Comparison of the safety and efficacy of single injection of subtenon triamcinolone and topical dexamethasone in reducing postoperative inflammation after phacoemulsification and intraocular lens implantation.

OBJECTIVE: To compare the safety and efficacy of single injection of sub-tenon triamcinolone and topical dexamethasone in reducing post-operative inflammation after phacoemulsification and intraocular lens implantation. METHODS: The randomised controlled study was conducted at Khyber Teaching Hospital, Peshawar, Pakistan, from September 2013 to February 2014. Patients who had undergone uneventful phacoemulsification with intraocular lens implantation by the same surgeon were included. Patients in Group A received 0.1% dexamethasone eye drops and those in Group B received sub-tenon triamcinolone injection (40mg/1ml). Follow-up was at 1st day, 14th day and 6 weeks post-operatively. At follow-up visit, grades of anterior chamber cells and aqueous flare were examined with slit lamp, and intraocular pressure was recorded. RESULTS: Of the 108 patients, each group had 54(50%) subjects. The mean age was 58.87±9.69 years (range: 33 to 84 years) in Group A and 57.77±8.93 years (range: 30 to 78 years) in Group B (p=0.544). On the first post-operative day, all the patients in both groups had some degree of inflammation in the anterior chamber. On the 14th post-operative day, anterior chamber cells were present in 4(7.4%) eyes in Group A and in 3(5.55%) eyes in Group B (p>0.999), while aqueous flare was present in 5(9.25%) eyes in Group A and 9(16.66%) eyes in Group B (p=0.391). Six weeks after the operation, no anterior chamber cells or aqueous flare was seen in any eye in either group. CONCLUSIONS: Sub-tenon triamcinolone injection was found to be a safe and effective alternative to topical dexamethasone for control of post-operative inflammation after phacoemulsification.

D-Pinitol improves cognitive dysfunction and neuronal damage induced by isoproterenol via modulation of NF-κB/BDNF/GFAP signaling in Swiss albino mice.

Objectives: Neurological disorders are the world's most distressing problem. The adverse effects of current medications continue to compel scientists to seek safer, more effective, and economically affordable alternatives. In this vein, we explored the effect of D-Pinitol on isoproterenol-induced neurotoxicity in mice. Materials and Methods: Forty-two mice were randomly distributed into 7 groups each having 6 animals. Group I; received saline. Group II; received isoproterenol (ISO) 15 mg/kg/day, s.c. for 20 days. Group III, IV; received 50 and 100 mg/kg/day/oral of D-Pinitol, respectively along with ISO for 20 days. Group V; received D-Pinitol 100 mg/kg/day/oral for 20 days. Group VI; received propranolol 20 mg/kg/day/oral and ISO for 20 days. Group VII; received propranolol 20 mg/kg/day/oral for 20 days. On the 21st day after behavioral tests, blood was collected and mice were sacrificed for various biochemical, histopathological, and immunohistochemical analyses. Results: Chronic administration of isoproterenol caused neurotoxicity, cognitive dysfunction, and histopathological changes in the brain as evidenced by increase in GFAP, oxidative stress (via SOD, CAT, TBARS, and GSH), neuroinflammation (NF-kB, TNF-α, IL-6, and IL-10), and decrease in AchE and BDNF. Co-administration of D-Pinitol (100 mg/kg) significantly prevented these pathological alterations. The cognitive improvement was also observed through the forced swim test, elevated plus maze test, and rotarod test. Conclusion: Our findings on D-Pinitol thus clearly established its neuroprotective role in ISO-induced neurodegeneration in Swiss albino mice.

Clinicopathological analysis of malignant eyelid tumours in north-west Pakistan.

OBJECTIVE: To analyse the demography, mode of presentation, gross morphology, histopathological diagnosis and subsequent course of malignant eyelid tumours in north-west Pakistan. METHODS: The retrospective observational study was performed at the Department of Ophthalmology, Khyber Teaching Hospital, Peshawar, from January 2007 to July 2010, and comprised data related to 222 patients. Charts of patients with malignant eyelid tumours admitted to the department during study period were reviewed. Patients' demographic data, gross and microscopic features of the tumours and their subsequent course of treatments were recorded. SPSS 14 was used for statistical analysis. RESULTS: Of the total, 122 (54.1%) patients were male and 102 (45.9%) were female. Mean age of all patients was 59.3 +/- 14.2 years. Among the patients, 73 (32.9%) had the involvement of the lower lid; 57 (25.7%) the upper lid; 18 (8.11%) the medial canthus; 2 (0.9%) the lateral canthus; and 72 (32.4%) had more than one region involved. On histopathology, basal cell carcinoma was the most common (n= 131; 59%), followed by squamous cell carcinoma in 70 (31.5%), sebaceous gland carcinoma in 15 (6.8%), malignant melanoma in 3 (1.3%) and undifferentiated carcinoma in 3 (1.3%) cases. Of the total tumours, 164 (73.87%) did not spread, and 58 (26.13%) spread either locally or distantly. CONCLUSION: Basal cell carcinoma was is the most common malignant eyelid tumour in the study. Squamous cell carcinoma, which was second, was found to be more common in north-west Pakistan than in any other part of Asia, while the sebaceous gland carcinoma was relatively less common.

Ocular injuries in blast victims.

OBJECTIVE: To study the type and severity of ocular injuries in blast victims. METHODS: It was a descriptive case series. The study was conducted at the Department of Ophthalmology, Khyber Teaching Hospital and Iqbal Eye Clinic Peshawar from March 2010 to May 2011. Detailed history was taken and complete ocular examination was done. B-scan was done to know about any posterior segment pathology (when required). Digital X-ray orbit and/or computed tomography were done to rule out intraocular foreign body. The treatment and follow up varied according to the type and extent of eye injury. RESULTS: Total number of patients were 79, 78 (98.73%) males and 1 (1.26%) female. Mean age of patients was 23.43 +/- 10.67 years. Ocular injury was unilateral in 50 (63.29%) and bilateral in 29 (36.70%) patients. Forty-one (37.96%) eyes had closed globe injury and 67 (62.03%) had open globe injury. The most common type of injury was corneal/scleral perforation (48.14%) followed by vitreous haemorrhage (38.88%) and traumatic cataract (30.55%). The most commonly performed surgery was corneal/scleral repair (in 33 eyes). Final best corrected visual acuity (BCVA) improved in 56 (51.85%) eyes, remained unchanged in 49 (45.37%) eyes and worsened in 03 (2.77%) eyes. CONCLUSION: Blast related ocular injuries are becoming increasingly common. In severely injured eyes the visual prognosis remains poor despite development of advanced microsurgical techniques and better methods of visual rehabilitation.

Tourist experience at port and town: assessing cruiser satisfaction during self-organized onshore excursions at Lautoka Port, Fiji, in 2018-2019.

Fiji is regarded as a South Pacific paradise; it attracts many tourists and cruisers desirous of a one-of-a-kind, memorable and long-lasting experience. The archipelago has witnessed an unprecedented rate of development in the cruise industry in the last decade, with an increase in the number of cruise liners as well as cruisers, especially those who take a halt for less than a half-day at a port and thus gain experience as tourists in Fiji. Cruisers opt for either pre-booked tours (booking made before disembarking) or self-organized excursions. Their experience during self-organized excursions at Fiji ports has not been studied so far. This study attempts to fill in this research gap. The study carries out a statistical analysis of the empirical data on cruisers' feedback on onshore experiences. This data was collected through a questionnaire survey of 369 cruisers who enjoyed self-organized excursions at Lautoka port anytime between December 2018 and April 2019. The study uses a Likert-type scale to measure cruiser's satisfaction; it carries out principal component analysis with Varimax Kaiser normalization and SPSS (demo); it further uses a factor analysis model to make observations. The results of this study indicate that cruiser satisfaction and behaviour are positively or adversely affected by many socio-cultural and economic factors. The study puts forward some constructive suggestions to achieve high satisfaction among cruisers.

In-silico Validation of the Proposed Treatment Strategy of Periodontitis.

OBJECTIVE: The present study aims to assess a proposed treatment approach or therapy for periodontitis by using the in-silico technique. The proposed treatment strategy offers a singular vehicular system consisting of minocycline (antibiotic), celecoxib (selective COX-II inhibitor), doxycycline hyclate (matrix metalloproteinase inhibitor), and hydroxyapatite (osteogenic agent). MATERIAL AND METHODS: Molecular docking studies of drugs were performed using Maestro version 9.4 software Schrödinger, and 3-Dimensional Crystallographic X-ray protein structures of targeted proteins were downloaded from RCSB protein data bank in .pdb file format. These agents were docked, and their affinities towards the receptors/protein/enzyme were calculated. Furthermore, their affinities were compared with the standard drug. RESULTS: The study suggests that minocycline and metronidazole possess equal affinity towards the RGPB and Inlj protein of P.gingivalis. Celecoxib, a well-known inhibitor of the COX-II enzyme, showed very high affinity. Selective inhibitor of MMP-8 possessed higher affinity than doxycycline, whereas CMT-3 showed equal affinity as doxycycline for MMP-13. Similarly, hydroxyapatite and simvastatin also showed a comparatively similar affinity for osteopontin receptor. CONCLUSION: Based upon molecular docking results, it can be concluded that the proposed treatment strategy would be a suitable approach for periodontitis and all the selected therapeutic agents have potential similar to the standard drugs, thereby constituting a reliable system for periodontitis.

How do political coups disrupt Fiji's tourism? Impact assessment on ecotourism at Koroyanitu National Heritage Park (KNHP), Abaca.

The nexus between mass tourism and politics has been widely validated in tourism literature; nonetheless, the impacts of political putsches on ecotourism are understudied in the context of the Pacific Islands, i.e., Fiji. This study aims to investigate how Fiji's political upheavals impacted ecotourism after examining ecotourist arrivals and revenue generated at KNHP from its inception till 2018. Additionally, it presents a comparative analysis of Fiji coups on tourism and ecotourism and examines the recovery pattern of ecotourism in the post-coup stage. The study implies both empirical and non-empirical methods. This research is based on field visits to the Abaca ecotourism project, Lautoka, from 2017 to 2019, and has employed quantitative data of Abaca's tourist revenue records; supplemented by conducting oral unstructured interviews of the Abaca project manager through talanoa sessions. The collected data were analyzed using Microsoft Excel 2010 and STATA and Augmented Dickey Fullar (ADF) test to check the stationarity. The research has defied the antecedent arguments of the failure of ecotourism projects in Fiji and made a first-ever comparative analysis of ecotourism data with mass tourism in relation to post-coup recovery tenure. It postulates an apparent correlation of the success of this ecotourism park with the democratically elected government of Fiji. The Abaca ecotourist park displayed potential to emerge as an ecotourism hub in the entire South Pacific, provided the democratically elected government could sustain in Fiji, which has been tagged as 'coup-coup land'. Henceforth, this study can be replicated for similar destinations in the world.

Investigating stress, anxiety, social support and sex satisfaction on physical education and sports teachers during the COVID-19 pandemic.

Academia was no exception to the widespread impact of Coronavirus Disease (COVID-19). There is only a small amount of research conducted with regard to the consequences of the Pandemic in Fiji. Thus, in order to gather a longitudinal dataset, a cross-sectional survey was conducted from February to August 2020. 300 physical education and sports teachers used Google Forms to complete an online survey. There are questions on the form about age, gender, marital status, and other daily activities. A similar survey was conducted to study the long-term psychological effects (coronavirus fear and fascination with COVID-19). The characteristics of society have been explored. Efforts have been made to use different sets of psychological data, showing the anticipated results. Sex, age, marital status, and family type are significantly affected by stress, anxiety, sexual satisfaction, and social support. There is a substantial difference between marital status, gender, and social support when it comes to the Pandemic. According to research findings, fifty per cent of secondary school physical education and sports teachers in Fiji may have been affected by the Pandemic. Considerations should be taken to keep teachers calm during a pandemic. Because of this, it is necessary to submit some practical recommendations in order to minimize the adverse effects of this problem.

3-arylidene-5-(4-isobutylphenyl)-2(3H)-furanones: a new series of anti-inflammatory and analgesic compounds having antimicrobial activity.

An ideal anti-inflammatory drug should have the desired effect in minimum dose with minimum side effects. Antimicrobial actions associated with such agents will be an added advantage as they broaden the spectrum of the compounds. Promising anti-inflammatory and antimicrobial activity together with low ulcerogenic properties of some 2(3H)-furanones, synthesized in our previous study, prompted us to investigate the effect of the isobutyl group on their pharmacological profile. Since compounds 3, 9, 13, and 14 have both anti-inflammatory and analgesic effects in addition to low ulcerogenic incidence, they were selected for investigation of their inhibitory effects on various cyclo-oxygenase enzymes. It was found that they were more selective toward COX-2 enzymes. An MIC of 6.25 microg/mL was recorded for compounds 3, 13, and 14 against S. aureus, E. coli, R. oryza, and P. citrum. The study supports the development of furanone derivatives as potential anti-inflammatory agents with antimicrobial activity.

Adjustments of serum lactate dehydrogenase isoenzymes and their significance in monitoring the treatment in patients with tubercular pyothorax.

The adjustments and diagnostic significance of polyacrylamide gel electrophoretic (PAGE) profiles of lactate dehydrogenase isoenzymes (LDH: 1.1.1.27) was evaluated in the sera and pleural fluid of patients with tubercular pyothorax. Sera and pleural fluid samples were randomly collected from 72 and 18 patients respectively at two different timings; first, when patients were admitted to the Hospital and second, after an intensive phase of treatment. Sera of 20 healthy individuals served as control. Our results demonstrate significant differences in sera LDH (sLDH) and pleural fluid LDH (pfLDH) isoenzymes. In patients the order of LDH isoenzyme in sera and pleural fluid followed: LDH-5>-4>-2>-3>-1 and LDH-5>-4>-3>-2>-1 respectively. The ranking of activity levels in control was LDH-2>-1>-3>-5>-4. In the second phase of sampling from 31 patients, values of sLDH isoenzymes showed recovery and resembled profiles of controls. Therefore, the sLDH zymograms of patients can be used as the prognostic marker, since they tend to reach the normal level during recovery signifying the effect of chemotherapy in hospitalized patients. Moreover, according to the present findings on LDH-PAGE profiles, the levels of LDH-5 and-4 rise in pyothorax patients significantly (P<0.05). This elevation along with the rise in total LDH activity may, therefore, be used in the diagnosis and monitoring of tubercular pyothorax.

Malaria: hitches and hopes.

Malaria, a devastating infectious disease caused by parasites of Plasmodium genera is transmitted from person to person through bites of infected mosquitoes. It generally traps underdeveloped nations with poor infrastructure and high population density. It has attracted considerable attention from academic institutions, pharmaceutical industries and government agencies but the efforts to eradicate this threat face a number of technical, economic, financial and institutional hurdles. In the absence of clinically proven vaccines to combat malaria, chemotherapy continues to be the best available option, although it suffers from a big loophole of resistance. Emergence of resistance is associated with the two phases of Plasmodium's life cycle: asexual in humans and sexual in mosquito, which are intricate to target simultaneously. Consequently, the search for novel antimalarial agents is a never-ending task for scientists and chemists. This review aims at highlighting the currently used antimalarial agents, targets for the therapy and present scenario in the development of new antimalarial drugs to combat this global problem.

Comparison of the efficacy of subtenon with peribulbar local anesthesia without hyaluronidase in patients undergoing cataract surgery.

OBJECTIVE: To compare the efficacy of subtenon with peribulbar local anesthesia without hyaluronidase in patients undergoing cataract surgery. STUDY DESIGN: A randomized controlled trial. PLACE AND DURATION OF STUDY: Eye "B" Unit, Khyber Teaching Hospital, Peshawar, from October 2009 to October 2010. METHODOLOGY: Patients undergoing cataract surgery were divided into two groups. Group A received subtenon anesthesia and group B received peribulbar anesthesia. Pain score, akinesia and intraocular pressure were compared in the two groups. Statistical Package for Social Sciences-14.0 was used for data analysis. RESULTS: There were 304 patients, 152 patients in each group. At the time of injection, there was less pain in group A as compared to group B (p < 0.001). At the time of surgery and till 90 minutes after administration of anesthesia, there was no significant difference in pain between the 2 groups (p = 0.999 and 0.59 respectively). Group A had better akinesia as compared to group B (p = 0.04). There was a greater rise in mean intraocular pressure just after injection in group B as compared to group A (p < 0.001); in both groups, the intraocular pressure declined to its base level 10 minutes after the injection (p = 0.52). CONCLUSION: Subtenon anesthesia is less painful at the time of its administration, provides better akinesia and leads to smaller rise in intraocular pressure just after the injection than peribulbar anesthesia.

Novel hydrazine derivatives as selective DPP-IV inhibitors: findings from virtual screening and validation through molecular dynamics simulations.

The present study demonstrates and validates the discovery of two novel hydrazine derivatives as selective dipeptidyl peptidase-IV (DPP-IV) inhibitors. Virtual screening (VS) of publicly available databases was performed using virtual screening workflow (VSW) of Schrödinger software against DPP-IV and the most promising hits were selected. Selectivity was further assessed by docking the hits against homology modeled structures of DPP8 and DPP9. Two novel hydrazine derivatives were selected for further studies based on their selectivity threshold. To assess their correct binding modes and stability of their complexes with enzyme, molecular dynamic (MD) simulation studies were performed against the DPP-IV protein and the results revealed that they had a better binding affinity towards DPP-IV as compared to DPP 8 and DPP 9. The binding poses were further validated by docking these ligands with different softwares (Glide and Gold). The proposed binding modes of hydrazines were found to be similar to sitagliptine and alogliptine. Thus, the study reveals the potential of hydrazine derivatives as highly selective DPP-IV inhibitors.

Vogt Koyanagi Harada disease: treatment and visual prognosis.

Vogt Koyanagi Harada (VKH) disease is a chronic, bilateral, granulomatous panuveitis associated with central nervous system, auditory and integumentary manifestations. The study was conducted from January 2001 to December 2010 at the Department of Ophthalmology, Khyber Teaching Hospital, Peshawar. A total of 9 patients with diagnosis of Vogt Koyanagi Harada disease were included in the study. Extracted data included age, gender, duration of disease, initial and final visual acuities, treatment and complications. Initial visual acuity was ranging from 6/24 to perception of light. All the patients were treated with systemic and topical corticosteroids. In addition, one patient also received cytotoxic therapy. Final visual acuity was 6/18 or better in all cases (100%). One patient developed bilateral cataract, glaucoma and subretinal fibrosis at the macula. The cataract and glaucoma were managed as per established protocols. The visual prognosis of Vogt Koyanagi Harada disease is generally favourable if the disease is identified early and adequately treated and the associated complications are addressed properly.