Systemic prednisolone versus topical tranexamic acid for prevention of rebleeding in patients with traumatic hyphema: A randomized clinical trial.

PURPOSE: To compare the efficacy of systemic prednisolone and topical tranexamic acid (TA) on the rate of rebleeding in patients with macroscopic traumatic hyphema (MTH). METHOD: In a randomized clinical trial, patients with MTH were randomized to receive oral prednisolone (OP group) or topical TA drops (TA group). Comprehensive ophthalmic examinations including slit lamp examination and fundoscopy, intraocular pressure (IOP), best-corrected visual acuity (BCVA) and check for rebleeding were performed in all cases. RESULTS: Ninety eyes of 90 patients were included, and 45 patients were allocated into each group. Age, sex, IOP, BCVA and grade of hyphema were not different between groups. Rebleeding in the TA group (2 patients, 4.4%) occurred less frequently than in the OP group (7 patients, 15.6%), but this difference did not reach statistical significance (P=0.081). However, there was a significant difference between the two groups over time in terms of absorption of the MTH (P<0.001). CONCLUSION: Topical TA appears promising in the management of macroscopic traumatic hyphema.

Comparison of Ondansetron versus Clonidine efficacy for prevention of postoperative pain, nausea and vomiting after orthognathic surgeries: A triple blind randomized controlled trial.

BACKGROUND: The aim of this randomized controlled triple blind trial was to compare the efficacy of clonidine with dexamethasone versus ondansetron with dexamethasone for postoperative pain, nausea and vomiting prevention in orthognathic surgery patients. MATERIAL AND METHODS: In this clinical trial study, 30 consecutive patients with skeletal class III deformities were candidates for orthognathic surgery in Qaem hospital, Mashhad University of medical sciences, Mashhad, Iran from March to November 2017. These subjects were randomly assigned to two equal number groups, ondansetron or clonidine. Patients received either oral ondansetron 8mg or oral clonidine 150µg as premedication, 1 hour before the surgery (both dissolved in 20 cc of water). Also both groups received intravenous dexamethasone 8mg (1 hour preoperatively and every 4 hours intraoperatively). RESULTS: In this study, a total of 30 patients (14 males and 16 females) with a mean age of 23.9 ± 3.9 were investigated. The incidence of postoperative nausea in women was more than men (p=0.003), also the correlation between the incidence of PON and the surgery duration ≥ 3 hours was statistically significant (p = 0.050). The frequency of postoperative nausea (PON) in the ondansetron group was less than clonidine (53.3% vs 73.3% respectively). There was no postoperative vomiting (POV) in the ondansetron group, but 6.7% of cases in clonidine group suffered POV. Post-operative nausea in ondansetron group occurred significantly later than clonidine (525.0±233.2 vs 100.0±34.0 min; p <0.001). On the other hand, the incidence time of post-operative severe pain or in other word the analgesia time in clonidine group was significantly more than ondansetron one (875/0±68/5 vs 614.3±159.1 min; p <0.001). CONCLUSION: Ondansetron with dexamethasone premedication was more effective in controlling PONV after orthognathic surgery compared to clonidine with dexamethasone group.

Pseudo-outbreaks of Stenotrophomonas maltophilia on an intensive care unit in England.

BACKGROUND: In June 2014, a cluster of identical S. maltophilia isolates was reported in an adult intensive care unit (ICU) at a district general hospital. An outbreak control team was convened to investigate the cluster and inform control measures. AIM: To identify potential risk factors for isolation of S. maltophilia in this setting. METHODS: We conducted a cohort study of ICU patients for whom a bronchoalveolar lavage (BAL) specimen was submitted between October 2013 and October 2014. Cases were patients with S. maltophilia-positive BAL. We calculated the association between isolation of S. maltophilia and patient characteristics using risk ratios (RRs) with 95% confidence intervals (95% CIs) and univariate logistic regression. Chi-squared or Fisher's exact tests were used. BAL specimens were microbiologically typed using pulse-field gel electrophoresis (PFGE). FINDINGS: Eighteen patients met the case definition. Two patients had clinical presentations that warranted antibiotic treatment for S. maltophilia. All cases were exposed to bronchoscopy. PFGE typing revealed clusters of two strain types. We found statistically significant elevated risks of isolating BRISPOSM-4 in patients exposed to bronchoscope A (RR: 13.56; 95% CI: 1.82-100; P < 0.001) and BRISPOSM-3 in patients exposed to bronchoscope B (RR: 16.89; 95% CI: 2.14-133; P < 0.001). S. maltophilia type BRISPOSM-4 was isolated in water used to flush bronchoscope A after decontamination. CONCLUSION: Two pseudo-outbreaks occurred in which BAL specimens had been contaminated by reusable bronchoscopes. We cannot exclude the potential for colonization of the lower respiratory tract of exposed patients. Introduction of single-use bronchoscopes was an effective control measure.

The effect of donor age on progression of spermatogenesis in canine testicular tissue after xenografting into immunodeficient mice.

The objective of this study was to examine the effect of donor age on progression of spermatogenesis in dog (Canis lupus familiaris) testis tissue after xenografting. In Experiment 1, canine testes were obtained by surgical castration. Based on developmental pattern of spermatogenesis at the time of grafting, donors were categorized as immature, young, and adult (<4, 4 to 6, and >6 mo old, respectively). Fragments of testis tissue were implanted subcutaneously on the back of immunodeficient mice; xenografts were retrieved and analyzed 4, 6, or 8 mo later. At 4 mo postgrafting, immature and young groups had higher graft recovery rates, graft weights, vesicular gland indices, seminiferous tubule numbers, and larger seminiferous tubular diameters compared with those of adult donor xenografts. At 8 mo postgrafting, immature donor xenografts had maintained growth and development as exhibited by greater graft weights, vesicular gland indices, seminiferous tubule numbers, and tubular diameters compared with those of adult donor xenografts. At this time point, growth and development of xenografts did not differ between immature and young donors, whereas those from young donors had greater seminiferous tubule numbers and diameters compared with those of adult donor xenografts. Elongated spermatids were the most advanced germ cell type present at 4 and 8 mo postgrafting in xenografts of immature age groups. In Experiment 2, the longer-term efficiency of spermatogenesis and the potential sperm production in xenografts from immature donor dogs were determined. Testis tissue from 2-mo-old donor dogs were grafted into recipient mice, and xenografts were retrieved after 13 mo. Complete spermatogenesis was present in 5 of 29 recovered xenografts, with isolation of fully formed sperm (up to 36.3x10(6) per gram tissue). In conclusion, immature and young donors (<6 mo of age) were the most promising donors for dog testis tissue xenografting. This strategy may offer an alternative for male germ-line preservation for canids that die prematurely or must be castrated before maturation.

Cryopreservation of immature porcine testis tissue to maintain its developmental potential after xenografting into recipient mice.

The purpose of this study was to develop effective strategies for cooling and cryopreservation of immature porcine testis tissue that maintain its developmental potential. Testes from 1-wk-old piglets (Sus domestica) were subjected to 1 of 12 cooling/cryopreservation protocols: as intact testes, cooling at 4 degrees C for 24, 48, or 72h (Experiment 1); as fragments, programmed slow-freezing with dimethyl sulfoxide (DMSO), glycerol, or ethylene glycol (Experiment 2); or solid-surface vitrification using DMSO, glycerol, or ethylene glycol, each using 5-, 15-, or 30-min cryoprotectant exposure times (Experiment 3). For testis tissue xenografting, four immunodeficient recipient mice were assigned to each protocol, and each mouse received eight grafts. Recipient mice were killed 16 wk after grafting to assess the status of graft development. Based on morphology and in vitro assessment of cell viability, cooling of testis tissue for up to 72h maintained structural integrity, cell viability, in vivo growth, and developmental potential up to complete spermatogenesis comparable with that of fresh tissue (control). In frozen-thawed testis tissues, higher numbers of viable cells were present after programmed slow-freezing using glycerol compared with that after DMSO or ethylene glycol (P<0.001). Among the vitrified groups, exposure to DMSO for 5min yielded numerically higher viable cell numbers than that of other groups. Cryopreserved tissue fragments recovered after xenografting had normal spermatogenesis; germ cells advanced to round and elongated spermatids after programmed slow-freezing using glycerol, as well as after vitrification using glycerol with 5- or 15-min exposures, or using DMSO for a 5-min exposure.

Aspergillus fumigatus Majocchi's granuloma in a patient with acquired immunodeficiency syndrome.

Majocchi's granuloma, also known as nodular granulomatous perifolliculitis, is an uncommon fungal infection of the skin and subcutaneous tissue. It can occur in healthy and immunocompromised patients. The most common cause of Majocchi's granuloma is Trichophyton rubrum. We report a case of a Majocchi's granuloma caused by Aspergillus fumigatus in a patient with acquired immunodeficiency syndrome.

Abnormal Cambridge low-contrast grating sensitivity results associated with diabetic retinopathy as a potential screening tool.

Contrast sensitivity is proposed as a potential screening tool for the early detection of diabetic retinopathy. A cross-sectional study was performed in a tertiary referral university eye centre. A total of 80 diabetes patients were recruited and tests were performed on 154 eyes. Contrast sensitivity was checked using Cambridge low-contrast grating. Abnormal contrast sensitivity was observed in 27.1% of eyes with diabetic retinopathy, compared with 9.0% in unaffected eyes, a statistically significant difference. Cambridge low-contrast grating is a potential screening tool for early detection of diabetic retinopathy by non-ophthalmologists.

Complications of hydroxyapatite pegging: comparison between polycarbonate and titanium peg system.

PURPOSE: Polycarbonate peg has been customarily used for pegging of hydroxyapatite for years. For better movement, tissue tolerance, and to decrease the complications of pegging, titanium peg system has been used. This study compares the two systems. METHODS: Complications associated with pegging (polycarbonate: Bio-Eye or titanium: Dr-Perry new P-K) were retrospectively reviewed from the charts of 153 patients admitted to the Labbafinejad Medical Center, Tehran, Iran, for over 5 years from 1997 to 2003. RESULTS: A total of 153 cases were studied. Ninety-six (62.3%) were male and 57 (37.7%) were female, and the mean age was 27.7 years (6-59 years). In 88 cases pegs were poly-carbonate and sleeve system and in 65 cases pegs were titanium. Forty-one (46%) of cases with polycarbonate and 18 (27%) of cases with titanium had at least one or more complications (p=0.018). The most common complications were granulation tissue, discharge, overgrowth of conjunctiva, and peg falling out in 25%, 23%, 13%, and 8% in polycarbonate peg and 15%, 5%, 1.5%, and 0% in titanium peg group. The prevalence of the last three complications was statistically lower in titanium peg compared with polycarbonate. Twenty-five cases (35%) with polycarbonate peg and 5 cases (7.5%) with titanium peg had two or more complications (p=0.03). Peg removal was done in 11 cases of polycarbonate but only two cases of titanium peg in order to treat the complication. CONCLUSIONS: Both pegging systems had some complications, although these were less severe and prevalent in titanium peg. More studies on complications due to titanium pegs are recommended.

Abnormal Cambridge low-contrast grating sensitivity results associated with diabetic retinopathy as a potential screening tool

Contrast sensitivity is proposed as a potential screening tool for the early detection of diabetic retinopathy. A cross-sectional study was performed in a tertiary referral university eye centre. A total of 80 diabetes patients were recruited and tests were performed on 154 eyes. Contrast sensitivity was checked using Cambridge low-contrast grating. Abnormal contrast sensitivity was observed in 27.1% of eyes with diabetic retinopathy, compared with 9.0% in unaffected eyes, a statistically significant difference. Cambridge low-contrast grating is a potential screening tool for early detection of diabetic retinopathy by non-ophthalmologistsp

Successful treatment of ocular leishmaniasis.

PURPOSE: To report successful treatment of a case of ocular leishmaniasis with combined stibogluconate and allupurinol. METHOD: A 32-year-old physician developed a non-tender reddish chalazion like lesion in his right lower lid, associated with conjunctivitis and nodular episcleritis. Biopsy of the lesion in his eyelid and conjunctiva disclosed a dense inflammatory response including histiocytes containing typical leishmania organisms. RESULT: Therapy with stibogluconate, both intralesional and intramuscular, was initiated with some improvement. However recurrence of the lesion occurred. Systemic retreatment with combined stibogluconate and allupurinol led to complete healing of the lesion. CONCLUSION: Ocular leishmaniasis is a rare and potentially blinding disorder. Combined stibogluconate and allupurinol may be an effective therapy in such cases.

Vitrectomy in ocular trauma. Factors influencing final visual outcome.

The results of vitrectomy in 240 consecutive cases of ocular trauma were reviewed. Of these cases, 71.2% were war injuries. Intraocular foreign bodies were present in 155 eyes, of which 74.8% were metallic and 61.9% ferromagnetic. Multivariate analysis identified the prognostic factors predictive of poor visual outcome, which included: (1) presence of an afferent pupillary defect; (2) double perforating injuries; and (3) presence of intraocular foreign bodies. Association of vitreous hemorrhage with intraocular foreign bodies was predictive of a poor prognosis. Eyes with foreign bodies retained in the anterior segment and vitreous had a better prognosis than those with foreign bodies embedded in the retina. Timing of vitrectomy and type of trauma had no significant effect on the final visual results. Prophylactic scleral buckling reduced the incidence of retinal detachment after surgery. Injuries confined to the cornea had a better prognosis than scleral injuries.

Synthesis and evaluation of the antitumor properties of esters of 2-furoic acid and 2-furylacrylic acid.

A series of activated and nonactivated esters of 2-furoic and 2-furylacrylic acids were synthesized and examined for antineoplastic activity in the Ehrlich ascites carcinoma screen at 20 mg/kg/d. 2-Furoic acid and 2-furylacrylic acid demonstrated potent activity, as did the methyl and cyanomethyl esters of each series. The vinyl ester of 2-furoic acid possessed antineoplastic activity. However, the ethyl and D,L-tetrahydropyranyl esters of each series were inactive in the tumor screen.

Neonatal IgE values in the black population.

Ninety-three cord blood samples from black neonates were evaluted for the total IgE level using the PRIST method. The results reveal values comparable to the IgE levels in other racial groups, suggesting that the influence of racial differences was not obvious at this stage.

Aspirin intolerance--a review.

1. Association of bronchial asthma, nasal pathology and intolerance to aspirin is a unique syndrome. Aspirin-induced prolongation of bleeding time, and a tendency for diabetes, may exist with it. 2. The syndrome occurs most often in the middle-aged female. 3. Progression of asthma and nasal polyposis is not prevented by avoidance of aspirin. 4. Salicylates other than aspirin are well tolerated but cross-reactivity with other analgesics, and with tartrazine, may occur. 5. The underlying mechanism is unknown. An immunologic basic is most unlikely.

Alpha-1 antitrypsin in childhood asthma.

Alpha-1 antitrypsin (AAT) phenotypes and serum levels were studied in two childhood perennial asthmatic populations. The first was an ambulatory, mostly mild nonsteroid-dependent group living in Rochester, N.Y. The second was a more severe mostly steroid-dependent group residing at an asthma residential treatment center in Denver, Colo. The prevalences of alpha-1 antitrypsin protease inhibitor (Pi) tyes were the same for bothe groups and similar to prevalences in a random population. Alpha-1 antitrypsin serum levels were significantly elevated for the mild nonsteroid-dependent group when compared to the more severe steroid-dependent group. The steroid-dependent group had serum levels similar to a group of nonasthmatic control children. These findings indicate that there is not a strong association of alpha-1 antitrypsin Pi variants such as Pi MZ or Pi MS with more severe asthma. Elevated serum levels in the milk perennial asthmatic group may be the result of chronic inflammatory processes. Normal levels in the sterioid-dependent group may be the result of corticosteroid control of inflammation associated with asthma.