Ultra-wide field retinal imaging: A wider clinical perspective

The peripheral retina is affected in a variety of retinal disorders. Traditional fundus cameras capture only a part of the fundus even when montaging techniques are used. Ultra-wide field imaging enables us to delve into the retinal periphery in greater detail. It not only facilitates assessing color images of the fundus, but also fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and red and green free images. In this review, a literature search using the keywords “ultra-widefield imaging”, “widefield imaging”, and “peripheral retinal imaging” in English and non-English languages was done and the relevant articles were included. Ultra-wide field imaging has made new observations in the normal population as well as in eyes with retinal disorders including vascular diseases, degenerative diseases, uveitis, age-related macular degeneration, retinal and choroidal tumors and hereditary retinal dystrophies. This review aims to describe the utility of ultra-wide field imaging in various retinal disorders.     

Aqueous colloidal systems of bovine serum albumin and functionalized surface active ionic liquids for material transport

Detailed physicochemical and computational investigation are made to explore different aspects of complexation between bovine serum albumin (BSA) and three structurally different surface active ionic liquids (SAILs), 1-dodecyl-3-methylimidazolium chloride, [C₁₂mim][Cl]; 3-(2-(dodecylamino)-2-oxoethyl)-1-methyl-1H-imidazol-3-ium chloride, [C₁₂Amim][Cl] and 3-methyl-1-dodecyloxy carbonyl methylimidazolium chloride, [C₁₂Emim][Cl]. The interfacial and bulk complexation behavior has been monitored using tensiometry, conductivity, steady-state fluorescence and turbidity measurements. Thermodynamic insights about complexation have been obtained using isothermal titration calorimetry (ITC) measurements whereas molecular docking studies were used to predict the possible binding sites of SAILs on BSA. The information obtained from these studies helped in establishing the formed BSA–SAIL complex as a pH dependent colloidal transport system for controlled transport of a lipophilic dye, Rhodamine 6G (R6G), in aqueous phase, which is supported by confocal laser scanning microscopy (CLSM). In the present work, the effect of functionalization over the alkyl chain of SAILs, modulating the colloidal properties of SAIL–BSA systems, has been explored along with the utilization of these complexes as a pH dependent reversible carrier of lipophilic molecules. It is expected that besides providing basic understanding of colloidal complexes of BSA with SAILs, the present work is expected to be helpful in extending the applications of such colloidal systems for material transport.

Physicochemical and computational investigation of complexation between BSA and SAILs with application in material transport.     

Thoracic aortic aneurysm repair. Direct hospital cost and Diagnosis Related Group reimbursement

Objective. The main objective of this study was to analyze direct hospital cost and to compare cost with existing DRG reimbursement for open repair of thoracic and thoraco-abdominal aortic disease. Study sample and methodology. Between January 2003 and September 2003, the cost of treatment for 24 surgical procedures on ascending aorta and arch, descending or thoraco-abdominal aortic disease were examined prospectively. Seven patients had urgent or emergency surgeries. Ten had sternotomies for disease of the ascending aorta and aortic arch; two had left thoracotomies and three thoraco-laparotomy incisions with procedures performed on x-corporeal circulation. Nine other patients had more distal thoraco-abdominal aortic operations with a clamp-and-sew technique. Micro-cost analysis was performed on each hospital stay, in addition overhead hospital costs were allocated to each procedure. Results. The patients were grouped by discharge diagnosis (ICD-10) and surgical procedure performed (NCSP) into Norwegian DRG code. Patient with surgery on ascending aorta & aortic arch were allocated to DRG 108 (n =9) or 483 (tracheostomy, n =1) while patient with surgery on descending or thoraco-abdominal aorta were allocated to DRG 108 (n =3), 110 (n =4), 111 (n =4) or 483 (tracheostomy, n =3). The mean EuroSCORE for patients with proximal aortic disease was 11 , and the length of stay was 5 days (range 3–8 days), spending 2 days (range 1–7 days) in thoracic intensive care unit. For patients with distal aortic disease the mean Euroscore was 7 , and the mean length of stay 10 days (range 4–23 days) with a mean 4 days (range 1–13 days) in intensive care unit. Eight patients developed medical problems requiring new surgical procedures or prolonged ICU stay. The average direct hospital cost for proximal aortic surgery was USD 15 877 (USD 1 =NOK 7.5) while the respective 100% DRG reimbursement including one patient needing a tracheostomy, was 19 803 USD. For patients with distal aortic disease, average direct hospital cost was 23 005 USD and DRG reimbursement including patients needing a tracheostomy was 31543 USD. Conclusion. Our results underscore previous findings that these patients are resource intensive. This study shows that Norwegian 100% DRG reimbursement did over-compensate observed total hospital costs in this cohort. Detailed analysis showed that this was due to the higher DRG reimbursement for patients needing prolonged ventilatory support. Thus the actual DRG reimbursement seems to be relevant to the tertiary hospital actual costs when these complicated patients are considered as a group. It remains however unclear whether this reimbursement is sufficient to support the scientific infrastructure for new knowledge and skills needed for the further refinement of treatment.     

Fractures of the shaft of humerus

Humeral shaft fractures account for 1–3% of all fractures. Non-surgical management with functional bracing is arguably the standard of care for most humeral shaft fractures.It results in high union rates and in general the outcome is excellent. Surgical management is indicated in some cases, such as open fractures, polytrauma, those with associated vascular injury, pathological fractures, floating elbow injuries and fractures that have failed non-surgical management. Options for surgical fixation include open reduction and internal fixation with plate osteosynthesis, antegrade or retrograde intramedullary nailing and external fixation. Both plate osteosynthesis and intramedullary nailing yield similar results, with a slightly higher rate of complications and re-operations with nailing. A high incidence of radial nerve injury has been associated with humeral shaft fractures and should be actively sought. The management of nerve injuries is still a matter of debate, however; initial expectant treatment with delayed exploration if needed seems to yield similar results to early exploration. Proper patient selection is key to achieving good outcomes with both surgical and non-surgical management of these injuries.     

Gastrointestinal dysfunction in Parkinson’s disease: molecular pathology and implications of gut microbiome,probiotics, and fecal microbiota transplantation

Journal of Neurology - Gastrointestinal symptoms and gut dysbiosis may occur before the onset of motor symptoms in Parkinson's disease (PD). Prediagnostic and prodromal features, such as...     

HIV sero-discordance among married HIV patients initiating anti-retroviral therapy in northern Vietnam

Background

In many countries in Asia, the HIV epidemic is in a concentrated phase, with high prevalence in certain risk groups, such as men who inject drugs. There is also a rapid increase of HIV among women. The latter might be due to high levels of sero-discordant couples and increasing transmission from male to female partners over time.

Methods

All adult married patients initiating antiretroviral treatment at four out-patient clinics in Quang Ninh province in north-eastern Vietnam between 2007 and 2009 were asked to participate in the study. Clinical information was extracted from patients’ records, and a structured questionnaire was used to collect social, demographic and economic data.

Results

Two hundred eighty-eight married patients for whom information on the HIV status of their spouse was available were included in the study. Overall, the sero-discordance rate was 58%. The sero-discordance rate was significantly higher among married males, 71% had spouses not infected, than married females, of whom 18% had spouses not infected. Other factors associated with a high rate of sero-discordance were injection drug use (IDU) history, tuberculosis (TB) history and the availability of voluntary counselling and testing (VCT) in residential locations. High sero-concordance was associated with college/university education.

Conclusion

The sero-discordance was significantly higher among married males than married females. Other factors also related to high sero-discordance were history of IDU, history of TB and the availability of VCT in residential locations. In contrast, college/university education and female sex were significantly related to low sero-discordance. To contain the increasing HIV prevalence among women, measures should be taken to prevent transmission among sero-discordant couples. Trial registration NCT01433601

     

Assessing disease activity in psoriasis and psoriatic arthritis: impact on management and therapy

The management of psoriatic arthritis (PsA) and psoriasis has undergone major advancements over the last decade. This has been made possible, in part, due to the introduction of new therapies for their management, as well as global collaboration in the development of outcome measures and “treat- to- target” paradigms. In this review article, we discuss how disease activity is measured and the outcome measures that have been recently developed for the management of PsA. The importance of assessing the individual domains as well as global assessments both from the physician and patient perspective, and the development of composite measures are discussed. The newer PsA specific measures are expected to be more commonly used in clinical trials as well as clinical practice.