Femtosecond laser versus manual dissection for top hat penetrating keratoplasty.

AIM: To compare the outcomes of IntraLase-enabled top hat penetrating keratoplasty (IEK) versus retrospective results of manual top hat penetrating keratoplasty (TH-PKP) and conventional PKP. PATIENTS/METHODS: This non-randomised prospective study included 94 eyes: 23 eyes underwent IEK, 36 TH-PKP and 35 conventional PKP. Preoperative and postoperative manifest refraction, uncorrected and best-spectacle corrected visual acuity (BSCVA), high-order ocular aberrations (HOA), endothelial cell counts and complications were analysed. RESULTS: At 12 months of follow-up, the mean log MAR BSCVA was 0.32 (SD 0.31) in the IEK group, 0.53 (0.36) in the TH PKP group (p = 0.03) and 0.39 (0.30) in the conventional PKP group (p = 0.4). The mean spherical equivalent was similar between the groups and was less than -2.2 dioptres. The mean cylinder was similar in the IEK and conventional PKP group (3.6 (1.9) dioptres and 4.1 (1.8) dioptres, respectively), and was significantly lower than the TH-PKP group (5.1 (3.2) dioptres, p = 0.04). The complications rate and high-order ocular aberrations were similar between the three groups studied. The mean endothelial cell loss was significantly lower at 12 months of follow-up in the IEK and the TH-PKP groups versus conventional PKP (32.4% and 22.3% vs 40.8%, respectively) (p = 0.05). The mean time to suture removal was 4.1 (1.2) months in the IEK group and 3.9 (1.5) months in the TH-PKP group versus 9.7 (1.1) months in the conventional PKP group (p<0.0001). CONCLUSIONS: IEK is a safe and stable procedure. It results in higher endothelial counts and faster suture removal in comparison with the conventional PKP, and has less astigmatism and better BSCVA in comparison with the manual TH-PKP.

A comparative study of three different doses of 0.5% hyperbaric bupivacaine for spinal anaesthesia in elective caesarean section.

We conducted a double-blind comparison of three doses (7.5 mg, 8.75 mg and 10 mg) of 0.5% hyperbaric bupivacaine in women undergoing elective caesarean under spinal anaesthesia. Sixty women were randomised into 3 groups of 20. Group A received 7.5 mg, group B 8.75 mg and C 10 mg of study drug. The time to maximum sensory blockade did not differ among the groups (P > 0.05). Mean time to start of regression of sensory block was greater in group C than in groups A and B (P < 0.001 and P < 0.05 respectively). Time required for complete regression of sensory block was longer in group C than in groups A and B (P < 0.001). Duration of motor block was greater in group C than in groups A and B (P < 0.001 and < 0.05 respectively). Neonatal outcome was good in all the groups. None of the patients in any group experienced pain before delivery. After delivery of the baby, however, group C women had a lower incidence of visceral pain than did groups A and B (P < 0.05). The incidence of hypotension was greater in groups B and C than in group A (P < 0.05). Group C women had a greater incidence of bradycardia than did groups A and B (P < 0.05). The 7.5-mg dose of 0.5% hyperbaric bupivacaine was observed to provide acceptable analgesia without any significant incidence of adverse effects such as maternal hypotension or bradycardia.

Knowledge, attitudes and practices of newly diagnosed sputum positive cases of pulmonary tuberculosis.

Lack of awareness of risk posed to the community by a sputum positive case of Pulmonary Tuberculosis (PTB) is an impediment in the control of Tuberculosis. A study involving 212 newly diagnosed sputum positive patients aged 15 years or more, revealed that only 9% of the patients knew correctly the cause of PTB. Knowledge about mode of spread of the disease was not known to 49% of patients. Awareness regarding the investigations like chest X-ray and sputum examination was high as 70% but utility of sputum examination was known to only 29% of the patients. Awareness of harmful sequelae of inadequate and incomplete treatment was as high as 93% but knowledge per se of adequate duration of treatment was poor in a half (50%) of the subjects. Attitude towards domiciliary treatment was generally positive (88%) Practices regarding safe sputum disposal and preventive measures practised in the families were poor in nearly two third's of patients. Health education efforts need to be strengthened to create better awareness of these important aspects of tuberculosis diagnosis, treatment and control.

Folic acid and prevention of neural tube defects: a study of Canadian mothers of infants with spina bifida.

OBJECTIVES: To determine the diffusion of information about preventing neural tube defects (NTDs) through folic acid consumption by examining whether mothers of Canadian children born with spina bifida, who had become pregnant at least a year after evidence of the preventive effect of folic acid had been published, had taken sufficient amounts of folic acid in the periconceptional period and were aware of this important new information. DESIGN: Validated food-frequency questionnaire to assess folate intake. SETTING: The Hospital for Sick Children in Toronto between Jan. 4 and Aug. 16, 1994. PARTICIPANTS: Thirty mothers whose infants were being treated for spina bifida. MAIN OUTCOME MEASURES: The mothers' mean folate intake and knowledge about the protective effect of folic acid; demographic and health information. RESULTS: The mothers' mean folate intake was 0.182 mg/d (standard deviation 0.076 mg/d, range 0.02 to 0.53 mg/d), less than half the protective dose. Only 4 (13%) of the mothers had been aware of the relation between nutritional folate and NTDs when they conceived, but even they did not supplement their diets with sufficient folic acid. The medical data showed that, in addition to the failure of primary prevention of NTDs, secondary prevention through diagnostic tests during pregnancy were also inadequate. CONCLUSIONS: Our study, one of the first to be conducted after the role of folate in preventing NTDs was confirmed, reveals that, in one of the most advanced countries in the world, this new information has had no effect on patients' folate intake. Unless food is fortified with folate, the estimated 400 to 800 annual cases of NTDs in Canada will not be prevented.