Prevalence, pattern, and compliance with spectacles use among the elderly in homes for the aged in South India: The Hyderabad Ocular Morbidity in Elderly Study (HOMES).

Purpose: This study was conducted to report on the pattern of spectacles use and compliance among the elderly (aged ≥60 years) in homes for the aged in Hyderabad region in Telangana State, India. Methods: Participants were recruited from 41 homes for the aged centres for comprehensive eye health assessments. A questionnaire was used to collect information on current and past use of spectacles, type of spectacles, spectacles provider and amount paid for the spectacles. For those that reported using spectacles in the past, information was collected on the reasons for their discontinuation. Compliance with spectacles use was assessed after eight months of provision of the spectacles. Results: A total of 1182/1513 participants were examined from 41 homes for the aged in Hyderabad, India. The mean age of the participants examined was 75 years (standard deviation (SD): 8.8 years; range: 60-108 years); 764 (64.6%) of them were women and 240 participants (20.3%) had no formal education. The prevalence of spectacles use was 69.9% (95% confidence interval [CI]: 67.1-72.4; n = 825). Bifocals were the most commonly used type of spectacles (86.7%) followed by single vision glasses for distance vision (7.4%). Private eye clinics were the largest service provider (85.5%) followed by local optical outlets (6.9%) and other service providers (7.7%). The prevalence of spectacles compliance was 81.5% (211/259). Conclusion: Use of spectacles and compliance are high among the elderly living in residential care homes in the Hyderabad region. Spectacles use can be further improved by periodic eye assessments along the lines similar to school eye programs, which can immensely benefit this vulnerable, aged population.

Population-based assessment of barriers for uptake of eye care services among elderly people: Findings from rapid assessment of visual impairment studies from Telangana, India.

Purpose: To report the barriers for seeking eye care among the elderly population aged ≥60 years with avoidable vision impairment (VI) in the South Indian state of Telangana. Methods: A total of 3640 participants aged ≥60 years were recruited using cluster-random sampling. Demographic information, including presenting visual acuity, was measured using the standard Rapid Assessment of Visual Impairment (RAVI) protocol. "Avoidable VI" was considered if the VI was due to cataract or uncorrected refractive error (URE). A detailed interview was conducted using a validated questionnaire to report the barriers for not seeking eye care. Data were analyzed using the Stata statistical software version 14. Results: Prevalence of avoidable VI was 30.2% (95% CI: 28.02-31.06; n = 1102). Among those who noticed decreased vision (n = 1074), only 392 participants (36.4%) reported that they felt the need for seeking eye care. The major barriers for not seeking eye care were: cannot afford the consultation fee and services (42.0%) and no escort (25.7%). Overall, the personal barriers (57.9%) were the major reason for not seeking care, followed by economic barriers (42.0%). No significant difference was reported in barriers between the participants with unilateral and bilateral VI (>0.05). Conclusion: Overall, among the elderly people, personal and economic barriers were the major reason for not seeking eye care. Health care providers and policymakers should focus on newer models of eye care delivery to ensure better accessibility and uptake of care by the elderly people.

Status of oxidative stress markers, advanced glycation index, and polyol pathway in age-related cataract subjects with and without diabetes.

One of the major public health issues is the rising prevalence of cataracts, a primary reason for preventable blindness. The causes for the development of age-related cataracts and accelerated cataractogenesis in diabetes are multifactorial. Hence, this study was designed to examine the status and relationship between the three majorly associated molecular events, namely, oxidative stress, non-enzymatic glycation, and polyol pathway in age-related cataracts with and without diabetes. A total of 472 subjects were distributed into four groups: non-diabetic subjects with clear lens (135), diabetic subjects with clear lens (40), non-diabetic subjects with cataract (174), and diabetic subjects with cataract (123). Cataracts were graded by slit-lamp examination according to the Lens Opacities Classification System III. Age at onset of cataract, type of opacity, anthropometric measurements, and sociodemographic characteristics were recorded, and clinical profile was examined. Plasma oxidative stress markers were assessed by estimating the lipid peroxidation end product malondialdehyde, protein oxidation products protein carbonyls, and DNA oxidative damage marker 8-hydroxy-2-deoxyguanosine. Plasma advanced glycation end products index, erythrocyte aldose reductase activity, and sorbitol levels were evaluated. After adjusting for age, plasma malondialdehyde levels were significantly higher in diabetic cataracts (P < 0.001) and non-diabetic cataract subjects (P < 0.05), compared to non-diabetic subjects with clear lens. Plasma advanced glycation end products index was significantly higher (P < 0.05) only in diabetic cataracts, but not in non-diabetic subjects with cataracts. Aldose reductase activity and sorbitol levels were significantly higher (P < 0.001) in both diabetic and non-diabetic subjects with cataract compared to non-diabetic subjects with clear lens. The data indicated that plasma lipid peroxidation in age-related cataracts was independent of diabetes. An association of pronounced glycation was observed only in diabetic cataracts but not in non-diabetic cataracts and polyol flux between diabetic cataracts and non-diabetic cataracts was comparable.

Spontaneous and reversible self-assembly of a polypeptide fragment of insulin-like growth factor binding protein-2 into fluorescent nanotubular structures.

In this communication, we report the spontaneous and reversible in vitro self-assembly of a polypeptide fragment derived from the C-terminal domain of Insulin-like Growth Factor Binding Protein (IGFBP-2) into soluble nanotubular structures several micrometres long via a mechanism involving inter-molecular disulfide bonds and exhibiting enhanced fluorescence.

Sparing effect of tendon injury on osteoarthritis.

A case is reported in which a finger with no active flexion did not develop erosive osteoarthritis at the time that it developed in the other active digits.

Rupture of the triceps tendon with olecranon bursitis. A case report with a new method of repair.

Rupture of the triceps tendon is rare, and no previous report of its association with olecranon bursitis was found in the literature. A previously healthy 72-year-old man fell from a stationary bicycle and was examined by his family physician. Calcification over the olecranon area with an intact triceps tendon was revealed. Two months later the patient presented with triceps rupture and weakness of elbow extension with olecranon bursitis. Grossly, the pathologic lesion consisted of synovial frond proliferation and invasion of the cut end of a tendon. A "collar stud-shaped" bursa was found in front of and behind the triceps tendon and across a 3-cm gap in the tendon. The advancement was completed by splitting the tendon in partial thickness proximal to the cut end. The flap was turned down and anchored to the olecranon through drill holes. The end result was good return of function. Patients with chronic olecranon bursa problems should be carefully examined for triceps function. The gap in the tendon can be treated by mobilizing the tendon in the manner described.

Dorsal wrist synovectomy in rheumatoid arthritis--a long-term study.

Dorsal wrist synovectomy, tenosynovectomy of the extensor tendons, excision of the distal ulna, ulnar-side stabilization of the wrist, and placement of the extensor retinaculum underneath the extensor tendons is an effective procedure in wrists with rheumatoid arthritis. Twenty-seven patients who had surgery on 38 wrists were followed for 5 to 14 years, with an average of 7.4 years. There were 25 female and two male patients with an average age of 54 years. Over 95% had excellent pain relief. There was significant reduction of wrist motion, but the arc of motion was within a functional range. Subsequent tendon rupture was minimal and even tendons found to be thinned out at the time of surgery remained intact. There was no recurrence of synovitis. Carpal measurements were done by using the pisiform bone as a reference point. The carpal height was maintained in 70% of the wrists. Carpal translocation occurred in 44% of the wrists. Three patients required wrist arthrodesis, and five, arthroplasty. Carpal collapse and translocation could not be predicted by preoperative x-rays. Progressive carpal collapse was associated with increasing ulnar deviation of fingers. Progression of carpal collapse and ulnar translocation occurred in a linear fashion with the years of follow-up.

Failure of polyethylene acetabular cups. Two case reports.

Fatigue fracture involving the metallic femoral stem is well recognized after total hip arthroplasty. Two cases of Charnley-Mueller polyethylene acetabular cup failure, in a 54-year-old-woman and a 77-year-old woman with abnormal wear patterns, were diagnosed prior to operation. The fracture of the acetabular cup was recognized by the fragmented, crushed appearance of the cup. The arthrogram clearly showed the radiographic contrast agent passing through the substance of the cup. The wear of the cups was measured by micrometer calipers which have an accuracy of 0.001 mm. The polyethylene acetabular cup was analyzed in four zones formed by three circumferential grooves. Markedly increased wear of the components occurred in the superolateral dome area. This wear rate was as high as 0.8 mm/year, which is four times the average wear of 0.2 mm/year. This marked wear associated with repetitive cyclic fatigue or static load resulted in fracture of the polyethylene acetabular cup. Improper machining of the cup using low- rather than high-density polyethylene in the manufacturing process and the heavy weight of these patients may have been factors in the marked fissures and crack lines revealed by microscopic study of the fractured area after sputter coating with gold palladium. Fracture of the polyethylene acetabular component, although rare, may be encountered more often in longer follow-up studies of patients who have undergone total hip arthroplasty. Proper selection of patients, acetabular spacers, and pressure injection techniques may prevent early loosening of the acetabular polyethylene components.

Desmoplastic fibroma of the ulna. A case report.

This report of desmoplastic fibroma of bone (DFB) in the left ulna represents the 56th published case of the neoplasm. To the best of the authors' knowledge, the present case is the first instance of this type of excision of the distal ulna performed for DFB with a metallic prosthesis and successful restoration of distal radial ulnar anatomy and function.

Dislocation following total hip arthroplasty. Management by special brace in selected patients.

Dislocation after total hip arthroplasty (THA) occurs in 1%-3% of the cases reported in the literature. Recurrent dislocations due to malpositioned components should be treated by revision arthroplasty. Dislocated hips that have optimally positioned components but weak abductors can be treated by a special brace that prevents extremes of flexion, adduction, and rotation. Two hundred and eighty-nine total hip arthroplasties were performed from 1975 to 1981. Nine patients, all of whom had optimal position of components and the brace treatment, had dislocations. In one patient who had a spastic muscle disorder the brace was used as prophylaxis. The short chair-back brace has a lateral joint with thigh cuff. The joint can be locked at a particular position to give the desired movement of the hip joint. The brace, applied after the second dislocation, is worn for six to nine months. Excellent results were obtained in nine patients. One patient is still using the brace. The brace is light and can be worn under normal clothing; ordinary activities are easily performed by patients wearing the brace. Patients should be trained to avoid positions and activities that predispose to dislocation.

Extensor tendon rupture over the metacarpal heads.

Rupture of the extensor tendons is common in longstanding rheumatoid arthritis of the hand. The tendons commonly involved are those of the ring and little fingers and the common site of rupture is over the dorsal ulna and distal edge of the extensor retinaculum. We are reporting two cases of extensor tendon rupture over the metacarpal head of the middle finger due to prominent osteophytes.

The Jeweller's Thumb: An Occupational Neuroma A Case Report.

Perineural fibrosis and scarring of superficial nerves can occu r secondary to chronic frictional forces. This results in a tender lump in the nerve and hyperesthesia of the area of its distribution. Bowler's thumb is a well known entity which involves the ulna side digital nerve of the thumb at the level of the MP joint. This article describes a perineural fibrosis of the digital branch of the thumb in a jeweller who presented with pain and swelling at the center interphalangeal joint. Surgical excision of the fibrous mass and neurolysis has relieved the symptoms.

Patellar complications after total condylar arthroplasty.

The incidence of complications in the initial three years' experience with total knee arthroplasty and patellar replacement was 9%. Of the total knee arthroplasties perforated in the last three years, neither fracture nor subluxation of the patella has occurred. A prosthesis with right and left femoral components and slight lateral (physiologic) slanting of the patellar groove is recommended. Lateral release is done only if absolutely necessary and is performed at a considerable distance from the patella to preserve blood supply. Excess bone removal from the patella is avoided. The fat pad is preserved in all cases. Patients who have undergone a patellectomy had a definitely weak knee. Treatment by simple immobilization failed to produce an excellent functional result.

Traumatic disruption of the manubriosternal joint. A case report.

A case of manubriosternal dislocation is presented. The possible mechanism of injury was hyperflexion of the spine which resulted in chin to chest contact, disrupting the manubriosternal joint. If the dislocation is Type I and the patient has compression symptoms on the trachea or major vessels, surgical treatment by wiring may be needed. In Type II dislocations, the best management is closed reduction and elastoplast strapping.