Advanced Vision Analyzer-Virtual Reality Perimeter: Device Validation, Functional Correlation and Comparison with Humphrey Field Analyzer.

Purpose: To evaluate the Advanced Vision Analyzer (AVA; Elisar Vision Technology) and to compare pointwise threshold sensitivity and functional correlation of Elisar Standard Algorithm (ESA) with the Swedish Interactive Threshold Algorithm (SITA) of the Humphrey Field Analyzer (HFA; Carl Zeiss Meditec, Inc). Design: Prospective, cross-sectional, observational case series. Participants: One hundred sixty eyes (85 control participants, 75 glaucoma patients) for functional assessment, 15 eyes for test-retest variability (TRV), 107 eyes for blind spot trial (45 normal eyes, 62 glaucoma eyes) were recruited consecutively. A separate group of participants was chosen for each assessment. Methods: All participants underwent ESA and SITA Standard 24-2 testing, and 1 eye of each participant was selected randomly. Intraclass correlation coefficient (ICC), Bland-Altman, linear regression, mean bias (MB), and proportional bias analyses were quantified and assessed. Threshold measurements, TRV, and blind spot location accuracy were compared with those of the HFA. Main Outcome Measures: Pointwise threshold sensitivity, sectoral mean sensitivity (MS), mean deviation (MD), pattern standard deviation (PSD), TRV, blind spot location, average test time were computed, and data were correlated. Results: The mean time required to perform a field test with the AVA was 7.08 ± 1.55 minutes and with HFA was 6.26 ± 0.54 minutes (P = 0.228). The MS difference between AVA and HFA was -2.2 ± 2.3 dB in healthy participants (P < 0.001) and -2.6 ± 3.5 dB in participants with glaucoma (P < 0.001). The correlation coefficients for pointwise threshold values were moderately to strongly correlated for both the devices (r = 0.68-0.89). For MS, the overall ICC value was 0.893 (P < 0.001) with MB of 2.48 dB and a limits of agreement (LOA) of 10.90 (range, 7.93 to -2.97). For TRV, response variability decreased with an increase in sensitivity and increased with eccentricity. Blind spot location was accurate, and global indices of testing methods correlated well. Conclusions: The AVA effectively captures threshold values for each point in the visual field. Adequate functional correlation suggests substantial equivalence between the AVA (ESA) and HFA (SITA Standard), implying that AVA may allow accurate assessment of visual field.

Single-pass four-throw pupilloplasty: Postoperative mydriasis and fundus visibility in pseudophakic eyes.

PURPOSE: To analyze the pharmacological mydriasis and the consequent fundus visibility after single-pass 4-throw pupilloplasty in pseudophakic eyes. SETTING: Dr. Agarwal's Eye Hospital, Chennai, India. DESIGN: Comparative case series. METHODS: Patients with bilateral pseudophakia with single-pass 4-throw pupilloplasty in 1 eye (study) and no single-pass 4-throw in the fellow eye (control) were included. The pupil measurements were analyzed before and after the instillation of mydriatics (tropicamide 0.8%-phenylephrine 5.0% and atropine 1.0%). The dimensions at the baseline and 40, 90, and 120 minutes after instillation were quantified by anterior-segment optical coherence tomography (Visante), a corneal topographer (Orbscan 11z), and an autorefractometer (HRK-7000). The serial photograph (DC3 digital camera) and the fundus imaging (TRC.50DX) were recorded. Changes in pupil size, area, and fundus visibility (50 degrees); the difference in mydriasis between the drugs; and a comparison of mydriasis with the fellow eyes were recorded. RESULTS: The study comprised 22 patients (22 study eyes and 22 control eyes). There was a significant increase in pupil size and area over time (P < .0001). The occurrence of mydriasis was higher in the vertical axis (mean 4.5 mm ± 1.3 [SD]) than in the horizontal axis (mean 4.0 ± 1.3 mm) with a significant difference (P = .021). There was a statistically significant difference in pupil dilation between the study eyes and the control eyes (P = .002). The fundus imaging showed good illumination in 13 eyes (59%) and defective illumination in 9 eyes (41%) for retinal visibility. CONCLUSION: Although pharmacological pupil mydriasis was not equivalent to normal eyes, significant mydriasis occurred and aided in fundus visualization after single-pass 4-throw pupilloplasty.

Zinc adjunct therapy reduces case fatality in severe childhood pneumonia: a randomized double blind placebo-controlled trial.

BACKGROUND: Pneumonia is a leading cause of children's deaths in developing countries and hinders achievement of the fourth Millennium Development Goal. This goal aims to reduce the under-five mortality rate, by two thirds, between 1990 and 2015.Few studies have examined the impact of zinc adjunct therapy on the outcome of childhood pneumonia. We determined the effect of zinc as adjunct therapy on time to normalization of respiratory rate, temperature and oxygen saturation. We also studied the effect of zinc adjunct therapy on case fatality of severe childhood pneumonia (as a secondary outcome) in Mulago Hospital, Uganda. METHODS: In this double blind, randomized, placebo-controlled clinical trial, 352 children aged 6 to 59 months, with severe pneumonia were randomized to zinc (20 mg for children ≥ 12 months, and 10 mg for those < 12 months) or a placebo once daily for seven days, in addition to standard antibiotics for severe pneumonia. Children were assessed every six hours. Oxygen saturation was normal if it was above 92% (breathing room air) for more than 15 minutes. The respiratory rate was normal if it was consistently (more than 24 hours) below 50 breaths per minute in infants and 40 breaths per minute in children above 12 months of age. Temperature was normal if consistently below 37.5°C. The difference in case fatality was expressed by the risk ratio between the two groups. RESULTS: Time to normalization of the respiratory rate, temperature and oxygen saturation was not significantly different between the two arms.Case fatality was 7/176 (4.0%) in the zinc group and 21/176 (11.9%) in the placebo group: Relative Risk 0.33 (95% CI 0.15 to 0.76). Relative Risk Reduction was 0.67 (95% CI 0.24 to 0.85), while the number needed to treat was 13. Among HIV infected children, case fatality was higher in the placebo (7/27) than in the zinc (0/28) group; RR 0.1 (95% CI 0.0, 1.0).Among 127 HIV uninfected children receiving the placebo, case fatality was 7/127 (5.5%); versus 5/129 (3.9%) among HIV uninfected group receiving zinc: RR 0.7 (95% CI 0.2, 2.2). The excess risk of death attributable to the placebo arm (Absolute Risk Reduction or ARR) was 8/100 (95% CI: 2/100, 14/100) children. This excess risk was substantially greater among HIV positive children than in HIV negative children (ARR: 26 (95% CI: 9, 42) per 100 versus 2 (95% CI: -4, 7) per 100); P-value for homogeneity of risk differences = 0.006. CONCLUSION: Zinc adjunct therapy for severe pneumonia had no significant effect on time to normalization of the respiratory rate, temperature and oxygen saturation. However, zinc supplementation in these children significantly decreased case fatality.The difference in case fatality attributable to the protective effect of zinc therapy was greater among HIV infected than HIV uninfected children. Given these results, zinc could be considered for use as adjunct therapy for severe pneumonia, especially among Highly Active Antiretroviral Therapynaïve HIV infected children in our environment. CLINICAL TRIALS REGISTRATION NUMBER: clinicaltrials.gov NCT00373100.

Respiratory cryptosporidiosis in HIV-seronegative children in Uganda: potential for respiratory transmission.

BACKGROUND: Respiratory cryptosporidiosis is recognized as a late-stage complication in persons with human immunodeficiency virus (HIV) infection and AIDS. However, respiratory signs and symptoms are common in otherwise healthy children with intestinal cryptosporidiosis, which suggests that respiratory infection may occur in immunocompetent hosts. METHODS: We recruited children 9-36 months of age who presented with diarrhea to Mulago Hospital in Kampala, Uganda, from November 2007 through January 2009. Children with stool samples positive or negative for Cryptosporidium species were selected for further evaluation, including sputum induction in those with cough or unexplained respiratory signs and collection of saliva and blood specimens. Sputum samples were subjected to comprehensive bacteriologic testing, and both sputum and saliva specimens were tested for Cryptosporidium species by nested polymerase chain reaction. RESULTS: Of 926 fecal samples screened, 116 (12.5%) were positive for Cryptosporidium. Seventeen (35.4%) of 48 sputum samples tested from children with positive stool samples were positive for Cryptosporidium. Sixteen (94.1%) of the 17 children with confirmed respiratory cryptosporidiosis were HIV seronegative, and 10 (58.8%) of 17 children were not malnourished. None of the 12 sputum specimens from children with negative stool samples tested positive for Cryptosporidium (P = .013, compared with children who tested positive for Cryptosporidium in the stool). Parasite DNA was detected in only 2 (1.9%) of 103 saliva samples (P < .001, compared with sputum samples). CONCLUSIONS: Respiratory cryptosporidiosis was documented in one-third of HIV-seronegative children who were tested. These novel findings suggest the potential for respiratory transmission of cryptosporidiosis. Trial registration. ClinicalTrials.gov identifier: NCT00507871.