The Postnatal Growth and Retinopathy of Prematurity Model: A Multi-institutional Validation Study.

PURPOSE: The G-ROP model was proposed to improve the retinopathy of prematurity (ROP) screening efficiency. It is based on gestational age, birth weight and postnatal weight gain. The current study aimed to validate the G-ROP model's ability to predict ROP in cohorts of premature infants from Egypt and the United Kingdom (UK). METHODS: We retrospectively reviewed the records of preterm infants born between 1st of January and 30th of June 2018 with a known outcome for ROP screening and regular weight measurements until day 39 after birth. We applied the G-ROP model to the study group and calculated the sensitivity of the model for detecting Early Treatment of ROP (ETROP) study type 1 ROP and for any ROP and calculated the reduction of the number of infants requiring ROP screening by the model application. RESULTS: We applied the G-ROP model on 605 infants (504 from Egypt and 101 from the UK). The model successfully predicted all type 1 ROP cases (100% sensitivity) in both cohorts (95% confidence interval [CI], 91.1-100% in the Egyptian cohort and 65.5-100% in the UK cohort). The model reduced the number of infants requiring screening by 14.1% in the Egyptian cohort and 21.8% in the UK cohort. CONCLUSIONS: The G-ROP model was successfully validated for detecting type 1 ROP and in both cohorts from Egypt and the UK.

Cargo Release from Myosin V Requires the Convergence of Parallel Pathways that Phosphorylate and Ubiquitylate the Cargo Adaptor.

Cellular function requires molecular motors to transport cargoes to their correct intracellular locations. The regulated assembly and disassembly of motor-adaptor complexes ensures that cargoes are loaded at their origin and unloaded at their destination. In Saccharomyces cerevisiae, early in the cell cycle, a portion of the vacuole is transported into the emerging bud. This transport requires a myosin V motor, Myo2, which attaches to the vacuole via Vac17, the vacuole-specific adaptor protein. Vac17 also binds to Vac8, a vacuolar membrane protein. Once the vacuole is brought to the bud cortex via the Myo2-Vac17-Vac8 complex, Vac17 is degraded and the vacuole is released from Myo2. However, mechanisms governing dissociation of the Myo2-Vac17-Vac8 complex are not well understood. Ubiquitylation of the Vac17 adaptor at the bud cortex provides spatial regulation of vacuole release. Here, we report that ubiquitylation alone is not sufficient for cargo release. We find that a parallel pathway, which initiates on the vacuole, converges with ubiquitylation to release the vacuole from Myo2. Specifically, we show that Yck3 and Vps41, independent of their known roles in homotypic fusion and protein sorting (HOPS)-mediated vesicle tethering, are required for the phosphorylation of Vac17 in its Myo2 binding domain. These phosphorylation events allow ubiquitylated Vac17 to be released from Myo2 and Vac8. Our data suggest that Vps41 is regulating the phosphorylation of Vac17 via Yck3, a casein kinase I, and likely another unknown kinase. That parallel pathways are required to release the vacuole from Myo2 suggests that multiple signals are integrated to terminate organelle inheritance.

Anxiety And Depression In Medical Students Of A Private Medical College.

BACKGROUND: Depression and anxiety are the common mental disorders with a prevalence of 10-44% in developing countries and is the fourth leading cause of morbidity. Undergraduate medical studies are generally perceived to be more stressful for the students as compared to other undergraduate programs as students have to undergo strenuous curriculum and evaluation which may lead to many emotional stresses that may end with psychiatric disorders like depression and anxiety. This study aimed to determine the frequency of anxiety and depression in medical students of Foundation University Medical College (FUMC), Islamabad. METHODS: In this cross-sectional study, Beck Depressive Inventory and Beck Anxiety Scales were used to assess anxiety and depression at three different times of the Academic year. All five-year students were included in the study. RESULTS: Out of a sample of 150 students, mild depression was seen in 37.46% and moderate to severe depression was observed in 14% students. About 19% of the students had moderate to severe anxiety. In Second year students time of assessment was significantly related to depression and anxiety (p-0.000). Females had higher association with depression in final year (p-0.037). CONCLUSIONS: High Psychiatric morbidity found needs to be identified and treated at the earliest; otherwise it can lead to serious consequences such as suicidal ideation and burnout.

An intramolecular interaction within the lipid kinase Fab1 regulates cellular phosphatidylinositol 3,5-bisphosphate lipid levels.

Phosphorylated phosphoinositide lipids (PPIs) are low-abundance signaling molecules that control signal transduction pathways and are necessary for cellular homeostasis. The PPI phosphatidylinositol (3,5)-bisphosphate (PI(3,5)P2) is essential in multiple organ systems. PI(3,5)P2 is generated from PI3P by the conserved lipid kinase Fab1/PIKfyve. Defects in the dynamic regulation of PI(3,5)P2 are linked to human diseases. However, few mechanisms that regulate PI(3,5)P2 have been identified. Here we report an intramolecular interaction between the yeast Fab1 kinase region and an upstream conserved cysteine-rich (CCR) domain. We identify mutations in the kinase domain that lead to elevated levels of PI(3,5)P2 and impair the interaction between the kinase and CCR domain. We also identify mutations in the CCR domain that lead to elevated levels of PI(3,5)P2 Together these findings reveal a regulatory mechanism that involves the CCR domain of Fab1 and contributes to dynamic control of cellular PI(3,5)P2 synthesis.

Reciprocal benefit to senior and junior peers: An outcome of a pilot research workshop at medical university.

A study was planned to explore and evaluate the role of senior peers in the learning process of their juniors during a Research Methodology workshop, and to assess educational advantages for seniors in leading roles. Twenty medical students participated with 15 juniors (1st to 3rd year) and 5 seniors (final/fourth year) divided into 5 groups with one senior student each at Foundation University Medical College, Islamabad, Pakistan. The seniors supervised and engaged the groups to develop research questions, formulate objectives, review literature, outline study designs, develop study tools/questionnaire and finally shape their projects in synopsis. Overall advantages to both juniors and seniors through this peer-assisted learning model were assessed by feedback proformas with open and closed-ended questions. Senior peers' facilitation was effective in the learning process of junior peers. Senior peers also gained academic benefit by exercising their leadership qualities through teaching and maintaining group dynamics.

Frequency of depression and anxiety in patients attending a diabetes clinic.

BACKGROUND: Depression is very common among people with type-2 diabetes and is associated with poor treatment compliance and outcome. This study was done to see the frequency of depression in patients with established type-2 diabetes attending a diabetes clinic in a tertiary care hospital. METHODS: One hundred and ten patients with chronic type-2 diabetes were included in this cross sectional study, excluding type-1 diabetics, patients with severe co-morbid illness with type-2 diabetes and patients with some psychiatric illness. Hospital Anxiety and Depression Scale was used to assess depression and anxiety in these patients. RESULTS: Almost 50% of patients were found to have anxiety and depression in our study. Female gender, lack of education and housewives were found to be ffected'more -hile duration of diabetes, treatment and control of diabetes have little effect on anxiety and depression in patients with chronic type-2 diabetes patients. CONCLUSION: There is a high incidence of depression and anxiety in patients with chronic type-2 diabetes and clinicians must screen regularly for better care of these patients.

Retinal detachment in paediatric patients.

OBJECTIVE: To assess the causes of retinal detachment in children and the various operative procedures requiring vitreoretinal surgical intervention for the same. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi, from January 2006 to May 2009. METHODOLOGY: A total of 281 eyes of 258 patients, (aged 0-18 years) who underwent vitreo-retinal surgical intervention for retinal detachment were included. Surgical log was searched for the type of retinal detachment and its causes. Frequencies of various interventions done in these patients viz. vitrectomy, scleral buckle, use of tamponading agents, laser photocoagulation and cryotherapy were noted. Results were described as descriptive statistics. RESULTS: Myopia was the cause in 62 (22.1%) and trauma in 51 (18.1%) of the eyes. Total retinal detachment (RD) was treated in 94 (33.5%) eyes, sub total RD in 36 (12.8%), recurrent RD in 32 (11.4%), giant retinal tear in 28 (10%), tractional RD in 15 (5.3%) and exudative RD in 2 (0.7%). Prophylactic laser or cryotherapy was applied in 74 (26.3%) of the eyes. Pars plana vitrectomy (PPV) was carried out in 159 (56.6%) eyes while scleral buckle procedure was done in 129 (45.9%) eyes. Silicon oil was used in 149 (53%), perfluorocarbon liquid in 32 (11.4%) and gas tamponade in 20 (7.1%) eyes. CONCLUSION: The most common cause of retinal detachment in paediatric patients was myopia, followed by trauma. Total RD was more common as compared to the other types. The most common procedure adopted was pars plana vitrectomy followed by scleral buckle procedure.

Outcome of surgical treatment of monocular elevation deficiency.

OBJECTIVE: To assess the outcome of surgical treatment in patients with monocular elevation deficiency. METHODS: This prospective study included 36 patients of monocular elevation deficiency surgically treated from January 2006 to June 2009, at a tertiary care eye hospital in Rawalpindi, Pakistan. Corrected visual acuity, refractive error, ocular examination, orthoptic assessment and ptosis evaluation were recorded. Strabismus surgery was performed according to the results of forced duction test (FDT). Ptosis surgery, if required, was performed after the strabismus surgery. Patients having any restrictive cause or previous strabismus surgery were excluded. The study conformed to all local laws and was compliant with the principles of the Declaration of Helsinki and had the approval of the Hospital Ethics Committee. RESULTS: The 36 patients were treated surgically and completed the required follow-up. The forced duction test was positive for inferior rectus (IR) of the involved eye in 20 of the 36 eyes (55.55%). Twelve patients had inferior rectus recession with or without one horizontal muscle recession or resection, 12 had Knapp procedure correcting for any horizontal deviation if present, 10 had inferior rectus recession followed by Knapp surgery, with or without recession or resection of horizontal recti, 1 patient had horizontal correction only, while one patient had ptosis correction only without squint surgery. Of the 36 patients, 33 had post-operative (PO) hypotropia within 10 prism diopters (PD). Three patients developed consecutive hypertropia. CONCLUSION: Careful pre-operative evaluation can lead to satisfactory cosmetic improvement after surgery in monocular elevation deficiency. The forced duction test should be performed in both eyes so that any associated oblique muscle laxity (OML) can be noted.

Bilateral iridocorneal endothelial (ICE) syndrome with microspherophakia.

Iridocorneal endothelial syndrome is described to be a rare, usually unilateral ocular condition in young females. There are three known overlapping clinical variants of this condition namely, essential iris atrophy, Cogan-Reese and Chandler syndrome. We report a case of bilateral iridocorneal endothelial (ICE) syndrome with microspherophakia. A 25 years old female presented with microspherophakic lens dislocated into anterior chamber in right eye, and displaced inferiorly in left eye. She was also diagnosed with ICE syndrome and underwent lensectomies in both eyes. This unique combination has never been reported before.

Successful treatment of ligneous conjunctivitis with topical cyclosporine and heparin.

Ligneous conjunctivitis is a rare disease characterized by wood-like pseudomembranes developing on the ocular and extraocular mucosae. We present a case of ligneous conjunctivitis and cataracts in a 10-year-old boy with a positive family history of the disease and consanguinity. His condition was managed with topical cyclosporine, heparin, and steroids.

Ptosis associated with monocular elevation deficiency.

OBJECTIVE: To document the various clinical features of ptosis associated with monocular elevation deficiency (MED) seen in patients, presenting to the Paediatric and Strabismus Unit, over a period of 2 years. METHODS: All patients seen with monocular elevation deficiency presenting to the Strabismus Clinic from January 2006 to December 2007 were examined and evaluated for presence of associated ptosis, jaw winking phenomenon and pseudoptosis. Patients having acquired causes of monocular limitation in elevation were excluded. RESULTS: A total of 22 patients having MED were seen. Out of these 50% were males (N = 11) and 50% females (N = 11). Twelve (54.54%) had MED in the left eye and 10 (45.45%) had MED in the right eye. Ptosis was present in the eye affected with MED in 16 (72.72%) patients. Pseudoptosis was seen in 4 (18.18%) patients whereas no associated ptosis was noticed in 2 (9.09%) patients. Jaw winking phenomenon was present in 9 (40.90%) which comprise almost half (56%) the MED cases with ptosis. CONCLUSION: Careful clinical assessment for ptosis, pseudoptosis and jaw winking phenomenon before forced duction test, can help in planning the correct order of surgical management of patients having monocular elevation deficiency. The patient needs to be counseled regarding the multiple surgeries required according to associated clinical features present with MED.

Frequency of depression and anxiety in patients attending a rheumatology clinic.

OBJECTIVE: This study was done to find out the frequency of anxiety and depression among patients with common rheumatic disorders and determine the possible relationship of different demographic and clinical variables with anxiety and depression. STUDY DESIGN: Cross-sectional, analytical study. PLACE AND DURATION OF STUDY: The study was carried out at Fauji Foundation Hospital, Rawalpindi, during April to August 2006. METHODOLOGY: Patients attending the rheumatology outpatient department, with more than 2 years duration of rheumatic disorder were selected. A proforma regarding the demographic details was filled for all the patients. A physician made the assessment regarding the rheumatological disorder. Urdu version of Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. Clinical assessment was done by two psychiatrists according to International Classification of Diseases-10 (ICD-10). Data was analyzed on SPSS10 and p-value was calculated using Chi-square test as test of significance. RESULTS: There were 108 patients mostly females (90%), mean age 44.7 + 11 years, majority (72%) were married and 51% were uneducated. Almost 80% of the patients had rheumatoid arthritis. Two-third of the patients had persistent symptoms. According to the HADS, scoring 56% of the patients had more than the cut off score for depression and 65.7% patients had scores falling in the category of cases. Regarding the clinical diagnosis, 42% of the patients were found to be depressed. Considering the factors which might be associated with depression or anxiety; only gender was found to be significantly associated with depression (p=0.03). CONCLUSION: Depression and anxiety is high in patients being treated for chronic rheumatological disorders. A close liaison between rheumatologist and mental health professionals could prove beneficial for these patients.

Frequency of diabetics in asteroid hyalosis patients.

BACKGROUND: A steroid hyalosis is a benign condition characterized by small white or yellow-white spherical opacities throughout the vitreous. The aetiology of this disorder is not clearly understood. Association of asteroid hyalosis with diabetes mellitus has been a debatable issue in ophthalmology. This study was carried out to determine the relationship between asteroid hyalosis and diabetes. METHODS: The study was carried out in the Department of Ophthalmology, Military Hospital, Rawalpindi. Cases were picked up during routine eye examination that showed evidence of asteroid hyalosis. All patients of diabetes scheduled for routine follow-ups were also checked for active signs of diabetes. Fasting and two-hour postprandial blood glucose were checked and the frequency of diabetes mellitus in patients with asteroid hyalosis was determined. RESULTS: Ninety-six cases of asteroid hyalosis were included. The median age of presentation was 55.68 years (range 40-71). It was bilateral in thirty-six cases. Twenty-eight cases were positive for diabetes. CONCLUSION: The association between asteroid hyalosis and diabetes appears to be significant. Patients found to be having the findings of asteroid hyalosis should be screened for diabetes.