Screening for vision-threatening diabetic retinopathy in South India: comparing portable non-mydriatic and standard fundus cameras and clinical exam.

PurposeTo evaluate the sensitivity and specificity of a portable non-mydriatic fundus camera to diagnose vision-threatening diabetic retinopathy (VTDR).Patients and methodsA prospective, single-site, comparative instrument validation study was undertaken at the Aravind Eye Care System. Overall, 155 subjects with and without diabetes were recruited. Images from 275 eyes were obtained with the (1) non-mydriatic Smartscope, (2) mydriatic Smartscope, and (3) mydriatic table-top camera of the macular, nasal, and superotemporal fields. A retina specialist performed a dilated fundus examination (DFE), (reference standard). Two masked retina specialists graded the images. Sensitivity and specificity to detect VTDR with the undilated Smartscope was calculated compared to DFE.ResultsGraders 1 and 2 had a sensitivity of 93% (95% confidence interval (CI): 87-97%) and 88% (95% CI: 81-93%) and a specificity of 84% (95% CI: 77-89%) and 90% (95% CI: 84-94%), respectively, in diagnosing VTDR with the undilated Smartscope compared to DFE. Compared with the dilated Topcon images, graders 1 and 2 had sensitivity of 88% (95% CI: 81-93%) and 82% (95% CI: 73-88%) and specificity of 99% (95% CI: 96-100%) and 99% (95% CI: 95-100%).ConclusionsRemote graders had high sensitivity and specificity in diagnosing VTDR with undilated Smartscope images, suggesting utility where portability is a necessity.

Granisetron (Kytril): a survey of use in clinical practice in Switzerland.

Data on the use of intravenous grainsetron (Kytril) were collected during a surveillance exercise amongst Swiss oncologists. The data were analysed to ascertain how grainsetron was used, and to document the incidence of adverse experiences in a clinical setting. Forty-nine oncologists at 40 Swiss centres were surveyed for their use of granisetron for the prevention and treatment of chemotherapy-induced nausea and vomiting. All were advised to follow the Swiss prescribing instructions for granisetron. They were invited to return data on patient demography, chemotherapy duration, granisetron dosing and adverse experiences. From 285 patients it was deduced that the mean daily dose of granisetron was 1.3 ampoules (3.9 mg) and the median daily dose was 1 ampoule (3 mg). The average number of doses of granisetron per patient per session was 3.8. There were 44 reports of adverse experiences by 34 patients, the most common report being headache. The survey confirmed that the large majority of patients undergoing chemotherapy required only a single dose of granisetron per day, and that the adverse experience profile was good.

Experience with parenteral and sequential parenteral-oral amoxicillin/clavulanate (augmentin) in hospitalized patients.

The efficacy and safety of sequential parenteral-oral Augmentin (amoxicillin plus clavulanic acid) therapy was evaluated in an open study with 249 adult patients in 18 Swiss hospitals. The patients were suffering from infections of the respiratory tract, skin and/or soft tissues, urinary tract, or female pelvic organs, and 36 had bacteraemia. One quarter of the patients treated were in a poor or critical condition. The overall bacteriological success rate was 94.1%. Augmentin achieved a satisfactory clinical response (cure or improvement) in 96.7% of the infections treated, with the following response rates for the five major categories of infection: respiratory tract infections 97.0%, urinary tract infections 97.8%, pelvic inflammatory disease 100%, septicaemia 91.4% and skin and soft tissue infections 95.7%. The observed adverse drug events include slight to moderate diarrhoea in 3.6% of the patients and skin reactions in 4.8%. It is concluded that Augmentin was an effective and safe treatment in this group of hospitalized patients.

Clinical experience with Timentin in severe hospital infections.

Sixty-four severe infections in hospitalized patients were treated with intravenous Timentin. Most patients (mean age: 50.5 years, range 18-85) had serious underlying conditions such as agranulocytosis, heart failure, cancer, diabetes mellitus, chronic alcoholism or other functional or anatomical abnormalities. Forty-three episodes were bacteriologically proved, and bacteraemia was diagnosed in 18. The sites of infection were: lower respiratory tract (10), upper respiratory tract (10), soft tissues (9), urinary tract (7), bones (6), peritoneal cavity (3), meninges (1) and pelvis (1). In addition, 13 episodes of fever and four of septicaemia in patients with agranulocytosis were treated with Timentin plus amikacin. Overall, 59% of the episodes were cured, 14% improved and 17% failed to respond. In 9% of cases the efficacy of the Timentin was unassessable mainly because of concurrent administration of other antimicrobials. Failure appeared to be more frequent in soft tissue and intra-abdominal infections, in patients infected with bacteria susceptible to Timentin but resistant to ticarcillin and in patients superinfected with Timentin-resistant strains. Major side effects were haemorrhagic diathesis with platelet dysfunction (1), severe water sodium overload (1), and possibly pancreatitis (1). Other side effects were mild: catheter-related phlebitis, and abnormal but clinically insignificant laboratory test results. Timentin appears to be an effective and safe broad-spectrum combination which compares favourably with third-generation cephalosporins in the treatment of severe hospital infections. More experience is needed to decide whether the somewhat lower response rate in patients infected with ticarcillin-resistant strains is significant.

Pharmacokinetics of a syrup formulation of amoxycillin-potassium clavulanate in children.

The pharmacokinetics of a syrup formulation consisting of four parts of amoxycillin and one part of potassium clavulanate (Augmentin) were studied in 11 paediatric patients, 3 to 14 years of age. Single oral doses of 25 mg of Augmentin per kg body weight (20 mg of amoxycillin per kg plus 5 mg of potassium clavulanate per kg, i.e. 1 mg of the syrup per kg) were administered on an empty stomach, and were well accepted and tolerated. Mean peak plasma concentrations 60-90 min after dosing were 7.2 mg/l for amoxycillin and 2.0 mg/l for clavulanic acid. Mean terminal phase plasma half-lives were 1.4 and 1.0 h, respectively. It is concluded that 25-mg/kg doses of this syrup formulation of Augmentin administered three times daily should be adequate therapy for various childhood bacterial infections.

Single-dose pharmacokinetics of intravenous clavulanic acid with amoxicillin in pediatric patients.

Pharmacokinetics of a parenteral formulation comprised of 5 parts of amoxicillin and 1 part of clavulanic acid were determined in 12 pediatric patients, 2 to 14 years of age. A single dose amounting to 25 mg of amoxicillin and 5 mg of clavulanic acid per kg of body weight was infused intravenously over 2 min. Mean plasma concentrations 5 min after dosing were 89.4 micrograms of amoxicillin per ml and 19.5 micrograms of clavulanic acid per ml. Terminal phase plasma half-lives were 1.2 and 0.8 h, respectively. The data acquired in this study indicate that amoxicillin and clavulanic acid are pharmacokinetically compatible. Moreover, taken with assessment of microbiological activities by others, the present data suggest that intravenous administration of 25 mg of amoxicillin plus 5 mg of clavulanic acid per kg every 6 h is a reasonable starting regimen for assessing the activity of the combined drug formulation in noninvasive childhood diseases caused by Haemophilus influenzae, Staphylococcus aureus, Streptococci spp., Neisseria spp., Branhamella catarrhalis, and other susceptible organisms.

Ullrich-Turner syndrome (45,X/46,X,i[Xq]) in a child with a familial inversion of chromosome 3.

We report a girl with shortness of stature and minor anomalies representing a mild form of the Ullrich-Turner syndrome. Cytogenetic studies showed 3 distinct anomalies: 1) a familial pericentric inversion, inv(3) (p25q21)pat, in all cells examined; 2) monosomy X (45,X) in 70% of cells; 3) isochromosome X (46,X,i(Xq)) in 30% of cells. The karyotype designation is: 45,X,inv(3) (p25q21)pat/46,X,i(Xq), inv(3) (p25q21)pat. The pedigree, which was originally interpreted as representing the segregation of a 2;3 translocation, is corrected and updated. Reproductive risks in families with pericentric inversions are discussed.

46,XY/48,XXY, +8 in a male with clinical and dermatoglyphic features of mosaic trisomy 8 syndrome.

A 15-year-old male was referred for management of scoliosis secondary to congenital vertebral anomalies. Cytogenetic analysis was performed because of multiple congenital malformations. The patient was found to have a mosaic 46,XY/48,XXY,+8 chromosome complement with the characteristic clinical and dermatoglyphic features of mosaic trisomy 8 syndrome.

Long arm deletion of chromosome 13 with exclusion of esterase D from 13q32 leads to 13qter.

A de novo partial 13q monosomy is reported in a severely affected 8-year-old female with the karyotype 46,XX,del(13)(q32). Abnormal features included mental retardation, delayed development, microcephaly, encephalocele, hearing loss, hypertelorism, ptosis, flat nasal bridge, protruding upper incisors, facial asymmetry, short neck, hypoplastic thumbs, scoliosis and clubfeet. The deletion was demonstrable by R-banding but was not apparent by GTG banding. The locus for esterase D (EC 3.1.1.1) is excluded from the deleted segment 13q32 leads to 13qter.

Trisomy 6q25 leads to 6qter in two sisters resulting from maternal 6;11 translocation.

Chromosome banding was used to define a partial duplication of the long arm of chromosome 6 (6q25 leads to 6qter) in two profoundly affected sisters and to identify their phenotypically normal mother and sister as balanced translocation carriers whose karyotypes were interpreted as 46,XX,t(6;11) (q25;q25). Prominent clinical features included profound mental retardation, hypertelorism, micrognathia, down-turned mouth, dental anomalies, clubfeet, webbed neck, late progressive scoliosis, flexion contractures, and low total finger ridge count. By comparison with published reports, it has been possible to establish a trisomy 6q25 leads to 6qter syndrome.

Abnormal dermatoglyphics in arthrogryposis multiplex congenita.

Dermatoglyphic abnormalities have been found in patients with arthrogryposis multiple congenita. These unusual features, which appear to be pathognomonic, indicate an early prenatal pathogenesis and may aid in differential diagnosis.