Sexual dimorphism in relation to adipose tissue and intrahepatocellular lipid deposition in early infancy.

Sexual dimorphism in adiposity is well described in adults, but the age at which differences first manifest is uncertain. Using a prospective cohort, we describe longitudinal changes in directly measured adiposity and intrahepatocellular lipid (IHCL) in relation to sex in healthy term infants. At median ages of 13 and 63 days, infants underwent quantification of adipose tissue depots by whole-body magnetic resonance imaging and measurement of IHCL by in vivo proton magnetic resonance spectroscopy. Longitudinal data were obtained from 70 infants (40 boys and 30 girls). In the neonatal period girls are more adipose in relation to body size than boys. At follow-up (median age 63 days), girls remained significantly more adipose. The greater relative adiposity that characterises girls is explained by more subcutaneous adipose tissue and this becomes increasingly apparent by follow-up. No significant sex differences were seen in IHCL. Sex-specific differences in infant adipose tissue distribution are in keeping with those described in later life, and suggest that sexual dimorphism in adiposity is established in early infancy.

Potential contamination of the G-probe used for transscleral cyclodiode.

AIM: To present a case where we noted occult contamination of the G-probe used for transscleral cyclodiode and to critically analyze the techniques used for making a G-probe suitable for repeated use. MATERIALS AND METHODS: Close microscopic examination of the G-probes used once for transscleral cyclodiode was done and a critical review of the literature on practice of reuse of the G-probe and the techniques used to "cleanse" the probe before reuse was performed. RESULTS: We noticed microscopic contamination of the G-probe by the tear film fluid in all the probes examined by us. The review of literature indicates that repeated use of the G-probe is not uncommon. The types of techniques used for making it suitable for repeated use indicate that it is not universally recognized that the lumen of the G-probe can accumulate fluid during the procedure, which makes it potentially hazardous when used for other patients. CONCLUSIONS: In our opinion the G-probe should not be reused as inadequately reprocessed G-probe can lead to risk of nosocomial infections, serious iatrogenic complications, and medico-legal problems.

In the bag IOL dislocation following uncomplicated phacoemulsification.

We present two cases of early post-operative, in the bag intraocular lens (IOL) dislocation following uncomplicated phacoemulsification. Dislocation occurred in the presence of capsular fibrosis and anterior capsular phimosis. One patient was a known diabetic, the other diagnosed with pseudoexfoliation syndrome. These are recognised risk factors for capsular fibrosis. Surgical management included enlargement of the anterior capsular opening using intraocular micro-scissors and vitreous cutter to facilitate the removal of the dislocated IOL from the capsular bag. Both patients achieved a satisfactory visual outcome following IOL exchange with a rigid, sulcus fixated posterior chamber IOL (PCIOL). We discuss the risk factors for capsular fibrosis and propose preventative strategies to reduce the incidence of in the bag IOL dislocation.

Accelerated postnatal head growth follows preterm birth.

BACKGROUND: Poor growth after preterm birth, particularly poor head growth, is associated with impaired neurodevelopmental outcome. OBJECTIVE: To evaluate weight gain and head growth between birth and term in a contemporary cohort of preterm infants, taking into account breast milk intake and illness severity. METHODS: Subjects were inborn infants or=37 weeks postmenstrual age. Weight and head circumference (HC) were expressed as standard deviation score (SDS), growth between birth and discharge as SDS gain (SDSG), and illness severity and breast milk exposure as the number of days of level 1 (full) intensive care (%L1IC) and the number of days on which breast milk was received (%BM) as a percentage of days from birth to discharge. RESULTS: Infants showed poor postnatal weight gain but accelerated head growth. There was a highly significant fall in mean (SD) weight SDS between birth and discharge (-0.31 (0.96) and -1.32 (1.02) respectively, p<0.001) and a highly significant increase in HC SDS (-0.52 (0.95) and -0.03 (1.25) respectively, p = 0.003). %L1IC had a highly significant negative impact on weight SDSG (p = 0.006), and %BM had a significant positive impact on HC SDSG (p = 0.043). CONCLUSIONS: Accelerated postnatal head growth suggests catch up after antenatal restraint. This raises the possibility that poor neurocognitive outcomes after extremely preterm birth may in part be consequent on poor intrauterine brain growth. As postnatal head growth may be facilitated by breast milk, there is an urgent need to evaluate the optimal use of breast milk in preterm neonates. Illness severity is a significant determinant of poor postnatal weight gain.

Self-Monitoring of Intraocular Pressure Outside of Normal Office Hours Using Rebound Tonometry: Initial Clinical Experience in Patients With Normal Tension Glaucoma.

PURPOSE: To determine the value and accuracy of 24-hour intraocular pressure (IOP) phasing using Icare ONE rebound tonometry (RTONE), in subjects with normal tension glaucoma (NTG). METHODS: Eighteen consecutive patients with treated NTG were studied, all subjects had undergone 24-hour IOP phasing during a 1-year period. Each patient had daytime (08:00 to 16:00) IOP phasing with Goldmann applanation tonometer at 2-hourly intervals; at these same time points an IOP reading was also obtained by the patient using RTONE. Self-measured IOPs were then recorded at home using RTONE between 18:00 and 06:00 (at 2-hourly intervals). The frequency with which the phasing results altered clinical management was evaluated. RESULTS: The mean peak IOP was significantly higher during nighttime phasing (15.78±4.8 mm Hg) compared with daytime phasing (12.83±2.7 mm Hg, P=0.0018) and clinic IOP measurements (11.8±1.6 mm Hg, P<0.0001). Following IOP phasing a change in management occurred in 10 of 18 patients (56%). In the majority of these patients, a peak IOP was identified during nighttime phasing compared with daytime phasing, this difference was significant (P=0.0090). There were strong correlations between the IOP measurements obtained with Goldmann applanation tonometer and RTONE (Spearman r values >0.60, P<0.001). CONCLUSIONS: This study suggests that in patients with NTG with progression that is disproportionate to their clinic IOP measurements, 24-hour phasing can reveal higher IOP spikes than those identified during typical office hours. RTONE is a safe, easy to use, and accurate device for self-monitoring of IOP.

Practical preterm parenteral nutrition: systematic literature review and recommendations for practice.

Current practice in relation to the prescribing, compounding and administration of parenteral nutrition for extremely preterm infants is inconsistent and based on largely historical evidence. Increasingly there are calls for more 'aggressive' nutritional interventions to prevent 'postnatal growth failure'. However the evidence base for these recommendations is weak, and there are no long-term studies examining the impact of such practices. Here we summarise the evidence for preterm parenteral nutrition interventions. We suggest principles to guide practice based on evidence from a systematic search and review of evidence to date, and recommend actions necessary to advance the understanding of this important aspect of preterm care.

Neonatal intrahepatocellular lipid.

There is increasing evidence that preterm birth is a risk factor for the development of adiposity associated disease, although the pathophysiological basis is unclear. We have previously shown that preterm infants have increased internal abdominal (visceral) adiposity by term. In adults increased internal adiposity is associated with elevated intrahepatocellular lipid (IHCL). We measured IHCL using (1)H NMR spectroscopy in 26 infants (eight healthy preterm-at-term and 18 term-born) and compared values with a reference group of 32 adults. There was no significant difference between adult and term-born IHCL content. In preterm-at-term infants IHCL was significantly elevated when compared with term-born infants and with adults (IHCL CH2/water median (interquartile range): preterm 1.69 (1.04-3.53), term 0.21 (0-0.54) and adult 0.55 (0.08-1.57).