The Impact of Baseline Intraocular Pressure on Initial Treatment Response in the LiGHT Trial: Selective Laser Trabeculoplasty versus Medication.

PURPOSE: The Laser in Glaucoma and Ocular Hypertension Trial demonstrated the efficacy and safety of selective laser trabeculoplasty (SLT) compared with topical hypotensive medication as first-line therapy for ocular hypertension and open-angle glaucoma. This substudy explored the impact of pretreatment (baseline) intraocular pressure (IOP) on treatment response. DESIGN: Post hoc analysis of randomized control trial data. PARTICIPANTS: A total of 1146 eyes from 662 patients were included in this analysis: 559 eyes in the SLT group and 587 in the medication group. METHODS: Intraocular pressure reduction at 8 weeks after treatment with either SLT or prostaglandin analog (PGA) eye drops was assessed at different levels of baseline IOP, and the groups were compared. Differences in absolute and percentage IOP lowering between SLT and PGA groups were tested with a linear mixed-effects model. Differences in the probability of achieving ≥ 20% IOP lowering between SLT and PGA groups, at different levels of baseline IOP, were estimated using a logistic mixed-effects model. MAIN OUTCOME MEASURE: Intraocular pressure-lowering response to SLT versus PGA eye drops. RESULTS: Mean IOP was not significantly different between the groups at baseline or 8 weeks after treatment initiation. Both treatments showed greater IOP lowering at higher baseline IOP and less IOP lowering at lower baseline IOP. Selective laser trabeculoplasty tended to achieve more IOP lowering than PGA drops at higher baseline IOP. Prostaglandin analog drops performed better at lower baseline IOP, and the difference compared with SLT, in terms of percentage IOP reduction, was significant at baseline IOP of ≤ 17 mmHg. A significant difference was found in the relationship between baseline IOP and probability of ≥ 20% IOP lowering between the two treatments (P = 0.01), with SLT being more successful than PGA at baseline IOP of more than 22.5 mmHg. CONCLUSIONS: We confirm previous reports of greater IOP lowering with higher baseline IOP for both SLT and PGA drops. In treatment-naïve eyes, at higher baseline IOP, SLT was more successful at achieving ≥ 20% IOP lowering than PGA drops. At lower baseline IOP, a statistically greater percentage, but not absolute, IOP lowering was seen with PGA drops compared with SLT, although the clinical significance of this is uncertain. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Thermal hydrolysis of sewage sludge: Improvement in biogas generation and prediction of global warming potential.

Anaerobic digestion (AD) is a prominent treatment method for the sludge produced from sewage treatment plants. Poor solid reduction and longer retention time are the main drawbacks of AD. Thermal hydrolysis (TH) is a potential pretreatment method for solubilization of sewage sludge (SS) solids thereby improving biogas production during AD post-treatment. In this study, the SS sample (total solids = 1.75 wt% and total chemical oxygen demand (COD) = 15,450 mg L-1) was subjected to TH pretreatment (temperature = 140-180°C and reaction time = 60 minutes) in a 0.7-L capacity stainless-steel high-pressure reactor. At a reaction temperature of 180°C, the maximum solid solubilization (total dissolved solids = 4652 mg L-1) and improved dewaterability (time to filter = 4.7 s.L g-1) were observed. The biochemical methane potential test results showed almost doubling of methane generation from 145 to 284 mL gCOD-1 after TH pretreatment at 180°C. The life cycle assessment approach was used to compare various SS treatment and disposal scenarios, two of which included hydrothermal pretreatment. The scenarios involving hydrothermal pretreatments showed the least global warming potential.

Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial.

BACKGROUND: Primary open angle glaucoma and ocular hypertension are habitually treated with eye drops that lower intraocular pressure. Selective laser trabeculoplasty is a safe alternative but is rarely used as first-line treatment. We compared the two. METHODS: In this observer-masked, randomised controlled trial treatment-naive patients with open angle glaucoma or ocular hypertension and no ocular comorbidities were recruited between 2012 and 2014 at six UK hospitals. They were randomly allocated (web-based randomisation) to initial selective laser trabeculoplasty or to eye drops. An objective target intraocular pressure was set according to glaucoma severity. The primary outcome was health-related quality of life (HRQoL) at 3 years (assessed by EQ-5D). Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness, and safety. Analysis was by intention to treat. This study is registered at controlled-trials.com (ISRCTN32038223). FINDINGS: Of 718 patients enrolled, 356 were randomised to the selective laser trabeculoplasty and 362 to the eye drops group. 652 (91%) returned the primary outcome questionnaire at 36 months. Average EQ-5D score was 0·89 (SD 0·18) in the selective laser trabeculoplasty group versus 0·90 (SD 0·16) in the eye drops group, with no significant difference (difference 0·01, 95% CI -0·01 to 0·03; p=0·23). At 36 months, 74·2% (95% CI 69·3-78·6) of patients in the selective laser trabeculoplasty group required no drops to maintain intraocular pressure at target. Eyes of patients in the selective laser trabeculoplasty group were within target intracoluar pressure at more visits (93·0%) than in the eye drops group (91·3%), with glaucoma surgery to lower intraocular pressure required in none versus 11 patients. Over 36 months, from an ophthalmology cost perspective, there was a 97% probability of selective laser trabeculoplasty as first treatment being more cost-effective than eye drops first at a willingness to pay of £20 000 per quality-adjusted life-year gained. INTERPRETATION: Selective laser trabeculoplasty should be offered as a first-line treatment for open angle glaucoma and ocular hypertension, supporting a change in clinical practice. FUNDING: National Institute for Health Research, Health and Technology Assessment Programme.

Efficacy of Repeat Selective Laser Trabeculoplasty in Medication-Naive Open-Angle Glaucoma and Ocular Hypertension during the LiGHT Trial.

PURPOSE: To determine the efficacy of repeat selective laser trabeculoplasty (SLT) in medication-naive open-angle glaucoma (OAG) and ocular hypertensive (OHT) patients requiring repeat treatment for early to medium-term failure during the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial. DESIGN: Post hoc analysis of SLT treatment arm of a multicenter prospective randomized controlled trial. PARTICIPANTS: Treatment-naive OAG or OHT requiring repeat 360-degree SLT within 18 months. Retreatment was triggered by predefined IOP and disease-progression criteria (using objective individualized target IOPs). METHODS: After SLT at baseline, patients were followed for a minimum of 18 months after second (repeat) SLT. A mixed-model analysis was performed with the eye as the unit of analysis, with crossed random effects to adjust for correlation between fellow eyes and repeated measures within eyes. Kaplan-Meier curves plot the duration of effect. MAIN OUTCOME MEASURES: Initial (early) IOP lowering at 2 months and duration of effect after initial and repeat SLT. RESULTS: A total of 115 eyes of 90 patients received repeat SLT during the first 18 months of the trial. Pretreatment IOP before initial SLT was significantly higher than before retreatment IOP of repeat SLT (mean difference, 3.4 mmHg; 95% confidence interval [CI], 2.6-4.3 mmHg; P < 0.001). Absolute IOP reduction at 2 months was greater after initial SLT compared with repeat SLT (mean difference, 1.0 mmHg; 95% CI, 0.2-1.8 mmHg; P = 0.02). Adjusted absolute IOP reduction at 2 months (adjusting for IOP before initial or repeat laser) was greater after repeat SLT (adjusted mean difference, -1.1 mmHg, 95% CI, -1.7 to -0.5 mmHg; P = 0.001). A total of 34 eyes were early failures (retreatment 2 months after initial SLT) versus 81 later failures (retreatment >2 months after initial SLT). No significant difference in early absolute IOP reduction at 2 months after repeat SLT was noted between early and later failures (mean difference, 0.3 mmHg; 95% CI, -1.1 to 1.8 mmHg; P = 0.655). Repeat SLT maintained drop-free IOP control in 67% of 115 eyes at 18 months, with no clinically relevant adverse events. CONCLUSIONS: These exploratory analyses demonstrate that repeat SLT can maintain IOP at or below target IOP in medication-naive OAG and OHT eyes requiring retreatment with at least an equivalent duration of effect to initial laser.

Visual Field Outcomes from the Multicenter, Randomized Controlled Laser in Glaucoma and Ocular Hypertension Trial (LiGHT).

PURPOSE: To compare visual field outcomes of ocular hypertensive and glaucoma patients treated first with medical therapy with those treated first with selective laser trabeculoplasty (SLT). DESIGN: Secondary analysis of patients from the Laser in Glaucoma and Ocular Hypertension study, a multicenter randomized controlled trial. PARTICIPANTS: Three hundred forty-four patients (588 eyes) treated first with medical therapy and 344 patients (590 eyes) treated first with SLT. METHODS: Visual fields (VFs) were measured using standard automated perimetry and arranged in series (median length and duration, 9 VFs over 48 months). Hierarchical linear models were used to estimate pointwise VF progression rates, which were then averaged to produce a global progression estimate for each eye. Proportions of points and patients in each treatment group with fast (<-1 dB/year) or moderate (<-0.5 dB/year) progression were compared using log-binomial regression. MAIN OUTCOME MEASURES: Pointwise and global progression rates of total deviation (TD) and pattern deviation (PD). RESULTS: A greater proportion of eyes underwent moderate or fast TD progression in the medical therapy group compared with the SLT group (26.2% vs. 16.9%; risk ratio [RR], 1.55; 95% confidence interval [CI], 1.23-1.93; P < 0.001). A similar pattern was observed for pointwise rates (medical therapy, 26.1% vs. SLT, 19.0%; RR, 1.37; 95% CI, 1.33-1.42; P < 0.001). A greater proportion of pointwise PD rates were categorized as moderate or fast in the medical therapy group (medical therapy, 11.5% vs. SLT, 8.3%; RR, 1.39; 95% CI, 1.32-1.46; P < 0.001). No statistical difference was found in the proportion of eyes that underwent moderate or fast PD progression (medical therapy, 9.9% vs. SLT, 7.1%; RR, 1.39; 95% CI, 0.95, 2.03; P = 0.0928). CONCLUSIONS: A slightly larger proportion of ocular hypertensive and glaucoma patients treated first with medical therapy underwent rapid VF progression compared with those treated first with SLT.

Eco-friendly decolorization and degradation of reactive yellow 145 textile dye by Pseudomonas aeruginosa and Thiosphaera pantotropha.

Dyes are toxic and inherently resistant to microbial degradation. In this study, decolorization and degradation of textile dye reactive yellow 145 (RY145) were evaluated using pure bacterial strains Pseudomonas aeruginosa (RS1) and Thiosphaera pantotropha ATCC 35512. In nutrient broth under static condition, complete decolorization of 50 mg L-1 RY145 could be achieved within 96 h and 72 h, for Pseudomonas aeruginosa (RS1) and Thiosphaera pantotropha, respectively. In contrast, under shaking condition both the cultures could achieve only 50% decolorization in 96 h. Treatment under sequential static and shaking condition resulted in complete decolorization and 65% mineralization after 96 h. Higher dye concentration in excess of 100 mg L-1 and 50 mg L-1 decreased the extent of dye mineralization in Pseudomonas aeruginosa and Thiosphaera pantotropha, respectively. Even with the repetitive addition of the dye, both the strains were capable of decolorizing the dye. Acclimatized cultures showed 54% decolorization of RY145 in mineral media (MM) even in the absence of a readily degradable external carbon source. Amongst various individual carbon and nitrogen sources, maximum decolorization was observed in MM supplemented with peptone as carbon and nitrogen source at pH 7 under static condition.

Primary Selective Laser Trabeculoplasty for Open-Angle Glaucoma and Ocular Hypertension: Clinical Outcomes, Predictors of Success, and Safety from the Laser in Glaucoma and Ocular Hypertension Trial.

PURPOSE: To report clinical efficacy, predictors of success, and safety of primary selective laser trabeculoplasty (SLT) used in treatment-naive patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). DESIGN: Post hoc analysis of a multicenter, prospective, randomized, controlled trial. PARTICIPANTS: Treatment-naive patients with OAG or OHT. METHODS: Patients randomized to SLT or topical medication and treated to predefined target intraocular pressures (IOPs) requiring ≥20% IOP reduction from baseline for all disease severity levels. OUTCOME MEASURES: Initial (early) absolute IOP-lowering at 2 months. Achievement of drop-free disease-control: meeting target IOP without disease progression or need for additional topical medication over 36 months after SLT. Predictors of early absolute IOP-lowering and drop-free disease-control after single initial SLT. Frequency of laser-related complications. RESULTS: A total of 611 eyes (195 OHT and 416 OAG) of 355 patients received SLT, and 622 eyes (185 OHT and 437 OAG) of 362 patients received topical medication at baseline. Early absolute IOP-lowering after SLT was no different between OHT and OAG eyes (adjusted mean difference = -0.05 mmHg; 95% confidence interval [CI], -0.6 to 0.5 mmHg; P = 0.85). No difference was noted in early absolute IOP-lowering between topical medication and primary SLT (adjusted mean difference = -0.1 mmHg; 95% CI, -0.6 to 0.4 mmHg; P = 0.67). Early absolute IOP-lowering with primary SLT was positively associated with baseline IOP (coefficient 0.58; 95% CI, 0.53-0.63; P < 0.001) and negatively with female gender (coefficient -0.63; 95% CI, -1.23 to -0.02; P = 0.04). At 36 months, 536 eyes (87.7% of 611 eyes) of 314 patients (88.5% of 355 patients) were available for analysis. Some 74.6% of eyes (400 eyes) treated with primary SLT achieved drop-free disease-control at 36 months; 58.2% (312 eyes) after single SLT. Total SLT power and 2-month IOP were predictors of drop-free disease-control at 36 months after single SLT. Six eyes of 6 patients experienced immediate post-laser IOP spike (>5 mmHg from pretreatment IOP) with 1 eye requiring treatment. CONCLUSIONS: Primary SLT achieved comparable early absolute IOP-lowering in OHT versus OAG eyes. Drop-free disease-control was achieved in approximately 75% eyes at 36 months after 1 or 2 SLTs, the majority of these after single SLT. These analyses are exploratory but support primary SLT to be effective and safe in treatment-naive OAG and OHT eyes.

Performance of non-catalytic thermal hydrolysis and wet oxidation for sewage sludge degradation under moderate operating conditions.

Land disposal of waste activated sludge pose environmental risks due to the presence of heavy metals, pathogens and organic pollutants. Anaerobic digestion (AD) is one of the preferred treatment methods for sludge treatment. However, sludge hydrolysis is often found the rate-limiting step thereby reducing the biogas generation potential. Therefore, an effort was made to determine the optimum conditions for sludge solubilization by means of hydrothermal pretreatment. In this study, response surface methodology using Box Behnken design approach was used to optimize four hydrothermal reaction variables (i.e., initial pH, time, temperature, and oxidation coefficient) for sludge solubilization and total chemical oxygen demand (tCOD) reduction. Temperature and pH were found to be the most significant parameters. The maximum tCOD reduction and volatile suspended solids solubilization of 58% and 52%, respectively, were obtained at the following optimum conditions: temperature = 180 °C, time = 5 h, pH = 3.3 and oxidation coefficient = 0.5. Under similar conditions and alkaline pH, Maillard's reaction occurs which may have adverse impact on the performance of downstream AD process. The highest NH4+N and volatile fatty acids (VFAs) concentrations were detected in the treated sludge at the optimum conditions. The future studies should be aimed at the recovery of proteins, VFAs and biogas using appropriate methods.

Adsorption and oxidation of ciprofloxacin in a fixed bed column using activated sludge derived activated carbon.

In this study, the performance of activated sludge derived granular activated carbon (SGAC) was investigated for ciprofloxacin (CPX) removal from synthetic and simulated wastewaters in a fixed-bed adsorption column operated in continuous mode. The adsorbent was synthesized using chemical activation using ZnCl2 as activating agent. Its surface area and pore volume were found comparable to that of the commercial granular activated carbon (CGAC). The maximum saturation adsorption capacities for CPX were ~16 mg/g and ~14 mg/g, respectively, with SGAC column under identical operating conditions (CPX concentration = 50 mg/L, bed height = 4 cm and wastewater flow rate = 1.5 mL/min) for synthetic and simulated wastewaters. The presence of other organics reduced CPX adsorption capacity of SGAC. The breakthrough curve data for both wastewaters could be adequately fit in Thomas and Yoon-Nelson kinetic models. The addition of H2O2 in wastewater showed no considerable improvement in CPX removal. However, H2O2 oxidation of spent adsorbent exhibited better results compared to thermal treatment for adsorbent regeneration. The results showed that sewage sludge can be recycled as an efficient adsorbent for the removal of recalcitrant organic pollutants from wastewater.

A comparative treatment of bleaching wastewater by physicochemical processes.

The bleaching effluent discharged from a pulp and paper mill contains chlorinated organic compounds which are toxic to living matter. Physicochemical treatments such as coagulation and different advanced oxidation processes (AOPs) were employed for combined bleaching effluent generated from the first two stages (i.e. chlorination and alkali extraction) (pH = 3.5, chemical oxygen demand (COD) = 1,920 mg/L, and total organic carbon (TOC) = 663 mg/L). At optimum conditions (pH = 7.5, polyaluminium chloride (PAC) dose = 3.84 g/L and slow mixing time = 25 min), ∼68% removal in UV254 and ∼23% TOC removal was obtained during coagulation. Among various AOPs, UV/Fe2+/TiO2/H2O2 system showed the highest TOC and COD removals (∼78%) after 2 h duration (Fe2+:H2O2 molar ratio = 1:100). After the AOP process, chloride ion concentration and biodegradability of the treated wastewater was increased to 2,762 mg/L and 0.46 from an initial value of 2,131 mg/L and 0.29, respectively. The wastewater and sludge analysis showed oxidation and adsorption as the major mechanisms for organics removal. Upon reuse of the regenerated catalysts, TOC removal was reduced significantly. It was found that three times more sludge per unit TOC removal was generated after coagulation in comparison to that produced after UV/Fe2+/TiO2/H2O2 treatment.

Early features in acute macular neuroretinopathy.

Acute macular neuroretinopathy (AMNR) is a rare disorder characterised by acute onset of unilateral or bilateral visual impairment associated with reddish-brown wedge-shaped outer macular lesions. It is more frequently reported in young females and though the pathophysiology remains unclear, factors reported in association with its onset include post-viral illness and vasoconstrictor use. We report a case of AMNR in an 18-year old female patient presenting with a 2-day history of acute painless blurring of central vision bilaterally, following 1 month of preceding flu-like illness. For 1 week prior to presentation, the patient had taken large doses of oral preparations containing phenylephrine hydrochloride. In addition to demonstrating characteristic optical coherence tomography findings seen in AMNR, we illustrate some rarely seen acute ophthalmoscopic features. Based on associations from this case, we add further insight into the pathophysiology of this condition which remains poorly understood.

Hydrothermal pretreatment of press mud: Characterization and potential application of hydrochar and process water.

In the present study, press mud (PM), a major waste by-product from sugar industries, was subjected to hydrothermal pretreatment (HTP) to create resource recovery opportunities. The HTP process was performed with the PM samples in a laboratory scale high pressure batch reactor (capacity = 0.7 L) at 160 °C and 200 °C temperatures (solids content = 5 % and 30 %). The pretreatment resulted in separation of solid and liquid phases which are termed as solid hydrochar (HC) and process water (PW), respectively. High heating value (HHV) of HC was âˆ¼14-18 MJ kg-1, slightly higher than that of PM (14 MJ kg-1). The thermogravimetric analysis showed about 1.5-1.7 times higher heat release from HC burning compared to that observed from combustion of PM. Apart from this, the HC and PM showed no phytotoxicity during germination of mung bean (Vigna radiata). Moreover, the biochemical methane potential test on the PW showed a generation of 167-245 mL biogas per gram of chemical oxygen demand added. Hence, the HTP offers several resource recovery opportunities from PM which may also reduce the risks of environmental degradation.

Performance of electro-Fenton process for the treatment of synthetic sulphidic spent caustic waste stream generated from petroleum refineries.

Sulphidic spent caustic (SSC) is an alkaline waste stream which is generated during caustic scrubbing of liquefied petroleum gas and ethylene products. Due to presence of high concentrations of sulphides and phenols, the waste stream requires proper treatment before mixing with the low strength wastewater streams produced from other refinery operations. Electrochemical process is an emerging treatment method that can work efficiently at ambient conditions. The present study reports performance of electro-Fenton (EF) process for the treatment of synthetic SSC wastewater (sulphides = 10 g L-1, phenol = 2 g L-1 and pH = 12.9). The EF runs were carried out for 2 h duration in a reactor equipped with iron electrodes. The effects of H2O2 dose (0.26-1.3 M), current density (1-20 mA cm-2), pH (4.5-12.9) and stirring speed (100-1000 rpm) were investigated on removal of pollutants. The H2O2 was rapidly consumed in initial 30 min during which the significant fraction of the pollutants was degraded or removed. The optimum conditions for EF process were found to be as follows: pH = 4.5, H2O2 dose = 1.05 M, current density = 5 mA cm-2 and stirring speed = 500 rpm. At these conditions, the maximum sulphide and phenol removals from the wastewater were 98% and 91%, respectively. The results will be helpful to the wastewater treatment plant operators worldwide dealing with high concentrations of such pollutants.

VATS thoracic duct clipping in post-CABG with chylothorax.

Post-coronary artery bypass graft (CABG) surgery, chylothorax is a rare, but a serious, complication. We report a case of 49-year-old female who underwent CABG, and developed pleural effusion on post-operative day 2 which was milky in nature. Chylothorax was confirmed based on the biochemical analysis of the pleural fluid. As the medical line of management failed, video-assisted thoracoscopic surgery (VATS) was done and thoracic duct clipped on the right side. Close to the proximal portion of the left internal thoracic artery, disrupted tributaries of thoracic duct were noted and clipped. Rarity of the case and management is highlighted.

Three-year outcomes of surgical valve replacement with Dafodil™ pericardial bioprosthesis: Dafodil™-1 trial.

Background: The Dafodil™-1 trial was designed to evaluate the clinical safety and performance of Dafodil™ pericardial bioprosthesis for replacing diseased native or prosthetic aortic or mitral valves in patients with advanced valvular heart disease (VHD). Methods: The Dafodil™-1 trial was a prospective, multicenter, first-in-human clinical trial. Patients were enrolled if they had advanced VHD requiring aortic valve replacement (AVR) or mitral valve replacement (MVR) with or without concomitant valve surgery and having surgical risk scores <4%. Major adverse cardiac events (MACE), including all-cause death, myocardial infarction (MI), and stroke; and hemodynamics were analyzed. Results: A total of 136 patients (aortic: 67 and mitral: 69) were enrolled in the trial (with mean age-AVR group: 60.2 ± 8.3 years and MVR group: 49.7 ± 14.4 years). A total of 134 patients (aortic: 66 and mitral: 68) completed the 3-year follow-up (total 300 per 100 patient-years of follow-up). The AVR group demonstrated a significant reduction in the mean pressure gradients from 51.2 ± 24.1 mmHg at baseline to 11.1 ± 6.0 mmHg at the 3-year follow-up (p < 0.0001). The mean effective orifice area (EOA) improved from baseline (0.9 ± 0.6 cm2) to 3-year follow-up (1.8 ± 0.4 cm2) (p < 0.0001). In the MVR group, the mean indexed EOA (iEOA) increased significantly from baseline (0.7 ± 0.4 cm2/m2) to 3-year follow-up (1.1 ± 0.4 cm2/m2) (p < 0.001). There was significant improvement in New York Heart Association functional class and mean SF-12 scores in both groups. At 3-year follow-up, the MACE incidence was 2.3% per 100 patient-years (1.3% strokes per 100 patient-years and 1.3% deaths per 100 patient-years) for AVR group and 4.7% per 100 patient-years (0.6% strokes per 100 patient-years and 4.0% deaths per 100 patient-years) for MVR group. No cases of MI, structural valve deterioration and prosthetic valve endocarditis were reported. The AVR and MVR groups achieved 89.6% and 79.7% MACE-free survival, respectively at 3-year follow-up. Conclusions: The Dafodil™-1 trial demonstrated satisfactory outcomes of clinical safety, hemodynamic performance, and quality-of-life metrics. Additionally, no incidence of structural valve deterioration and very low rates of valve thrombosis during the 3-year follow-up period of Dafodil™-1 first-in-human trial indicated acceptable valve durability up to three years and similar outcomes are warranted for longer follow-ups as a primary goal. Clinical Trial Registration Number: https://www.ctri.nic.in/Clinicaltrials/showallp.php?mid1=18377&EncHid=&userName=CTRI/2017/07/009008, CTRI/2017/07/009008.

Use of improvised vaccum assisted suction drainage for cases of deep sternal wound infection.

AIM: To devise a simple, cheap and effective improvised method of treating deep sternal wound infections (DSWI) by negative pressure obviating high cost of patented systems. METHOD: Records of ten post CABG patients operated via median sternotomy approach over a two and half year period and treated for DSWI were analysed. Sterile foam with drain was placed in the wound, which was covered with Ioban (Steridrape), the drain being connected to a suction unit maintaining 100mmHg pressure (<$12 cost). RESULTS: Ten (10) patients of DSWI were managed with this therapy. Mean age was 60.4 years. Pseudomonas found in 1 (10%), Acinetobacter and Pseudomonas in 1 (10%) with Escherichia coli in 1 (10%). Five (50%) patients had diabetes mellitus. Mean hospitalisation period was 43 days. Seven (70%) patients underwent secondary suturing. Two (22%) patients had relapse, which was managed with dressings and secondary intention suturing. One patient who underwent a muscle flap cover had major recurrence with multiple sinuses. Excellent wound healing in 9 (90%) patients with no (0%) 90-day mortality. Improvised components can be safely employed to provide effective negative pressure therapy for DSWI with excellent results.

Effect of diaper waste on composting of household wet biodegradable waste in a decentralized system.

Due to changes in lifestyle and improved economic status, the use of diapers is also increasing in developing nations. Hence, there is a need to develop an eco-friendly system for the disposal of discarded diapers which is termed diaper waste (DW). In the present study, the co-composting of DW with household wet biodegradable waste (HWBW) was performed in a compartmentalized rotary drum (CRD) (total capacity = 160 L, number of compartments = 4) under passive aeration conditions. For the co-composting runs, 1 kg of HWBW and DW mixture (mass ratio = 100:0, 90:10, 85:15, and 80:20) was added in four individual compartments daily for 10 days. During the process, the highest temperature of ~ 50-56 °C could be achieved in different compartments for a duration of 2-8 days. The compost yield (i.e., below 4 mm size material) was ranged 10.4-13% after 55 days of composting and the mass of DW was reduced by ~ 61-68%. A mixture of 15% DW and 85% HWBW can be suggested as the best combination for the co-composting process. Based on the "Dewar test" results, the samples recovered after composting could be categorized as "stable". The pot results showed an improvement in the growth of Vigna Radiata when 10% compost sample was mixed with soil whereas with 20% compost in the soil-compost mixture, the plant growth was adversely affected. Hence, co-composting of DW with HWBW can be a feasible proposition which can produce a good quality compost.

Double scleral tunnel technique to prevent glaucoma drainage device exposure.

PURPOSE: To describe a new surgical technique designed to reduce the risk of tube exposure following glaucoma drainage device (GDD) surgery. METHODS: A retrospective, single-center study included all patients who underwent GDD surgery by a single surgeon between January 2018 and December 2019, using a double scleral tunnel technique to secure the tube to the sclera. A 23-gauge needle was used to create a 3 mm partial thickness scleral tunnel near to the GDD plate, with a second partial thickness scleral tunnel created 2.5 mm from the surgical limbus into the anterior chamber (AC). The silicone tube was passed through both scleral tunnels and into the AC. RESULTS: 46 GDD surgeries were performed during the time frame. The mean age of patients was 65 ± 13 years. Mean follow up duration was 27.7 ± 8.15 months (range 11 to 44). Significant reductions in intraocular pressure and number of glaucoma medications were achieved. Zero exposures were recorded occurring during follow-up. CONCLUSION: This double scleral tunnel technique to secure the GDD silicone tubing firmly to the sclera may reduce micro-movements which have been purported to be associated with tissue erosion post GDD surgery. The addition of this simple technique to existing GDD surgery may reduce the risk of post-operative tube exposure.