Correlating cognition and cortical excitability with pain in fibromyalgia: a case control study

Abstract Background: Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal symptoms, primarily attributed to sensitization of somatosensory system carrying pain. Few reports have investigated the impact of fibromyalgia symptoms on cognition, corticomotor excitability, sleepiness, and the sleep quality — all of which can deteriorate the quality of life in fibromyalgia. However, the existing reports are underpowered and have conflicting directions of findings, limiting their generalizability. Therefore, the present study was designed to compare measures of cognition, corticomotor excitability, sleepiness, and sleep quality using standardized instruments in the recruited patients of fibromyalgia with pain-free controls. Methods: Diagnosed cases of fibromyalgia were recruited from the Rheumatology department for the cross-sectional, case-control study. Cognition (Mini-Mental State Examination, Stroop color-word task), corticomotor excitability (Resting motor threshold, Motor evoked potential amplitude), daytime sleepiness (Epworth sleepiness scale), and sleep quality (Pittsburgh sleep quality index) were studied according to the standard procedure. Results: Thirty-four patients of fibromyalgia and 30 pain-free controls were recruited for the study. Patients of fibromyalgia showed decreased cognitive scores (p = 0.05), lowered accuracy in Stroop color-word task (for color: 0.02, for word: 0.01), and prolonged reaction time (< 0.01, < 0.01). Excessive daytime sleepiness in patients were found (< 0.01) and worsened sleep quality (< 0.01) were found. Parameters of corticomotor excitability were comparable between patients of fibromyalgia and pain-free controls. Conclusions: Patients of fibromyalgia made more errors, had significantly increased reaction time for cognitive tasks, marked daytime sleepiness, and impaired quality of sleep. Future treatment strategies may include cognitive deficits and sleep disturbances as an integral part of fibromyalgia management.(AU)

Surgically induced astigmatism and refractive outcomes following phacotrabeculectomy

Purpose: To objectively evaluate surgically induced astigmatism (SIA) after phacotrabeculectomy using keratometry and topography and to compare the magnitude of SIA and the refractive outcomes of single-site and twin-site phacotrabeculectomies. Methods: Forty prospective subjects were enrolled in the study and were randomized into single-site and twin-site cohorts. SIA was objectively assessed using keratometry and Orbscan before and at three months after surgery. For both cohorts, the changes in SIA were assessed using power vector analysis compared at the third month after surgery. Results: Each cohort consisted of 20 eyes. The preoperative parameters and postoperative IOP were comparable and similar, respectively, in both the cohorts (P = 0.1). Majority of the patients in both the cohorts had preoperative against-the-rule (ATR) astigmatism. The median change in SIA at the three-month postoperative visit was similar in both the cohorts, with a small increase in ATR astigmatism. Although the SIA change measured by keratometry in the J0 component was similar in both the groups (P = 0.54), that of J45 was significantly different (P = 0.01). However, the median change in SIA was similar in both the groups for both the J0 (P = 0.52) and J45 components (P = 0.94) when measured by Orbscan. The SIA in both the groups measured with keratometry (P = 0.62) and topography (P = 0.52) were clinically and statistically similar. In both the groups, the refraction was similar at 1 month and 3 months. Conclusion: The SIA as measured with keratometry and topography was similar in the single-site and twin-site phacotrabeculectomy cohorts at the end of 3-months. The postoperative refraction was stabilized in 1-month in both the groups.

Trabeculectomy in pregnancy: Case studies and literature review

Glaucoma management during pregnancy is a challenge for the patient and doctor. During pregnancy, the intraocular pressure (IOP) decreases. However, some women with preexisting glaucoma have elevated IOP requiring enhanced medical treatment. Glaucoma refractory to medical treatment combined with disease progression may necessitate laser trabeculoplasty or surgical intervention. Surgery during pregnancy has potential risks for both the mother and fetus. The challenges include problems with anesthesia, positioning for surgery, difficulties in the surgical procedure, potential risk with antimetabolites, and concerns with the management of postoperative complications. We report two case scenarios that highlight the challenges associated with trabeculectomy in pregnant women and the modifications that can be adopted to improve safety and the efficacy of glaucoma filtering surgery during pregnancy.

Profile of childhood glaucoma at a tertiary center in South India

Purpose: To describe the prevalence of various types of childhood glaucomas, their clinical features and treatment methods. Methods: We prospectively included consecutive children with glaucoma presenting to glaucoma clinic for the first time between March 2013 and May 2014. We classified childhood glaucomas as per the classification proposed by Congenital Glaucoma Research Network. Results: Of the 275 children (449 eyes) with glaucoma during this period, primary glaucomas constituted 56% (n = 252 eyes of 145 children), including 169 eyes (37.64%) of 97 children with primary congenital glaucoma (PCG), 16 eyes (3.56%) of 10 children with infantile glaucoma, and 67 eyes (14.9%) of 38 children with juvenile open angle glaucoma. Among these, 85% (214 eyes of 107 children) had bilateral involvement. Secondary glaucomas constituted 44%; they were glaucoma associated with ocular anomalies 18% (n = 80 eyes), glaucoma associated with acquired conditions (steroid induced and traumatic glaucoma) 14% (n = 61 eyes), glaucoma following congenital cataract surgery 7.6% (n = 34 eyes), and glaucoma associated with systemic or syndromic conditions 5% (n = 22 eyes). In primary glaucomas, boys and girls were equally affected (1:1), and more boys (3.8:1) had acquired glaucomas. Close to 80% PCG eyes were managed surgically with combined trabeculotomy and trabeculectomy (CTT). Majority of secondary glaucomas were managed medically. Conclusion: In our cohort, PCG was the most common childhood glaucoma and CTT was the most common surgery performed in these eyes. Steroid-induced and traumatic glaucomas were the most common acquired glaucomas; appropriate measures should be taken to avert these preventable glaucomas in children.

In-the-bag multifocal intraocular lens causing pigment dispersion and refractory secondary ocular hypertension

Pigment dispersion and elevated intraocular pressure (IOP) with sulcus placed hydrophobic acrylic intraocular lenses (IOLs) are described and are rare with in-the-bag IOLs. We report a case of a young lady with elevated IOP and pigment dispersion in one eye following an uneventful phacoemulsification and multifocal IOL implantation. The eye had eccentric capsulorrhexis and localized capsular fibrosis with anterior displacement of the IOL optic, resulting in pigment dispersion. The uncontrolled IOP and continued pigment dispersion were managed with IOL exchange (three-piece IOL) followed by filtration surgery, which helped to resolve the condition successfully.

clinical trial of patient satisfaction with tooth and magnet supported overdenture by visual analogue scale [VAS]

The purpose of this study was to determine the effect of magnet retained overdenture treatment over tooth supported overdenture and degree to which subjective treatment outcome could be predicted by VAS [Visual Analogue Scale]. 10 patients were identified and conventional over denture was delivered, they form group A1. In the same patients magnets were attached to the abutments and the same over denture was converted to magnet retained over denture after 6 months. They form group A2. They finished a questionnaire with 10 statements on overdenture complaint. Visual analogue scale were used to investigate their satisfaction. Difference between the group were analyzed. Magnet retained overdenture was shown to be very effective on compare to tooth supported overdenture

Combined atropine and glycopyrrolate in organophosphate poisoning: The right solution for an old problem.

Unintentional and intentional organophosphate (OP) poisonings continue to be a significant cause of morbidity and mortality in India. Conventional treatment with atropine may lead to CNS toxicity, although control of secretions may still be inadequate. The aim of this study was to assess the effectiveness of atropine along with glycopyrrolate in organophosphate poisonings. A prospective randomized double-blinded, placebo-con-trolled trial was done in an emergency department of a university hospital. Patients who consumed OP compounds were included. Pregnant women, hypothermic adults, mixed poisonings, and concomitant alcoholic intoxications were excluded. The subjects received either atropine and glycopyrrolate, or atropine and a matching placebo as a bolus through a peripheral IV line. All other aspects of treatment were carried out as per standard procedure. Seventy six victims were involved during a six month period, 38 belonging to the study group, and the remaining to the control group. There were no significant differences in demographic data, time of arrival, or time of starting treatment. Results revealed that the duration on ventilator was reduced in 60% of the study group as compared to the control group, reduction in the duration of ICU stay occurred in 20% of control group, while it was 72% of the study group. CNS toxicity occurred in 40% of control group, and 2% of study group. Intermediate syndrome developed in 8 of 38 subjects in the control group, and 1 of 38 in the study group. Development of respiratory tract infection was seen in 12% of the control group, while it occurred in only 5% of the study group. Addition of glycopyrrolate appears to be a promising new intervention in the management of OP poisoning.