Effect of dexamethasone implant on intraocular cytokines in diabetic macular edema

Purpose: Our primary aim was to evaluate intraocular cytokines (IC) before and after dexamethasone in diabetic macular edema (DME). Our secondary aim was to study the early and late effects of single dexamethasone implant in DME. Methods: This before and after comparative study was conducted at the Department of Ophthalmology and Centre for Nanosciences at a quaternary referral center in Kerala, India, from September 2016 to September 2018. Patients underwent complete ophthalmological examination and cytokine analysis before and after dexamethasone implant. Levels of cytokines at baseline and repeat sample were studied. Results: Twenty?seven eyes (21 patients) were divided into two groups depending on time from baseline to second injection. Group 1 included patients with <3 months between the two samples – 12 (44.4%). Group 2 included patients with >3 months between the two samples –15 (55.6%). Best corrected visual acuity (BCVA) and central macular thickness (CMT) improved significantly post?dexamethasone in group 1, but not in group 2. Interleukin (IL)?4, IL?6, IL?10, vascular endothelial growth factor (VEGF), IL?1?, interferon?gamma inducible protein?10 (IP?10), monocyte chemoattractant protein?1 (MCP?1), and IL?2 decreased post?injection in group 1. But cytokines increased post?dexamethasone in group 2, except IL?10. When compared to baseline, IL?6 reduced to half in group 1 (P?value 0.814) and it tripled in group 2 ( P?value 0.009). The level of VEGF in the first and second samples was not different in either group. Conclusion: Our study suggests that dexamethasone acts more on IC than VEGF in DME. This is significant in the first 3 months with a rebound effect on IL?6 after 3 months. Our study also suggests that repeat injection of DEX in DME should be done at 3 months to prevent deterioration of visual acuity (VA) and worsening of CMT.

Preparation and validation of a new questionnaire to study faculty perception of online teaching - Use of Cronbach’s alpha and pilot.

Background: The COVID-19 pandemic has forced educators to shift to virtual online classes. Teachers being major stakeholders in the medical teaching-learning process, it becomes important to understand their perception towards this new endeavour. It will make this transition beneficial to the learners. Objectives: To document the process of validation of a new questionnaire devised to study the perception of medical undergraduate teaching faculty towards online classes, using Cronbach’s alpha, and the subsequent pilot for the same. Results: At initial validation, Cronbach’s alpha was not acceptable (0.65) for the questionnaire. One item was scored low by two validators and was removed. Three items were given poor rating for lay out, clarity and feasibility and required editing. The Cronbach’s alpha after revision was 0.92 (acceptable). Pilot study was conducted. Based on the proportion of positive perception (36.4%) regarding ongoing online teaching programme, conducted on 11 teaching faculty with 10% absolute precision and 95% confidence, the minimum sample size for the main study was calculated to be 89. This was feasible from the point of view of total faculty strength. Conclusion: Research work involving a new tool, such as questionnaire, must utilize the statistical tool Cronbach’s alpha for validation, and pilot study for estimating the sample size and testing the content validity.

Lipoprotein Lipase Deficiency in an Infant.

Patients with isolated hypertriglyceridemia usually present with recurrent abdominal pain, pancreatitis, eruptive xanthomas, lipemia retinalis and hepatosplenomegaly. We describe the diagnosis and treatment of an infant with severe hypertriglyceridemia. The child was found to be heterozygous for two novel mutations in the lipoprotein lipase gene.