breast abscesses to seek predictive features related to outcome. Because consensus for optimal treatment of breast abscesses has moved toward minimally invasive management using single or repeated needle aspiration (ASP) coupled with adjuvant antibiotics, we assessed whether any factors correlate with the need for repeat procedures by analyzing the number of ASPs and/or surgical incision and drainage (I&D) per abscess. We examined 127 abscesses in 114 patients from a single urban public hospital, and among clinical characteristics, we found that only smoking history (P = .021) and the presence of nipple rings (P = .005) were associated with greater likelihood of necessitating repeat for abscess resolution procedures. Neither diabetes, lactational status, and HIV nor ultrasound features imaging of an abscess including size >3 cm, multiloculation, rind thickness, or central vs peripheral location were correlated with the need for a repeat procedure. Likewise, no specific micro‐organisms predicted a greater likelihood of requiring repeat procedures, and no specific initial antibiotic regimen (gram‐positive and/or gram‐negative or multiresistance coverage) impacted clinical outcomes. Our data indicate that no specific imaging abscess characteristics, type of micro‐organism, or initial choice of antibiotics affect outcomes, and therefore, these features should not preclude attempts at conventional therapy by repeated aspiration and antibiotic treatment. While a smoking history and presence of a nipple ring may increase the risk of a prolonged course, the decision to change antibiotics or repeat aspiration should rely instead on clinical evaluation and judgment by experienced physicians.     

Dialysis membrane-induced oxidative stress: role of heme oxygenase-1

Dialysis membranes have been reported to induce monocyte apoptosis. We studied the role of oxidative stress in the induction of dialysis membrane-induced monocyte apoptosis. Superoxide dismutase, a superoxide scavenger, prevented dialysis membrane-induced monocyte apoptosis. Similarly, other antioxidants also inhibited dialysis membrane- induced apoptosis. In addition, the interaction of dialysis membranes with monocytes was associated with the generation of molecules leading to oxidative stress such as superoxide and TBARS. Interestingly, pre-induction of heme oxygenase (HO)-1 by hemin prevented dialysis membrane-induced monocyte apoptosis, whereas inhibition of HO-1 activity (treatment with tin protoporphyrin, SN-P) enhanced dialysis membrane-induced monocyte apoptosis. We suggest that oxidative injury associated with dialysis membrane and monocyte interaction plays a role in monocyte injury. Pre-induction of HO-1 may attenuate dialysis membrane-induced monocyte apoptosis.     

Blockade of NMDA receptors prevents analgesic tolerance to repeated transcutaneous electrical nerve stimulation (TENS) in rats.

Repeated daily application of transcutaneous electrical nerve stimulation (TENS) results in tolerance, at spinal opioid receptors, to the antihyperalgesia produced by TENS. Since N-methyl-D-aspartate (NMDA) receptor antagonists prevent analgesic tolerance to opioid agonists, we hypothesized that blockade of NMDA receptors will prevent tolerance to TENS. In rats with knee joint inflammation, TENS was applied for 20 minutes daily at high-frequency (100 Hz), low-frequency (4 Hz), or sham TENS. Rats were treated with the NMDA antagonist MK-801 (0.01 mg/kg to 0.1 mg/kg) or vehicle daily before TENS. Paw withdrawal thresholds were tested before and after inflammation and before and after TENS treatment for 4 days. On day 1, TENS reversed the decreased mechanical withdrawal threshold induced by joint inflammation. On day 4, TENS had no effect on the decreased withdrawal threshold in the group treated with vehicle, demonstrating development of tolerance. However, in the group treated with 0.1 mg/kg MK-801, TENS significantly reversed the mechanical withdrawal thresholds on day 4, demonstrating that tolerance did not develop. Vehicle-treated animals developed cross-tolerance at spinal opioid receptors. Treatment with MK-801 reversed this cross-tolerance at spinal opioid receptors. In summary, blockade of NMDA receptors prevents analgesic tolerance to daily TENS by preventing tolerance at spinal opioid receptors. PERSPECTIVE: Observed tolerance to the clinical treatment of TENS could be prevented by administration of pharmaceutical agents with NMDA receptors activity such as ketamine or dextromethorphan.     

Miliary Tuberculosis with Hemophagocytosis in a Two Months Old Infant

A two months old male infant, presented with fever, hepatosplenomegaly and pancytopenia. On bone marrow aspirate, hemophagocytosis was noted. Trephine biopsy showed epithelioid granulomas. ZN stain AFB detected, which confirmed the diagnosis of miliary tuberculosis. This case highlights the rare association of hemophagocytic syndrome with tuberculosis in infancy.     

Protective effect of aqueous extract of Spinacia oleracea leaves in experimental paradigms of inflammatory bowel disease

The present study was aimed to assess the protective effect of aqueous extract of Spinacia oleracea leaves (AESO 250, 500, and 1,000?mg/kg, p.o.) in inflammatory bowel disease using acetic acid- and ethanol-induced colitis in mice and indomethacin-induced enterocolitis in rats. The preliminary phytochemical analysis and further high performance thin layer chromatographic (HPTLC) analysis and phytochemical tests of HPTLC bands confirmed the presence of flavonoids and tannins in AESO. In acute oral toxicity study, administration of AESO (5,000?mg/kg, p.o.) did not show any sign of toxicity and mortality. The treatment with AESO significantly increased body weight, decreased diarrhea with bloody stools, increased blood hemoglobin and plasma total protein, and decreased serum and ileum or colon malondialdehyde content and attenuated the extent of lesions and ameliorated the histological injury of mucosa in all paradigms. The most prominent effects were evident for AESO 1,000?mg/kg. The results of the present study revealed that AESO was effective in attenuating almost all the symptoms of IBD in experimental paradigms. The effect might be due to the antioxidant activity of the flavonoids present in the AESO.