Impact of glaucoma on vision-specific quality of life in monocular glaucoma patients using the Indian vision function questionnaire.

Purpose: To evaluate the determinants affecting the quality of life in monocular glaucoma patients using the Indian vision function questionnaire. Methods: In this prospective cross-sectional study,: total of 196 patients were divided into two groups: cases and controls. Indian Vision Function Questionnaire (IND-VFQ) was administered and analyzed. One hundred twenty-nine (58.6%) patients who had lost their vision in one eye due to glaucoma were included as cases and 67 (30.4%) patients who had lost their vision due to other causes were taken as controls. Results: Median composite score of subscales was 54.62 (29.7-74.7) in group 1 and 45.38 (23.7-76.7) in group 2. The psychosocial impact scale was the most affected scale, the median scores were 33.02 (0 to 60.0) and 19.07 (0 to 53.0) in groups 1 and 2, respectively. Among all dimensions of IND-VFQ, the highest score was for color vision 100.0 (0-100.0) and 100.0 (0-100.0), and the lowest median score was found in mental health and dependency in both the groups. Multiple linear regression analysis demonstrated that visual acuity was associated with a low score (P < 0.001). Female gender was significantly associated with the overall score in the univariate model (P = 0.006). Conclusion: Monocular glaucoma patients have a poor general and vision-related quality of life. Depression associated with monocularity and the perception of dependency and being a burden on their family members greatly impacted the mental health of the participants.

Bleb revision with bleborhexis and clear corneal lamellar patch graft for overhanging cystic bleb.

Background: Trabeculectomy is associated with several complications. One of the common complications with mitomycin assisted trabeculectomy is thin cystic bleb leading to bleb leak, hypotony and infections. Various technique of bleb repair and reconstruction have been described, such as conjunctival advancement, or scleral, pericardial or corneal patch graft. Purpose: To demonstrate bleb revision by bleborhexis and clear corneal lamellar patch graft for a patient with thin cystic leaking bleb leading to hypotony and decreased vision. Synopsis: This was a 75-year-old one-eyed lady, diagnosed with primary angle-closure glaucoma in both eyes with absent light perception in the left eye, had undergone a combined trabeculectomy and cataract surgery in the right eye 6 years ago. She presented with diminution of vision (6/18p), introacular pressure (IOP) of of 6 mmHg, thin cystic leaking overhanging bleb, and dysesthesia. Bleb repair by bleborhexis with lamellar corneal patch graft was performed. Bleborhexis is a technique in which the overhanging fibrosed thin cystic conjunctival bleb is peeled off the cornea smoothly to leave a uniform clear corneal surface. Clear cornea, uniform diffuse bleb, well-formed anterior chamber with and IOP of 15 mmHg was noted on the first post-operative day, with a vision of 6/12p. This procedure helped meticulous reconstruction of the bleb, early recovery of vision, maintanance of normotensive eye, and save the eye from potential infections. Highlights: Bleborhexis with lamellar corneal patch graft provides for an easy and a elegant surgical technique with minimal corneal tissue damage, faster healing and patient comfort. It could be the favored technique in patients with thin overhanging clebs. Video link: https://youtu.be/GeFYHWToueU.

Checklist of digenean trematodes reported from Indian marine fishes.

This checklist summarises information on the digenean trematodes of Indian marine fishes contained in the world literature dating from 1913 to the end of 2008. Altogether more than 700 species of digeneans belonging to more than 200 genera and 32 families are recorded. For each parasite species information is provided on the host(s), geographical locality (-ies) and the published source(s). The synonymies proposed in the literature for some of the parasite species are also included. The classification follows that given in the 'Keys to the Trematoda'.

A new monorchiid trematode, Paramonorcheides selaris n. sp., from the carangid fish Selar crumenophthalmus in the Bay of Bengal off the Visakhapatnam coast of India.

Paramonorcheides selaris n. sp. is described from the intestine of the carangid fish Selar crumenophthalmus (Bloch) off the Visakhapatnam coast, Bay of Bengal. It is closest to the Australian species P. pseudocaranxi Dove & Cribb, 1998, but differs in its shorter cirrus-sac extending only to the level of the ovary rather than to the level of the testes, in lacking eye-spot pigment and in details of the armature of the terminal genitalia. P. pseudocaranxi of Machida (2005) is regarded as identical to the new species. The validity of Allobacciger Hafeezullah & Siddiqi, 1970, as distinct from Monorcheides Odhner, 1905, is discussed. A key to the six species of Paramonorcheides Yamaguti, 1938 is presented.

Midterm outcome of mitomycin C augmented trabeculectomy in open angle glaucoma versus angle closure glaucoma.

Purpose: The purpose of this study is to evaluate the efficacy and safety of Trabeculectomy with Mitomycin C in Open angle glaucoma versus Angle closure glaucoma. Methods: The medical records of patients who underwent Trabeculectomy with Mitomycin C were reviewed and followed for three years, divided into two groups: group 1: Open Angle Glaucoma (n = 41) and group 2: Angle Closure Glaucoma (n = 67). Success criterion was measured as Intraocular Pressure ≤21 mmHg with (qualified) or without (complete) use of Antiglaucoma medications. Results: A total number of 108 eyes of 137 patients were undertaken. Mean preoperative Intraocular pressure in group 1 was 31.4 ± 10.5 mmHg and in group 2 was 33.1 ± 9.4, which reduced to 10.5 ± 3.4, 10.5 ± 2.6, 11.6 ± 3.6, 11.0 ± 2.7, 11.0 ± 2.7 in group 1 and 10.9 ± 2.8, 12.0 ± 3.8, 12.8 ± 4.9, 12.4 ± 3.9, 12.4 ± 3.7 in group 2 with P value = 0.566, 0.032, 0.168, 0.049, 0.049 at three, six months, one, two, three years, respectively, with P < 0.001 at each visit. The number of Antiglaucoma medications was reduced from 0.75 ± 0.89 to 0.43 ± 0.55 at 3 yrs (P = 0.002). At 36 months follow-up, overall, 50.0% and 48.2% of eyes achieved complete and qualified success, respectively. Sub-group analysis showed that the success rate was higher in group 1 (68.3%) compared to group 2 (55.2%). Overall, complications such as hypotony (1.8%), choroidal detachment (2.8%), encapsulated bleb (2.8%), and bleb leakage (1.8%) were encountered. Conclusion: Primary Trabeculectomy with Mitomycin C is a safe and effective means of controlling Intraocular Pressure in both groups with good success and low rates of sight-threatening complications.

Enhancement of ε-poly-L-lysine (ε-PL) production by a novel producer Bacillus cereus using metabolic precursors and glucose feeding.

Epsilon poly-L-lysine (ε-PL) is a homo-biopolymer with approximately 25-30 L-lysine residues. It is a promising natural biopolymer widely used in food and pharmaceutical industry. The present work reports enhanced production of ε-PL with a novel producer Bacillus cereus using amino acids and TCA cycle intermediates in the fermentation medium. Among the various amino acids and TCA cycle intermediates tested 2 mM L-aspartic acid and 5 mM citric acid gave ε-PL yield of 145.5 and 230 mg/L, respectively. A combination of citric acid after 24 h and L-aspartic acid after 36 h improved ε-PL yield from 85 mg/L (control) to 335 mg/L. Glucose feeding strategy along with metabolic precursors was employed which further enhanced ε-PL yield to 565 mg/L. Thus, more than sixfold increase in ε-PL yield was achieved suggesting the potential of Bacillus cereus as a novel ε-PL producer.

Cercariae and metacercariae of Stephanostomum cloacum (Trematoda: Acanthocolpidae).

Cercariae and metacercariae of the acanthocolpid trematode, Stephanostomum cloacum (Srivastava, 1938) are described and illustrated, based on material collected from Chilka Lake, a brackish water lagoon. Natural infections with the cercariae were found in the snail, Nassarius orissaensis and with the metacercariae in the bivalve, Modiolus undulatus. Cercariae are distomate, ophthalmoxiphidiocercous, and possess a small stylet, simple tail, four pairs of penetration glands arranged in two groups and a large granular excretory bladder. Development of the cercaria into the metacercaria was followed in M. undulatus under laboratory conditions. Infections with adults of S. cloacum were identified in the fish Triacanthus biaculeatus, found in the lake.

Sister chromatid exchanges in patients with oral submucous fibrosis.

The incidence of sister chromatid exchange (SCE) was investigated in the lymphocyte chromosomes of 45 patients with oral submucous fibrosis and 56 age- and sex-matched nonsmoking controls. The frequency of SCE was 9.26 +/- 2.15 in patients with oral submucous fibrosis, which was significantly higher than the mean SCE value of 5.49 +/- 1.24 observed in normal controls. The frequency of SCE in patients with oral submucous fibrosis addicted to the habit of betel with tobacco chewing, "bidi"/cigarette smoking and combined habits of chewing and smoking of tobacco were 8.12 +/- 1.69, 9.43 +/- 1.87, and 10.06 +/- 2.28, respectively. These values were also significantly higher as compared with the SCE values observed in normal controls.

Double minute chromosomes in the leukocytes of a young girl with breast carcinoma.

Cytogenetic analysis was performed in a young girl with breast carcinoma. The most important finding was the existence of double minute (dmin) chromosomes, besides other chromosomal abnormalities. Removal of the tumor resulted in reduction of chromosomal abnormalities in the leukocyte cultures repeated after 1 year, suggesting that the presence of tumor may elevate the frequency of chromosomal abnormalities. The presence of dmin chromosomes indicates that factors causing their presence in tumor cells may also operate in human leukocytes.

Estimation of hookworm intensity by anthelmintic expulsion in primary schoolchildren in south India.

A study was carried out between March 1990 and February 1991 to determine the prevalence and intensity of hookworm infection in 151 primary schoolchildren, aged 6-12 years, in Jalaripet, a slum area in South India predominantly inhabited by fishermen. Pre-treatment stool samples were processed by a modified formalin-ethyl acetate sedimentation technique to determine ova counts. All children were treated with pyrantel pamoate and post-chemotherapy stools were collected over 48 h to recover expelled worms. The overall prevalence of hookworm infection was 45% and the mean egg count was 192 eggs/g. The mean worm burden was 1.25 worms/child. The influence of host factors such as age and sex, environmental factors and behavioural factors on the intensity of egg output and worm burden was investigated.

Miracidium of Allocreadium fasciatusi Kakaji 1969 (Trematoda: Allocreadiidae).

The miracidium of Allocreadium fasciatusi has 18 epidermal cells arranged in 3 tiers according to the formula 6,8,4. In the posterior part of the miracidium there is a fully formed redia while the anterior part contains 2 fluid-filled refractile sacs which appear to store the waste material released by the redia. The 2 excretory pores of the miracidium are middorsal and midventeral rather than lateral.

Egg and miracidium of Hirudinella ventricosa (Trematoda: Hirudinellidae).

It is reported for the first time that Hirudinella ventricosa releases eggs in strings, each string containing active spermatozoa and numerous oval, thick-shelled, translucent eggs measuring 40-42 x 28-30 microns. Each egg contained a fully developed miracidium with an anterior crown of spines.

Body image assessment: comparison of figure rating scales among urban Black women.

PURPOSE: To determine a psychometrically stable and socially acceptable scale for assessing perceptual body image in Black women. METHODS: The study sample (N = 50) was selected sequentially from Black women (mean age 52.3 +/- 10 years) who were being screened for a larger randomized trial (Project Joy). Three standard published figure rating scales (FRS) were compared with a new scale (Reese FRS). Distributions of respondents' selections on all scales were examined relative to anthropometric measures, including body mass index (BMI) and categories of obesity and overweight (National Expert Panel on Overweight and Obesity Guidelines). Cultural identity, developed from an adaptation from the African-American Acculturation Scale II (cross-validation and short form), and its relationship to FRS preference was also assessed. RESULTS: Body weight distribution of women in this study matched that of US Black women over 40 years of age in the NHANES III data. All four FRS performed similarly and correlated significantly with BMI, r was -0.70 to -0.75, P<.0001. Twenty-two percent of the women identified themselves with one of the three largest images (determined by consensus of an expert panel to represent obesity) on three FRS and 38% identified with the three largest images on one scale. For all scales, this was below 56% of women identified as obese based on national guidelines. Among women with the highest cultural identity scores, indicating the strongest identification with elements of Black culture, 72% preferred the new Reese FRS. CONCLUSION: Overall, there is considerable overlap among images selected for any weight category based on national BMI classifications. A strong preference exists for the Reese scale, especially among women with a strong Black cultural identity. This new scale performs similarly to existing scales in successively assessing the self-assignment of an image for self, but is more socially acceptable. Reasons for the small percentage of obese women who identified themselves as obese need further investigation.

Doctors who are using e-mail with their patients: a qualitative exploration.

BACKGROUND: Despite the potential for rapid, asynchronous, documentable communication, the use of e-mail for physician-patient communication has not been widely adopted. OBJECTIVE: To survey physicians currently using e-mail with their patients daily to understand their experiences. METHODS: In-depth phone interviews of 45 physicians currently using e-mail with patients were audio taped and transcribed verbatim. Two investigators independently qualitatively coded comments. Differences were adjudicated by group consensus. RESULTS: Almost all of the 642 comments from these physicians who currently use e-mail with patients daily could be grouped into 1 of 4 broad domains: (1) e-mail access and content, (2) effects of e-mail on the doctor-patient relationship, (3) managing clinical issues by e-mail, and (4) integrating e-mail into office processes. The most consistent theme was that e-mail communication enhances chronic-disease management. Many physicians also reported improved continuity of care and increased flexibility in responding to nonurgent issues. Integration of e-mail into daily workflow, such as utilization of office personnel, appears to be a significant area of concern for many of the physicians. For other issues, such as content, efficiency of e-mail, and confidentiality, there were diverging experiences and opinions. Physicians appear to be selective in choosing which patients they will communicate with via e-mail, but the criteria for selection is unclear. CONCLUSION: These physician respondents did perceive benefits to e-mail with a select group of patients. Several areas, such as identifying clinical situations where e-mail communication is effective, incorporating e-mail into office flow, and being reimbursed for online medical care/communication, need to be addressed before this mode of communication diffuses into most practices.

Community ecology of the metazoan parasites of the Indian mackerel Rastrelliger kanagurta (Scombridae) from the coast of Visakhapatnam, Bay of Bengal.

One hundred and eighty four specimens of the mackerel Rastrelliger kanagurta collected from fish landings at Visakhapatnam coast, Bay of Bengal, between January 2006 and 2007, were examined for analysis of their metazoan parasite community structure at infra and component community levels and study the effects of season and host body length on these communities. Fifteen species of metazoan parasites were collected including 3 spp. Monogenea, 7 spp. Digenea and 5 spp. Copepoda. All the fish were parasitized by one or more metazoan parasite species. A total of 2,004 parasites were collected with a mean of 10.9. The majority were digeneans accounting for 42.4% of total number of parasites collected and the hemiurid Lecithocladium angustiovum is found to be the most dominant species. Mean values of species richness (3.0 ± 1.5), abundance (12.4 ± 9.3) and diversity (H' = 0.92) were within ranges observed for most of the metazoan parasite communities of marine fish from temperate and tropical countries. Seasonally, the mean diversity and parasite species richness of infracommunities were high during December and January and low during September-October. No correlation was found between host total length and any of the community descriptors. Most of the parasites i.e., 12 out of 15 species of parasites collected were host specialists. Only one species Aponurus laguncula was a host generalist. All taxa of metazoan parasites showed a typical over-dispersed pattern of distribution. The dominance of the core species in all the infracommunities and the high degree of host specialization of the parasite species resulted in the predictable component in the infracommunities to be high, each infra community comprising a core species accompanied by a few secondary species.

Multidisciplinary management of a fractured premolar: a case report with followup.

The general dental practitioner must consider orthodontic extrusion of a tooth when a subgingival defect, such as, crown fracture occurs before prosthetic rehabilitation, especially in the aesthetic zone. Extrusion enables the root portion to be elevated which exposes sound tooth structure for placement of restorative margins. This case report describes the multidisciplinary management of a fractured upper first premolar in a general dental practice. The forced orthodontic eruption is achieved by an endodontic attachment and sectional fixed appliance with an offset placed in the wire. The ability to extrude premolars with this method is complicated by heavy occlusal forces, occlusal interferences, and short clinical crown length. The tooth was restored with a titanium post, composite core, and porcelain fused to metal crown. The entire course of treatment was carried out under National Health Scheme, UK and as a part of vocational training. The 21 months followup showed no change in occlusal contacts or gingival level.

Metazoan parasites of the Indian mackerel, Rastrelliger kanagurta (Scombridae) of Visakhapatnam coast, Bay of Bengal.

The metazoan parasite fauna of the Indian mackerel Rastrelliger kanagurta of Visakhapatnam coast, Bay of Bengal comprised 15 species including three species of Monogenea, seven species of Digenea and five species of Crustacea. Digeneans were the dominant members in the parasite spectrum while infections with ectoparasitic monogeneans and crustaceans were rare. The digeneans Opechona bacillaris and Lecithocladium angustiovum which occurred with high prevalence and mean intensity are the typical parasites of the mackerel. The parasitic fauna in general is found to be a reflection of the planktonivorous diet of the host. Except for two species of digeneans, Lecithocladium angustiovum and Aponurus laguncula, all the remaining species of metazoans showed narrow specificity to R. kanagurta, indicating a high degree of host specialization. The parasitological data may prove useful for differentiating stocks of R. kanagurta.