Role of prophylactic intravitreal antibiotics in open globe injuries

PURPOSE: To determine the efficacy of prophylactic intravitreal antibiotics in reducing the incidence of endophthalmitis after trauma. METHODS: This was a prospective, randomised, case control study of 70 consecutive patients with open globe injury. The patients were prospectively randomised into group I (32 eyes) and group II (38 eyes). Group I patients were given prophylactic intravitreal injection of vancomycin 1 mg and ceftazidime 2.25 mg at the conclusion of primary repair. Group II patients were not given prophylactic intravitreal antibiotics. All the patients received intravenous ciprofloxacin. RESULTS: The incidence of endophthalmitis was higher in group II (7 of 38 eyes; 18.42%) compared to group I (2 of 32 eyes; 6.25%). Both the patients who developed endophthalmitis despite prophylactic intravitreal antibiotics in group I had an initially undetected intraocular foreign body (eyelash) in the vitreous cavity. CONCLUSIONS: Prophylactic intravitreal broad spectrum antibiotic injection decreases the risk of post-traumatic endophthalmitis.     

Deciphering the TLR transcriptome and downstream signaling pathway in cerebrospinal fluid in pediatric meningitis

Inflammation Research - Pediatric meningitis is characterized by a colossal inflammatory response to the pathogen in the central nervous system (CNS). This unabated inflammatory response persists...     

Scleroderma lung disease,variation in screening,diagnosis and treatment practices between rheumatologists and respiratory physicians

Background: Interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) represent the leading causes of death in systemic sclerosis (SSc). Screening for these complications has assumed greater importance, but is not universal. The aim of this study is to determine the self‐reported screening, diagnosis and treatment practices of rheumatologists and respiratory physicians for SSc‐related lung disease. Methods: Email survey of 270 rheumatologists and 600 respiratory physicians. Results: Responses were received from 42 (16%) rheumatologists and 68 (11%) respiratory physicians. Of SSc patients seen by rheumatologists, 17% had ILD and 7.5% had a diagnosis of PAH compared with 31% and 21% for respiratory physicians. Forty per cent of all physicians screened asymptomatic SSc patients without a known diagnosis of ILD or PAH less than annually or not at all. The most commonly used screening investigations were pulmonary function tests (PFT) (95%) and transthoracic echocardiogram (TTE) (78%). In suspected ILD, both groups used high‐resolution computed tomography scans and PFT in >90% of patients. In suspected PAH, both used TTE and PFT (>90%); right heart catheterisation was used by only 50% of physicians. In treatment of ILD, rheumatologists used intravenous (IV) cyclophosphamide more often (CYC) (59% vs 28%, P= 0.003) and more respiratory physicians used oral CYC (44% vs 28%, P= 0.012). In PAH, more respiratory physicians used warfarin (68% vs 40%, P= 0.006). Only approximately 65% of physicians had used specific PAH therapy, which may reflect lack of access to a designated PAH treatment centre. Conclusion: The heterogeneity of responses revealed in this study raises the importance of screening, diagnosis and treatment algorithms in the management of this potentially life‐threatening disease.     

The effect of vernakalant (RSD1235), an investigational antiarrhythmic agent, on atrial electrophysiology in humans

OBJECTIVES: To determine the acute effects of vernakalant (RSD1235) on electrophysiologic (EP) properties in humans. BACKGROUND: Vernakalant is an investigational mixed ion channel blocker that can terminate acute atrial fibrillation (AF) in humans at 2 to 5 mg/kg and may be more "atrial-selective" than available agents. METHODS: Patients (N=19; 53% male; age, 48+/-11 years) underwent EP study before and after 25 minutes of intravenous vernakalant administration: 2 mg/kg over 10 min+0.5 mg/kg/hr for 35 min or 4 mg/kg over 10 min+1 mg/kg/hr for 35 min. EP measurements, including atrial refractory period (AERP) and ventricular refractory period (VERP), were obtained. RESULTS: The lower dose prolonged AERP at 600, but not at 400 or 300 msec paced cycle length. The higher dose significantly prolonged AERP from 203+/-31 msec to 228+/-24 msec at 600 msec, 182+/-30 msec to 207+/-27 msec at 400 msec, and 172 msec+/-24 to 193+/-21 msec at 300 msec. There was no significant prolongation of VERP at either dose or at any cycle length. There was a small but significant prolongation of AV nodal refractoriness; Wenckebach cycle length prolonged by 18+/-12 msec (from baseline 343+/-54 msec) at the higher dose (P<0.05). Sinus node recovery time also increased by 123+/-158 msec (from baseline 928+/-237 msec) at the higher dose (P<0.05). There was a slight prolongation of QRS duration at the higher dose, during ventricular pacing at CL=400 msec (15+/-15 msec, P=0.0547). QT and HV intervals were unchanged. CONCLUSIONS: At doses similar to those tested clinically, vernakalant dose-dependently prolonged atrial refractoriness, prolonged AV nodal conduction and refractoriness, and slightly prolonged QRS duration, but it had no effect on ventricular refractoriness.     

Cerebral infarction secondary to vasospasm after perimesencephalic subarachnoid hemorrhage

Perimesencephalic subarachnoid hemorrhage (pSAH) has been described as a distinct form of subarachnoid hemorrhage (SAH) associated with good outcomes. We report a 48-year-old female who developed cerebral infarction due to severe diffuse vasospasm following pSAH. The patient presented with non-aneurysmal pSAH and was discharged home on day 5. However, one week later she developed an acute onset of right hemiparesis. A brain MRI showed acute infarctions on diffusion weighted imaging and her cerebral angiogram showed diffuse vasospasm. The patient received intra-arterial diltiazem and hypervolemic-hypertensive-hemodilution therapy with resulting resolution of the vasospasm and hemiparesis. While not as common as in SAH, there is a potential for the occurrence of cerebral infarction due to vasospasm after pSAH.     

Evaluation of the efficacy of a redox agent in the treatment of chronic periodontitis

Abstract A redox dye, methylene blue, was compared with subgingival root surface debridement and sterile water in the treatment of adult periodontitis. Plaque and gingival indices, bleeding on probing, and microbiological samples were obtained at baseline, and at 1, 4, 8 and 12 weeks following treatment. All subjects had matched pockets in each of the 4 quadrants, of 5 mm or more. One treatment consisted of 0.1% methylene blue gel irrigated professionally at 0, 1 and 4 weeks, and by subjects at days in between up to 4 weeks, at chosen sites within a randomly selected quadrant (split-mouth design). A 2nd treatment was sterile water irrigation as above. A 3rd quadrant received subgingival debridement, and sites in the 4th received methylene blue incorporated into a slow-release device of a biodegradable collagen alginate vicryl composite. All sites showed improvements in clinical and microbiological parameters. However, no statistically significant differences between treatment types were found for clinical measurements. Although plaque index tended to increase after week 1, gingival index was reduced, as was the papilla bleeding index. Probing depth reductions were approximately 1.2 mm for all treatments. Microbiological variables showed an increase in cocci and a decrease in motile organisms for all groups, the latter reaching statistical significance for subgingival debridement. The reductions in spirochaetes were significant for subgingival debridement and methylene blue by slow-release. Culture demonstrated an increase in the aerobe:anaerobe ratio for all groups, which was statistically significant initially (weeks 1 and 4) for subgingival debridement. Methylene blue was also effective statistically in improving this ratio, both by irrigation and slow-release (week 4). Methylene blue also significantly reduced the numbers of black-pigmented anaerobes during the trial period, both by irrigation and slow–release, which sterile water and subgingival debridement failed to do. No serious adverse experiences were seen, however, significantly greater morbidity was associated with subgingival debridement. These results clearly demonstrate that in altering the microflora to one that is more compatible with periodontal health, methylene blue treatment is comparable, or even better, than the currently standard treatment of subgingival debridement, and is better tolerated.     

Do statins lower blood pressure?

Hypercholesterolemia is present in many patients with hypertension and adds a significant component of cardiovascular risk. The 3-hydroxy-3 methyl-glutarylcoenzyme A reductase inhibitors (statins) lower low-density lipoprotein cholesterol but also inhibit many of the structural and functional components of the arteriosclerotic process. Structural effects include reductions in vascular smooth muscle hypertrophy and proliferation, fibrin deposition, and collagen cross-linking. Among the functional effects are improvements in endothelial function, reduction in inflammatory cytokines and reactive oxygen species, and down-regulation of angiotensin II and endothelin receptors. These would be expected to reduce blood pressure in patients with hypertension; 14 studies have shown statin-induced decrease in blood pressure, but 11 studies showed no effect. Many of the studies had no placebo controls, were of short duration, or had small sample sizes, or combinations of these. Despite predictions made on the basis of the vasoprotective actions of statins, the blood-pressure-lowering effects of statins are at best modest.