Case series of central retinal artery occlusion in COVID-19-associated rhino-orbital-cerebral mucormycosis

Rhino orbital Mucormycosis caused by filamentous fungus of mucoraceae family was considered a rare disease affecting immunocompromised and diabetics with ketoacidosis until the recent COVID 19 pandemic. We are presenting a series of six cases of Rhino orbital cerebral Mucormycosis with central retinal artery occlusion. All six cases had common history of COVID 19 infection in recent past with sinusitis, proptosis and total ophthalmoplegia with central retinal artery occlusion on presentation. MR imaging showed invasive pan sinusitis with orbital and cerebral involvement. Urgent debridement was done and histopathological examination showed broad, filamentous aseptate fungi suggestive of Mucormycosis. All patients inspite of intravenous Amphotericin B with local debridement did not show any improvement and expired within a week of presentation. Hence our study shows poor prognosis of post covid 19 associated Mucormycosis with central retinal artery occlusion.

Comparing the efficacy of sodium hyaluronate eye drops and carboxymethylcellulose eye drops in treating mild to moderate dry eye disease

Purpose: Aim of this study was to compare the efficacy of sodium hyaluronate (SH) and carboxymethyl cellulose (CMC) eye drops in treating mild to moderate dry eye disease in terms of relief of symptoms, mean change in tear film breakup time, Schirmer’s test, and impression cytology of conjunctiva from baseline. Methods: An observational study was carried out during a 2?year period in our tertiary referral hospital. The study consisted of 60 patients randomly allotted to two groups to receive SH and CMC eye drops for an 8?week period. Ocular surface disease index, tear film breakup time, and Schirmer’s test were performed at baseline visit and 4 and 8 weeks of treatment, and impression cytology of conjunctiva was performed at baseline and 8 weeks. Results: Significant improvement in patient symptoms, tear film breakup time, and Schirmer’s test from baseline was seen in both SH and CMC groups at 8 weeks posttreatment, whereas impression cytology of conjunctiva in both groups did not show significant improvement at 8 weeks of treatment. Data analysis using unpaired t?test showed comparable results. Conclusion: Both CMC and SH demonstrated equal efficacy in treating mild to moderate dry eye disease.

Preoperative Templating of Bone-Patellar Tendon-Bone Graft for Anterior Cruciate Ligament Reconstruction: A Morphometry-Based Graft Harvest Method

Background@#Knowledge of anatomy and morphometry of the patella and patellar tendon is crucial for the selection of bonepatellar tendon-bone (BTB) graft for anterior cruciate ligament reconstruction. Graft tunnel mismatch in BTB graft especially in patients with patella alta or baja can result in compromised fixation for the bone-to-bone healing. This complication can be avoided by proper templating of graft using parameters measured from magnetic resonance imaging (MRI). The study aimed to derive morphometric data from MRI and predict the suitability of BTB graft preoperatively. @*Methods@#MRI of 1,002 knees was chosen from database after applying the eligibility criteria, which included individuals in the age group of 18–50 years (both sexes) with the intact patella and patellar tendon. Individuals with pathologies of the knee joint and associated structures such as patellar fracture/dislocations, fractures of the distal femur and proximal tibia, and avulsion of the quadriceps tendon or patellar tendon were excluded. For analysis, 1.5 Tesla, proton density, and fat-suppressed sequences of sagittal and axial sections of T2-weighted MRI images were used. @*Results@#Mean age of the 1,002 patients was 35.45 years and there were 290 women and 712 men. Respective measurements were as follows: patella length, width, and thickness, 40.3 mm, 40.2 mm, and 18.6 mm, respectively; patellar tendon length, width, and insertional thickness, 45.2 mm, 27.2 mm, and 5.7 mm, respectively; Insall-Salvati ratio, 1.13; overall graft length, 90.2 mm; and effective tendon length, 26.1 mm. @*Conclusions@#A simple MRI analysis can give us valuable inputs on BTB graft morphometry. The values can also help us with the near-perfect graft harvest. The intraoperative complication of graft tunnel mismatch can be avoided by predicting the overall graft length, effective tendon length, tibial tunnel length, and patellar position using the measured parameters on MRI.

A comparison of sub-tenon block with peribulbar block in small-incision cataract surgery

Purpose: To compare the efficacy and safety of sub?tenon block to peribulbar block with respect to analgesia, akinesia, and complications. Methods: It is an observational study conducted at a government hospital in Karnataka. Seventy patients who came to the ophthalmology OPD for small?incision cataract surgery (SICS) under local anesthesia were included in the study. The participants were divided into two groups of 35 as per the surgeon. The pain was evaluated at the time of administration of the block, during the surgery, and during the postoperative period of 4 h. Akinesia was noted in both the groups and the time of onset of akinesia was noted. Any complications associated with the block such as chemosis or subconjunctival hemorrhage were also noted. Statistical analysis was done using PSS version 25.0, where P < 0.05 was considered significant. Results: The baseline pain score was higher in the peribulbar group (1.57). The onset of akinesia was faster in sub?tenons (90.34 s). Complete akinesia was achieved in 82.9% of patients after peribulbar block. There was no significant difference in complications in both groups. Conclusion: Sub?tenons block is an effective and safer technique of ocular anesthesia for SICS. It can be considered as an alternative to the conventional peribulbar block for SICS.

Maternal Obesity and Its Associated Factors and Outcomes in Klang Valley, Malaysia: Finding from National Obstetric Registry

@#Introduction: Maternal obesity presents significant health risks to mothers and their fetuses. This study aimed to determine the proportion, associated factors and outcomes of maternal obesity among pregnant women in Klang Valley, Malaysia. Methods: A retrospective cross-sectional study was conducted between January 2018 and March 2018 using secondary data from the Malaysian National Obstetric Registry (NOR) for the year 2015. All pregnant women with first-trimester booking at 12 weeks and below that were registered with the NOR and met the inclusion and exclusion criteria were included in the study. Descriptive statistics and multiple logistic regression analysis were used. Data were analysed using SPSS version 22.0. A total of 2113 respondents were included in this study to determine the proportion, associated factors and outcomes of maternal obesity. Regarding the univariate and multivariate analyses, respondents were classified into two groups: normal and obese. The obese group comprised overweight and obese mothers. The underweight group was excluded in the subsequent analysis. Results: Out of the 2113 respondents, 7.1% were underweight, 41.7% were of normal weight, 28.6% were overweight, 15.9% were in obese class I, 4.6% were in obese class II, and 2.1% were in obese class III according to the WHO (1995) reference. However, when the MOH (2003) cutoff point was used, there was a marked increase in the proportion of respondents in the overweight categories by 2.7% and obesity class I by 12.8%. The Indian (AdjOR 2.06, 95% CI: 1.11, 3.83, p=0.021) and Malay (AdjOR 1.75, 95% CI: 1.02, 3.00, p=0.040) ethnicities, as well as both multiparity (AdjOR 1.46, 95% CI: 1.23, 1.73, p <0.001) and grand multiparity (AdjOR 2.41, 95% CI: 1.78, 3.26, p <0.001), were significantly associated with maternal obesity. There were significant association between maternal obesity with hypertensive disorder in pregnancy (p=0.025), caesarean section delivery (p=0.002) and macrosomic infant (p <0.001). Conclusion: The identification of risk factors for maternal obesity is important to facilitate intervention programmes focused on improving the pregnancy outcomes for a high-risk group of women.

Fungal keratitis caused by Laetisaria arvalis

A 53-year-old female presented with keratitis (right eye) after fall of insect 10 days back. The ulcer worsened in spite of aggressive treatment with topical natamycin (5%) and amphotericin-B (0.15%) eye drops and finally perforated. Iris tissue sealed the perforation site, and ulcer healed with formation of adherent leucoma. This case represents first reported case of keratitis caused by Laetisaria arvalis and stresses on aggressive course of keratitis caused by this fungus. Importance of DNA sequencing in identification of unidentified fungal species is also highlighted.

Effectiveness of selective risk based screening for Gestational Diabetes (GDM) in Malaysia: A retrospective cohort study based on the National Obstetric Registry (NOR) of Malaysia

Introduction: Gestational diabetes (GDM) has significant maternal and foetal implications. screening allows active interventions which significantly improves pregnancy outcomes. Despite World Health Organization (WHO), FIGO and National Institute of clinical Excellence (NIcE) recommendations for universal screening especially among high risk population; Malaysia currently adopts a selective risk based screening for GDM. Objective: the objective is to audit the effectiveness of the current practice of selective risk based screening in detection of GDM in Malaysia. Methodology: this is a retrospective cohort study based on the National Obstetric Registry (NOR) which comprises of 14 major tertiary hospitals in Malaysia. the study period was from 1st January 2011 till 31st December 2012 and a total of 22,044 patients with GDM were analysed. Logistic regression analysis was used to calculate the crude odd ratio. Results: the incidence of GDM in Malaysia is 8.4%. Maternal age of ≥25, booking bMI ≥27kg/m2, booking weight ≥80kg and previous hypertension are non-significant risk of developing GDM in Malaysia. Parity 5 and more was only associated with an odds-ratio of 1.02 (95% confidence Interval: 0.90-1.17) as compared to parity below 5. the association of women with previous stillbirth with GDM was not significant. conclusion: current risk based screening for GDM based on maternal age, booking bMI, weight and hypertension is inappropriate. An ideal screening tool should precede disease complications, which is the novel objective of screening. Universal screening for GDM in Malaysia may be a more accurate measure, especially with regards to reducing maternal and foetal complications.

Tricuspid annulus: A spatial and temporal analysis.

Background: Traditional two‑dimensional (2D) echocardiographic evaluation of tricuspid annulus (TA) dilation is based on single‑frame measurements of the septolateral (S‑L) dimension. This may not represent either the axis or the extent of dynamism through the entire cardiac cycle. In this study, we used real‑time 3D transesophageal echocardiography (TEE) to analyze geometric changes in multiple axes of the TA throughout the cardiac cycle in patients without right ventricular abnormalities. Materials and Methods: R‑wave‑gated 3D TEE images of the TA were acquired in 39 patients undergoing cardiovascular surgery. The patients with abnormal right ventricular/tricuspid structure or function were excluded from the study. For each patient, eight points along the TA were traced in the 3D dataset and used to reconstruct the TA at four stages of the cardiac cycle (end‑ and mid‑systole, end‑ and mid‑diastole). Statistical analyses were applied to determine whether TA area, perimeter, axes, and planarity changed significantly over each stage of the cardiac cycle. Results: TA area (P = 0.012) and perimeter (P = 0.024) both changed significantly over the cardiac cycle. Of all the axes, only the posterolateral‑anteroseptal demonstrated significant dynamism (P < 0.001). There was also a significant displacement in the vertical axis between the points and the regression plane in end‑systole (P < 0.001), mid‑diastole (P = 0.014), and mid‑systole (P < 0.001). Conclusions: The TA demonstrates selective dynamism over the cardiac cycle, and its axis of maximal dynamism is different from the axis (S‑L) that is routinely measured with 2D TEE.

Dynamic changes in the ischemic mitral annulus: Implications for ring sizing.

Objectives: Contrary to the rest of the mitral annulus, inter‑trigonal distance is known to be relatively less dynamic during the cardiac cycle. Therefore, intertrigonal distance is considered a suitable benchmark for annuloplasty ring sizing during mitral valve (MV) surgery. The entire mitral annulus dilates and flattens in patients with ischemic mitral regurgitation (IMR). It is assumed that the fibrous trigone of the heart and the intertrigonal distance does not dilate. In this study, we sought to demonstrate the changes in mitral annular geometry in patients with IMR and specifically analyze the changes in intertrigonal distance during the cardiac cycle. Methods: Intraoperative three‑dimensional transesophageal echocardiographic data obtained from 26 patients with normal MVs undergoing nonvalvular cardiac surgery and 36 patients with IMR undergoing valve repair were dynamically analyzed using Philips Qlab® software. Results: Overall, regurgitant valves were larger in area and less dynamic than normal valves. Both normal and regurgitant groups displayed a significant change in annular area (AA) during the cardiac cycle (P < 0.01 and P < 0.05, respectively). Anteroposterior and anterolateral‑posteromedial diameters and inter‑trigonal distance increased through systole (P < 0.05 for all) in accordance with the AAs in both groups. However, inter‑trigonal distance showed the least percentage change across the cardiac cycle and its reduced dynamism was validated in both cohorts (P > 0.05). Conclusions: Annular dimensions in regurgitant valves are dynamic and can be measured feasibly and accurately using echocardiography. The echocardiographically identified inter‑trigonal distance does not change significantly during the cardiac cycle.

Antimicrobial activity and Characterization of Marine bacteria.

Marine bacteria were isolated from seawater was collected from different coastal areas of the Tamilnadu Sea. The antimicrobial activities of these bacteria were investigated. Ethyl acetate extracts of marine bacterial fermentation were screened for antimicrobial activities using the method of agar diffusion. The results showed that 25 strains of the isolates have antimicrobial activity. The proportion of active bacteria associated with isolated from seawater. The active marine bacteria were assigned to the genera Alteromonas, Pseudomonas, Bacillus and Marinobacter. The TLC autobiographic overlay assay implied that the antimicrobial metabolites produced by four strains with wide antimicrobial spectrum were different. These marine bacteria were expected to be potential resources of natural antibiotic products. It can be concluded that isolation of Marine bacterial samples can offer a numbers of microbial strains for sources of new biomolecules from Marine sources.

In vitro antimicrobial activity and phytochemical analysis of Cassia auriculata Linn.

This study was performed to evaluate the antimicrobial activity of aerial parts of chloroform extract of Cassia auriculata L. The chloroform extract of C. auriculata were shown to possess an antimicrobial activity against two gram positive and two gram negative human pathogenic bacteria and fungi, viz. Bacillus subtilis, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and fungus cultures Candida albicans and Aspergillus niger by using disc diffusion method. The extract showed antibacterial activity at all concentrations selected, but only the extract with the concentration of 300μg/ml showed maximum antibacterial activity against all the organisms except Pseudomonas aeruginosa which are comparable with the standard control, amikacin. The anti fungal activity of chloroform extract of C. auriculata revealed significant effect against Candida albicans and Aspergillus niger with the net inhibition zone of 14 and 14 mm, respectively at 300μg/ml concentration, which is almost comparable with standard control, ketokonazole used as an antifungal agent. The phytochemical analysis showed the presence of alkaloids, carbohydrates, fixed oils, fats, tannins, gum & mucilage, flavonoids, saponins, terpenoids, lignin and sterols. It is concluded that the antimicrobial activity showed by the plant was due to the presence of these phytochemicals. Further studies are highly needed for future drug development.

In vitro antimicrobial activity and phytochemical analysis of Cassia auriculata Linn.

This study was performed to evaluate the antimicrobial activity of aerial parts of chloroform extract of Cassia auriculata L. The chloroform extract of C. auriculata were shown to possess an antimicrobial activity against two gram positive and two gram negative human pathogenic bacteria and fungi, viz. Bacillus subtilis, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and fungus cultures Candida albicans and Aspergillus niger by using disc diffusion method. The extract showed antibacterial activity at all concentrations selected, but only the extract with the concentration of 300μg/ml showed maximum antibacterial activity against all the organisms except Pseudomonas aeruginosa which are comparable with the standard control, amikacin. The anti fungal activity of chloroform extract of C. auriculata revealed significant effect against Candida albicans and Aspergillus niger with the net inhibition zone of 14 and 14 mm, respectively at 300μg/ml concentration, which is almost comparable with standard control, ketokonazole used as an antifungal agent. The phytochemical analysis showed the presence of alkaloids, carbohydrates, fixed oils, fats, tannins, gum & mucilage, flavonoids, saponins, terpenoids, lignin and sterols. It is concluded that the antimicrobial activity showed by the plant was due to the presence of these phytochemicals. Further studies are highly needed for future drug development.

Comparison of central corneal thickness of primary open angle glaucoma patients with normal controls in south India

Studies mainly in the western population have compared central corneal thickness in primary open angle glaucoma and normal individuals have found variable results. We did this study to compare the central corneal thickness of primary open angle glaucoma patients with normal controls in a south Indian population. This was a masked, cross-sectional study undertaken in a tertiary care center in South India. A total of 50 controls and 50 primary open angle glaucoma patients were studied. Central corneal thickness between the two groups was compared using Wilcoxon two sample test and the signed rank test. The mean central corneal thickness in the control group was 536 microm [462-608 microm] and in the primary open angle glaucoma group was 531 microm [476-609 microm]. There was no significant difference in the central corneal thickness between primary open angle glaucoma patients and the normal controls

The Effectiveness of Methadone Maintenance Therapy Among Opiate - Dependants Registered with Hospital Raja Perempuan Zainab II Kota Bharu, Kelantan

Background: The objective of this study was to determine the effectiveness of MMT program among injecting drug users (IDUs) in Kota Bharu , Kelantan. Methods: The study was a retrospective study based on the records of injecting drug users (IDUs) involved in the MMT program from November 2005 to 31st January 2008, registered at the Psychiatric Clinic of Hospital Raja Perempuan Zainab II. Opiate Treatment Index (OTI) was used as the research instrument. Repeated measures ANCOVA was used to compare the mean scores during the entry period and after completing twelve months of MMT program after adjusted for age, marital status and level of education. Results: A total of 117 file records were reviewed. There was significant reduction in the mean scores after 12 months of heroin Q score , HIV Risk-taking Behavior Scale and health scale after adjusted for age, marital status and level of education. For Heroin Q score, mean difference was 2.01 (95% CI: 1.45, 2.56), for HIV Risk-taking Behavior Scale, mean difference was 7.64 (95% CI: 6.03, 9.26); and for health scale, mean difference was 5.35(95% CI: 3.90, 6.79). Conclusion: This study supports the evidence that MMT program is effective in treating heroin and opiate dependence.

The involvement of amygdala nucleus in chronic stress induced changes on ingestive behavior of wistar rats.

Organisms are constantly subjected to stimuli that can be construed as stressors. Stress regulation is a highly integrated process controlled largely by the brain. The role of amygdala in stress tolerance has attracted continued interest because of its central role in processing emotional information. In the present study, the Wistar albino rats were subjected to chronic swimming (physical) stress and chronic immobilization (psychological) stress for 60 days with or without bilateral lesions of the nucleus of amygdala. Their food intake, water intake and body weight were measured. Exposure to stressors significantly decreased the body weight, food and water intake whereas amygdala lesioning significantly increased the body weight (P<0.001), food intake (P<0.001) and water intake (P<0.001).However, the stress induced decrease observed in the body weight and food intake of the amygdala lesioned groups was significantly more (P<0.001) during immobilization stress than swimming stress. It can be concluded that amygdala nucleus appears to play a prominent role in minimizing the stress induced changes in the food intake and body weight; and this role was more evident in immobilization stress than a physical stress. Thus, the present study support the notion that the amygdala nucleus play a definite role in minimizing stress induced changes in the ingestive behavior and its role in psychological stress is more prominent.

Efeito da respiração diafragmática sobre a variabilidade da frequência cardíaca na doença cardíaca isquêmica com diabete / Efecto de la respiración diafragmática sobre la variabilidad de la frecuencia cardiaca en la enfermedad cardiaca isquémica con diabetes / Effect of diaphragmatic breathing on heart rate variability in ischemic heart disease with diabetes

FUNDAMENTO: A diminuição da variabilidade da frequência cardíaca (VFC) está associada com um prognóstico desfavorável em pacientes com doença cardíaca isquêmica (DCI) e diabete. Ainda não foi provado em definitivo se a mudança no padrão respiratório pode modificar o fator de risco nesses pacientes. OBJETIVO: Avaliar o efeito da respiração diafragmática sobre a VFC em pacientes diabéticos com DCI. MÉTODOS: A população do estudo consistiu em 145 pacientes do sexo masculino selecionados ao acaso, dos quais 45 apresentavam DCI, 52 apresentavam DCI e diabete (DCI-DM) e 48 apresentavam DCI e neuropatia diabética (DCI-ND). A VFC foi avaliada através de ECG de 5 minutos usando o método de domínio de tempo. O grupo de intervenção foi dividido em grupo aderente e não-aderente e o seguimento foi registrado após três meses e um ano. RESULTADOS:A avaliação basal mostrou uma diminuição significante em VFC nos pacientes com doença cardíaca isquêmica com ou sem diabete (p<0,01). Os pacientes com DCI apresentavam VFC mais alta do que os pacientes com DCI-DM (p<0,01) e DCI-ND (p<0,01). Um aumento na VFC foi observado em pacientes que praticaram respiração diafragmática por três meses (DCI-DM: p<0,01; DCI-ND: p<0,05) e por um ano (DCI-DM: p<0,01; DCI-ND: p<0,01). A VFC diminuiu significantemente após um ano em pacientes não-aderentes. A prática regular de respiração diafragmática também melhorou o índice glicêmico nesses pacientes. CONCLUSÃO: A prática regular de respiração diafragmática melhora de forma significante a VFC em uma direção prognosticamente favorável em pacientes com DCI e diabete. Esses efeitos parecem ser potencialmente benéficos no manejo desses pacientes.

BACKGROUND: Reduced heart rate variability is associated with an unfavorable prognosis in patients with ischemic heart disease and diabetes. Whether change in breathing pattern can modify the risk factor in these patients has not been definitely proved. OBJECTIVE: To evaluate the effect of diaphragmatic breathing on heart rate variability (HRV) in ischemic heart disease patients with diabetes. METHODS: Study population consisted of 145 randomly selected male patients of which 45 had ischemic heart disease (IHD), 52 had IHD and diabetes (IHD-DM) and the remaining 48 had IHD and diabetic neuropathy (IHD-DN). HRV was assessed by 5 minute-electrocardiogram using the time domain method. The intervention group was divided into compliant and non-compliant groups and follow-up recording was carried out after three months and one year. RESULTS: Baseline recordings showed a significant decrease in HRV in ischemic heart disease (IHD) patients with or without diabetes (p<0.01). IHD patients had higher HRV than IHD patients with diabetes (p<0.01) or diabetic neuropathy (p<0.01). Increase in HRV was observed in patients who practiced diaphragmatic breathing for three months (IHD-DM: p<0.01; IHD-DN: p<0.05) and for one year (IHD-DM: p<0.01; IHD-DN: p<0.01). The HRV significantly decreased after one year in non-compliant patients. The regular practice of diaphragmatic breathing also improved the glycemic index in these patients. CONCLUSION: The regular practice of diaphragmatic breathing significantly improves heart rate variability with a favorable prognostic picture in ischemic heart disease patients who have diabetes. These effects seem to be potentially beneficial in the management of IHD patients with diabetes.

FUNDAMENTO: La disminución de la variabilidad de la frecuencia cardiaca (VFC) está asociada a un pronóstico desfavorable en pacientes con enfermedades cardiaca isquémica (DCI) y diabetes. Todavía no se aprobó en definitivo si el cambio en el estándar respiratorio puede modificar el factor de riesgo en esos pacientes. OBJETIVO: Evaluar el efecto de la respiración diafragmática sobre la VFC en pacientes diabéticos con DCI. MÉTODOS: La población del estudio consistió en 145 pacientes del sexo masculino seleccionados al azar, de los cuales 45 presentaban DCI, 52 presentaban DCI y diabetes (DCI-DM) y 48 presentaban DCI y neuropatía diabética (DCI-ND). La VFC se evaluó a través de ECG de 5 minutos con el empleo del método de dominio de tiempo. El grupo de intervención se dividió en grupo adherente y no-adherente y se registró el seguimiento tras tres meses y un año. RESULTADOS: La evaluación basal reveló una disminución significante en VFC en los pacientes con enfermedades cardiaca isquémica con o sin diabetes (p<0,01). Los pacientes con DCI presentaban VFC más alta que los pacientes con DCI-DM (p<0,01) y DCI-ND (p<0,01). Un aumento en la VFC se observó en pacientes que practicaron respiración diafragmática por tres meses (DCI-DM: p<0,01; DCI-ND: p<0,05) y por un año (DCI-DM: p<0,01; DCI-ND: p<0,01). La VFC disminuyó significantemente tras un año en pacientes no-adherentes. La práctica regular de respiración diafragmática también mejoró el índice glucémico en esos pacientes. CONCLUSIÓN: La práctica regular de respiración diafragmática mejora de forma significante la VFC en una dirección pronósticamente favorable en pacientes con DCI y diabetes. Esos efectos parecen ser potencialmente benéficos en el manejo de esos pacientes.

Lack of awareness amongst community patients with diabetes and diabetic retinopathy: the Singapore Malay eye study

<p><b>INTRODUCTION</b>We assessed awareness of diabetes and diabetic retinopathy in a Singaporean Malay population. We hypothesised that poor awareness is associated with poorer control of diabetic retinopathy risk factors (glycaemic and blood pressure levels) and suboptimal treatment with laser therapy.</p><p><b>MATERIALS AND METHODS</b>A population-based survey of 3280 (78.7% response rate) persons among Singaporean Malays aged between 40 and 80 years old. Diabetes was defined in persons with random glucose >or=11.1mmoL/L, use of diabetic medication, or a previous physician diagnosis. Diabetic retinopathy was graded from retinal photographs following the modified Airlie House classification. Patient awareness was assessed via structured interviews. Glycosylated haemoglobin was measured from venous blood.</p><p><b>RESULTS</b>Of the 3280 study participants, 768 had diabetes, of whom 13.2% (n = 101) were unaware of their diabetes status. Participants unaware of their diabetes status had significantly higher mean glycosylated haemoglobin (9.7% vs 8.2%, P <0.001), systolic blood pressure (160.0 mmHg vs 153.7 mmHg, P = 0.01) and diastolic blood pressure (83.5 mmHg vs 78.5 mmHg, P <0.001), compared to participants who were aware. Of the 272 (35.4%) participants detected to have diabetic retinopathy, 83.4% (n = 227) were unaware of having retinopathy. Of the 77 with vision-threatening retinopathy, laser treatment had been performed in only 55.6% of those unaware of having retinopathy.</p><p><b>CONCLUSION</b>In a sample of Malays with diabetes, high proportions were unaware of their disease. Unawareness was associated with poorer control of diabetic retinopathy risk factors. Only half of persons who were unaware that they had vision-threatening diabetic retinopathy had received laser treatment. These data highlight room for improvement in diabetic retinopathy prevention through better patient education and screening.</p>

Additional value of computed tomography angiography in multiple coronary artery aneurysms--a case report.

Though invasive coronary angiography is the gold standard for the diagnosis of coronary artery aneurysms, computed tomography angiography may be just as useful in providing details of their morphology, size, location and associated stenosis or ectasia. Besides, it has the advantage of being a non-invasive modality.We present a case in which an aneurysm, which was not identified by conventional angiography due to the presence of thrombus, was correctly identified by computed tomography angiography.

Effect of acute and chronic conditions of over-crowding on free choice ethanol intake in rats.

Male albino rats of Wistar strain were exposed to overcrowding stress in two different groups for a period of seven days. One group of rats was kept under stress for six hours per day (acute stressed group) and the other group rats was kept under stress continuously (chronic stressed group). The effect of these acute and chronic stresses on voluntary alcohol (2% w/v) intake was monitored during the 7 days of stress exposure, and ethanol preference and total ethanol intake in terms of g/kg body weight were also studied. A significant increase in ethanol preference and ethanol intake was observed in one-day and 7 days chronic stressed group. No significant increase in ethanol intake was observed in acute stress. Thus a short lasting stressor may not increase ethanol-drinking behavior, whereas when animals were exposed to more intense stressor continuously for 7 days, an increase in voluntary drinking behavior may be seen.