Clinical Analysis of Subarachnoid Haemorrhage of Unknown Aetiology (SAHUE).

Spontaneous subarachnoid haemorrhage accounts for 15 cases per lakh population. There are few reports of patients with perimesencephalic haemorrhage and few reports with limited number of patients. Therefore, the aim of the present study was to investigate the clinical course and outcome in patients with SAH. METHODSIn our study, we identified a total of 55 patients admitted to the Neurosurgery department of Sri Ramachandra Institute of Higher Study and Research with subarachnoid haemorrhage between 2018 and 2019. Medical records of all patients who underwent treatment for subarachnoid haemorrhage from July 2018 to April 2019 in the tertiary-care center were reviewed from a prospectively collected database. A detailed analysis was performed on potential predictors of post-operative complications, including age, gender, and type of admission. RESULTSNegative sub-arachnoid haemorrhage angiogram exhibited very mild prognosis than with aneurysmal sub-arachnoid haemorrhage. All patients had presence of blood either in perimesencephalic cisterns and in the lateral cisterns. The prognosis of patient varies based on the thickness of hematoma and people with hydrocephalus had poor prognosis. CONCLUSIONSEach patient with subarachnoid haemorrhage should be monitored as an individual case and to prevent death it is important to identify patients to reduce the aneurysms and modify the risk factors associated with.

A stability-indicating LC–MS/MS method for zidovudine: Identification, characterization and toxicity prediction of two major acid degradation products / 药物分析学报

Zidvovudine (AZT) is a nucleoside analogue reverse transcriptase inhibitor (NRTI), a class of anti-retroviral drug. A stability-indicating assay method for AZT was developed in line with ICH guideline. Successful separation of AZT and its degradation products was achieved by gradient elution mode on reverse phase C18 column using 10 mM ammonium acetate: acetonitrile as the mobile phase at 0.8 mL/min flow rate, 25 μL injection volume, 30 °C column temperature and 285 nm detection wavelength. Two major acid degradation products were identified and characterized by liquid chromatography–electrospray ionization mass spectro-metry (LC–ESI/MS/MS) and accurate mass measurements. The probable mechanisms for the formation of degradation products were identified based on a comparison of the fragmentation pattern of the [M + H] + ions of AZT and its degradation products. One of the degradation products, DP-1, was isolated by semi-preparative high performance liquid chromatography (HPLC) using Waters XBridge Prep C18 (250 mm×10 mm, 5 μm). Degradation products showed higher toxicity compared to the drug in some models assessed by TOPKAT software. The method validation was performed with respect to robustness, specificity, linearity, precision and accuracy as per ICH guideline Q2 (R1).

Advances in retinal imaging for diabetic retinopathy and diabetic macular edema.

Diabetic retinopathy and diabetic macular edema (DME) are leading causes of blindness throughout the world, and cause significant visual morbidity. Ocular imaging has played a significant role in the management of diabetic eye disease, and the advent of advanced imaging modalities will be of great value as our understanding of diabetic eye diseases increase, and the management options become increasingly varied and complex. Color fundus photography has established roles in screening for diabetic eye disease, early detection of progression, and monitoring of treatment response. Fluorescein angiography (FA) detects areas of capillary nonperfusion, as well as leakage from both microaneurysms and neovascularization. Recent advances in retinal imaging modalities complement traditional fundus photography and provide invaluable new information for clinicians. Ultra‑widefield imaging, which can be used to produce both color fundus photographs and FAs, now allows unprecedented views of the posterior pole. The pathologies that are detected in the periphery of the retina have the potential to change the grading of disease severity, and may be of prognostic significance to disease progression. Studies have shown that peripheral ischemia may be related to the presence and severity of DME. Optical coherence tomography (OCT) provides structural detail of the retina, and the quantitative and qualitative features are useful in the monitoring of diabetic eye disease. A relatively recent innovation, OCT angiography, produces images of the fine blood vessels at the macula and optic disc, without the need for contrast agents. This paper will review the roles of each of these imaging modalities for diabetic eye disease.

The role of central reading centers – current practices and future directions.

Central reading centers (CRCs) have several crucial roles in the conduct of clinical trials, providing key input during the study design, preparation of the operations manual, as well as site and photographer certification. They provide objective, standardized grading of images from study subjects, which determines study eligibility, and also evaluate lesion features at subsequent study visits. CRCs need to adhere strictly to Good Clinical Practice (GCP) guidelines, as well as the established standard operating procedures in order to ensure that images are graded properly. The role of CRCs will continue to evolve, and include the use of web‑based image transmission and grading platforms.

Predicting visual outcomes for macular disease using optical coherence tomography

In recent years, the management of macular disease has undergone radical changes, in part because of new therapeutic approaches, but also due to the introduction of a new imaging modality-optical coherence tomography [OCT]. The application of OCT imaging has clarified many aspects of chorioretinal disease pathophysiology and elucidated many hitherto unrecognized disease characteristics. From an early stage in its development, OCT has also been revolutionary in attempting to extract clinically useful measurements from image data in an automated fashion. As a result, OCT-derived measurements of retinal thickness have been rapidly embraced in clinical and research settings. However, as knowledge of OCT image analysis has developed, it has become increasingly clear that even accurate measurements of retinal thickness may fail to predict visual outcomes for many diseases. As a result, the focus of much current clinical imaging research is on the identification of other OCT-derived anatomic biomarkers predictive of visual outcomes-such biomarkers could serve as surrogate endpoints in clinical trials and provide prognostic information in clinical practice. In this review, we begin by highlighting the importance of accurate visual function assessment and describing the fundamentals of OCT image evaluation, before describing the current state-of-the-art with regard to predicting visual outcomes, for a variety of macular diseases, using OCT

Effects on the contralateral eye after intravitreal bevacizumab and ranibizumab injections: a case report

<p><b>INTRODUCTION</b>We report a case in which intravitreal bevacizumab and ranibizumab appeared to have effects in the contralateral, uninjected eye.</p><p><b>CLINICAL PICTURE</b>An 83-year-old man with macular oedema from branch retinal vein occlusion (BRVO) in the right eye developed neovascular macular degeneration in the left eye. Intravitreal bevacizumab in the left eye improved macular oedema in the right eye temporarily before it recurred. Subsequently, intravitreal ranibizumab in the left eye also resulted in significant reduction of macular oedema in the right eye.</p><p><b>OUTCOME</b>Vision and macular oedema in the right eye improved.</p><p><b>CONCLUSION</b>Bevacizumab and ranibizumab may have therapeutic effects in the uninjected eye, possibly because they may escape from the eye into the systemic circulation.</p>

Spectral domain optical coherence tomography

Optical coherence tomography [OCT] allows high-resolution cross-sectional images of the neurosensory retina to be obtained in a non-invasive manner and has become an important tool for the diagnosis and management of vitreoretinal disease. OCT works by measuring the properties of light waves backscattered by tissue [analogous to ultrasonography] using an interferometer. In conventional OCT systems, light traveling in the reference path of the interferometer is reflected from a mobile reference mirror located within the instrument. OCT instruments that adopt this approach are often termed "time domain" as movement of the reference mirror allows assessment of the interference patterns generated as a function of time. Stratus OCT [Carl Zeiss Meditec, Dublin, CA], the most commonly used OCT system worldwide, is based on time domain technology. The requirement for a mobile reference mirror limits the image acquisition speed of time domain systems [Stratus OCT: 400 A-scans/second]. As a result, only sparse sampling of the macular area is possible in a single time domain OCT image set for any given patient. More recently however, the next generation of commercial OCT systems, boasting greatly increased image acquisition speed, has been released. These systems, termed spectral domain OCT, are based on the assessment of interference patterns as a function of frequency rather than that of time. With spectral domain OCT, A-scans can be acquired 50-100 times more quickly than in time domain systems, allowing dense sampling of the retina, volumetric rendering, and the generation of OCT fundus images. Spectral domain OCT is likely to supplant time domain OCT as the standard of care for retinal specialists, as it allows earlier detection of morphological changes in disease states and improved monitoring of disease progression over time

Role of magnification endoscopy in the diagnosis and evaluation of suspected celiac disease: correlation with histology.

BACKGROUND: Magnification endoscopy (ME), with 115-fold magnification, allows visualization of duodenal villi. We assessed the efficacy of ME for evaluation of villous atrophy. METHODS: ME and duodenal biopsy were done in 16 patients with suspected celiac disease and 16 control subjects undergoing endoscopy for reflux symptoms. The pathologist was unaware of the ME findings. RESULTS: Sensitivity, specificity and positive and negative predictive values for villous atrophy (partial or total) were 100%, 91%, 83% and 100%, respectively. Corresponding values for normal villous structure were 91%, 100%, 100% and 83%, respectively. There was significant concordance between the ME and histology findings. CONCLUSION: ME is a reliable technique to diagnose villous atrophy.

Axial length: a risk factor for cataractogenesis

<p><b>INTRODUCTION</b>To evaluate whether eyes with longer axial lengths are associated more often with clinically significant cataracts than eyes with shorter axial lengths.</p><p><b>MATERIAL AND METHODS</b>Charts of consecutive patients who underwent cataract surgery by 4 resident surgeons at Los Angeles County Hospital from July 2001 through May 2002 were retrospectively reviewed. Those patients whose axial lengths were significantly different between the 2 eyes (>or=0.30 mm) and who had no pathology (other than cataracts) affecting visual acuity were included in the study. The 2 eyes in each patient were compared for preoperative best-corrected visual acuity and severity of cataracts.</p><p><b>RESULTS</b>Thirty-four of 353 patients had interocular axial length differences of at least 0.3 mm and were included in this study. Thirty-one patients had worse, 1 had equal, and 2 had better preoperative vision in the eye with longer versus the shorter axial length. Fourteen patients had more severe, 11 had the same, and 1 had less severe posterior subcapsular cataract (PSC) in the eye with longer axial length. In 8 patients, PSC severity could not be assessed due to obscuring nuclear sclerosis. Twenty-four patients had more severe, 7 patients had equal, and 3 patients had less severe nuclear sclerosis in the longer eye. Overall, longer axial lengths correlated with worse visual acuity, posterior subcapsular cataracts, and nuclear sclerosis. Diabetic status did not affect the correlation. The correlations were stronger with greater axial length asymmetry.</p><p><b>CONCLUSIONS</b>Eyes with longer axial lengths have a higher prevalence of cataracts.</p>

Hydrolysis of organophosphorus compounds by an esterase isozyme from insecticide resistant pest Helicoverpa armigera.

Esterase activity of resistant and susceptible H. armigera were compared in gels with different substrate such as naphthyl acetate, naphthyl phosphate, paraoxon and monocrotophos. Whole body extract of resistant H. armigera hydrolyzed paraoxon, monocrotophos and naphthyl phosphate in gels. Resistant H. armigera showed high esterase, phosphatase and paraoxon hydrolase activity compared to susceptible ones.

Significance of antibody coated bacteria in neurogenic bladder cases.

A total of 85 urine samples from 63 patients with neurogenic bladder, were subjected for pus cell counting and culture. Fifty nine (69.4%) samples showing significant bacterial growth were tested for the presence of antibody coated bacteria (ACB). One serum sample per patient was collected for the estimation of C-reactive protein. E. coli was the commonest bacterial isolate (45.8%) from the clinical samples followed by Ps. aeruginosa (20.3%) and K. pneumoniae (18.6%). Thirty two culture positive samples belonging to 27 patients, were found to be antibody coated. Of all the isolates, K. pneumoniae was antibody coated in higher proportion (63.7%) followed by Ps. aeruginosa (58.3%) and E. coli (55.6%). Immunoglobulin G was found in all the ACB positive samples, where as 87.5% of them were also coated with IgA class of antibodies. All patients with ACB in urine had raised serum CRP levels except one, where as all the rest of the patients had CRP level within normal limit. The presence of pus cells in urine and radiological abnormalities in the urinary tract were significantly higher in ACB positive patients than in ACB negative patients.