Microscope integrated OCT (Mi-OCT) guided retrieval of intrastromal corneal foreign body.

Introduction: To describe the role of microscope integrated optical tomography (Mi-OCT) in removal of intrastromal corneal foreign body. Methodology: A young male presented with trauma to the right eye with sugarcane stick. Ocular examination revealed two sugarcane particles, approximately 3.5 mm in greatest dimension, embedded in the corneal stroma. For removal of foreign body, Mi-OCT was switched on and the area of interest was focused. Sugarcane particles appeared as hyperreflective structures embedded in the corneal stroma with everted edges of the overlying corneal epithelium and anterior stroma. Results: Both the sugarcane particles were removed successfully under real time images provided by Mi-OCT without causing any inadvertent damage to the corneal stroma. Conclusion: Mi-OCT can be used as an adjunct in emergency surgical procedures like removal of intrastromal corneal foreign bodies with accurate precision.

Primary Macular Retinoblastoma: Clinical Presentation and Treatment Outcomes.

Purpose: To describe the clinical features and treatment outcomes in eyes with primary macular retinoblastoma (RB). Methods: Patients with primary macular RB were analyzed. Results: Of 41 patients (47 eyes), 20 (49%) were boys and 21 (51%) were girls. The mean age at diagnosis was 16 months (range, 1-60 months). The RB was bilateral in 6 patients (15%). At presentation, the macula was completely covered with the tumor in 22 eyes (47%) and partially covered with the fovea spared in 13 eyes (28%) and the fovea involved 12 eyes (25%). Based on the International Classification of Intraocular Retinoblastoma, 25 (53%), 15 (32%), and 7 (15%) of tumors were in Group B, Group C, and Group D, respectively. The tumor had exophytic features in 36 eyes (77%). The mean tumor basal diameter was 10.0 mm and the mean thickness, 5.6 mm. Associated features included subretinal seeds (10 eyes; 21%) and surrounding subretinal fluid (16 eyes; 34%). Forty-three eyes (92%) were treated with intravenous chemotherapy, 2 (4%) with intra-arterial chemotherapy, and 2 (4%) with transpupillary thermotherapy. Local tumor control was achieved in 45 eyes (96%), with 33 eyes (70%) showing a type III regression pattern. Over a mean follow-up of 23 months (range, 3-48 months), the macular tumor recurred in 5 eyes (11%), the globe was salvaged in all eyes with associated foveal atrophy (36 eyes; 77%), and 1 patient (2%) died. Conclusions: Macular RB has a good prognosis for globe salvage while vision salvage might be compromised as a result of associated foveal atrophy.

Poisoning among Patients Presenting to the Department of Emergency Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Poisoning is one of the major public health problems worldwide. The World Health Organization has estimated 0.3 million deaths a year due to various poisoning agents; pesticides being the leading one. Poisoning is one of the leading causes of emergency room visits. It has become a significant public health issue in Nepal. This study aimed to find out the prevalence of poisoning among patients presenting to the Department of Emergency Medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Department of Emergency Medicine of a tertiary care centre from 24 June 2022 to 6 July 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 11/2022). Data from 765 patients were collected from the hospital records. The patient's history and clinical examination were used to make the diagnosis of poisoning. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 765 patients visiting the emergency department, 8 (1.04%) (0.99-1.09, 95% Confidence Interval) patients were of poisoning. The most common poison used was organophosphates which was consumed by 2 (25%) patients and benzodiazepines by 2 (25%) patients. Conclusions: The prevalence of poisoning among patients presenting to the Department of Emergency Medicine was similar when compared to other studies conducted in similar settings. Although agricultural poisons were commonly used, cases of drug poisoning seems to be on the rise nowadays. Keywords: emergency department; poisoning; prevalence.

Adding α-tocopherol-selenium and ascorbic acid to periparturient sow diets influences hemogram, lipid profile, leptin, oxidant/antioxidant imbalance, performance and neonatal piglet mortality.

Alpha-tocopherol-selenium (ATS) and ascorbic acid (AA) are the potent antioxidants. The present study investigated whether supplementation of ATS and AA in periparturient sows has positive effects on amelioration of oxidative stress, serum immunoglobulin G (IgG), lipid profile and sows performance. For this, twenty-four pregnant multiparous sows (landrace×indigenous) were randomly distributed into four groups (6 sows per group) 20 days before expected date of farrowing as Control (basal diet); ATS (basal diet + ATS); AA (basal diet + AA) and ATS-AA (basal diet + ATS plus AA). The results of the study revealed that the concentrations of triglyceride and cholesterol significantly reduced from day -7 to day 7 of farrowing irrespective of supplementations to sows, but the leptin concentration significantly reduced on day 7 of farrowing in ATS-AA supplemented sows (p<0.05). Moreover, sows of supplemented groups experienced decreased oxidative stress and cortisol level than control sows. The serum IgG concentration was significantly increased on day 7 post-farrowing in ATS group but it was much earlier on day 2 of farrowing in ATS-AA group (p<0.001). Supplementing sows with ATS and/or AA did not influence significantly the birth weight, weaning weight and litter size at weaning (p>0.05). Although piglet survival rate was not affected significantly by supplementation, however, piglet mortality rate was lowest in ATS-AA than any other groups. It was concluded that supplementation of ATS and/or AA to sows during late gestating and early lactating period ameliorated oxidative stress, improved lipid profile and serum IgG level without influencing reproductive performance.

Enhancement in Iron Absorption on Intake of Chemometrically Optimized Ratio of Probiotic Strain Lactobacillus plantarum 299v with Iron Supplement Pearl Millet.

This research article aims to establish the intake ratio of probiotic Lactobacillus plantarum 299v with iron supplement pearl millet by central composite design of response surface methodology so as to enhance iron absorption. In anemic rat models, the food intake pattern, body weight, hemoglobin content, and hematocrit values were found to be significantly increased on treatment with pearl millet:probiotic; however, incorporation of probiotics at lower dose (0.5 g) was significantly (p < 0.05) effective in enhancing iron absorption, and further increment in probiotic doses (1.0 g) did not produce significant increase in hemoglobin and hematocrit values as evidenced by the experimental findings.

Effectiveness of 2.0 mm Standard and 2.0 mm Locking Miniplates in Management of Mandibular Fractures: A Clinical Comparative Study.

To compare and evaluate the effectiveness of 2.0 mm locking miniplates versus 2.0 mm standard miniplates in treatment of mandible fractures. Sixty randomly selected patients who sustained mandibular fractures were selected for this study. The fractured fragments were stabilized using 2.0 mm locking miniplates in 30 cases and in the remaining 30 cases the fractured fragments were fixed with conventional 2.0 mm miniplates. Post-operative stability was assessed with radiographs at 7th day, 1st, and 3rd months. The stability of the reduced fracture was assessed clinically and both the types of plates were assessed with an OPG or conventional radiographs. This study shows favorable results on use of locking miniplates in mandibular fractures. The results show that there were no significant differences in the post-operative complications between the conventional and the locking plate/screw mandibular systems. The locking plate/screw system was more rigid than conventional plate/screw system, thereby reducing the need and duration of intermaxillary fixation (IMF).

Epilepsy care in ontario: an economic analysis of increasing access to epilepsy surgery.

BACKGROUND: In August 2011 a proposed epilepsy care model was presented to the Ontario Health Technology Advisory Committee (OHTAC) by an Expert Panel on a Provincial Strategy for Epilepsy Care in Ontario. The Expert Panel recommended leveraging existing infrastructure in the province to provide enhanced capacity for epilepsy care. The point of entry for epilepsy care and the diagnostic evaluation for surgery candidacy and the epilepsy surgery would occur at regional and district epilepsy centres in London, Hamilton, Toronto, and Ottawa and at new centres recommended for northern and eastern Ontario. This economic analysis report was requested by OHTAC to provide information about the estimated budgetary impact on the Ontario health care system of increasing access to epilepsy surgery and to examine the cost-effectiveness of epilepsy surgery in both children and adults. METHODS: A prevalence-based "top-down" health care system budgetary impact model from the perspective of the Ministry of Health and Long-Term Care was developed to estimate the potential costs associated with expanding health care services to increase access to epilepsy care in general and epilepsy surgery in particular. A 5-year period (i.e., 2012-2016) was used to project annual costs associated with incremental epilepsy care services. Ontario Health Survey estimates of epilepsy prevalence, published epilepsy incidence data, and Canadian Census results for Ontario were used to approximate the number of individuals with epilepsy in the province. Applying these population estimates to data obtained from a recent field evaluation study that examined patterns of care and costs associated with epilepsy surgery in children, a health care system budget impact was calculated and the total costs and incremental costs associated with increasing access to surgery was estimated. In order to examine the cost-effectiveness of epilepsy surgery in children, a decision analysis compared epilepsy surgery to continued medical management in children with medically intractable epilepsy. Data from the field evaluation were combined with various published data to estimate the costs and outcomes for children with drug-refractory epilepsy over a 20-year period. Outcomes were defined as the number of quality-adjusted life years (QALYs) accumulated over 20 years following epilepsy surgery. RESULTS: There are about 20,981 individuals with medically intractable epilepsy in Ontario. Of these, 9,619 (1,441 children and 8,178 adults) could potentially be further assessed at regional epilepsy centres for suitability for epilepsy surgery, following initial evaluation at a district epilepsy care centre. The health care system impact analysis related to increasing access to epilepsy surgery in the Ontario through the addition of epilepsy monitoring unit (EMU) beds with video electroencephalography (vEEG) monitoring (total capacity of 15 pediatric EMU beds and 35 adult EMU beds distributed across the province) and the associated clinical resources is estimated to require an incremental $18.1 million (Cdn) annually over the next 5 years from 2012 to 2016. This would allow for about 675 children and 1050 adults to be evaluated each year for suitability for epilepsy surgery representing a 150% increase in pediatric epilepsy surgery evaluation and a 170% increase in adult epilepsy surgery evaluation. Epilepsy surgery was found to be cost-effective compared to continued medical management in children with drug-refractory epilepsy with the incremental cost-effectiveness ratio of $25,020 (Cdn) to $69,451 (Cdn) per QALY for 2 of the scenarios examined. In the case of choosing epilepsy surgery versus continued medical management in children known to be suitable for surgery, the epilepsy surgery was found to be less costly and provided greater clinical benefit, that is, it was the dominant strategy. CONCLUSION: Epilepsy surgery for medically intractable epilepsy in suitable candidates has consistently been found to provide favourable clinical outcomes and has been demonstrated to be cost-effective in both adult and child patient populations. The first step to increasing access to epilepsy surgery is to provide access to evidence-based care for all patients with epilepsy, both adults and children, through the provision of resources to expand EMU bed capacity and associated clinical personnel across the province of Ontario.

Health technology assessment and primary data collection for reducing uncertainty in decision making.

BACKGROUND: Health care expenditures continue to escalate, and pressures for increased spending will continue. Health care decision makers from publicly financed systems, private insurance companies, or even from individual health care institutions, will continue to be faced with making difficult purchasing, access, and reimbursement decisions. As a result, decision makers are increasingly turning to evidence-based platforms to help control costs and make the most efficient use of existing resources. Most tools used to assist with evidence-based decision making focus on clinical outcomes. HEALTH TECHNOLOGY ASSESSMENT: Health technology assessment (HTA) is increasing in popularity because it also considers other factors important for decision making, such as cost, social and ethical values, legal issues, and factors such as the feasibility of implementation. In some jurisdictions, HTAs have also been supplemented with primary data collection to help address uncertainty that may still exist after conducting a traditional HTA. ROLE OF PRIMARY DATA COLLECTION: The HTA process adopted in Ontario, Canada, is unique in that assessments are also made to determine what primary data research should be conducted and what should be collected in these studies. In this article, concerns with the traditional HTA process are discussed, followed by a description of the HTA process that has been established in Ontario, with a particular focus on the data collection program followed by the Programs for Assessment of Technology in Health Research Institute. An illustrative example is used to show how the Ontario HTA process works and the role value of information analyses plays in addressing decision uncertainty, determining research feasibility, and determining study data collection needs.

BioBuilder as a database development and functional annotation platform for proteins.

BACKGROUND: The explosion in biological information creates the need for databases that are easy to develop, easy to maintain and can be easily manipulated by annotators who are most likely to be biologists. However, deployment of scalable and extensible databases is not an easy task and generally requires substantial expertise in database development. RESULTS: BioBuilder is a Zope-based software tool that was developed to facilitate intuitive creation of protein databases. Protein data can be entered and annotated through web forms along with the flexibility to add customized annotation features to protein entries. A built-in review system permits a global team of scientists to coordinate their annotation efforts. We have already used BioBuilder to develop Human Protein Reference Database http://www.hprd.org, a comprehensive annotated repository of the human proteome. The data can be exported in the extensible markup language (XML) format, which is rapidly becoming as the standard format for data exchange. CONCLUSIONS: As the proteomic data for several organisms begins to accumulate, BioBuilder will prove to be an invaluable platform for functional annotation and development of customizable protein centric databases. BioBuilder is open source and is available under the terms of LGPL.

Physicians' perceptions of teratogenic risk associated with radiography and CT during early pregnancy.

OBJECTIVE: The objective of our study was to determine family physicians' and obstetricians' perceptions of the risk of major fetal malformations associated with exposure to radiation from radiography and CT during early pregnancy. MATERIALS AND METHODS: Structured questionnaires were sent to 400 family physicians and 100 obstetricians selected randomly across Ontario, Canada. The physicians were informed about the 1-3% baseline risk for major malformations and were asked about their perceptions of the risk to the fetus associated with an abdominal radiograph and an abdominal CT scan during early pregnancy and whether they would recommend a therapeutic abortion after such exposure. RESULTS: Fifty-five percent (218/400) of the family physicians and 69% (69/100) of the obstetricians responded to our questionnaire. Forty-four percent of family physicians estimated the risk associated with an abdominal radiograph to be 5% or greater, and 61% estimated the risk associated with an abdominal CT scan to be 5% or greater. Eleven percent of obstetricians estimated the risk associated with radiographs to be 5% or greater (p < 0.001), and 34% estimated the risk associated with CT scans to be 5% or greater (p < 0.001). Among family physicians, 1% recommended an abortion if the fetus was exposed to radiation from radiography and 6% after exposure to radiation from CT. None of the obstetricians recommended an abortion after exposure to radiation from an abdominal radiograph, but 5% recommended an abortion after exposure to radiation from an abdominal CT scan in early pregnancy. CONCLUSION: Our survey shows that physicians who care for pregnant women perceive the teratogenic risk associated with an abdominal radiograph and an abdominal CT scan to be unrealistically high during early pregnancy. This misperception could lead to increased anxiety among pregnant women seeking counseling and to unnecessary terminations of otherwise wanted pregnancies. This perception of high teratogenic risk associated with radiation could also lead to a delay in needed care of pregnant women.

Human protein reference database as a discovery resource for proteomics.

The rapid pace at which genomic and proteomic data is being generated necessitates the development of tools and resources for managing data that allow integration of information from disparate sources. The Human Protein Reference Database (http://www.hprd.org) is a web-based resource based on open source technologies for protein information about several aspects of human proteins including protein-protein interactions, post-translational modifications, enzyme-substrate relationships and disease associations. This information was derived manually by a critical reading of the published literature by expert biologists and through bioinformatics analyses of the protein sequence. This database will assist in biomedical discoveries by serving as a resource of genomic and proteomic information and providing an integrated view of sequence, structure, function and protein networks in health and disease.

Development of human protein reference database as an initial platform for approaching systems biology in humans.

Human Protein Reference Database (HPRD) is an object database that integrates a wealth of information relevant to the function of human proteins in health and disease. Data pertaining to thousands of protein-protein interactions, posttranslational modifications, enzyme/substrate relationships, disease associations, tissue expression, and subcellular localization were extracted from the literature for a nonredundant set of 2750 human proteins. Almost all the information was obtained manually by biologists who read and interpreted >300,000 published articles during the annotation process. This database, which has an intuitive query interface allowing easy access to all the features of proteins, was built by using open source technologies and will be freely available at http://www.hprd.org to the academic community. This unified bioinformatics platform will be useful in cataloging and mining the large number of proteomic interactions and alterations that will be discovered in the postgenomic era.

From biological databases to platforms for biomedical discovery.

The use of high-throughput DNA sequencing and proteomic methods has led to an unprecedented increase in the amount of genomic and proteomic data. Application of computing technologies and development of computational tools to analyze and present these data has not kept pace with the accumulation of information. Here, we discuss the use of different database systems to store biological information and mention some of the key emerging computing technologies that are likely to have a key role in the future of bioinformatics.

Taking ginger for nausea and vomiting during pregnancy.

QUESTION: Many of my patients prefer to use natural or herbal medicines, such as ginger, before taking drugs to treat nausea and vomiting of pregnancy. Is there evidence that ginger is safe to use during pregnancy? Is it effective? ANSWER: Although ginger is used in many cultures to treat the symptoms of nausea and vomiting, no trials have established its safety for use during pregnancy. On the other hand, its efficacy has been documented in two randomized, blinded controlled trials.

Development of a health-related quality of life instrument for nausea and vomiting of pregnancy.

OBJECTIVE: To develop a questionnaire that measures change in symptoms of nausea and vomiting of pregnancy (NVP). METHODS: Eligible and consenting callers to the NVP Healthline at the Hospital for Sick Children, Toronto, underwent telephone interview by using a structured questionnaire. Callers were asked to indicate which of 195 items had been a problem for them and the importance of that problem. For each item, the "frequency" (of women who identified the item as problematic) and "mean importance" (mean importance score of women who indicated that the item was problematic) were multiplied to give the "overall impact." Patterns of response were examined by maternal characteristics. Factor analysis was used to explore relationships between factors. RESULTS: Among 500 women enrolled, areas of quality of life impairment were frequent and similar by maternal characteristics. The questionnaire contains 30 items in 4 domains (physical symptoms/aggravating factors, fatigue, emotions, and limitations) and takes 10 minutes to administer. CONCLUSIONS: This questionnaire contains topics of quality of life impairment important to women with NVP and shows promise for use as an outcome measure in clinical trials.