Modified technique of endocapsular lens aspiration for severely subluxated lenses.

PurposeSeverely subluxated crystalline lenses pose a difficult situation to anterior segment surgeons and can only be managed surgically by removal of the lens as well as the capsular bag. Several techniques have been described in literature for the management of such cases. We describe a modified technique of endocapsular lens aspiration by the limbal route for lens extraction through small incisions on the cornea.Patients and methodsThirty-two eyes of 16 consecutive patients with severely subluxated crystalline lenses were recruited in the study. All eyes underwent a modified technique of lens aspiration within the capsular bag using a single instrument, vitrectomy cutter, and irrigation cannula, followed by sacrificing of the capsular bag. The patients were either left aphakic or implanted with an open loop anterior chamber intraocular lens (ACIOL Kelman Multiflex) and prospectively followed up for a period of 3 months.ResultsThe mean age of the patients was 9 years 3 months±3 years (range 5-15 yrs). All eyes underwent complete lens aspiration within the capsular bag with no dislocation of the lens matter. ACIOL was inserted in 22 eyes (68.7%) and 10 eyes (31.2%) were left aphakic. All the surgeries were uneventful. The mean best corrected visual acuity (BCVA) at 3 months post surgery was 0.47±0.11 logMAR which was significantly better than pre-operative BCVA (P=0.001). The percentage endothelial cell loss at 3 months was 7.1%. There was no evidence of glaucoma, corneal decompensation, or retinal detachment. The astigmatism which increased from 1.45D±086 preoperatively to 3.76D±2.02 1 week post-operatively due to sutures reduced to 1.97D±0.81 post suture removal at 3 months.ConclusionThe modified technique of endocapsular lens aspiration proves to be a simple and effective method of removal of the lens-capsular bag complex in severely subluxated lenses.

Clinical spectrum and surgical outcomes in spherophakia: a prospective interventional study.

PurposeTo study the varied clinical presentations of patients with spherophakia, their management using surgical methods, and the clinical outcomes.Patients and methodsA prospective interventional study of 13 patients of spherophakia who presented to us from January 2014 and were followed up over the course of their treatment, and the data were documented for analysis.ResultsIn all, 26 eyes of 13 patients were reviewed and the median age of presentation was 12±12.05 years. All patients had a bilateral presentation with 22 eyes having lenticular myopia with a mean refractive error of -11.5±12.945 DS. Ten eyes presented with glaucoma of which six had raised intraocular pressure (IOP) >21 mm Hg. A total of 23 eyes underwent lens extraction for dislocation/subluxation. Lens extraction helped lower overall IOP. Refractive rehabilitation was done with ACIOL, posterior chamber intraocular lens (PCIOL) with capsular tension ring, and scleral-fixated intraocular lens (SFIOL) in respective cases with ACIOLs being the most commonly used option.ConclusionsSpherophakia is a rare condition, which exhibits a varying degree of lenticular myopia, glaucoma, and subluxation of the crystalline lens. Lensectomy with proper rehabilitation using ACIOL, PCIOL, or SFIOL is a method of managing subluxation and unacceptable myopia. Lensectomy may also be a viable option of controlling glaucoma alongside medications and glaucoma surgery for the management of glaucoma in such cases.

Comparison of new motorized injector vs manual injector for implantation of foldable intraocular lenses on wound integrity: an ASOCT study.

PURPOSE: To compare intraocular lens implantation using a motorized injector vs standard manual injector through a 2.2-mm clear corneal incision. METHODS: Patients underwent standard phacoemulsification using a 2.2-mm clear corneal incision. Hydrophobic acrylic aspheric intraocular lens (Acrysof SN60WF intraocular lens (IOL)) was inserted using D cartridge with manual monarch injector or autosert motorized injector. IOL safety, final incision size and wound integrity in terms of anterior and posterior wound gape, and descemet's membrane detachment were compared between the two groups at post-operative day 1 and at 1 month using Anterior Segment Optical Coherence Tomography. RESULTS: The study recruited 32 patients in the group I (manual injector) and 30 patients in group II (motorized injector). In group I, the final incision after IOL insertion increased by 0.12 mm (95% CI: 0.134-0.106) (P<0.0001), which was seen in 100% of the patients. In group II, the incision enlarged by 0.01 (95% CI: 0.021-0.0.001) (P=0.07) and was seen in only 6.67% of the cases. IOL nicks were seen in 9.37% of the cases in group I only. Although the incidence of descemet's membrane detachment and anterior wound gape was similar for both groups, posterior wound gape was seen more often with the manual injector in the immediate post-operative period. (P=0.018) CONCLUSION: The motorized insertion system was gentle and safe for the IOLs with lesser incidence of IOL nicks. Regarding wound safety, it caused significantly less incision enlargement and better posterior wound integrity.

Meeting challenges related to the dietary assessment of ethnic minority populations.

BACKGROUND: Migrants from the Indian subcontinent comprise the largest minority group in the UK. With the process of migration come alterations in lifestyle and eating habits. The present study aimed to disseminate the valuable information, experiences and challenges faced by researchers who conduct studies with ethnic minority groups in the area of diet and nutritional surveys, with an emphasis on migrant South Asians. METHODS: The findings reported are the result of research carried out during 2008-2012, involving 1100 face-to-face dietary recalls conducted in the UK among South Asian children (aged 1.5-11 years; n = 300) and adults (≥30 years; n = 100). RESULTS: Factors to consider when planning and carrying out diet and nutrition survey studies among migrant South Asians were identified and include the employment of culture-specific tools, visual aid reinforcement and the involvement of key community members and translators to facilitate recruitment and data collection. One of the best practices found when working with minority groups was the use of incentives and tangible benefits to reward study participants. It was also found that constant communication and follow-up of the study participants improved the quality of the data and the likelihood of maintaining links with community members for future studies. CONCLUSIONS: From the results of in-house studies and a revision of practices reported in earlier literature, two 24-h face-to-face dietary recalls are recommended as the optimal method for the dietary assessment of migrant South Asians. To complement this assessment, ethnic-specific food frequency questionnaires such as that developed and successfully implemented among South Asians in the present study must be employed.

South Asian dietary patterns and their association with risk factors for the metabolic syndrome.

BACKGROUND: Certain dietary patterns have been associated with higher risk of noncommunicable diseases, with South Asians identified as a high-risk group. The present study aimed to identify the association between dietary patterns and the metabolic syndrome (MS) in South Asians living in the UK. METHODS: Dietary patterns were derived by principal component analysis from 15 different food groups using an ethnic-specific food frequency questionnaire. MS risk factors, including obesity and hypertension, were measured, whereas existing conditions of dyslipidaemia and hyperglycaemia were self-reported. Participants (n = 100) were divided into quartiles based on dietary factor scores and the link between dietary patterns and risk factors was investigated. RESULTS: Three different patterns were derived, which together explained 46% of the total diet variation; eastern pattern, mixed pattern and western pattern. An inverse correlation was found between the eastern pattern and education P = 0.05). A direct correlation was found between the western pattern and physical activity (P = 0.05) and the overall risk of MS (P = 0.05). Body composition was altered as residence time in the UK increased, with a reduction in muscle mass (29-26%) and an increase in body fat (31-37%). Diagnosis criteria for MS were found in 20% of the participants. CONCLUSIONS: Dietary acculturation, including a reduction in vegetarianism, an increased intake of caffeinated drinks and altered meal patterns, may be associated with the higher prevalence of MS in migrant South Asians in the UK.

New food composition data on selected ethnic foods consumed in Europe.

BACKGROUND: Reliable data on the composition of foods is needed to better understand individual diets, measure nutrient intakes and provide nutritional guidance for improving the health of the populations. Ethnic foods are becoming increasingly popular among all European consumers, and are the main source of nutrients in the diets of ethnic groups. However, there is limited information on the nutrient composition of ethnic foods in Europe. The objective of this study therefore was to generate new and reliable data on ethnic foods using harmonised methods for chemical analyses. METHODS: New data on 128 ethnic foods were generated for inclusion in the national databases within the European Food Information Resource Network of Excellence through participants from France, Israel, Spain, Denmark, Italy, The Netherlands, Belgium and the United Kingdom. In each selected country, the list of prioritized foods and key nutrients, methods of analyses and quality assurance procedure were harmonised. RESULTS: This paper presents the nutrient composition of 40 ethnic foods consumed in Europe. The nutrient composition of the foods varied widely because of the nature and variety of foods analysed, with energy content (kcal) ranging between 24 (biteku-teku, Blegium) and 495 (nachos, Italy) per 100 g of edible food. Polyunsaturated and monounsaturated fatty acids were generally higher in most ethnic foods consumed in Italy and Spain compared with ethnic foods of other countries. CONCLUSIONS: The new data were scrutinised and fully documented for inclusion in the national food composition databases. The data will aid effective diet and disease interventions, and enhance the provision of dietary advice, in all European consumers.

Intracameral SF6 injection and anterior segment OCT-based documentation for acute hydrops management in pellucid marginal corneal degeneration.

PURPOSE: To report a case of acute hydrops in pellucid marginal corneal degeneration (PMCD) documented with anterior segment optical segment tomography and successfully treated with sulphur hexafluoride (SF6) intracameral injection. METHODS: A 47-year-old female patient presented with spontaneous onset of pain, redness and decreased vision in her left eye. Clinical evaluation revealed bilateral PMCD with evidence of acute hydrops in the left eye. Anterior segment Slit lamp Adapted Optical Coherence Tomography (SL-OCT) examination revealed intrastromal clefts with Descemet's membrane detachment in the left eye. She was managed with descemetopexy with 0.2ml injection of iso-expansile SF6 (18%) intracameral. RESULTS: The patient showed excellent early resolution of the stromal edema with reattachment of the Descemet's membrane. CONCLUSION: Prompt intervention in acute hydrops in PMCD cases helps in achieving early good visual results and prevents potentially serious complications such as perforation. Newer imaging modalities like SL-OCT helps in better visualisation and also in monitoring the response to treatment.

Role of early trabeculectomy in primary open-angle glaucoma in the developing world.

BACKGROUND: The lack of prospective data comparing early surgery and medical management in primary open-angle glaucoma (POAG) in the developing world led us to conduct a small randomised controlled clinical trial to evaluate acceptance and effectiveness of early trabeculectomy in these patients. METHODS: A total of 60 patients with moderately advanced POAG were randomised into three groups (Group I-Conventional medical management, Group II-Option for early trabeculectomy, Group III-Received an educational package about their disease before an option for early trabeculectomy). The patients were followed up for a period of 6 months for visual acuity, intraocular pressures (IOP), and subjective satisfaction. RESULTS: The three study groups were statistically similar with respect to mean IOP, demographic, and socio-economic profile. 35% of the patients accepted early surgery when offered a choice between early surgery and medical management in one of the groups. 65% of patients in another group expressed willingness for an early surgery after receiving health education on glaucoma. The mean IOP in the operated eyes was lower than the medically treated eyes at 2 weeks (16.6 vs 23.0 mmHg), 6 months (18.5 vs 22.8 mmHg), and 1-year review (17.9 vs 22.3 mmHg) (P<0.001). No significant difference was seen among the groups with regard to visual acuity and subjective satisfaction. CONCLUSION: There is a reasonable acceptance of early surgery in POAG patients in the developing world and increases on educating patients about their disease. Early surgery offers better IOP control with no long-term subjective adverse effects.

Residents' perceptions of work environment during their postgraduate medical training in Pakistan.

BACKGROUND: In Pakistan, there is a lack of information about the work environment of residency programs. This lack is a major impediment in their improvement. One of the approaches for improvement in these programs can be directed through the residents' own perception of their working conditions. Therefore, we collected data which would reflect working conditions of residents. AIM: To assess the perceived status of "work environment" in different specialities. MATERIALS AND METHODS: A cross-sectional survey was conducted in four teaching hospitals of Karachi from July 1999 to January 2000. Residents from selected programs were grouped into four broad groups: specialist, medical, surgical and multidisciplinary. Responses of residents were obtained on a Likert scale of 0 to 4. Indices were formed for two components of work environment: academic and mistreatment. STATISTICAL ANALYSIS: Differences between residents' groups were assessed through analysis of variance (ANOVA) at 5% significance. RESULTS: A total of 341 registered residents responded (response rate: 75%). Surgical residents were working more than 80 h/week and this was more than the other three groups. Medical residents were spending the highest actual time on research and teaching activities (10% and 14%, respectively). Academic index score was highest for surgical group (15.81, SD = 4.69) and lowest for multidisciplinary group (11.82, SD = 4.80). Medical group had the highest perceived mistreatment index score (5.56, SD = 4.57). CONCLUSIONS: In a study of work environment of residency programs, differential impact was found for the four groups on work environment perceptions. Most of the residents recognized undergraduate teaching, grand rounds, patient rounds and seminars or workshops as contributing to their academic learning. Reporting of sexual harassment was low, indicating either underreporting or cultural dynamics of our setting.

Significance of non-calcified pulmonary nodules in patients with extrapulmonary cancers.

BACKGROUND: This study sought to determine the rate and patterns of malignancy in patients with extrapulmonary cancers and non-calcified pulmonary nodules, and to develop a statistical model to guide clinicians regarding choice of patients for diagnostic biopsy. METHOD: The medical records of 151 patients evaluated at the Memorial Sloan-Kettering Cancer Center between January 1999 and December 2001 for non-calcified pulmonary nodules were reviewed. Nodules were considered malignant based on the results of a diagnostic biopsy, and were considered benign if their appearance remained stable 2 years after the initial study, if they resolved, or if a biopsy showed a non-malignant condition. RESULTS: Sixty four of 151 patients (42%) were diagnosed with malignant nodules; 32 had newly diagnosed lung cancers, 28 had metastatic spread of their primary cancers, and four had lesions that were either new cancers or of undetermined aetiology. On univariate analysis the likelihood of malignancy increased with nodule size, tobacco exposure, and the finding of a solitary nodule. On multivariable analysis only nodule size and tobacco exposure were predictive of malignancy. The model had good predictive accuracy (area under the curve 0.751) but had insufficient discrimination for use as a clinical tool to determine which patients should undergo diagnostic biopsy. CONCLUSION: Nearly half the non-calcified pulmonary nodules identified in this series were malignant. Lung cancer was more common than metastatic disease. These findings support the need for close interval follow up and a low threshold for diagnostic biopsy in patients with extrapulmonary cancers and non-calcified pulmonary nodules. In smokers, such lesions should raise concern for lung cancer.

Factors influencing the selection of surgical specialty among Pakistani medical graduates.

CONTEXT: The delineation between selection of surgery and non-surgery residency programmes could provide a pragmatic view of the influences on medical graduates' careers. This would also help coordinators and educators of residency programmes in surgery to further understand the dynamics of specialty selection. AIMS: To identify the different factors that influence the graduates to select surgical specialties in Pakistan. SETTINGS AND DESIGNS: A cross-sectional survey was conducted in 4 teaching hospitals of Karachi between July 1999 and January 2001. SUBJECTS AND METHODS: A total of 455 residents in 1-5 years of residency programmes were contacted. Three hundred and forty-one residents consented to the interview. Residents who were registered both with the College of Physicians and Surgeons of Pakistan (CPSP) and the Post Graduate Medical Education (PGME) office of the selected hospitals were included in this study. STATISTICAL METHOD USED: Logistic regression analysis. RESULTS: Final multivariate analysis identified 4 factors that remained significantly associated with the selection of surgical specialty: deriving gratification from direct patient care (adjusted odds ratio [aOR] = 5.79; 95% confidence interval [CI]: 1.24, 26.99), procedure-based medical practice (aOR = 2.85; 95% CI: 1.23, 6.61), nature of clinical problems (aOR = 3.39; 95% CI: 1.47, 7.84), and lack of consideration of stress during professional work (aOR = 2.27, 95%CI: 1.25, 4.13). CONCLUSIONS: Direct patient care is perceived to be an integral part of surgery residency and immediate patient outcome is a positive influence in selecting surgical specialty. The inclination towards surgery appeared to be determined by the type of procedures and technical skills involved in its practice. The nature of clinical problems is an important determinant of the choice of specialty. Stress was not perceived to be an important influencing factor for those who decided to select surgical specialties.

Distribution of conjugated and free phenols in fruits: antioxidant activity and cultivar variations.

Total and free phenolic contents of 16 commonly consumed fruits (comprising 9 apples, 4 pears, and one each of peach, plum, and kiwi fruit cultivars) were measured by Folin-Ciocalteu assay. Total phenol contents varied from 272 to 475 mg of CtE/100 g of fresh weight. Of the apple cultivars studied, Braeburn and Empire had the highest and lowest total phenol content, respectively. The apple cultivars ranked in the following decreasing order: Braeburn > Red Delicious > Crisp Pink > Granny Smith > Royal Gala > Bramley > Golden Delicious > Fuji > Empire. Among pear cultivars, the order was Forelle > Taylor's > Peckham's > Conference. Peach and plum equally had high contents. The percentage of conjugated phenolics ranged between 3 (Red Delicious) and 77% (Empire) of the total phenols. Comparison of different cultivars of the same fruit and between different fruits showed broad variations in both phenolic content and in vitro antioxidant activity; a weak correlation (R(2) = 0.58) was observed between the phenolic content of the fruits and the total antioxidant activity, as estimated by the FRAP assay. The calculated dietary intake of total, free, and conjugated phenols from average per capita consumption of apples and pears in different regions of the U.K. varied between 104-126, 53-64, and 51-62 mg of CtE/day, respectively.

Effect of addition of clonidine to local anaesthetic mixture for peribulbar block.

Clonidine added to local anaesthetics prolongs the duration of anaesthesia and analgesia of peripheral, neuraxial and retrobulbar blocks. The present randomized blinded controlled study was conducted to evaluate the effect of the addition of clonidine to local anaesthetic mixture on the quality, onset time, duration of peribulbar block, perioperative analgesia and patients' comfort. The study comprised two groups of 12 patients each. Group A (control) patients received 7 ml of a mixture of 2% lignocaine and hyaluronidase with 1 ml normal saline, while group B (clonidine group) patients had clonidine 1 microg/kg added to the above mixture. Onset and duration of lid akinesia, globe anaesthesia and akinesia, time to first analgesic medication and total analgesic requirement were assessed. Patients were monitored for heart rate, blood pressure, sedation and respiratory depression. Addition of clonidine to local anaesthetic mixture resulted in a significant increase in duration of lid akinesia (85.4+/-25.6 vs 173.3+/-35.3 min, P<0.001), globe anaesthesia (63.2+/-6.9 vs 78.8+/-17.5 min, P=0.012) and globe akinesia (161.3+/-24.3 vs 201.2+/-45.7 min, P=0.016). The onset time and quality of block were similar in both the groups. No significant haemodynamic, respiratory or sedative effects were recorded. The perioperative pain scores and the analgesic requirements were significantly (P<0.01) lower in group B patients. We found that addition of clonidine 1 microg/kg to local anaesthetic mixture significantly increases the duration of anaesthesia and analgesia after peribulbar block.

Total phenol, catechin, and caffeine contents of teas commonly consumed in the United kingdom.

Levels of total phenol, catechins, and caffeine in teas commonly consumed in the United Kingdom have been determined using reversed phase high-performance liquid chromatography. Tea bags or tea leaves were purchased from local supermarkets and extracted in boiling water for 5 min. The resulting data showed considerable variability in both total phenols [80.5-134.9 mg/g of dry matter (DM) in black teas and 87-106.2 mg/g of DM in green teas] and catechins (5.6-47.5, 51.5-84.3, and 8.5-13.9 mg/g of DM in black, green, and fruit teas, respectively); this was most probably a result of differing agronomic conditions, leaf age, and storage during and after transport, as well as the degree of fermentation. Caffeine contents of black teas (22-28 mg/g of DM) were significantly higher than in less fermented green teas (11-20 mg/g of DM). The relative concentration of the five major tea catechins ranked EGCG > ECG > EC > EGC > C. The estimated U.K. dietary intakes of total tea catechins, calculated on the basis of an average tea consumption of three cups of tea (200 mL cup, 1% tea leaves w/v), were 61.5, 92.7, and 405.5 mg/day from fruit teas, black teas, and green teas, respectively. The coefficients of variation were 19.4, 88.6, and 17.3%, respectively, indicating the wide variation in these intakes. The calculated caffeine intake ranged between 92 and 146 mg/day. In addition, many individuals will consume much larger quantities of tea, of various strengths (as determined by the brewing conditions employed). This broad spread of U.K. daily intakes further emphasizes the need for additional research to relate intake and effect in various population groups.

A dose response study of clonidine with local anesthetic mixture for peribulbar block: a comparison of three doses.

UNLABELLED: Clonidine prolongs anesthesia and analgesia of local anesthetics in various neural blocks as well as the duration of retrobulbar block. We assessed the dose-response relationship of clonidine added to lidocaine in peribulbar block. Sixty patients undergoing cataract surgery were given peribulbar block with 7 mL of 2% lidocaine and hyaluronidase with either saline (Control) or clonidine in 0.5-microg/kg (0.5 Clon), 1.0-microg/kg (1.0 Clon), or 1.5-microg/kg (1.5 Clon) doses. The onset and duration of lid and globe akinesia, globe anesthesia and analgesia, postoperative analgesic requirement, and adverse effects (hypotension, bradycardia, hypoxia, sedation, and dizziness) were recorded. The success rate and onset of block were comparable in all groups. The duration of lid and globe akinesia, globe anesthesia and analgesia was significantly (P < 0.01) prolonged in patients receiving 1.0 and 1.5 microg/kg clonidine as compared with the Control group. Perioperative pain scores and analgesic requirement were significantly less in these groups. 0.5 microg/kg clonidine did not increase the duration of anesthesia and analgesia significantly. Hypotension and dizziness were observed more in patients receiving 1.5 microg/kg clonidine as compared with other groups. We conclude that 1.0 microg/kg clonidine with a mixture of lidocaine (2%) significantly prolonged the duration of anesthesia and analgesia after peribulbar block with limited side effects. IMPLICATIONS: We studied the effect of the addition of 0.5, 1.0 and 1.5 microg/kg clonidine to a lidocaine-hyaluronidase mixture on the onset and duration of peribulbar block and perioperative analgesia. A dose of 1.0 microg/kg produced a significant increase in duration of anesthesia and analgesia with minimal side effects.