Premature presbyopia: causes, diagnosis, and management strategies - an overview

Premature presbyopia refers to the early onset of age-related vision changes typically associated with presbyopia, a condition characterized by the loss of near vision accommodation. This review article aims to provide an overview of the causes, diagnosis, and management strategies for premature presbyopia. The database collected from PubMed, PubMed Central (PMC), Cochrane library, and Google scholar and research gate. This review discusses the potential underlying mechanisms contributing to premature presbyopia, including genetic factors, environmental influences, and ocular conditions. Additionally, the diagnostic criteria and assessment methods used to identify premature presbyopia and differentiate it from other vision disorders. Finally, this review examines various management options for premature presbyopia, including corrective lenses, pharmacological interventions, surgical procedures, and emerging treatments. By understanding the factors contributing to premature presbyopia and implementing appropriate management strategies, healthcare professionals can effectively address the needs of individuals experiencing early onset age-related vision changes.

Prevalence of Dyslipidaemia in Type 2 Diabetes Mellitus: A Prospective Study in a Tertiary Care Hospital

Background: Atherosclerosis leading to ischemic heart disease remains the major cause of death and premature disability in developed countries and its prevalence is rising constantly in developing countries. Dyslipidaemia due to insulin resistance, the major cause of coronary atherosclerosis and ischemic heart disease is frequently associated with type 2 diabetes mellitus. Type 2 diabetes mellitus is an emerging pandemic with the number of patients increasing rapidly in both developed and developing countries around the world. Materials & Methods: In this study lipid abnormalities associated with type 2 diabetes mellitus were studied and association between HbA1C level and extent of dyslipidaemia detected. In this cross- sectional study 60 known cases of type 2 diabetes mellitus will be selected. They will be investigated for HbA1C and lipid profile. Results: In the present study, dyslipidaemia was found to be present in 88% patients of type 2 diabetes mellitus. Of these, 22% had single abnormal lipid parameter while 66% had combined dyslipidaemia. There was significant correlation between HbA1C & total cholesterol, HbA1C & LDL cholesterol, HbA1C & triglycerides, HbA1C & Tc/HDL ratio and HbA1C & non HDL cholesterol. Conclusion: Prevalence of dyslipidaemia was alarmingly high in type 2 diabetes mellitus patients. Thus, HbA1C can be considered as a marker of dyslipidaemia in type 2 diabetes mellitus.

PARFLEX--a very useful drug for management of surgical pain.

The aim was to assess and document the efficacy and tolerability of parflex (FDC of aceclofenac with paracetamol and serratiopeptidase) in management of pain and inflammation in adult patients undergoing surgical procedures (or operations). The design was open, prospective, non-comparative and multi-dose study of patients undergoing surgical procedures at a leading, tertiary-care, teaching hospital (setting) in Lucknow, the name being, King George's Medical College, Lucknow 226003. The patients were 50 adult patients of either sex undergoing surgery. They were given 1 tablet twice daily, taken after meals. Treatment duration was for a total of up to 7 days (intervention). Primary efficacy variables were relief from postoperative pain. Secondary efficacy variables were global assessment of efficacy and toleration by patients and treating physicians. Record was made of spontaneously reported adverse events with their nature, intensity and outcome (tolerability). Out of 50 patients, 31% were (ENT), 36% were (Orthopaedic) and 33% were (Gynaecology). They were enroled in this study. The observations made were mean pain score showed significant improvement with study drug - decreasing from 2.66 at baseline to 1.36 after 48 hours, and to 0.8 at the end of study. Composite score for pain, fever and swelling also showed substantial gains visit-on- visit-decreasing from 3.62 at baseline to 2.04 after 48 hours, and to 0.98 at final visit. None of the patients reported any adverse event. Global efficacy assessment was rated as 'excellent or good' by 54% of patients and in 59% of patients by their treating physicians. To conclude, parflex is an effective analgesic, anti-inflammatory drug that has a valuable therapeutic option for controlling pain and inflammation after surgical procedures.

A field study and continuous removal of fluoride in a packed column.

The synthetic water performance in the light of fluoride removal was studied and compared with the actual fluoride contaminated water of different selected water collection stations. An indegeneous activated alumina was used as adsorbent. The performance of the column for fluoride contaminated water was about 94% fluoride reduction at a pH value of 7.0 and the presence of total dissolved solids (T.D.S.). 2114 mg/L in subsoil water decreased the fluoride removal by 5%.

Prevention of radiation induced taste aversion in rats.

Diltiazem, a calcium channel blocker, and a cardiovascular therapeutic agent offers significant protection to mice against lethal dose of ionizing radiation. Considering the potential efficacy of diltiazem as a radioprotector for human use, it was deemed necessary to investigate its influence on radiation-induced behavioural changes like nausea, vomiting, learning, memory and performance. In the present studies, conditioned taste aversion (CTA) test based on consumption of saccharin solution, was used as a marker of behavioural changes. Significant CTA (97 +/- 2%) was observed in rats irradiated with Co-60 gamma rays (absorbed dose 1 Gy). Administration of diltiazem at doses greater than 10 mg/kg, body wt, evoked CTA in a dose-dependent manner and that was found to be further aggravated on irradiation. At a lower dose of 5 mg/kg, body wt, diltiazem did not evoke CTA and protected against radiation induced aversion significantly (62 +/- 3%). The results suggest that diltiazem at concentrations lower than 10 mg/kg, body wt, in rats may be useful in preventing radiation induced behavioural changes. This observation could be of particular significance in clinical radiotherapy where radiation induced nausea and vomiting are of great concern.

Dopaminergic involvement in the effects of piracetam on foot shock induced aggression in mice.

The effects of piracetam-a nootropic drug, were studied on foot shock induced aggressive behaviour in mice. Intraperitoneal injection of piracetam resulted in a biphasic response i.e.; initial excitation followed by inhibition of the aggressive behaviour. The initial excitation was observed with only 100 and 50 mg/kg doses of piracetam and not with the lower doses (25 and 12.5 mg/kg). Dopaminergic receptor blocker haloperidol (0.5; 0.25 and 0.12 mg/kg, ip) and pimozide (1.0 mg/kg, ip) produced inhibition of the aggressive behaviour. Lowering of the dose of haloperidol to 0.06 mg/kg resulted in an excitation of the aggressive behaviour. No motor deficit or catalepsy was observed with either haloperidol or pimozide injected in the doses indicated above. Pretreatment of the mice with haloperidol (0.12; 0.25 and 0.5 mg/kg) led to a dose-dependent blockade of the piracetam (100 mg) induced excitation of the aggressive behaviour, but the inhibition of the aggressive behaviour was not blocked by pretreatment with the excitatory dose of haloperidol. Similarly, pimozide (1.0 mg/kg) pretreatment also effectively blocked the excitatory effect of piracetam on aggressive behaviour. The results suggest the involvement of dopaminergic system in the excitatory effects of piracetam on aggressive behaviour. The inhibitory effect of piracetam appears to be independent of this mechanism.

Serotonergic modulation of spinal cord sympathetic preganglionic neurone activity in cardiovascular regulation.

The present study demonstrates the effect of activation of spinal serotonergic receptors on heart rate, blood pressure and cardiac arrhythmia induced by coronary artery ligation in cervical spinal cord transected and bilaterally vagotomized dogs. Intrathecal injection of serotonin (5-HT) evoked a fall in blood pressure (mean decrease, 16 +/- 3) and a decrease in heart rate (mean change, 24 +/- 6) and these effects were blocked by intrathecal pretreatment with methysergide. The magnitude of ventricular ectopics evoked by coronary artery ligation was decreased by serotonin (mean decrease, 31 +/- 5%), and this effect of serotonin was blocked by methysergide pretreatment intrathecally (mean change, 7 +/- 5%). Methysergide per se, increased the magnitude of ventricular ectopics (mean increase, 24 +/- 5%). The serotonergic receptors of the spinal cord appear to have an inhibitory influence on the cardiovascular functions.

Allergic bronchopulmonary aspergillosis and Candida albicans colonization of the respiratory tract in corticosteroid-dependent asthma.

Fungal studies were conducted on 35 patients with corticosteroid-dependent asthma (CSDA) and 20 asthmatics who had never received prednisolone. Candida albicans was repeatedly cultured from the sputa of 12 patients with CSDA. Isolation was more frequent in those patients who were receiving more than 10 mg prednisolone for more than six months. Nearly half of these patients demonstrated a positive immediate cutaneous reaction and precipitating antibodies against C. albicans. Although no pathological significance, beside colonization, could be attributed to this finding, it was felt that it would be prudent to restrict the daily dose of prednisolone to less than 10 mg, when administered for more than six moths. Two patients with allergic bronchopulmonary aspergillosis (ABPA), were identified, one from each group. The possibility of ABPA, however, remained open in two other patients with CSDA. It is probable that some patients with CSDA may be suffering from ABPA but characteristic features of the disease are masked by costicosteroid therapy, making it difficult to diagnose.

Fibrebronchoscopy in pulmonary sarcoidosis--an Indian experience.

Twenty-four patients suspected to have sarcoidosis were subjected to fibrebronchoscopy. Histopathological support for the diagnosis was ultimately obtained in 20 patients. Fibrebronchoscopy provided the diagnosis in 17 patients, while histopathological confirmation was obtained from extrapulmonary biopsy sites in 3 patients. Transbronchial lung biopsy, attempted without fluoroscopic guidance, revealed non-caseating granulomata in 15 patients. The only complication encountered was a small pneumothorax, not requiring intervention, in one patient. Lack of fluoroscopic guidance did not compromise the diagnostic yield or increase the complication rate of the procedure. Bronchial biopsy confirmed the diagnosis in 2 patients with a non-specific lung biopsy. It was positive in 6 of 8 patients with an abnormal appearing mucosa and in 5 of 12 patients with a normal bronchial tree. Random bronchial biopsy in all patients, irrespective of mucosal changes, made an important contribution to the yield of fibrebronchoscopy. Fibrebronchoscopy confirmed the diagnosis of tuberculosis in 2 patients with an atypical radiological picture, thereby differentiating the two conditions which occasionally mimic each other.

Primary carcinoid tumour of trachea.

Tracheal carcinoid is a rare entity. A patient with a primary carcinoid tumour of trachea treated as a case of bronchial asthma for over a decade, is presented.

Chronic anaerobic pneumonitis.

A case of chronic anaerobic pneumonitis, without any predisposing factors, nor the classical features often associated with it, which masqueraded as pulmonary tuberculosis is described. Therapy with metronidazole resulted in striking improvement.

Central alpha-adrenoceptor influence over the cardiovascular reflexes activated by veratrine.

Intravenous veratrine induced alterations in cardiovascular parameters in cats were used as a tool for assessing the influence of central alpha-adrenoceptors over reflex adjustments in the heart rate and blood pressure. Blockade of central alpha 2-adrenoceptors with idazoxan or yohimbine, inhibited, while their activation by clonidine, as also blockade of alpha 1-adrenoceptors, with prazosin, potentiated the veratrine induced bradycardia. The hypotensive effect was relatively unaltered by these treatments. Low doses of clonidine potentiated the veratrine-induced bradycardia. It appears that alpha 2-adrenoceptor mechanisms exert greater control over the reflex regulation of heart rate than over reflex control of blood pressure.