Reading eye movements among homonymous hemianopia.

PURPOSE: To measure the reading eye movement's parameters and quantify the oculomotor dysfunction among subjects with homonymous hemianopia compared to age-matched controls using ReadAlyzer. METHODS: This was a prospective study carried out in the neuro-optometry clinic of a tertiary eye care hospital in South India, from October 2018 to Janurary 2019. Fifty consecutive patients diagnosed with homonymous hemianopia were enrolled in the study after obtaining their written informed consent. Reading eye movements were measured using ReadAlyzer in patients with homonymous hemianopia and age-matched controls. Reading eye movement parameters were represented in median [interquartile range (IQR)]. RESULTS: Subjects with homonymous hemianopia showed increased number of fixations/100 words- median (IQR) [175 (80-270)] compared to controls [91 (52.5-127.5)]; increased number of regressions/100 words [33 (-13-79)] compared to controls [18 (-10-46)]; and reduced reading rate [93 (46-140) words/min] compared to controls [186 (144-228) words/min] (Mann-Whitney U test, P ≤ 0.05). Similar trend was observed for grade level equivalent 2 (0-4) and regression to fixation ratio 15 (1-29) compared to controls [grade equivalent 7 (3-11) and regression to fixation ratio 11 (-2-24)] (Mann-Whitney U test, P ≤ 0.005). CONCLUSION: Reading eye movements assessed using ReadAlyzer are found to be significantly impaired among homonymous hemianopias compared to age-matched controls (Mann-Whitney U test, P ≤ 0.05).

Efficacy of Neuro-Optometric visual rehabilitation in Homonymous Hemianopia.

OBJECTIVES: To assess oculomotor dysfunction and the effectiveness of neuro-optometric visual rehabilitation in improving oculomotor parameters in participants with homonymous hemianopia. MATERIALS AND METHODS: Fifty subjects diagnosed with homonymous hemianopia (HH), referred through the neuro-ophthalmology department, were recruited for the study. All the subjects underwent a detailed neuro-optometric evaluation that included testing for sensory, visuo-motor and oculomotor functions. Subjects with homonymous hemianopia were then prescribed with yoked prisms and were randomized to two treatments at one month, namely group 1: yoked prisms (n = 15) and group 2: yoked prisms with in-office visual search training (n = 15). RESULTS: The mean ± SD age of the subjects was 46 ± 12 years. Subjects with HH exhibited a significant delay in the completion time, response and accuracy of tasks on proactive, saccadic and visual search parameters using the SVI compared to age-matched controls (Independent t-test, p < 0.05). A significant improvement in the reading speed and visual search parameters (RM ANOVA, p < 0.001) was seen post neuro-optometric visual rehabilitation with both yoked prisms and SVI. Statistically significant differences were observed in the reaction time of the visual search paradigms between the two rehabilitative modalities yoked (group1), yoked and SVI (group2) (Mann-Whitney U test, p < 0.001), with the group 2 showing better visual search performance outcomes compared to group 1 (yoked). CONCLUSION: Visual search parameters among participants with homonymous hemianopia improved following combined rehabilitation (yoked prisms and visual search trainng).

Designing an efficient multi-epitope vaccine against Campylobacter jejuni using immunoinformatics and reverse vaccinology approach.

Campylobacterjejuni causes acute diarrhea as a leading cause of morbidity and mortality in children especially in the developing countries of Asia and Africa. C.jejuni has been identified as a member of the priority pathogens category due to the sudden emergence of multidrug-resistant isolates. Therefore, it is important to develop a protective vaccine against this pathogen. In the present study, the Reverse vaccinology approach was used to identify vaccine targets from the proteome of diarrheagenic C. jejuni strain NCTC11168 for the development of chimeric vaccine candidates against C. jejuni. Pathogen proteins that have adhesin like properties and role in virulence but not present in the human host were selected for the design of a multi-epitope vaccine. MHC class I & II and B-cell epitopes present in the selected vaccine target proteins were screened using different immunoinformatics tools. The commonly predicted epitopes from their corresponding different servers were selected and further shortlisted based on their immunogenicity, antigenicity, and toxicity analysis. Shortlisted peptides were joined by GPGPG linkers to design a multi-epitope vaccine construct. Immune-modulating adjuvant monophosphoryl lipid sequence was added with the vaccine construct's N terminal using EAAAK linkers to enhance the immunogenicity. The designed vaccine construct was evaluated by antigenicity, allergenicity, solubility, and physicochemical analysis using various bioinformatics tools. A three-dimensional model of vaccine construct was modeled by the Phyre2 server and refinement by the GalaxyRefine tool. Constructed model quality was validated by the ProSA-web error-detection tool and the Ramachandran plot. After that vaccine model was docked with TLR-4 protein and complex stability confirmed by molecular dynamics simulation studies. Finally, In-silico cloning of vaccine constructs into a vector was performed to ensuring its effective expression in the microbial system.

Predictive Model for Ambulatory Hypertension Based on Office Blood Pressure in Obese Children.

Background: The epidemic of obesity, along with hypertension (HT) and cardiovascular disease, is a growing contributor to global disease burden. It is postulated that obese children are predisposed to hypertension and subsequent cardiovascular disease in adulthood. Early detection and management of hypertension in these children can significantly modify the course of the disease. However, there is a paucity of studies for the characterization of blood pressure in obese children through ambulatory blood pressure monitoring (ABPM), especially in the developing world. This study aims to characterize ambulatory blood pressure in obese children and to explore feasibility of using office BP that will predict ambulatory hypertension. Methods:In the present study, 55 children with a body mass index (BMI) in the ≥95th percentile for age and sex were enrolled in a tertiary care hospital and underwent 24 h of ABPM and detailed biochemical investigations. Results:Ambulatory hypertension was recorded in 14/55 (25.5%; white coat hypertension in 17/29 (58.6%) and masked hypertension in 2/26 (7.69%). For office SBP percentile the area under curve (AUC) was 0.773 (95% CI: 0.619-0.926, p = 0.005) and for office DBP percentile the AUC was 0.802 (95% CI: 0.638-0.966, p = 0.002). The estimated cut offs (Youden's index) for office blood pressure which predicts ambulatory hypertension in obese children were the 93rd percentile for systolic BP (sensitivity-67% and specificity-78%) and the 88th percentile for diastolic BP (sensitivity-83% and specificity-62%). Conclusion:Ambulatory blood pressure abnormalities are highly prevalent among children with obesity. Office blood pressure did not accurately predict ambulatory hypertension. More than half of the children labeled as "hypertension" on office blood pressure measurement in the study were diagnosed to have white coat hypertension (WCH), thus emphasizing the role of ABPM for evaluation of WCH before the child is subjected to detailed investigations or started on pharmacotherapy.