Humoral immune response to Covid-19 vaccination in diabetes: age-dependent but independent of type of diabetes and glycaemic control-the prospective COVAC-DM cohort study

AimsImmune response to COVID-19 vaccination and a potential impact of glycaemia on antibody levels in people with diabetes remains unclear. We investigated the seroconversion following first and second COVID-19 vaccination in people with type 1 and type 2 diabetes in relation to glycaemic control prior to vaccination and analysed the response in comparison to individuals without diabetes. Materials and MethodsThis prospective, multicenter cohort study analysed people with type 1 and type 2 diabetes, well (HbA1c<7.5% or <58 mmol/mol) or insufficiently (HbA1c[≥]7.5% or [≥]58 mmol/mol) controlled and healthy controls. Roches Elecsys anti-SARS-CoV-2 S was used to quantify anti-spike protein antibodies 7-14 days after the first and 14-21 days after the second vaccination. Results86 healthy controls and 161 participants with diabetes were enrolled, 150 (75 with type 1 diabetes and 75 with type 2 diabetes) were eligible for the analysis. After the first vaccination, only 52.7% in the type 1 diabetes group and 48.0% in the type 2 diabetes group showed antibody levels above the cut-off for positivity. Antibody levels after the second vaccination were similar in people with type1, type 2 diabetes and healthy controls if adjusted for age, sex and multiple testing (p>0.05). Age (r=-0.45, p<0.001) and glomerular filtration rate (r=0.28, p=0.001) were significantly associated with antibody response. ConclusionsAnti-SARS-CoV-2 S antibody levels after the second vaccination were comparable in healthy controls, people with type 1 and type 2 diabetes, irrespective of glycaemic control. Age and renal function correlated significantly with the extent of antibody levels.

Comparison of the Recurrence Rate of Entropion via Subciliary Route and Transconjunctival Route in Combined Lateral Tarsal Strip with Retractor Advancement Procedure for Involutional Entropion Correction.

OBJECTIVE: To compare the recurrence rate of entropion via subciliary route and transconjunctival route in combined lateral tarsal strip with retractor advancement procedure for involutional entropion correction. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Eye, Combined Military Hospital, Jhelum Cantt, Pakistan from March 2018 to November 2020. METHODOLOGY: Seventy-eight eyes of 78 patients with entropion were randomly divided into two groups of 39 each. One group underwent a lateral tarsal strip procedure combined with retractor advancement through the subciliary approach; and the second group underwent the same procedure through the transconjunctival approach. A strip of preseptal orbicularis was excised in every case. Recurrence rate of entropion was recorded in both groups at six-month postoperation. Duration of surgery was recorded in each case. Fisher's Exact test was selected to compare the recurrence rate of entropion and independent samples 't' test was elected for comparing duration of surgery among the two groups. RESULTS: The recurrence rate of entropion with transconjunctival route repair was statistically not significant compared with the subciliary route repair (p>0.999). The transconjunctival route repair achieved statistically significant shorter duration of surgical time as compared to the subciliary route (p<0.001). CONCLUSION: The transconjunctival approach for involutional entropion correction is as effective as the subciliary approach with lateral tarsal strip and retractor advancement procedure. Surgery duration through the transconjunctival route is significantly shorter as compared to the subciliary approach. Key Words: Entropion, Involutional, Lateral tarsal strip, Lower eyelid, Retractor advancement, Recurrence, Subciliary, Transconjunctival.

Covid-19 fatality prediction in people with diabetes and prediabetes using a simple score at hospital admission

AIMWe assessed predictors of in-hospital mortality in people with prediabetes and diabetes hospitalized for COVID-19 infection and developed a risk score for identifying those at the highest risk of a fatal outcome. MATERIALS AND METHODSA combined prospective and retrospective multicenter cohort study was conducted in 10 sites in Austria on 247 people with diabetes or newly diagnosed prediabetes, who were hospitalised for COVID-19. The primary outcome was in-hospital mortality and predictor variables at the time of admission included clinical data, comorbidities of diabetes or laboratory data. Logistic regression analyses were performed to identify significant predictors and develop a risk score for in-hospital mortality. RESULTSThe mean age of people hospitalized (n=238) for COVID-19 was 71.1 {+/-} 12.9 years, 63.6% were males, 75.6% had type 2 diabetes, 4.6% had type 1 diabetes, and 19.8% had prediabetes. The mean duration of hospital stay was 18 {+/-} 16 days, 23.9% required ventilation therapy, and 24.4% died in the hospital. Mortality rate in people with diabetes was numerically higher (26.7%) as compared to those with prediabetes (14.9%) but without statistical significance (p=0.128). A score including age, arterial occlusive disease, CRP, eGFR and AST levels at admission predicted in-hospital mortality with a C-statistics of 0.889 (95%CI: 0.837 - 0.941) and calibration of 1.000 (p=0.909). CONCLUSIONSThe in-hospital mortality for COVID-19 was high in people with diabetes and not significantly different to the risk in people with prediabetes. A risk score using five routinely available patient parameters demonstrated excellent predictive performance for assessing in-hospital mortality.

Effect of Pterygium Morphology on Recurrence with Preoperative Subconjunctival Injection of Mitomycin-C in Primary Pterygium Surgery.

OBJECTIVE: To investigate the effect of pterygium morphology on recurrence with preoperative subconjunctival injection of mitomycin-C in primary pterygium surgery. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Eye Department, Combined Military Hospital, Malir Cantt, Karachi, from February 2017 to February 2018. METHODOLOGY: On the basis of pterygium morphology, 165 eyes of 165 patients were equally divided into three equal groups of atrophic, intermediate and fleshy pterygia. In each morphology group, length was graded into three groups using limbus, pupil margin and midiris as landmarks. All pterygia received 0.1 ml of mitomycin-C injection in a concentration of 0.15 mg/ml at 24 hours prior to undergoing a bare sclera surgical excision technique in all cases. All patients were followed up for 12 months. The recurrence rate was recorded in each morphology group. Pearson Chi-Square test was used to compare recurrence rate and morphology group. Fisher's exact test was applied to compare recurrence rate with length and age in each type of morphology. RESULTS: Among the three morphology groups, the recurrence rate was statistically significant between fleshy and atrophic pterygia (p=0.01) and no significant association was found among other morphology comparisons. Age less than 40 years had a significant effect on recurrence in all morphology groups. Length did not affect the recurrence rate in any of morphology types. CONCLUSION: Recurrence of primary pterygium is related to fleshiness of the pterygium and is a significant risk factor for recurrence after preoperative subconjunctival injection of mitomycin-C given at 24 hours before sclera excision.

Relationship of the Van Herick Grading System with Peripheral Iris Configuration and Level of Iris Insertion.

OBJECTIVE: To determine the relationship of the van Herick angle grading system with the level of iris insertion and peripheral iris configuration. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Eye department, Combined Military Hospital, Malir Cantt., Karachi, from May to October 2015. METHODOLOGY: Sixty-five eyes of 65 patients were recruited. Anterior chamber depth at the temporal limbus was measured as a fraction of corneal section thickness using van Herick technique and graded on the standard 4-point scale of the van Herick grading system. Gonioscopy of the temporal quadrant was performed with a Posner 4 mirror goniolens and both the true level of iris insertion and peripheral iris configuration were recorded on a 4-point scale so as to equate with the van Herick 4-point grading system. Spearman's rho test was applied to determine the relationship of the van Herick grading system with level of iris root insertion and peripheral iris configuration. RESULTS: Amoderate positive correlation between van Herick grade and peripheral iris configuration was found which was statistically significant (rs=0.42, p < 0.001). Astatistically significant and moderate positive correlation was also detected between van Herick grade and the level of iris insertion (rs=0.45, p < 0.001). CONCLUSION: The van Herick grade has a moderately positive relationship with the peripheral iris configuration and true level of iris insertion.

Comparison of the Long-term and Short-term Fluctuations of Frequency-Doubling Technology Perimetry Between Peripheral and Paracentral Zones of Visual Field.

OBJECTIVE: To compare the long- and short-term fluctuations of frequency doubling technology perimetry between peripheral and paracentral zone and determine the relationship between threshold sensitivity and long- and short-term fluctuation within peripheral and paracentral zone of visual field. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Eye Department, United Nations, Pakistan Field Hospital Level-3 Darfur, Sudan, from February to July 2015. METHODOLOGY: Normal eyes of 30 volunteers were recruited. Frequency doubling technology perimetry, program N-30, full threshold was employed. Each subject was tested at weekly intervals, once in the 1st, 3rd and 4th sessions and three times in the 2nd session. Visual field was divided into paracentral, superior, and inferior zones. Short-term and long-term fluctuation as well as threshold sensitivity were calculated for each patient as the mean fluctuation and mean sensitivity value. Mann-Whitney U-test was used to compare each zone in terms of their short- and long-term fluctuations and Spearman's rho correlation test for determining the relationship of threshold sensitivity with short- and long-term fluctuations. RESULTS: Long-term fluctuation values differences were insignificant between superior and paracentral zones. Short-term fluctuation values were statistically insignificant between all three zones. Short-term fluctuation and threshold sensitivity in each zone did not correlate. Long-term fluctuation and threshold sensitivity had a very weak negative, statistically insignificant correlation in superior and paracentral zones. CONCLUSION: Frequency doubling perimetry exhibits uniform short- and long-term fluctuations in peripheral and paracentral zones of visual field in normal subjects. Threshold sensitivity and long- and short-term fluctuations are independent of each other in peripheral and paracentral zones of visual field.

Effectiveness of Preoperative Subconjunctival Injection of Mitomycin-C in Primary Pterygium Surgery.

OBJECTIVE: To compare the effectiveness of preoperative subconjunctival injection of Mitomycin-C at 24-hour and at one month before primary pterygium excision. STUDY DESIGN: Randomised controlled trial. PLACE AND DURATION OF STUDY: Eye Department, Combined Military Hospital, Sargodha, from January to December 2014. METHODOLOGY: Eyes of 60 patients were randomly allocated into two equal groups (A and B) of 30 each. In group A Mitomycin-C was injected into the pterygium one month before, and in group B Mitomycin-C was injected 24 hours before excision. All pterygia received 0.1 ml of Mitomycin-C in a concentration of 0.15 mg/ml. Primary pterygia greater or equal to 2.5 mm were selected and excised as a bare sclera technique. Postoperatively, all patients were followed-up for 06 months. The recurrence and corneoscleral complications were recorded. Pearson chi-square test was used to compare the recurrence between group A and group B. RESULTS: The recurrence of pterygium in group A was 3.3%; and in group B, it was 6.7%. Comparison of the recurrences between both the groups was statistically insignificant, (p=0.554).Postoperatively, no serious corneoscleral complications occurred in either group. CONCLUSION: The preoperative subconjunctival injection of Mitomycin-C in a dose of 0.15 mg/ml given 24 hours prior to excision is as effective as 01 month preoperative injection for primary pterygium surgery with bare sclera technique.

Efficacy of 2.5% and 1.25% Povidone-Iodine Solution for Prophylaxis of Ophthalmia Neonatorum.

OBJECTIVE: To determine the efficacy of 2.5% and 1.25% Povidone-Iodine solution for Ophthalmia neonatorum prophylaxis. STUDY DESIGN: Interventional study. PLACE AND DURATION OF STUDY: Eye Department, Combined Military Hospital, Sargodha, from May to November 2014. METHODOLOGY: Atotal of 200 eyes of 100 newborn babies were enrolled and divided into two groups of 100 right eyes and 100 left eyes. Aconjunctival swab for bacterial culture was taken within 30 minutes after delivery. Asingle drop of 2.5% Povidone-Iodine was then placed in the right eye while in the left eye a single drop of 1.25% Povidone-Iodine was placed. Thirty minutes after placing Povidone-Iodine, a conjunctival swab was again taken. Abacterial suspension was prepared from each swab in determining bacterial counts. The bacterial suspension was inoculated on yeast extract agar and the number of colony forming units were counted. At each culture, the number of colony forming units before and after instillation of 2.5% Povidone-Iodine and 1.25% Povidone-Iodine were compared. Wilcoxon's signed rank test was used for statistical analysis. RESULTS: The 2.5% Povidone-Iodine solution caused a statistically significant decrease in the number of colony forming units (p=0.001). Similarly, the 1.25% Povidone-Iodine solution also reduced the number of colony forming units to a statistically significant level (p=0.001). CONCLUSION: The 1.25% concentration of Povidone-Iodine is as effective as the 2.5% concentration of Povidone-Iodine in reducing the number of colony forming units in healthy conjunctivae of newborns.

The impact of pterygium excision on corneal astigmatism.

OBJECTIVE: To compare the corneal astigmatism before and after the excision of pterygium and also to determine the correlation of pterygium size with the postoperative corneal astigmatism. STUDY DESIGN: Cross-sectional interventional study. PLACE AND DURATION OF STUDY: Eye Department, Combined Military Hospital, Abbottabad, from May 2011 to March 2012. METHODOLOGY: Thirty patients underwent pterygium excision. Pre-operatively Snellen visual acuity, manifest refraction and slit lamp examination was done. The size of the pterygium was recorded in mm by projecting a horizontal slit lamp beam from the limbus to the apex. All the pterygium were equal to or greater than 2.5 mm. Keratometry was performed with an automated keratometer. Keratometric data was recorded pre-operatively and at 28 days postoperatively. Wilcoxon signed rank test was used for comparing the pre-operative and the postoperative corneal astigmatism. Spearman's rank order was calculated to observe correlation of pterygium size with the postoperative astigmatism. RESULTS: The median (mean rank) pre-operative astigmatism of 2.25 (15.50) reduced to a median (mean rank) postoperative astigmatism of 1.30 (14.96). This decrease in the postoperative astigmatism was statistically significant (p < 0.001). There was a statistically non-significant correlation between the postoperative astigmatism and the pterygium size (rs = -0.29, p = 0.12). CONCLUSION: Pterygium excision caused significant reduction in corneal astigmatism.

CXCR1/CXCR2 antagonism is effective in pulmonary defense against Klebsiella pneumoniae infection.

Klebsiella pneumoniae-associated pathology is largely mediated by neutrophilic inflammation. In this study, we administered Klebsiella pneumoniae to experimental guinea pig groups and the ELR-CXC chemokine antagonist CXCL8(3-72), ceftazidime, and dexamethasone to different groups, respectively. After 24 h, we assessed the animal's pulmonary inflammatory levels, including gross histopathology, airway neutrophilia, lung myeloperoxidase levels, expressions of CXCL8 and TNF, and airway bacterial loads. Compared with ceftazidime and dexamethasone treatments, the administration of the ELR-CXC chemokine antagonist CXCL8(3-72) alone was more effective than other methods, although it did not markedly attenuate the bacterial load. These results suggest new methods for the treatment of Klebsiella pneumoniae pathology.

Grading complication following radical cystectomy and ileal conduit for bladder cancer using Clavien grading system.

OBJECTIVE: To determine the 30-day complication rate of radical cystectomy and urinary diversion using a validated system. STUDY DESIGN: An analytical descriptive study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from 1990 to 2010. METHODOLOGY: Patients who had undergone ileal conduit (IC) formation, following radical cystectomy (RC) for muscle invasive transitional cell carcinoma, were studied, using a prospectively maintained data base. Basic details were determined, complications were noted and graded according to the modified Clavien grading system (CG). Results were presented using descriptive statistics. RESULTS: Of all the RC performed at this hospital 89 patients received IC. Of them 75 were male and 14 female. Mean age was 60 years. Mean duration of hospital stay was 14 days. Ten patients each received pre-operative chemotherapy and radiotherapy, respectively. Mean duration of surgery was 8.2 hours, with mean estimated blood loss of 1334 ml. Preoperative radiotherapy was associated with more complications. No other factor like ASA, co-morbidities, blood loss or duration of stay influenced the complications. Fifty patients (56.2%) did not have any complications. Most common complication of wound infection was seen in 7 patients (CG-2), followed by uretero-ileal leakage in 5, requiring percutaneous intervention under local anaesthesia (GC-3a). Mortality rate was 4.5%, classified as CG-V. CONCLUSION: Radical cystectomy with Ileal conduit is a major procedure with a good safety profile at this institute. Longterm follow up is still needed to evaluate delayed complications and quality of life.

The clinical significance of perilimbal conjunctival pigmentation in vernal conjunctivitis.

OBJECTIVE: To compare the extent of perilimbal conjunctival pigmentation and limbal palisadal pigmentation in patients with vernal conjunctivitis and controls and correlate it with the duration of disease. STUDY DESIGN: Case control study. PLACE AND DURATION OF STUDY: Eye Department, Combined Military Hospital, Abbottabad, from May 2009 to March 2010. METHODOLOGY: One hundred subjects including 50 patients with vernal conjunctivitis and 50 controls were studied. Demographic data, family and personal history, disease duration, symptoms, signs, complications and extent of perilimbal and palisadal conjunctival pigmentation were recorded among patients and controls. Mann Whitney-U test and Spearman's rho test were used for statistical analysis. RESULTS: The extent of perilimbal conjunctival pigmentation in patients with vernal conjunctivitis was more than controls (p < 0.0001). Similarly, limbal palisadal pigmentation was also more extensive than controls (p = 0.004). There was no correlation between the duration of disease and severity of conjunctival pigmentation (r = 0.24) (p = 0.086). CONCLUSION: The presence of increased perilimbal and limbal palisadal conjunctival pigmentation among patients with vernal conjunctivitis is a specific sign of vernal conjunctivitis.

The 'molar tooth sign' in Joubert syndrome.

The molar tooth sign is seen in very few conditions and is a very rare paediatric central nervous system congenital anomaly. Molar tooth sign is the result of cerebellar vermis hypoplasia, thick and maloriented superior cerebellar peduncles, and an abnormally deep interpeduncular fossa. In Joubert syndrome this is seen in about 85% of patients. We present a case of 13 months old baby boy with recurrent episodes of fits and hyperpnoea, regression of milestones and developmental delay. MRI examination showed the characteristic molar tooth sign with apposition of cerebellar hemispheres, batwing-shaped fourth ventricle communicating through a thin fissure with foramen of Magendie, cerebellar vermis agenesis and deep interpeduncular fossa consistent with diagnosis of Joubert syndrome.