Stress and psoriasis: Exploring the link through the prism of hypothalamo-pituitary-adrenal axis and inflammation.

BACKGROUND: Psoriasis is an immune-mediated, chronic inflammatory disease affecting mainly the skin. Chronic stress leads to the blunted hypothalamic-pituitary-adrenal axis (HPA) that might induce pro-inflammatory conditions. Hence, we assessed the blood levels of the HPA hormones and interleukin-17 (IL-17) and the effect of stress and emotional distress to understand the link between stress and psoriasis better. METHODS: This cross-sectional study included 45 patients with psoriasis and 45 age and gender-matched apparently healthy volunteers (n = 45). IL-17, cortisol, and adrenocorticotrophic hormone (ACTH) levels were assessed in both groups. Psoriasis Area Severity Index (PASI) was used to assess disease severity. Presumptive Stressful Life Events scale [PSLE], Perceived Stress scale [PSS] and Daily Hassles and Uplifts Scale [DHUS] scoring were used to assess stress levels and emotional distress. RESULTS: Patients with psoriasis had higher levels of IL-17 and ACTH and lower levels of cortisol, as compared to controls. Stress scores (PSS, PSLE & DHUS) were significantly elevated in cases, as compared to the controls. IL-17, ACTH and stress scores showed a significant positive correlation with one another and a significant negative correlation with cortisol levels. They also showed a significant positive correlation with PASI, while cortisol levels showed a significant negative correlation. CONCLUSION: Psoriasis patients having high ACTH, IL-17 and stress scores had lower levels of cortisol, indicating a dysregulated HPA axis with the pro-inflammatory state. This might lead to exacerbation of psoriatic flares, which needs investigation in further prospective studies.

Interleukin-9 serves as a key link between systemic inflammation and angiogenesis in psoriasis.

BACKGROUND: Psoriasis is a T helper cell-mediated chronic immune-mediated inflammatory disease affecting mainly the skin, although systemic pathological effects are also observed. Cytokine-mediated interaction between T lymphocytes and keratinocytes lead to excessive proliferation of keratinocytes, which in turn leads to formation of a proinflammatory milieu and finally to psoriatic plaque formation. AIM: To measure interleukin (IL)-9, IL-17 and vascular endothelial growth factor (VEGF) levels in patients with psoriasis compared with controls, and to evaluate the effect of methotrexate (MTX) monotherapy on the aforesaid cytokine levels in psoriasis. METHODS: This cohort study included 54 patients with psoriasis and 54 age- and sex-matched healthy controls (HCs). IL-9, IL-17 and VEGF levels were measured by using commercially available ELISA kits. Patients with psoriasis who were on MTX monotherapy were followed up for a period of 3 months. RESULTS: Patients with psoriasis had increased levels of IL-9, IL-17 and VEGF at baseline, compared with the HC group. After 3 months of MTX monotherapy, Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI) and levels of cytokines (IL-9, IL-17 and VEGF) were significantly decreased compared with baseline. PASI and DLQI at baseline also showed a positive correlation with IL-9, IL-17 and VEGF. CONCLUSION: Our results suggest the existence of a proinflammatory milieu in psoriasis, with increased levels of IL-9, IL-17 and the proangiogenic growth factor VEGF, showing an increasing trend with increasing disease severity and impaired quality of life (QoL). MTX treatment helps to reduce levels of IL-9, IL-17 and VEGF, thereby limiting disease progression and improving QoL in psoriasis.

Dataset on the assessment of water quality of ground water in Kalingarayan Canal, Erode district, Tamil Nadu, India.

This data article aimed to investigate the quality of ground water in Kalingarayan Canal for the analysis of pollution level, Tamil Nadu. In order to understand the pollution status of the canal, nine ground water samples (GW1- GW9) were collected from the downstream side of the canal during the period between January 2014 - December 2016. Nine stations were selected along the Kalingarayan Canal, and ground water samples were collected on a monthly basis from these stations. The parameters like pH, electrical conductivity (EC), total dissolved solids (TDS), chlorides, total hardness (TH) nitrates, sulphates, sodium, calcium and magnesium were analyzed to observe the current status of the groundwater quality. Also, the groundwater quality is expressed in terms of Water Quality index (WQI). The APHA method was applied to determine the physico chemical parameters of the water samples. From the investigation, WQI reflects a low quality of groundwater in sampling stations Kolathupalayam (GW3) and Perumparai (GW6) which is mainly contaminated with nitrate and the water is found to be very hard in nature. Also, it was observed that calcium and magnesium content in groundwater is very high at certain stations. Most of the groundwater from this place cannot be used for any kind of industrial processes and human consumption without proper treatment.

Asymmetric dimethylarginine and angiopoietin-like protein-2 are independent predictors of cardiovascular risk in pre-dialysis non-diabetic chronic kidney disease patients.

BACKGROUND: Chronic kidney disease (CKD) is associated with increased cardiovascular (CVD) morbidity and mortality. Hence, this study was carried out to assess the biomarkers of endothelial dysfunction and inflammation as predictors of CVD risk in Indian patients with CKD. METHODS: In this case control study, we recruited 43 patients with CKD and 43 healthy control volunteers. Circulating levels of endothelial dysfunction markers [asymmetric dimethylarginine (ADMA), angiopoietin-like protein-2 (ANGPTL2), matrix metallopeptidase 9 (MMP-9)] and systemic inflammation [high-sensitivity C-reactive protein (hs-CRP)] were assessed in the study population. All study participants underwent brachial artery flow mediated dilation (FMD) to estimate endothelial dysfunction. Disease severity (e-GFR) was assessed by a nephrologist. RESULTS: CKD patients showed markedly elevated levels of ADMA, ANGPTL2, MMP-9, and hs-CRP. FMD and eGFR were significantly decreased in cases, as compared to the controls. ADMA, ANGPTL2, MMP-9 and hs-CRP showed significant positive correlation with one another and significant negative correlation with FMD and disease severity. We also observed a significant negative correlation of FMD with disease severity and duration of CKD. In the multiple linear regression model, ADMA and ANGPTL2 were found to be independent predictors of FMD. CONCLUSION: In CKD patients, there is significantly increased endothelial dysfunction and systemic inflammation, which showed a positive correlation with disease severity. Thus, the markers of endothelial dysfunction such as ADMA and ANGPTL2 can be used as predictors of CVD risk in CKD.

Assessment of bone turnover markers to predict mineral and bone disorder in men with pre-dialysis non-diabetic chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) is commonly associated with disturbances in mineral metabolism and bone disease. Bone biopsy is the gold standard in diagnosing mineral bone disorder. Hence the search for non-invasive assessment of bone health gains importance. We undertook to assess the bone health in men with stage 4 and 5 chronic kidney Disease. METHODS: We recruited 32 male subjects with Stage 4 and 5 chronic kidney disease and 32 age-matched healthy male controls. 25-hydroxyvitamin D, intact parathyroid hormone, and bone-specific alkaline phosphatase were assayed. Bone mineral density (BMD) was estimated using dual-energy X-ray absorptiometry. RESULTS: CKD is associated with significantly higher levels of bone-specific alkaline phosphatase and intact parathyroid hormone and lower levels of 25-hydroxyvitamin D and bone mineral density, when compared to controls. In the multivariate linear regression model, bone-specific alkaline phosphatase emerged as an independent predictor of reduced BMD. Receiver Operator Characteristic analysis for prediction of reduced BMD in CKD showed both intact parathyroid hormone and bone-specific alkaline phosphatase have significant predicting power. CONCLUSION: The combination of bone-specific alkaline phosphatase and intact parathyroid hormone has more significant predicting power and is a more reliable index for non-invasive assessment of bone health in men with chronic kidney disease, than either marker when used alone.

Is the first post-operative day review necessary following uncomplicated phacoemulsification surgery?

PURPOSE: To assess the necessity for first post-operative day review in determining the need for post-operative intervention in patients who had uncomplicated phacoemulsification surgery. METHODS: A retrospective study was carried out to review the first post-operative day findings in patients who underwent uncomplicated phacoemulsification surgery by a single surgeon between January 1997 and March 1998. The findings analysed were wound integrity, corneal clarity, anterior chamber activity, intraocular pressure and the intraocular lens status. The need for medical or surgical intervention was also analysed. Those eyes that had coexisting ocular pathology such as glaucoma, ocular hypertension, uveitis, trauma or previous intraocular surgery were excluded from the study. Fisher's exact test was used to compare the difference between the groups. RESULTS: Seventy-one eyes of 71 patients who underwent an uncomplicated phacoemulsification procedure were included in the study. Intraocular pressure of 30 mmHg or greater was found in 7 eyes (10%), all of which also had corneal oedema. These patients received acetazolamide SR 250 mg twice daily for 3 days. Another 21 eyes (30%) had corneal oedema for which no specific treatment was given. The intraocular pressure had returned to baseline and corneal oedema resolved by the first clinic follow-up in 1-2 weeks. None of the 71 patients needed surgical intervention in the post-operative period. CONCLUSION: First post-operative day review is necessary as it gives an opportunity to manage the post-operative rise in intraocular pressure.

A clinical evaluation of diclofenac-gentamicin combination eye drops in the control of inflammation after cataract surgery. Diclofenac-Gentamicin versus Gentamicin Study Group.

The purpose of this study was to compare the efficacy and safety of diclofenac-gentamicin (DR 1352/1) combination eye drops with gentamicin eye drops in the postoperative management of patients undergoing extracapsular cataract surgery and lens implantation. This was a prospective, randomised, double-masked, parallel-group, four-week, multicentre study with patient visits preoperatively, on the day of surgery, and postoperatively on days 1, 5-8, 12-16, and 26-32. Of the 196 patients (diclofenac-gentamicin 99, gentamicin 97) recruited into the study, 161 (diclofenac-gentamicin 83, gentamicin 78) were available for per-protocol analyses. The two treatment groups were clinically similar at baseline. On days 12-16 postoperatively, diclofenac-gentamicin was significantly more effective (p = 0.002) than gentamicin in reducing intraocular inflammation as assessed by the sum of grades of anterior chamber cells and flare. The level of conjunctival hyperaemia was significantly less in the diclofenac-gentamicin group compared with the gentamicin group on postoperative days 5-8 and 12-16. There was no significant difference between the two study groups in the global assessment of local tolerance. Possibly drug-related adverse events were slightly more in the diclofenac-gentamicin group (22,22%) compared with gentamicin (17,17%); however, all affected study patients normalised with appropriate therapy except one patient with endophthalmitis. In conclusion, diclofenac-gentamicin (DR1352/1) eye drops were more effective than gentamicin eye drops and appeared to be as safe in the control of post-cataract surgery inflammation.

Measurement of axial length in the calculation of intraocular lens power.

PURPOSE: Accurate measurement of ocular axial length is essential for accurate intraocular lens (IOL) power calculation. Although it is common practice to average several axial length measurements to improve accuracy, it has been suggested that a single high-quality A-scan ultrasonographic measurement is adequately accurate owing to the high test-retest reliability of A-scan biometry. The aim of this study was to compare the accuracy of a single high-quality A-scan measurement with that of the average of three acceptable measurements in the calculation of IOL power. METHOD: We studied 103 eyes of 103 patients who underwent cataract-IOL surgery. All these patients underwent pre-operative ocular biometry, a standardised extracapsular cataract extraction with posterior chamber IOL implantation, and clinical refraction between 10 and 14 weeks post-operatively. RESULTS: There was no statistically significant difference between the two study groups in measured axial length (p > 0.01), calculated emmetropic IOL power (p > 0.05) or the prediction of post-operative refraction (p > 0.99). CONCLUSION: The use of a single high-quality axial length measurement was as accurate as the mean of three acceptable axial length measurements in the calculation of IOL power.

Topical Lomefloxacin versus Topical Chloramphenicol in the Treatment of Acute Bacterial Conjunctivitis.

We performed a prospective, randomised, investigator-masked and parallel-group study to compare topical lomefloxacin 0.3% instilled twice daily with topical chloramphenicol instilled five times daily in the treatment of acute bacterial conjunctivitis. 191 patients (lomefloxacin 96, chloramphenicol 95) were enrolled in this study with clinically diagnosed acute bacterial conjunctivitis. The two treatment groups were similar at baseline. The treatments were equally effective and significantly (p < 0.001) reduced the Cumulative Sum Score of the clinical signs and symptoms of bacterial conjunctivitis. At the end of the trial, there was no difference between the two treatments in the Cumulative Sum Score of signs and symptoms (p = 0.63), and the investigator (p = 0.28) and patients' (p = 0.50) assessments of the success of therapy. The two drugs were equally well tolerated locally, with no serious systemic or local adverse drug reactions reported in any study patient. Bacteriological confirmation of acute conjunctivitis was possible in 96 patients (lomefloxacin 47, chloramphenicol 49) out of the 191 enrolled. Both treatments significantly (p < 0.001) reduced the conjunctival bacterial colony count score with no difference (p = 0.12) between the two treatment groups. In conclusion, lomefloxacin 0.3% eye drops instilled twice daily were as effective and well tolerated as chloramphenicol 0.5% eye drops instilled 5 times daily in the treatment of acute bacterial conjunctivitis.

Topical diclofenac sodium compared with prednisolone acetate after phacoemulsification-lens implant surgery.

PURPOSE: This study was performed to compare the efficacy, safety and tolerability of diclofenac sodium 0.1% ophthalmic solution with that of prednisolone acetate 1.0% ophthalmic suspension for treatment of inflammation following phacoemulsification and posterior chamber lens implantation. METHODS: One hundred and sixteen patients (diclofenac 57, prednisolone 59) with visually disabling cataract were enrolled in this prospective, randomised, double-masked, parallel group study in two centres. Post-operative patient assessments at day 1, 5-8 and 12-16 included visual acuity, slit-lamp examination, applanation tonometry and subjective evaluation of local tolerance. RESULTS: There was no statistically significant difference between the diclofenac and predisolone groups in the sum of the grades of anterior chamber flare and cells or the degree of conjunctival hyperaemia at any study visit. The overall assessment of local tolerance was similar for both the study medications. There were two (3.4%) possibly drug-related adverse events in the prednisolone group but neither was severe. CONCLUSIONS: Diclofenac sodium 0.01% ophthalmic solution was as effective, safe and well tolerated overall as prednisolone acetate 1.0% ophthalmic suspension.

Efficacy and safety of topical diclofenac in reducing ocular pain after excimer photorefractive keratectomy.

PURPOSE: To evaluate the efficacy and safety of diclofenac sodium 0.1% ophthalmic solution in patients having myopic photorefractive keratectomy (PRK). SETTING: Corneal Laser Centre, Clatterbridge Hospital, Wirral, United Kingdom. METHODS: We performed a prospective, randomized, double-masked, parallel-group, placebo-controlled study of 50 patients (diclofenac 25, placebo 25) of both sexes who had myopic excimer laser PRK. Results were evaluated by several types of questionnaires and comprehensive clinical examination on the day of the procedure and 1 and 3 to 14 days postoperatively. RESULTS: Diclofenac-treated patients experienced significantly less photophobia, burning/stinging, and ocular pain and took significantly fewer oral narcotic analgesics over the first 24 hours postoperatively than placebo-treated patients. CONCLUSION: Topical diclofenac significantly reduced the ocular pain and discomfort immediately after excimer PRK without any clinically significant complications or adverse effects.

Efficacy and tolerance of diclofenac sodium 0.1%, flurbiprofen 0.03%, and indomethacin 1.0% in controlling postoperative inflammation.

PURPOSE: To compare the anti-inflammatory effect of diclofenac sodium 0.1% ophthalmic solution, flurbiprofen 0.03% ophthalmic solution, and indomethacin 1.0%. SETTING: Department of Ophthalmology, University of Köln, and Bundesknappschaftskrankenhaus, Sulzbach, Germany. METHODS: One hundred seventeen patients enrolled in this prospective, randomized, double-masked, and parallel-group study had phacoemulsification and intraocular lens implantation and received one of the three solutions. Preoperatively at day 1 and postoperatively at day 4 or 5 and day 12, 13, or 14, they were examined by slitlamp, applanation tonometry, and laser flare meter. RESULTS: Anterior chamber flare reduction from baseline was significantly greater in the diclofenac group than in the flurbiprofen group (P = .022). Patients in the diclofenac group had significantly less burning and stinging than those in the flurbiprofen and indomethacin groups at postoperative days 4-5 and 12-14 (P = .001). CONCLUSION: Diclofenac sodium appeared to be more potent than flurbiprofen in controlling intraocular inflammation after cataract surgery and appeared to be locally tolerated better than flurbiprofen and indomethacin.

Calculation of the power of anterior chamber implants.

Ninety seven eyes with anterior chamber implants and a best corrected visual acuity of at least 6/12 were studied, firstly, to compare the predictive accuracies of the commonly used formulas for intraocular lens (IOL) power calculation and, secondly, to determine the effect of optimising the 'A' constant on the predictive accuracies of the empirical Sanders-Retzlaff-Kraff (SRK) formulas. The accuracies of the empirical formulas (SRK and SRK II) were generally similar to those of the theoretical formulas (Binkhorst II and Colenbrander-Hoffer). However the original SRK formula was more accurate than the two theoretical formulas in long eyes and in all eyes overall. Optimisation of the 'A' constants did not improve the predictive accuracy of the empirical SRK formulas.

Comparative evaluation of the Allergan Humphrey 570 and Canon RK-1 autorefractors: I. Objective autorefraction in normal subjects.

Fifty normal subjects were studied comparing objective autorefraction using the Allergan Humphrey 570 (AH 570) and Canon RK-1 autorefractors in terms of ease of operation, the time taken and their accuracy compared with clinical refraction. Both the autorefractors were equally easy to operate but the AH 570 was quicker. Objective autorefraction with the AH 570 was more accurate than using the Canon RK-1 especially with respect to spherical equivalence, sphere power and cyclinder axis: approximately 80% of the values were within 0.51 dioptres or 11 degrees of clinical refraction compared to approximately 60% for the Canon RK-1. The possible reasons for the superior performance of the AH 570 are discussed.

Comparative evaluation of the Allergan Humphrey 570 and Canon RK-1 autorefractors: II. Objective autorefraction in pseudophakes.

Fifty patients (50 eyes) with posterior chamber intraocular lenses and a best corrected visual acuity of at least 6/12 were studied. The Allergan-Humphrey 570 (AH-570) and Canon RK-1 autorefractors were compared in terms of ease of operation, time taken and their accuracy relative to clinical refraction. Both the autorefractors were equally easy to operate but the AH-570 was quicker. The AH-570 had a higher percentage of eyes within 11 degrees of clinically determined cylinder axis while the Canon RK-1 had a higher percentage of patients within 0.51 diopters of spherical equivalence, sphere power and cylinder power as determined by clinical refraction. This difference in the accuracy of objective autorefraction was not statistically significant; the clinical significance is uncertain.

Objective autorefraction in posterior chamber pseudophakia.

Automated refraction with the Canon RK-1 Autoref keratometer was evaluated in 110 eyes (110 patients) six to eight weeks after they had undergone extracapsular cataract extraction with posterior chamber intraocular lens implantation and achieved a best corrected visual acuity of at least 6/12. Autorefraction readings were obtained in 100 (91%) of these eyes. The agreement between autorefraction and clinical refraction data was 98% for spherical equivalence less than 0.51 dioptres (D), 95% for sphere power less than 0.51D, 94% for cylinder power less than 0.51D, and 85% for cylinder axis less than 11 degrees. Autorefraction can provide acceptably accurate postoperative refraction values in pseudophakic eyes.