Study of Correlation of Serum Vitamin D Levels with Arterial Stiffness and Cardiovascular Morbidity in Elderly Individuals of Western Rajasthan.

Introduction: Vitamin D deficiency is highly prevalent condition in western countries as well as in India. Lower level of vitamin D is associated with increased arterial stiffness by activating renin-angiotensin-aldosterone system leading to increased cardiovascular morbidity and mortality including increased risk of coronary artery disease, stroke, peripheral vascular disease, hypertension, diabetes mellitus and metabolic syndrome. Our aim was to study the correlation between serum vitamin D level, various measures of arterial stiffness and cardiovascular morbidity in elderly individuals. Material and Method: The present study was conducted in collaboration with Department of Medicine, Department of Cardiology and Regional Geriatric Centre, NPHCE, MDM Hospital attached to Dr. S.N. medical college Jodhpur. Total 100 elderly individuals 60 yrs and above attending hospital for minor short illness, acute illness or for routine health checkup or with acute coronary events are included in the study. Vitamin D level was assessed by chemiluminescent immunoassay. Pulse Wave Velocity was determined by Periscope. Results: In subjects with coronary artery disease, 28.30% were vitamin D deficient, 49.05% were vitamin D insufficient and only 22.64% are vitamin D sufficient. In healthy subjects, 25.53% were vitamin D deficient, 23.40% were vitamin D insufficient and 51.04% were vitamin D sufficient. The difference between these groups was statistically highly significant. (p value-0.006). Various measures of arterial stiffness including Rt baPWV, Lt baPWV, cf PWV and pulse pressure are more in vitamin D deficient group as compared to vitamin D sufficient group. The difference was statistically significant. Conclusion: Vitamin D deficiency is quite common condition in elderly individuals which besides its bone mineralization action is also involved in cardiovascular functions. Deficiency of vitamin D may cause increase in arterial stiffness and widening of pulse pressure which are the predictor of atherosclerosis and cardiovascular morbidity and mortality.

Physical function and activity among older adults in Jodhpur, India.

BACKGROUND: Physical activity impacts the ageing process; yet, few studies have examined relationships among physical activity, functional abilities and health among older adults in non-Western settings. AIM: This study tests for associations among measures of physical activity, function and self-report health conditions among 200 older adults (49--50 years old) in Jodhpur, Rajasthan, India. METHODS: Seven consecutive days of accelerometry data were used in measures of physical activity (Total Daily Energy Expenditure [TDEE], Physical Activity Level [PAL], Daily Average Activity Count [AC] and Activity Energy Expenditure [AEE]). Measures of physical function included grip strength, timed walk and daily average sit time. Participants reported if they had been diagnosed with diabetes, hypertension, arthritis and/or depression. RESULTS: All four measures of physical activity were positively associated with grip strength (p ≤ 0.05). AC was negatively associated with timed walk (p ≤ 0.05), and both AC and AEE were negatively associated with daily average sit time (p ≤ 0.05). Women who reported diagnosis of hypertension had lower PAL and AC (p ≤ 0.05). CONCLUSION: This study provides further evidence for a positive relationship between physical activity and functional ability among older adults and between physical activity and cardiovascular health among women in India.

Clinical profile and mortality among novel influenza A (H1N1) infected patients: 2009-2010 Jodhpur, Rajasthan pandemic.

OBJECTIVES: Influenza causes annual seasonal epidemics around the world. Periodically, a genetically novel strain of influenza circulates worldwide, causing an influenza pandemic. The present study aims to assess the clinical profile, factors determining the response, prognosis of the disease and outcome in H1N1 positive patients during 2009-2010 H1N1 pandemic, so that epidemiology of the disease could be known and high risk groups can be identified. METHODS: Medical records of the H1N1 positive patients, confirmed by RT-PCR method, admitted in ICU/Isolation ward in M.D.M. Hospital, Jodhpur during pandemic of H1N1 influenza (2009-2010) were retrieved and retrospectively studied, the data collected was analysed. RESULTS: During the study period there were 221 H1N1 positive admissions. The age group most affected was 21-40 years in both males (52%) and females (67%). There were 80 deaths; mortality was high in rural population (64%) and pregnant women particularly in third trimester (80%). Common presenting symptoms were Cough, Fever, Breathlessness, Sore throat, Nasal Discharge, Expectoration and Body aches, other less common symptoms were Headache, Vomiting, Diarrhoea and Fatigue. CONCLUSION: Swine flu influenza infection took its heaviest toll in terms of human lives and economy because the young and productive population was mostly affected. Pregnant women and the patients with co-morbid conditions were the susceptible population and thus preventive and therapeutic interventions should be directed to them. Early vaccination of high risk groups and high index of suspicion in the symptomatic patients and chemoprophylaxis accordingly can save many human lives.

Shapiro syndrome.

We report here a case of Shapiro syndrome who presented with episodic generalized sweating, hypotension, and hypothermia. Brain magnetic resonance imaging demonstrated corpus callosum agenesis with colpocephaly. Patient was treated with Clonidine and Propranolol. This case is being reported here because only a few cases of Shapiro Syndrome are reported in world literature.

Case report of a small outbreak of epidemic dropsy.

Epidemic dropsy results from use of edible oils adulterated with Argemone mexicans oil. We report of the disease in a family caused due to sesame oil adulteration. Peculiarity to report this disease is that it occurred due to consumption of contaminated sesame seeds oil instead of mustard oiland secondly epidemic dropsy is also not very common in western Rajasthan. Five members of a family presented to the hospital with history of generalised body swelling, itching and marked cutaneous flush. Few of them also have shortness of breath, dry cough, palpitation, diarrhoea, vomiting and haemoptysis. On physical examination rashes, pallor and signs of cardiac failure were present in few patients. None of them had neurological symptoms and signs. After multiple interviews history of consumption of home made sesame seeds oil was explored in the family and the differential diagnosis of epidemic dropsy was made. Edible oil sample of the sesame seeds oil turned out to be positive for sanguinarine. Sanguinarine and dehydrosanguinarine are two major toxic alkaloids of Argemone oil, which cause widespread capillary dilatation, proliferation and increased capillary permeability. Leakage of the protein-rich plasma component into the extracellular compartment leads to the formation of oedema. There is no specific therapy. Removal of the adulterated oil and symptomatic treatment of congestive cardiac failure and respiratory symptoms, along with administration of anti-oxidants and multivitamins, remains the mainstay of treatment.

Effect of tobacco use on arterial stiffness in community dwelling females.

AIMS: The goal of this study was to investigate the changes in arterial stiffness by evaluation of arterial stiffness index and pulse wave velocity in community dwelling tobacco user females and to correlate those changes with duration of tobacco use, amount consumed and severity of addiction. METHODS: This observational cohort study was conducted in Department of Medicine at Dr. S N Medical College, Jodhpur, comprised of 100 females, out of which 55 were community dwelling females using tobacco (cases) and 45 are age-sex matched healthy control group. Out of 55 tobacco user females 21 (38%) were smoker and 34 [62%] were smokeless tobacco user. Pulse wave velocity and arterial stiffness index were evaluated by means of an 8-channel real-time PC-based simultaneous acquisition and analysis system (Periscope). RESULTS: Average C-F PWV in tobacco user female was 1327 +/- 515.2 as compared to 796 +/- 157.3 in control and average ASI was 71 +/- 20.9 in tobacco user female as compared to 62 +/- 13.9 in control that is statistically significant (p < or = .05). Both C-F PWV and ASI were significantly higher in tobacco user than control. Average C-F PWV in smoker group is 1683 +/- 566.7 as compared to 1108 +/-387.9 in smokeless group. Average ASI is 76 +/- 22.9 in smoker group as compared to 66 +/- 18.9 in smokeless tobacco user group. Both C-F PWV and ASI were higher in smoker group than smokeless group that is statistically significant (P Value 0.0018). CONCLUSIONS: This study has demonstrated that PWV and ASI are increased in tobacco user females and they are independent predictor of cardiovascular morbidity. Tobacco use either smoking or smokeless causes Atherovascular diseases. Smoking is more prone to increase atherosclerosis and cardiovascular morbidity in comparison to smokeless tobacco use.

Inter-instrument agreement and influence of central corneal thickness on measurements with Goldmann, pneumotonometer and noncontact tonometer in glaucomatous eyes.

PURPOSE: This study was conducted to compare the intraocular pressure (IOP) measurements by the Goldman applanation tonometer (GAT), non contact tonometer (NCT) and the ocular blood flow (OBF) pneumotonometer in different IOP ranges in glaucomatous eyes. The effect of central corneal thickness (CCT) on IOP measurement in chronic glaucomatous eyes using the three different tonometers was also evaluated. MATERIALS AND METHODS: IOP measurements of 130 eyes of primary glaucoma patients were performed using GAT by an ophthalmologist while NCT and OBF-pneumotonometer measurements were performed by an experienced optometrist. The IOP values were compared amongst the three instruments in the three different IOP ranges (0-18 mmHg, > 18 to 25 mmHg, > 25 mmHg). CCT was also measured in all patients. RESULTS: The mean of paired difference between GAT and NCT was 0.9 +/- 3.1 mmHg while that between GAT and OBF-pneumotonometer was 0.3 +/- 3.4 mmHg. The OBF-pneumotonometer and NCT were more affected by corneal thickness (0.41 mmHg and 0.4 mmHg / 10 micro corneal thickness respectively) while GAT was the least affected by corneal thickness (0.3 mmHg / 10 micro corneal thickness) though the difference was not statistically significant ( P =0.42). CONCLUSION: With appropriate correction for corneal thickness the NCT and OBF-pneumotonometer can be used as reliably as GAT in following up glaucomatous patients.

Calibration of dynamic molecular rulers based on plasmon coupling between gold nanoparticles.

Pairs of noble metal nanoparticles can be used to measure distances via the distance dependence of their plasmon coupling. These "plasmon rulers" offer exceptional photostability and brightness; however, the advantages and limitations of this approach remain to be explored. Here we report detailed plasmon peak versus separation calibration curves for 42- and 87-nm-diameter particle pairs, determine their measurement errors, and describe experimental procedures to improve their performance in biology, nanotechnology, and materials sciences.

Biocompatible force sensor with optical readout and dimensions of 6 nm3.

We have developed a nanoscopic force sensor with optical readout. The sensor consists of a single-stranded DNA oligomer flanked by two dyes. The DNA acts as a nonlinear spring: when the spring is stretched, the distance between the two dyes increases, resulting in reduced Förster resonance energy transfer. The sensor was calibrated between 0 and 20 pN using a combined magnetic tweezers/single-molecule fluorescence microscope. We show that it is possible to tune the sensor's force response by varying the interdye spacing and that the FRET efficiency of the sensors decreases with increasing force. We demonstrate the usefulness of these sensors by using them to measure the forces internal to a single polymer molecule, a small DNA loop. Partial conversion of the single-stranded DNA loop to a double-stranded form results in the accumulation of strain: a force of approximately 6 pN was measured in the loop upon hybridization. The sensors should allow measurement of forces internal to various materials, including programmable DNA self-assemblies, polymer meshes, and DNA-based machines.

Effect of intraoperative intracameral 2% hydroxypropyl methylcellulose viscoelastic during trabeculectomy.

BACKGROUND AND OBJECTIVE: To evaluate the effect of intraoperative intracameral injection of 2% hydroxypropyl methylcellulose (HPMC) on anterior chamber depth and intraocular pressure (IOP) following trabeculectomy in eyes with uncontrolled primary open-angle glaucoma in a prospective randomized manner. PATIENTS AND METHODS: Thirty consecutive eyes with primary open-angle glaucoma scheduled for trabeculectomy were randomized to conventional trabeculectomy without HPMC injection (group I; n = 15) or to intracameral injection of 2% HPMC during trabeculectomy (group II; n = 15). All patients were observed serially on days 1, 3, 5, 7, and 14 and months 1, 3, and 6 postoperatively. The main outcome measure was restoration of anterior chamber depth to preoperative level with IOP of less than 21 mm Hg with no additional antiglaucoma medication or surgery. RESULTS: The anterior chamber depth decreased from 2.5 +/- 0.53 to 1.5 +/- 0.94 mm on postoperative day 1 in group I and increased slightly from 2.4 +/- 0.43 to 2.5 +/- 0.36 mm on postoperative day 1 in group II (P = .04). Overall, the IOP decreased to 5.0 +/- 2.8 mm Hg in group I (87% reduction) and 9.0 +/- 4.6 mm Hg in group II (70% reduction). Two eyes developed postoperative flat anterior chamber and related complications in group I, whereas none of the eyes in group II developed such complications. CONCLUSIONS: Intracameral injection of 2% HPMC during trabeculectomy helps to maintain anterior chamber depth and reduces incidence of complications related to shallow anterior chamber depth following trabeculectomy.

A prospective longterm study of primary chronic angle closure glaucoma.

PURPOSE: To prospectively evaluate the longterm outcome of therapy for chronic primary angle closure glaucoma (PACG) and to assess the efficacy of medical and surgical treatment in terms of intraocular pressure (IOP) and visual field stabilization. METHODS: Seventy consecutive patients with chronic PACG, whose IOP remained > 21 mmHg despite a patent iridotomy, had their IOP controlled by medications or trabeculectomy performed without antimetabolites. They were followed over a 6-year period. Best corrected visual acuity, IOP (mean of annual diurnal variation readings), cup : disc ratio and visual fields were recorded. A trabeculectomy was performed if the IOP was not adequately controlled on maximal tolerable medical therapy or if there was a progression of the glaucomatous defect. Data from one eye of each patient were analysed; if both eyes met the inclusion criteria, one was randomly selected for the analysis. The baseline parameters were compared with those at the end of 6 years. RESULTS: A total of 46 eyes (65%) were controlled medically throughout the 6-year follow-up period, while 24 eyes (35%) required surgery. The mean IOP was 25.4 +/- 4.9 mmHg at baseline and 15.6 +/- 4.6 mmHg at 6 years follow-up (p < 0.001). Stereoscopic evaluation of the cup : disc ratio did not show a significant change from a mean of 0.6 +/- 0.18 at baseline to a mean of 0.64 +/- 0.2 at 6 years (p = 0.12). Progression of visual field defects was seen in seven eyes (10%), which had statistically larger cup : disc ratios (p = 0.04) and more extensive visual field deficits at the initial assessment (p = 0.04), and which also maintained higher levels of IOP (p = 0.03) over the 6 years of follow-up. CONCLUSIONS: Stable visual fields and good longterm IOP control were seen in 90% of chronic primary angle closure glaucoma eyes on medical/surgical therapy over 6 years.

Long-term evaluation of trabeculectomy in primary open angle glaucoma and chronic primary angle closure glaucoma in an Asian population.

PURPOSE: A retrospective cohort study was undertaken to evaluate and compare the long-term results of trabeculectomy in primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) in an Asian population. METHODS: Yearly diurnal measurements of intraocular pressure (IOP), best-corrected visual acuity, optic disc and visual field records of patients having primary adult glaucomas who had undergone trabeculectomy, without anti-mitotic agents, with a minimum of 5 years follow up were evaluated. Only one eye of each patient was studied. The success rates for IOP control in POAG and CPACG were statistically analysed. RESULTS: Sixty-four eyes of 64 patients were studied. The overall probability of success of trabeculectomy in controlling IOP to < or = 21 mmHg with or without additional topical antiglaucoma medication was 0.94 and 0.88 at 5 and 10 years, respectively. There was no statistically significant difference in the qualified and absolute success rates for IOP control between POAG and CPACG eyes (log rank test P= 0.6, 0.88, respectively). Twelve of 38 CPACG eyes had a two-line decrease in visual acuity as compared to four of 26 POAG eyes (P = 0.17). Progression or development of a cataract was the most common cause of visual decline. CONCLUSIONS: Trabeculectomy without antimetabolite use appears to be efficacious in lowering IOP and in visual field preservation over a period of 10 years in both POAG and CPACG. Development/progression of cataract especially in eyes with chronic angle closure glaucoma after trabeculectomy must be considered an important issue.

Evaluation of contact versus non-contact diode laser cyclophotocoagulation for refractory glaucomas using similar energy settings.

PURPOSE: To compare the efficacy of contact and non-contact techniques of diode transscleral cyclophotocoagulation (TSCPC) in patients with refractory glaucoma in a prospective randomized manner. METHODS: Sixty eyes with refractory glaucoma were randomly treated with either the contact or non-contact technique of diode TSCPC and followed up for a minimum of 12 months. A standard protocol of 1500 mW for 2 s per spot, with 40 spots over the entire 360 degrees circumference was followed for all eyes in both groups. RESULTS: The reduction of mean baseline intraocular pressure (IOP) from 44.5 +/- 7.4 mmHg to 14.8 +/- 1.8 mmHg with the contact mode was not significantly different from that in the non-contact mode of 41.9 +/- 8.8 mmHg reduced to 14.5 +/- 1.5 mmHg (P = 0.34). The probability of IOP survival (<22 mmHg) at 1 year using the Kaplan-Meier plot was better using the contact mode, although the results did not achieve statistical significance. However, the average repeat treatments per eye with the non-contact mode (1.6 +/- 0.7) was significantly higher than with the contact method (1.2 +/- 0.6; P < 0.05). CONCLUSION: Using an energy setting of 3 J per spot, both the contact and non-contact methods of laser delivery were found to be equally effective in lowering IOP in eyes with refractory glaucoma.

Corneal endothelial status in the subtypes of primary angle closure glaucoma.

PURPOSE: To study the corneal endothelium and pachymetry in eyes with different subtypes of primary angle closure glaucoma (PACG), as compared to controls. METHODS: A cross-sectional study was conducted on 30 consecutive patients in each subtype of PACG, subacute, acute and chronic, and 30 age and refraction matched controls. The parameters recorded included gonioscopy, optic disc evaluation, applanation tonometry, specular microscopy and central ultrasonic pachymetry. RESULTS: The mean endothelial cell counts in the four groups were as follows: subacute PACG 2396 +/- 271 cells/mm2, acute PACG 1597 +/- 653 cells/mm2, chronic PACG 2229 +/- 655 cells/mm2 and controls 2461 +/- 321 cells/mm2. The mean endothelial cell count in the fellow eyes of subacute PACG, acute PACG and chronic PACG patients was 2294 +/- 305 cells/mm2, 2388 +/- 226 cells/mm2 and 2108 +/- 203 cells/mm2, respectively (NS). The acute PACG patients had significantly lower endothelial cell counts (P < 0.001) as compared to the other three groups. Eyes in which the acute attack of angle closure persisted for less than 72 h had a mean endothelial cell count of 2016 +/- 306 cells/mm2, as compared to 759 +/- 94.4 cells/mm2 in eyes with an attack lasting for 72 h or more (P < 0.001). The endothelial count was also significantly lower in eyes with chronic PACG as compared to control eyes (P < 0.001). There was increased pleomorphism and polymegathism of the corneal endothelial cells seen in eyes with resolved acute and chronic PACG. The mean central corneal thickness was 531.4 +/- 25.3 microm in eyes with subacute PACG, 567.9 +/- 37.3 microm in eyes with acute PACG, 526.4 +/- 31.9 microm in eyes with chronic PACG and 525 +/- 12.6 microm in control eyes. The acute PACG eyes had a significantly higher corneal thickness (P < 0.001) when compared to all the other groups. CONCLUSION: There is a significant decrease in the corneal endothelial cell density in eyes that have had an acute attack of angle closure glaucoma and in eyes with chronic PACG. The endothelial cell population in eyes with sub-acute PACG and in the fellow eyes of all subtypes of PACG is not significantly different from the normal population.

Pulsatile ocular blood flow among normal subjects and patients with high tension glaucoma.

PURPOSE: To estimate pulsatile ocular blood flow (POBF) among normal subjects and to compare various parameters in eyes of primary open angle glaucoma with high intraocular pressure (IOP). METHODS: POBF was estimated in 95 eyes of 95 normal subjects above the age of 40 years and in 35 eyes of 35 primary open angle glaucoma patients using the OBF system (OBF Labs Ltd., UK). Correlation of age, gender, IOP, pulse amplitude, pulse volume and pulse rate with POBF was studied. POBF values were measured in glaucomatous patients before IOP control and one month later after control of IOP to < 22 mmHg. RESULTS: The mean POBF among normal subjects was 1382.2 +/- 413 ml/min (range 636-2291 m/min). Females had a significantly higher mean POBF (1512 +/- 347 ml/min) than males (1193 +/- 312 ml/min). The mean IOP among normal subjects was 12.6 mmHg and in glaucoma patients, 29.1 mmHg. Mean POBF in glaucomatous eyes with initially elevated IOP was 718.9 +/- 322.6 ml/min, which improved after IOP control to 1129 +/- 291 ml/min. IOP had a strong (P < .01) negative correlation with POBF (r = -0.667) CONCLUSIONS: POBF among eyes of normal subjects in this study is higher than reported among Caucasian eyes. Primary open angle glaucoma eyes with high IOP have significantly reduced ocular blood flow. Therapy aimed at lowering IOP has a positive effect onocular haemodynamics.

Intravitreal sodium hyaluronate and secondary glaucoma after complicated phacoemulsification.

We report 4 cases that presented with intractable glaucoma after complicated phacoemulsification during which sodium hyaluronate 1.0% (Healon) was used to tamponade a central posterior capsule rupture. The postoperative intraocular pressure (IOP) was uncontrolled on maximal medical therapy. In 2 patients, the IOP took 8 to 10 weeks to resolve and simultaneous ultrasound B-scans showed the presence of clear globules in the anterior and midvitreous that became smaller with conservative therapy. An early pars plana vitrectomy in 2 cases immediately controlled the IOP. The presence of globules presumed to be sodium hyaluronate in the vitreous cavity of the patients while the IOP was elevated suggests a causal relationship with the refractory secondary glaucoma.

Effect of changing from concomitant timolol pilocarpine to bimatoprost monotherapy on ocular blood flow and IOP in primary chronic angle closure glaucoma.

The aim of the present prospective masked study was to assess the effect of bimatoprost monotherapy on ocular blood flow and intraocular pressure (IOP) in eyes of primary chronic angle closure glaucoma patients already on concomitant timolol and pilocarpine. Thirty two patients of bilateral primary chronic angle closure glaucoma (PCACG) on topical timolol 0.5% twice a day and pilocarpine 2% three times daily were switched over to bimatoprost 0.03% once daily in both eyes. Intraocular pressure (IOP) and pulsatile ocular blood flow (POBF) were recorded before and after starting bimatoprost and were followed up every four weeks for three months. Bimatoprost had statistically significant (p < 0.05) mean IOP reduction from 19.3 +/- 6.6 to 13.5 +/- 4.5 mmHg (30.5%) and there was improvement from 858 +/- 260 to 1261 +/- 321 microL/min (46.8%) in mean pulsatile ocular blood flow (p < 0.05). Conjunctival hyperemia (32%) was the most common adverse effect of bimatoprost. Bimatoprost 0.03% monotherapy improved ocular blood flow and provided a better diurnal IOP control than concomitant timolol-pilocarpine in eyes with primary chronic angle closure glaucoma and was found to be well tolerated.

Correlation analysis of visual field thresholds and scanning laser ophthalmoscopic optic nerve head measurements in glaucoma.

In a cross-sectional study of 50 consecutive primary open-angle glaucoma cases, full threshold 30-2 visual fields on Humphrey Visual Field Analyser were correlated to stereometric parameters obtained using a scanning laser ophthalmoscope (HRT II). The strength of linear correlation between the stereometric parameters and visual thresholds was used to generate a correspondence map between the optic disc and the visual field. Rim/disc area ratio and cup/disc area ratio correlated with the visual thresholds at the highest number of points in the visual fields. Thresholds at superior hemifield locations correlated best with the rim/disc area ratio and cup/disc area ratio in the inferonasal sector and the ones in the inferior hemifield correlated best with the rim/disc area ratio and cup/disc area ratio in the superotemporal sector. Optic disc parameters correlated better with inferior field locations and non-edge points than superior field locations and edge points. The data indicate that rim/disc area ratio and cup/disc area ratio measurements on HRT II have a good correlation with visual field damage seen on automated visual fields.