Reconciling visual field defects and retinal nerve fibre layer asymmetric patterns in retrograde degeneration: an extended case series.

BACKGROUND: Accurate diagnosis in patients presenting with lesions at various locations within the visual pathway is challenging. This study investigated functional and structural changes secondary to such lesions to identify patterns useful to guide early and effective management. METHODS: Over 10,000 records from patients referred for optic nerve head assessment were reviewed and 31 patients with a final diagnosis of likely neuropathic lesions posterior to the eye were included in the current study. Fundus photographs, optic coherence tomography images and visual field tests were evaluated for changes with respect to retinal nerve fibre layer topography and prediction of structure-function paradigms. Emerging clinical patterns were examined for their consistency with the likely anatomical origin of the underlying insult in the presence of varying diagnoses. RESULTS: Data from patients with lesions along the visual system allowed identification of retinal nerve fibre layer asymmetry correlated with visual field defects and ganglion cell analysis. Bilateral discordance in retinal nerve fibre loss easily discernible from an altered pattern of the temporal-superior-nasal-inferior-temporal curve was characteristic for post-chiasmal lesions. These sometimes-subtle changes supported diagnosis in cases with multiple aetiologies or with ambiguous visual field analysis and/or ganglion cell loss. CONCLUSION: Intricate knowledge of the retinal architecture and projections allows coherent predictions of functional and structural deficits following various lesions affecting the visual pathway. The integration of adjunct imaging and retinal nerve fibre layer thinning will assist clinicians to guide clinical investigations toward a likely diagnosis in the light of significant individual variations. The case series presented in this study aids in differential diagnosis of retrograde optic neuropathies by using retinal nerve fibre layer asymmetric patterns as an important clinical marker.

OCT and Fundus Autofluorescence Enhances Visualization of White Dot Syndromes.

PURPOSE: White dot syndromes (WDS) are a group of inflammatory conditions characterized by white lesions at the retina and choroid level. Detection and monitoring of these syndromes are currently hampered by the subtlety of these lesions, making them difficult to image using traditional clinical techniques. New imaging modalities such as optical coherence tomography (OCT) and fundus autofluorescence (FAF) offer new opportunities for clinicians to noninvasively image WDS. METHODS: A literature search was performed using a variety of WDS as the search terms. All articles from January 2004 to May 2014 were analyzed for clinical information regarding imaging of the diseases using OCT or FAF. RESULTS: Current descriptions of OCT and FAF imaging of WDS are fragmented across case reports and small-scale studies. Assessing clinical presentation of WDS using OCT and FAF, however, is useful as the retinal layers affected in these syndromes are well characterized by these technologies. Furthermore, the new information revealed by OCT and FAF is helpful to elucidate the underlying mechanisms of these diseases in combination with known clinical and angiographic findings. CONCLUSIONS: This review collates current literature and provides a succinct overview of the clinical presentation of WDS using OCT and FAF.

Breast cancer among Yemeni women using the National Oncology Centre Registry 2004-2010.

BACKGROUND: In developing countries including Arab countries breast cancer is one of the most common cancers found in women. Even though breast cancer incidence is lower in Arab developing countries than in western countries, Arabic women are more likely to be diagnosed at an earlier age than the women in western countries. METHOD: A descriptive study was undertaken to investigate the type of breast cancer, lymph node involvement, side of breast and, region and age distribution of breast cancer patients registered in the National Oncology Centre in Yemen. RESULTS: From September 2004 to December 2010, 2654 women across Yemen diagnosed with breast cancer were registered in the National Oncology Centre for treatment. Between the years 2004 and 2010, breast cancer represented 22% of all cancers registered in women. Seventy-one per cent of the women were aged 50 or younger at the time of diagnosis. The most common age group affected was women aged 41-50 years, with (35%) of cases occurring in this age. Invasive ductal carcinoma was the most common pathology (76%) and 79% of the patients had lymph node involvement at the time of diagnosis. Approximately 2% had bilateral disease and the frequency of left (44%) and right breast cancer (42%) were similar. CONCLUSION: This study has shown that breast cancer is a disease of young women in Yemen. The majority of women presented with lymph node involvement. Hence efforts are needed to increase breast cancer awareness in Yemen for early detection at all age groups, and to target women living in areas that have lower access to health care services.

Use of adjuvant hyperbaric oxygen therapy to support limbal conjunctival graft in the management of recurrent pterygium.

PURPOSE: To assess the role of hyperbaric oxygen therapy (HBOT) in the management of recurrent pterygium. METHODS: Thirty-nine eyes with recurrent pterygium were treated with surgical excision and limbal conjunctival autograft, followed by a course of HBOT. Patients were followed for development of recurrence. RESULTS: Of the 39 eyes, 18 had a known history of exposure to beta radiation or mitomycin C. The mean duration of follow-up in this group was 23.1 months. A single recurrence was noted in this group. For the remaining 21 eyes, the mean duration of follow-up was 19.4 months. No recurrences were recorded in this group. No significant complications from HBOT were recorded. CONCLUSIONS: The use of HBOT together with excision and limbal conjunctival autograft for recurrent pterygium is associated with a low recurrence rate. Adjuvant HBOT should be considered in the surgical management of recurrent pterygium.

The effect of low-level laser therapy on electrically induced muscle fatigue: a pilot study.

OBJECTIVE: The purpose of this pilot study is to determine if low-level laser therapy (LLLT) could attenuate skeletal muscle fatigue induced by surface neuromuscular electrical stimulation (NMES) in healthy volunteers. MATERIALS AND METHODS: Five college-age participants underwent three cross-over randomized trials: two (LLLT + NMES) test trials and a control trial (NMES only), in which NMES was applied to their dominant knee extensor muscle group. The LLLT doses, 500 mW at 808 nm, were either adjusted to deliver a total energy of 7 J for 10 min or 3 J for 5 min in a blinded fashion. Following LLLT irradiation, the NMES protocol was immediately delivered for 3 min to induce fatigue in the knee extensor muscle group. RESULTS: The five participants completed the three trials. After the control trial, torque significantly decreased (62%; p < 0.0001) at the end of 3 min. There was no significant difference between the 7 J and 3 J trials on muscle fatigue. Following both LLLT trials, torque significantly decreased (51%; p < 0.0001) at the end of 3 min. Although there was a difference (11%) in fatigue between the two LLLT trials and the control trial, this difference did not attain statistical significance (p = 0.63). CONCLUSION: LLLT did not attenuate muscle fatigue evoked by NMES, but this needs to be further addressed in human studies and clinical settings. The lack of significant findings could be explained by the small sample size and the selection of LLLT parameters.

Crystal structure of the soluble form of the redox-regulated chloride ion channel protein CLIC4.

The structure of CLIC4, a member of the CLIC family of putative intracellular chloride ion channel proteins, has been determined at 1.8 Angstroms resolution by X-ray crystallography. The protein is monomeric and it is structurally similar to CLIC1, belonging to the GST fold class. Differences between the structures of CLIC1 and CLIC4 are localized to helix 2 in the glutaredoxin-like N-terminal domain, which has previously been shown to undergo a dramatic structural change in CLIC1 upon oxidation. The structural differences in this region correlate with the sequence differences, where the CLIC1 sequence appears to be atypical of the family. Purified, recombinant, wild-type CLIC4 is shown to bind to artificial lipid bilayers, induce a chloride efflux current when associated with artificial liposomes and produce an ion channel in artificial bilayers with a conductance of 30 pS. Membrane binding is enhanced by oxidation of CLIC4 while no channels were observed via tip-dip electrophysiology in the presence of a reducing agent. Thus, recombinant CLIC4 appears to be able to form a redox-regulated ion channel in the absence of any partner proteins.

Centripetal lens epithelial cell migration: a prospective study of the Alcon SA60AT intraocular lens.

PURPOSE: To evaluate prospectively the incidence and severity of centripetal lens epithelial cell migration (CLECM) onto the anterior surface of the Alcon SA60AT intraocular lens (IOL). METHODS: One hundred and four consecutive cases of SA60AT IOL implantations were prospectively evaluated. At the 1-month postoperative visit, best corrected visual acuity (BCVA) was obtained. Following maximal pupillary dilatation, the extent of CLECM was assessed using a simplified grading scale (0-4). The centrality of the lens within the capsular bag was recorded. Patients with the highest grade of CLECM were recalled for reassessment at a minimum of 3 months. RESULTS: Centripetal lens epithelial cell migration data were obtained on 99 patients. Of these, 94% demonstrated CLECM of varying severity at 1 month postoperatively. The severity was low grade in 54% of patients (29% grade 1, 24% grade 2), and high grade in 40% of patients (16% grade 3, 24% grade 4). BCVA results were good (91.9% 6/6 or better) and did not correlate with CLECM grade. Operative capsulorhexis size did not correlate with the severity of CLECM. The lens was well-centred in 91 of 92 patients in whom lens position was assessed. Twenty-three patients with grade 4 CLECM at 1 month were brought back for reassessment (3.5-13 months postoperatively) and 18 of these demonstrated complete regression of CLECM (to grade 0). CONCLUSIONS: There is a high incidence and severity of CLECM 1 month postoperatively using the Alcon SA60AT IOL. There was no significant correlation between CLECM grade and either BCVA at 1 month, capsulorhexis size or lens centration. CLECM appears to be a frequent, benign and transient event with this lens.

Suggested mechanisms of action of UVA phototherapy in morphea: a molecular study.

BACKGROUND: Ultraviolet A (UVA) phototherapy proved to be an efficient line of treatment of scleroderma. The mechanism through which it acts is still not clear. OBJECTIVES: To detect the mechanism of action of UVA phototherapy in morphea through measuring its effect on the levels of different parameters related to collagen metabolism. METHODS: Twenty-one cases of morphea were treated with low-dose broad-band UVA for 20 sessions. Twelve cases received 20 J/cm(2)/session with a cumulative dose of 400 J/cm(2) and nine cases received 10 J/cm(2)/session with a cumulative dose of 200 J/cm(2). The response was assessed clinically every week. Two skin biopsies were taken from the lesional skin of each patient before starting and after the end of therapy. Paraffin sections were examined for quantitative polymerase chain reaction measurement of collagen I, collagen III, collagenase, transforming growth factor-beta (TGF-beta) and interferon gamma (IFNgamma). RESULTS: Eighteen patients reported remarkable softening of the skin lesions, with variable degrees ranging from moderate in 57.1% of them good in 19% to very good response in 9.5%. After treatment, all the studied parameters revealed statistically significant changes. There was a significant decrease in collagen I, collagen III and TGF-beta and a significant increase in collagenase (MMP-1) and IFNgamma. The relative change was found to be greatest in collagenase, followed by IFNgamma then TGF-beta and finally collagen I. The changes in collagen I, collagenase, IFNgamma and TGF-beta were found to increase gradually with the degree of clinical response. In all the parameters studied the relative change was significantly higher in cases treated with 20 J/cm(2)/session in contrast to those treated with 10 J/cm(2)/session although no statistically significant difference could be detected in the clinical response to those doses. CONCLUSIONS: The efficacy of low-dose UVA phototherapy in the treatment of localized scleroderma is mainly obtained by the increased production of MMP-1 and IFNgamma, and to a lesser extent by decreasing TGF-beta and collagen production. Concerning the use of 10 or 20 J/cm(2)/session those effects are dose dependent, but the clinical response does not significantly differ.

Acute haptic-induced pigmentary glaucoma with an AcrySof intraocular lens.

A 49-year-old man had uneventful endocapsular phacoemulsification with in-the-bag implantation of an AcrySof SA60AT single-piece intraocular lens (IOL) (Alcon) in the right eye. Twenty-seven days postoperatively, he presented with ocular pain, intraocular pressure of 48 mm Hg, 360 degrees of hyperpigmentation of the trabecular meshwork, and iris pigment epithelial atrophy in the region of the upper temporal haptic, which had dislocated into the sulcus. The patient made an excellent recovery following IOL removal and exchange. Scanning electron microscopy of the explanted IOL demonstrated that the haptic had a rough lateral surface and anterolateral edge. We do not think this IOL should be implanted in the sulcus placement of the heptics. In this article, we report the case of a patient with an AcrySof SA60ATIOL (Alcon) who developed acute pigmentary glaucoma when the inferior haptic slipped out of the bag and came into contact with the pigmented iris and ciliary body.

Kerosene poisoning in children in Iraq.

One hundred and three children with kerosene poisoning were studied. The majority of the patients were under five years of age and included a newborn baby. More patients were seen in spring and fewer in winter months. Most of the patients were children of poor families living in overcrowded conditions. Negligence and ignorance were the main causes of poisoning. Respiratory and central nervous systems were mainly involved. Chest X-ray abnormalities were frequently seen. The patients were treated symptomatically. Only one patient died, he had been in a coma on admission to the hospital. All other patients had rapid and complete recoveries.

Application of limulus test (G pathway) for the detection of different conformers of (1-->3)-beta-D-glucans.

The reactivity of factor G mediated coagulation pathway in limulus amebocyte lysate which is triggered by (1-->3)-beta-D-glucans is thought to depend on the structure of the glucans, especially on the ultrastructure: triple helix, single helix and random coil. We used Sonifilan (SPG) and grifolan (GRN) as parent compounds to compare the reactivities of these three conformers. Under a neutral condition, alkaline treated SPG (SPG-OH, single helix) and polycarboxylated SPG (PC-SPG, random coil) showed significantly stronger reactivity than untreated SPG (triple helix). After the alkaline treatment, all three conformers showed comparable reactivities. It is suggested that the pretreatment of the glucan preparations by sodium hydroxide is quite important to compare quantitatively the reactivity of the glucans by limulus test, and comparing the data of untreated and alkaline treated glucans would provide information about their conformations. Using this approach, it was found that after heat treatment at around 150 degrees C, the conformation of GRN was changed to rich in the triple helix, and that following sodium hydroxide treatment and dialysis of GRN, the conformation of GRN was changed to single helix rich conformer. About half of the single helix conformer was gradually changed to triple helix conformer over one week at 4 degrees C.

Enoxacin in the treatment of typhoid fever.

Enoxacin 400 mg twice daily was given orally to 40 patients who had Salmonella typhi- or Salmonella paratyphi-positive blood or bone marrow cultures. One patient was switched to parenteral therapy within 48 hours of study enrollment, but the remaining 39 patients were given enoxacin for 10 to 14 days. All 39 patients were cured by enoxacin, even though 23 (58.9%) strains were resistant to cotrimoxazole and 16 (41%) strains were multiply resistant to ampicillin, chloramphenicol, and cotrimoxazole. No adverse events necessitated the interruption of therapy. In this study, enoxacin was well tolerated and efficacious in the treatment of typhoid fever.

Solubilization of limulus test reactive material(s) from Candida cells by murine phagocytes.

Solubilization of limulus test reactive materials from Candida was examined in the presence or absence of phagocytic cells. Solubilized limulus test reactive materials (LTRM) were detected in culture supernatant, and hot water and sodium hydroxide extracts of the acetone dried cells of Candida parapsilosis. Suspensions of Candida cells also reacted with limulus test, and LTRM were released from the acetone dried cells by serum treatment. After treatment of the acetone dried cells with polymorphonuclear leucocytes (PMN) or macrophages (M phi), a significant amount of LTRM was solubilized. Significant amounts of LTRM were also released by PMN during treatment of live and growing C. parapsilosis. The reactivity of LTRM was completely inhibited by the addition of excess amount of purified (1----3)-beta-D-glucan, suggesting LTRM from Candida cells as described above would contain (1----3)-beta-D-glucan. These results suggested that LTRM during fungal infection would come from the extracellular water soluble polysaccharide fraction as well as the insoluble cell wall fraction solubilized by the action of phagocytes.

Chai-ling-tang (Japanese name: sairei-to) as an oral adjuvant.

Immunomodulating and anti-tumor activities of orally administered Chai-Ling-Tang (Japanese name: sairei-to, ST) were investigated. The oral administration of ST into mice augmented the antibody response to intraperitoneally administered 2, 4, 6-trinitrophenyl-haptenated sheep red blood cells (TNP-SRBC). Orally administered ST showed also an enhancing effect on the antibody response to TNP-SRBC administered by the oral route. In addition, orally administered ST markedly activated the peritoneal macrophages to enhanced phagocytic and lysosomal enzyme activities. A significant inhibition of tumor growth was observed in a syngeneic tumor-mouse system when ST was administered orally. These results suggest that ST has an efficiency as an oral adjuvant or an oral biological response modifier (BRM).

[Clinical reevaluation of aztreonam (AZT) on urinary tract infections].

The clinical effectiveness and safety of Aztreonam (AZT) were studied in 55 patients with complicated urinary tract infections. AZT was administered at a dose of 4 g/day for 5 days. The results as evaluated by the UTI criteria were excellent in 8 cases, moderate in 26 and poor in 21. The overall effectiveness rate was 61.8%. Out of 64 strains of bacteria isolated before treatment, 50 strains (78.0%) were eradicated by the treatment. Bacteriological eradication rates for gram negative rods and gram positive cocci were 79.6% and 66.7%, respectively. There were no obvious side effects, except for a temporary elevation of glutamic oxaloacetic transaminase, glutamic pyruvic transaminase alkalinephosphatase, and total bilirubin in some patients. The results indicate that AZT tablets are useful and safe for the treatment of complicated urinary tract infections.

Brucellosis in children in Iraq.

We studied 50 children with brucellosis. Diagnoses were made from clinical pictures and agglutination titres. Fevers, sweating and chills were common complaints. Hepatosplenomegaly and arthritis were usual findings. Tetracycline is an effective drug for management of childhood brucellosis. Seven patients with relapse were treated successfully with combination of tetracycline and co-trimoxazole.