In vivo evaluation of some biophysical parameters of the facial skin of Indian subjects living in Mumbai. Part II: Variability with age and gender.

BACKGROUND: A previously published work explored the diversity of some biophysical parameters (colour, elasticity, sebum production, skin microrelief, etc.) of the skin of 1204 Indian women, differently aged, living in four Indian cities (Chennai, Delhi, Kolkata and Mumbai). The present work aimed at completing such research by focusing on possible gender-related differences in the same skin parameters, between Indian men and women living in the same Indian city (Mumbai). METHODS: A total of 297 Indian men, differently aged (18-70y), were recruited in Mumbai, completing the panel of 303 women who were previously recruited in this same city. The same instrumental measurements of facial skin colour and its homogeneity, its mechanical properties, the sebum production, skin pores size, skin relief, etc. as in the previous work, were conducted. RESULTS: Overall, the facial skin colour shows a darker complexion in men as compared to women, on forehead, ocular region, lips, chin and cheek. The skin colour unevenness, which increases with age, was found higher in men, as compared to women. At comparable age, women and men present a same density of skin pores, whereas those of men appear larger, up to 55y. The deepness of Crow's feet wrinkles does not significantly differ between genders. A lesser extensibility was found on the cheeks of men. In men, the sebum production was found significantly higher than that of women at ages above 40y. CONCLUSIONS: This work indicates some commonly shared age-related skin features between women and men from Mumbai, despite slight different characteristics such as skin pigmentation, forehead/cheek colour contrast, mechanical properties and sebum production.

In vivo evaluation of some biophysical parameters of the facial skin of Indian women. Part I: variability with age and geographical locations.

BACKGROUND: India is a large country (a subcontinent) of about 3.3 million km2 that covers large ranges in latitude and longitude. The last Indian census counted about 1.21 billion of inhabitants of many origins, creating a vast human diversity and skin types, the variability of which having been previously established. The present study aimed at deepening this knowledge through a set of biophysical measurements to describe, along the skin ageing process, the specificities of various Indian subjects living in different geographical locations. METHODS: A total of 1204 women, aged 18-84 years, of all socio-economic status, were recruited in four Indian cities (Mumbai, Kolkata, Chennai and Delhi). Measurements of face skin colour properties, elastic properties, sebum production, skin pores and microrelief roughness were performed. RESULTS: With regard skin colour, this study indicates, with age, a darkening of very low amplitude that leads to an increased skin colour heterogeneity. In all subjects, at all ages, the ocular region (dark circles) presents a much darker pigmentation than the cheeks, creating a contrast that appears constant at all ages. In addition to an increased skin colour heterogeneity, a progressive alteration of the skin surface relief, increased sizes of skin pores, a loss of skin elasticity and a drop in sebum production, post-menopause, are observed. CONCLUSIONS: This study confirms, in Indian women, some skin ageing measurements found on women from other ethnic groups (i.e. sebum, firmness, wrinkles and pores size) and also identifies some Indian specificities: a high and constant contrast between the ocular region and the cheek colour, associated to a very slow darkening effect along the lifespan.

Particulate matter adheres to human hair exposed to severe aerial pollution: consequences for certain hair surface properties.

BACKGROUND: The deposit and adherence of particulate matter (PM) from aerial pollution onto the surface of human hair is a poorly studied phenomenon. OBJECTIVES: (i) To reproduce in vitro the deposit of known PM on standardized hair swatches in a closed box, (ii) to compare in vitro data with those obtained under 'real-life' conditions of severe aerial pollution and (iii) to assess the changes of the hair surface properties, potentially caused by the adherence of airborne PM onto the hair. METHODS: In vitro: a PM was sprayed onto untreated or sebum-coated hair swatches. Real-life conditions: other swatches were exposed to a severely polluted environment, for 24 to 72 h, in Baoding (PR China). In both cases, swatches were examined using scanning electron microscopy. The shine, the frictional properties and the level of metals were measured and compared to those same properties for the unexposed swatches. RESULTS: This work clearly indicates that, under real-life conditions, a large number of PM of various sizes are deposited onto the hair surface. This phenomenon is increased by the presence of sebum and longer exposure times. The in vitro level of PM deposited onto the hair surface is comparable to the in vivo level. The presence of sebum seems to favour the deposit of larger PM. The shine of the exposed swatches is significantly decreased, whereas their respective friction coefficients are significantly increased. Both the presence of sebum and length of exposure time increased the amount of analysed metals present on the exposed hair surface (Al, Fe, Cu, Ba and Zn). CONCLUSION: This work indicates that a very high amount (e.g. billions) of PM can be deposited on a full head of hair for subjects living in a severely aerially polluted environment. This process can be reproduced in vitro. In real-life, pollution has a strong impact on hair surface properties, leading to a modification of the visual aspect (loss of shine) and the alteration of hair surface (increase in friction force). This work may be used to pave the way for prevention and cleansing studies in the field of hair care.

Validity of EuroQOL-5D, time trade-off, and standard gamble for age-related macular degeneration in the Singapore population.

BACKGROUND/AIMS: Utility values of age-related macular degeneration (AMD) in Asian patients are unknown. This study aims to assess utility values and construct validity of the EuroQOL-5D (EQ-5D), time trade-off (TTO), and standard gamble (SG) instruments in the Singapore multi-ethnic AMD population. METHODS: Cross-sectional, two-centre, institution-based study. Visual acuity (VA), clinical AMD severity, and utility scores on the EQ-5D, TTO, and SG were obtained from 338 AMD patients. VA was analysed in terms of the better-seeing eye (BEVA), worse-seeing eye (WEVA), and weighted average of both eyes (WVA). We evaluated SG on the perfect health-death (SG(death)) and binocular perfect vision-binocular blindness (SG(blindness)) scales. Construct validity was determined by testing a priorihypotheses relating the EQ-5D, TTO, and SG utility scores to VA and clinical AMD severity. RESULTS: The mean utilities on the EQ-5D, TTO, SG(death), and SG(blindness) were 0.89, 0.81, 0.86, and 0.90, respectively. EQ-5D scores correlated weakly with BEVA, WEVA, and WVA (Pearson's correlation coefficients -0.291, -0.247, and -0.305 respectively, P<0.001 for all). SG(death) and SG(blindness) demonstrated no correlation with BEVA, WEVA, or WVA (Pearson's correlation coefficients, range -0.06 to -0.125). TTO showed weak association only with WEVA and WVA (correlation coefficients -0.237, -0.228, P<0.0001), but not with BEVA (correlation coefficient -0.161). Clinical AMD severity correlated with EQ-5D and SG(death), but not with TTO and SG(blindness) (P=0.004, 0.002, 0.235, and 0.069, respectively). CONCLUSIONS: AMD has a negative impact on utilities, although utility scores were high compared with Western cohorts. EQ-5D, TTO, and SG showed suboptimal construct validity, suggesting that health status utilities may not be sufficiently robust for cost-utility analyses in this population.

Awareness of blindness and other smoking-related diseases and its impact on motivation for smoking cessation in eye patients.

PURPOSE: Cigarette smoking is a major cause of morbidity and mortality. The association between smoking and eye diseases is less widely recognised relative to other better-known smoking-related conditions. This study aims to assess the awareness and fear of known smoking-related diseases among current smokers attending an ophthalmology outpatient clinic and to evaluate their relative impact on the likelihood of smoking cessation. PATIENTS AND METHODS: A cross-sectional survey using a structured interview of randomly selected current smokers attending an eye clinic was conducted. The knowledge of six smoking-related diseases (lung cancer, heart attack, stroke, blindness, other cancers, and other lung diseases) was assessed. The fear of smoking-related conditions and the relative impact of each smoking-related condition on the smoker's motivation to quit smoking were evaluated. RESULTS: Out of 200 current smokers aged from 14 to 83 years, only 42.5% (85 patients) were aware that smoking causes blindness. Smokers' perception of harm caused by smoking was 6.53±3.21 (mean±SD) on a visual analogue scale of 0 to 10. Patients placed blindness as the second most important motivating factor to quit smoking immediately, within 1 year and 5 years, after lung cancer. CONCLUSION: The awareness of the risk of blindness from smoking was lowest compared with five other smoking-related diseases among eye patients who smoke. However, blindness remains a key motivational factor in smoking cessation and hence should be emphasised as an important negative health consequence of smoking in public health education and anti-smoking campaigns.

Optic neuropathy associated with dengue fever.

PURPOSE: To report a case series of three patients of optic neuropathy associated with dengue fever. METHODS: Observational case series. RESULTS: Three patients aged of 19, 31, and 40 years (cases 1, 2, and 3) complained of unilateral blurring of vision within a week of being diagnosed with dengue fever. Their presenting visual acuities were counting fingers in cases 1 and 2, and 6/6 in case 3, with features suggestive of optic neuropathy. Two of the three patients (cases 2 and 3) had bilateral ocular signs. The visual acuity recovered to 6/9 in case 1, worsened to no light perception in case 2, and remained unchanged in case 3. CONCLUSIONS: Although spontaneous visual recovery is possible, optic neuropathy associated with dengue fever may result in severe and permanent visual loss.

Practice preferences of ophthalmic anaesthesia for cataract surgery in Singapore.

INTRODUCTION: This study aims to describe the preferences of ophthalmic anaesthesia for cataract extraction among ophthalmologists in Singapore. METHODS: A nationwide questionnaire survey of all cataract surgeons in institutional and private practice in Singapore was conducted in August 2004. RESULTS: The response rate was 61.1 percent (88 out of 144 eligible ophthalmologists surveyed). Phacoemulsification was the preferred surgical technique for 92 percent of the respondents while extra-capsular cataract extraction was preferred by eight percent. For all surgeons performing phacoemulsification, the anaesthesia technique of choice was peribulbar anaesthesia for 43 percent, topical anaesthesia for 42 percent, retrobulbar anaesthesia for 13 percent, and sub-tenons and general anaesthesia for one percent each of the respondents. For all the surgeons performing extra-capsular cataract extraction, the preferred anaesthetic technique was peribulbar anaesthesia for 69 percent, retrobulbar anaesthesia for 30 percent and sub-tenons anaesthesia for one percent of the respondents. The surgeons' main reasons for choosing a specific anaesthesia modality for their surgery were patient comfort and surgeon's choice. The majority of surgeons used mild sedation and monitored anaesthesia care for their cataract surgeries. CONCLUSION: Peribulbar anaesthesia is currently the preferred anaesthesia technique for both phacoemulsification and extra-capsular cataract extraction in Singapore. Topical anaesthesia closely follows peribulbar anaesthesia as a preferred choice for phacoemulsification.

Psychiatric symptoms in neurologically asymptomatic Huntington's disease gene carriers: a comparison with gene negative at risk subjects.

OBJECTIVE: Psychiatric profiles of two at-risk groups [Huntington's disease (HD) gene carriers and non-carriers] were compared by means of a computerized battery and a structured interview. METHOD: To avoid confounding, only subjects who were free from neurological and cognitive deficits (neurologically asymptomatic) were included in the study. To avoid evaluation biases, all subjects were seen before the genetic testing was undertaken. RESULTS: Gene carriers had significantly worse recognition memory and scored higher in measures of irritability than controls. The groups also differed in terms of the factor structure of their psychiatric symptoms. None of the subjects qualified for a psychiatric diagnosis at the time of assessment. CONCLUSION: The groups differed with respect to their profile of psychiatric symptoms. It is hypothesized that these differences are the expression of different mechanisms, i.e. that cognitive deficits relate more to genetic factors and neurotic complaints more to being brought up in a disturbed family background. Issues concerning instrument sensitivity, selection bias and the advantage of seriatim assessments are discussed.

Psychiatric symptoms and CAG repeats in neurologically asymptomatic Huntington's disease gene carriers.

The putative relationship between the psychiatric profile of a sample of neurologically asymptomatic Huntington's disease gene carriers and CAG repeats was investigated. The psychiatric assessments (by consultant psychiatrist and computerised battery) were undertaken before the genetic testing was carried out. In this way, the informational distortions caused by neurological and cognitive deficits were avoided. The hypothesis that there is a relationship between psychiatric and CAG repeats was tested by seeking direct correlations between psychiatric systems and CAG repeats, and also by correcting the correlation by the number of years above or below the estimated age of onset in Huntington's disease. Scores for irritability and cognitive failures were high in the sample. There was no correlation between any psychiatric variable and CAG repeats. Possible explanations for this lack of correlations are discussed.

Fibroblast growth factor protects nitric oxide-induced apoptosis in neuronal SHSY-5Y cells.

Fibroblast growth factor (FGF) has been shown to protect tissue damage in animal models of cerebral and myocardial ischemia. The cellular and molecular mechanisms of FGF effects have not been fully defined. In the present study, we have investigated the effect of FGF homologs on nitric oxide (NO)-mediated neuronal cell death. Addition of NO donor S-nitroso-N-acetylpenicillamine (SNAP) to cultures of human neuroblastoma SHSY-5Y cells resulted in a concentration-dependent cell death. TdT-mediated dUTP-X nick end labeling and oligonucleosome assays confirmed that NO-mediated cell death occurred through the apoptotic pathway. In the presence of 150 microM SNAP, about 40% of the cells in culture underwent apoptosis. Treatment with FGF-2 resulted in greater than 80% reduction in NO-induced cell death. FGF addition to cell cultures also enhanced cell survival without affecting cell proliferation. FGF-2 effectively inhibited NO-mediated apoptosis even when added 6 h after treatment with SNAP. Examination of other homologs of FGF on NO-mediated cell death showed that in SHSY-5Y cells, FGF-2 and FGF-4, but not other FGF homologs, inhibited NO-mediated apoptosis. These results show that FGF-2 was a potent cell survival factor and protected SHSY-5Y cells from NO-mediated apoptosis. These effects were limited to FGF-2 and FGF-4 homologs.

Brachial plexus nerve block with CT guidance for regional pain management: initial results.

Brachial plexus nerve blocks are performed to treat patients with chronic pain referable to the brachial plexus. The needle insertion and trajectory are based on palpation of surface landmarks. Occasionally, the surface landmarks are difficult to identify owing to body habitus or anatomic alterations secondary to surgery or radiation therapy. The intent of this manuscript is to describe a technique for brachial plexus block guided with computed tomography and to report our initial results for regional pain management.

Psychometric behaviour of BDI in Alzheimer's disease patients with depression.

The psychometric properties of the Beck Depression Inventory (BDI) in subjects with Alzheimer's disease (AD) and depression have not been fully evaluated. Item endorsement patterns may be distorted by the presence of AD. This was tested by applying the BDI to a sample of 129 subjects with probable AD without depression and to 57 subjects with both probable AD and depression. It was found that the BDI under diagnoses depression in the context of AD. ROC curves for total BDI and cognitive and somatic items subsets showed low sensitivity and low areas under the curve indices. The results suggest that the BDI is not an ideal instrument to measure depression in AD. This may not result solely from the swing of the somatic items subset, but from other aspects which require further investigation.

Acute epiglottitis despite vaccination with haemophilus influenzae type B vaccine.

We present the case of a 20-month-old child who required admission to the intensive care with a presumptive diagnosis of acute laryngo-tracheo-bronchitis, for the management of acute upper airway obstruction. This child had received a complete course of Haemophilus influenzae type B (Hib) vaccine. Subsequent events showed that the diagnosis was not laryngo-tracheo-bronchitis but acute epiglottitis. We propose that a full course of vaccination is no guarantee against a subsequent illness with Hib and may actually lead to the wrong diagnosis and possibly life-threatening consequences.

The cognitive failures questionnaire in psychiatry.

As a self-report questionnaire, the Cognitive Failures Questionnaire (CFQ) was originally devised to measure perception, memory, and motor lapses in daily life. CFQ scores have been found to correlate with some psychiatric symptoms associated with stress; hence, high scores on the CFQ are considered by some as an indicator of increased vulnerability to stress. Attempts to identify a stable factor structure for the CFQ have produced disparate results. However, there is a measure of agreement with regard to the presence of a "general cognitive" factor that includes loadings from most items and accounts for the lion's share of the variance. Not enough is known about the performance of the CFQ in clinical populations to use it as a measure of change. The current study sought to explore the performance of the CFQ in three groups of patients, organic (n = 209), mixed (n = 115), and functional (n = 322), and to identify correlations with measures of psychiatric morbidity (General Health Questionnaire [GHQ]), depression (Beck Depression Inventory [BDI]), and recognition memory (Signal Detection Memory Test). In the organic and functional samples, the CFQ score significantly correlated with the BDI and GHQ but not with the recognition memory measure. Three factors were found to be common to the organic and functional samples: cognitive, dissociation, and clumsiness. No characteristic pattern of CFQ item endorsement to differentiate between the organic and functional samples was found. Seven items of the CFQ performed badly because of ceiling or floor effects. The "negative" results reported herein are of relevance to researchers who may be planning to use the CFQ in clinical research. The CFQ remains a promising instrument, particularly on account of its "ecological" features, but far more investigation is needed before it is used as a standard measure in clinical practice.