Publications by authors named "Anant Sharma"

44 Publications

Capturing the Occult Central Retinal Artery Occlusion Using Optical Coherence Tomography.

Curr Eye Res 2021 Apr 30:1-6. Epub 2021 Apr 30.

Ophthalmology Department, East Sussex Healthcare NHS Trust, East Sussex, UK.

: To report spectral-domain optical coherence tomography (OCT) findings in cases of impending or occult central retinal artery occlusion (CRAO) in which a diagnosis other than CRAO was made on initial presentation.: Retrospective, observational case series of patients diagnosed with CRAO for whom on initial presentation fundal examination and OCT findings were deemed unremarkable and/or a diagnosis other than CRAO was made. OCT images from the initial presentation were then reviewed for evidence of inner retinal ischaemia.: In total, 214 cases of CRAO were identified. Eleven patients (5.14%) had been given an alternative initial diagnosis at their first presentation in casualty and were included. The age range was 20-84 years and 81% (9/11) were male. On review of initial OCT imaging performed in casualty, all cases had evidence of inner retinal ischaemia.: CRAO is an ophthalmic emergency which leads to vision loss which is often irreversible. Examination of the fundus may be normal early in the course of the disease and therefore a timely diagnosis may be missed. This case series reports the OCT findings of inner retinal ischaemia in patients with occult or impending CRAO which may aid in the early diagnosis and referral to stroke services.
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http://dx.doi.org/10.1080/02713683.2021.1921219DOI Listing
April 2021

Contrast enhanced ultrasound quantitative parameters for assessing neoadjuvant chemotherapy response in patients with locally advanced breast cancer.

Br J Radiol 2021 May 16;94(1121):20201160. Epub 2021 Apr 16.

Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

Objectives: To evaluate the role of contrast-enhanced ultrasound (CEUS) quantitative parameters in predicting neoadjuvant chemotherapy (NACT) response in patients with locally advanced breast cancer (LABC).

Methods: 30 patients with histologically proven LABC scheduled for NACT were recruited. CEUS was performed using a contrast bolus of 4.8 ml and time intensity curves (TICs) were obtained by contrast dynamics software. CEUS quantitative parameters assessed were peak enhancement (PE), time-to-peak (TTP), area under the curve (AUC) and mean transit time (MTT). The parameters were documented on four consecutive instances: before NACT and 3 weeks after each of the three cycles. The gold-standard was pathological response using Miller Payne Score obtained pre NACT and post-surgery.

Results: A decrease in mean values of PE and an increase in mean values of TTP and MTT was observed with each cycle of NACT among responders. Post each cycle of NACT (compared with baseline pre-NACT), there was a statistically significant difference in % change of mean values of PE, TTP and MTT between good responders and poor responders (-value < 0.05). The diagnostic accuracy of TTP post-third cycle was 87.2% ( = 0.03), and MTT post--second and third cycle was 76.7% ( = 0.004) and 86.7% ( = 0.006) respectively.

Conclusion: In responders, a decrease in the tumor vascularity was reflected in the CEUS quantitative parameters as a reduction in PE, and a prolongation in TTP, MTT.

Advances In Knowledge: Prediction of NACT response by CEUS has the potential to serve as a diagnostic modality for modification of chemotherapy regimens during ongoing NACT among patients with LABC, thus affecting patient prognosis.
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http://dx.doi.org/10.1259/bjr.20201160DOI Listing
May 2021

A case of malignant glaucoma following insertion of Preserflo™ MicroShunt.

Eur J Ophthalmol 2021 Mar 18:11206721211003492. Epub 2021 Mar 18.

Moorfields Eye Hospital, NHS Trust, London, UK.

Purpose: To describe a case of malignant glaucoma following insertion of a Preserflo™ MicroShunt in a patient with primary open angle glaucoma (POAG).

Design: Case report.

Case: A 46-year-old Caucasian man with medically uncontrolled POAG developed malignant glaucoma 1 day after an uncomplicated insertion of a mitomycin C (MMC) augmented Preserflo MicroShunt (PMS).

Results: Initial medical treatment with aqueous suppressants and atropine 1% resulted in temporary resolution of the episode, although partial occlusion of the PMS with iris required a Nd:YAG laser iridotomy to open the inlet of the device. However, the malignant glaucoma recurred 6 days later. Temporary resolution was subsequently achieved with an Nd:YAG laser peripheral irido-zonulo-hyaloidotomy in combination with topical atropine, though a subsequent PMS revision was required due to bleb encapsulation. Unfortunately, the revision procedure was followed 2 days later, by a further recurrence of malignant glaucoma which was eventually resolved by left pars plana vitrectomy (PPV) in combination with clear lens extraction (CLE) and surgical irido-zonulo-hyaloidectomy. Subsequently, the eye remained stable, with a deep anterior chamber (AC), a partially functioning bleb, and an intraocular pressure (IOP) of 14 mmHg on one topical IOP-lowering agent, 8 months after the last procedure.

Conclusions: The management of malignant glaucoma after PMS insertion and its subsequent clinical course is described. Apart from the propensity for a small tube such as the PMS to obstruct with iris when the AC is shallow, management is similar to other scenarios in which malignant glaucoma may develop.
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http://dx.doi.org/10.1177/11206721211003492DOI Listing
March 2021

Ocular manifestations of emerging viral diseases.

Eye (Lond) 2021 04 29;35(4):1117-1139. Epub 2021 Jan 29.

Eye Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.

Emerging infectious diseases (EIDs) are an increasing threat to public health on a global scale. In recent times, the most prominent outbreaks have constituted RNA viruses, spreading via droplets (COVID-19 and Influenza A H1N1), directly between humans (Ebola and Marburg), via arthropod vectors (Dengue, Zika, West Nile, Chikungunya, Crimean Congo) and zoonotically (Lassa fever, Nipah, Rift Valley fever, Hantaviruses). However, specific approved antiviral therapies and vaccine availability are scarce, and public health measures remain critical. Patients can present with a spectrum of ocular manifestations. Emerging infectious diseases should therefore be considered in the differential diagnosis of ocular inflammatory conditions in patients inhabiting or returning from endemic territories, and more general vigilance is advisable in the context of a global pandemic. Eye specialists are in a position to facilitate swift diagnosis, improve clinical outcomes, and contribute to wider public health efforts during outbreaks. This article reviews those emerging viral diseases associated with reports of ocular manifestations and summarizes details pertinent to practicing eye specialists.
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http://dx.doi.org/10.1038/s41433-020-01376-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844788PMC
April 2021

Management and outcomes of the small pupil in cataract surgery: iris hooks, Malyugin ring or phenylephrine?

Eye (Lond) 2020 Nov 12. Epub 2020 Nov 12.

Moorfields Eye Clinic at Bedford Hospital, City Road, London, UK.

Purpose: To investigate outcomes for small versus large pupils in cataract surgery using different pupil expansion techniques.

Methods: Retrospective case-series reviewing 20,175 patients' cataract surgery electronic medical records at Moorfields Eye Clinic in Bedford Hospital NHS Trust from January 2010 to April 2020. Outcomes such as visual acuity (VA), intraocular pressure, intraoperative, post-operative complications were recorded and small pupil expansion device outcome.

Results: One thousand, four hundred twenty-six patients were identified as having small pupil (SP). Of these, 1110 patients (77.8%) had interventions to expand the pupil including 447 (31.3%) with intracameral phenylephrine (IC PE) alone, 194 (13.6%) with iris hooks and 469 (32.9%) with a Malyugin ring. The large pupil (LP) group had a statistically significant greater gain in VA than the SP group (p < 0.05). SPs had a significantly higher rate of intraocular complications including posterior capsular rupture (PCR) with vitreous loss (OR 2.75, p < 0.001). There was also a significantly higher rate of post-operative complications such as corneal oedema (OR 2.64, p < 0.001) and anterior uveitis (OR 2.11, p < 0.001) in the SP group. However, VA improvement and complications between the different pupil expansion groups showed no significant differences (p > 0.05) except for a greater rate of iris tears in the Malyugin group (p < 0.05).

Conclusion: To date, this is the largest reported case-series comparing Malyugin rings and iris hooks with other pupil expansion techniques. The various techniques to expand pupil size appear to be safe and equally effective in improving VA with a similar rate of complications except for a greater rate of iris tears with Malyugin ring.
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http://dx.doi.org/10.1038/s41433-020-01277-0DOI Listing
November 2020

Factors affecting awareness and practice of primary health care professionals towards interaction of various medications used in systemic conditions, and its effect on periodontal health.

J Family Med Prim Care 2020 Jun 30;9(6):2969-2974. Epub 2020 Jun 30.

Department of Periodontology and Oral Implantology, Darshan Dental College and Hospital, Udaipur, Rajasthan, India.

Background: Interaction of various drugs and its effects on gingival and periodontal health is the area of concern; hence the aim of the present study was to explore factors affecting the awareness and practice of primary health care professionals towards the interaction of various medications used for systemic diseases on periodontal health.

Materials And Methods: It was a cross-sectional, descriptive, questionnaire study conducted among 203 primary health care professionals which include 94 medical officers and 109 nurses working in primary health centers in rural areas of Udaipur district. The study was conducted in December 2019. Sampling techniques was stratified random sampling technique. A close-ended questionnaire was prepared to conduct an interview schedule.

Results: The majority of health professionals had poor awareness (157 [77.33%]) and poor practice (168 [82.75%]) regarding the interaction of various medications used in systemic conditions and periodontal health. Factors that significantly affect awareness and practice of study participants were age (0.01*), degree (0.05*), and number of patients with oral problems seen in a week (0.05*), gender (0.05*), designation (0.05*).

Conclusion: From above it was concluded that awareness and practice of primary care health professionals were poor. The factors that affect significantly affect awareness and knowledge of study participants was age, degree and number of patients with oral problems seen in a week, gender, designation, no. of patient attended in a day.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_195_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491786PMC
June 2020

Finger-Prick Autologous Blood in the Treatment of Persistent Corneal Epithelial Defects.

Cornea 2020 May;39(5):594-597

Moorfields Eye Centre at Bedford Hospital, Bedford, United Kingdom.

Purpose: Autologous hemoderivative eye drops have a role in the management of persistent epithelial defects (PEDs), but their use may be limited by cost and availability. Finger-prick autologous blood (FAB) treatment uses whole capillary blood, obtained from a sterilized fingertip, as an alternative form of hemoderivative eye drop therapy. To date, 1 report has described the safe and effective use of FAB for dry eye and PEDs. We report the results of 10 eyes (10 patients) treated with FAB for PEDs.

Methods: Ten patients with PEDs in 1 eye for a mean of 259 ± 201 days due to diabetic neurotrophic keratopathy (n = 3), herpetic keratitis (n = 3), postpenetrating keratoplasty (n = 1), keratoconjunctivitis sicca (n = 1), postradiotherapy (n = 1), and neuropathic ulcer (n = 1) were treated with FAB 4 times a day for 28 days in addition to conventional therapies. All patients had been unsuccessfully treated with conventional therapy before commencing on FAB. None of the patients had received any surgical treatment for PED.

Results: At day 28, the PED had healed in 60% (n = 6) of the eyes. In 1 eye, the PED reduced in size by half. Thirty percent (n = 3) of patients had incomplete follow-up data at the end of the study.

Conclusions: FAB in combination with conventional treatment may be successfully used in the management of refractory PEDs. No adverse effects arising from FAB treatment were observed.
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http://dx.doi.org/10.1097/ICO.0000000000002230DOI Listing
May 2020

A Mechanistic Understanding of Polysorbate 80 Oxidation in Histidine and Citrate Buffer Systems-Part 2.

PDA J Pharm Sci Technol 2019 Jul-Aug;73(4):320-330. Epub 2019 Feb 15.

Analytical Development, Lilly Research Laboratories, Eli Lilly and Company, 1400 West Raymond St., Indianapolis, IN 46221.

In our previously published work, we reported rapid polysorbate 80 (PS80) oxidation in a histidine buffer after brief exposure to stainless steel and the ability of citrate and EDTA to prevent this oxidation. The focus of our current study was to mechanistically understand PS80 oxidation by studying the impacts of temperature, light, and stainless steel and the role of citrate and EDTA. Additionally, PS80 oxidation was studied in three different buffer systems: histidine, citrate, and phosphate. When the PS80-containing buffers in glass containers were exposed to the elevated temperature of 50°C, no PS80 oxidation was observed in either the histidine or the citrate buffer systems after 30 days; however, PS80 oxidation was observed in the phosphate buffer system within 14 days. These results demonstrated that temperature does not initiate PS80 oxidation in the histidine or the citrate buffer systems, but it may be a factor in the phosphate buffer system. When the three buffer systems containing PS80 were exposed to 20%, 50%, or 100% ICH Q1B light conditions and subsequently incubated in the dark at 50°C, the PS80 in the phosphate buffer system underwent oxidation within 7 days, whereas the PS80 in the histidine and the citrate buffer systems showed oxidation products only after 14 and 35 days, respectively. PS80 in the phosphate buffer system seemed to be the most vulnerable to light as PS80 in both the histidine and the citrate buffer systems underwent oxidation to a lesser extent, with faster oxidation occurring in the histidine buffer system than in the citrate buffer system. Finally, the ability of citrate and EDTA to act as not only chelators but also radical quenchers/scavengers was demonstrated when a metal ion, Fe, was spiked into the histidine buffer containing PS80. While radicals could not be unambiguously identified by NMR or EPR, the observation of PS80 oxidation products indicated their presence. In our previously published work, we reported rapid polysorbate 80 (PS80) oxidation in a histidine buffer after brief exposure to stainless steel and the ability of citrate and EDTA to prevent this oxidation. The focus of our current study was to mechanistically understand PS80 oxidation by studying the impacts of temperature, light, and stainless steel and the role of citrate and EDTA. Additionally, PS80 oxidation was studied in three different buffer systems: histidine, citrate, and phosphate. The temperature study demonstrated that PS80 oxidation in the histidine or the citrate buffer systems is not initiated by temperature, but may be a factor in the phosphate buffer system. PS80 in the phosphate buffer system seemed to be the most vulnerable to light, as PS80 in both the histidine and the citrate buffer systems underwent oxidation at a lower level, with the histidine buffer system showing more rapid oxidation than the citrate buffer system. Finally, the ability of citrate and EDTA to act as not only chelators but also radical quenchers/scavengers was demonstrated when a metal ion, Fe, was spiked into the histidine buffer containing PS80. While neither NMR nor EPR could definitively identify the presence of free radicals, the observation of PS80 oxidation products indicates that they were present.
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http://dx.doi.org/10.5731/pdajpst.2018.009639DOI Listing
April 2020

The feasibility of finger prick autologous blood (FAB) as a novel treatment for severe dry eye disease (DED): protocol for a randomised controlled trial.

BMJ Open 2018 10 31;8(10):e026770. Epub 2018 Oct 31.

Bedford Hospital NHS Trust, Bedford, UK.

Introduction: Patients with severe dry eye disease (DED) often have limited treatment options with standard non-surgical management focused on the use of artificial tears for lubrication and anti-inflammatory drugs. However, artificial tears do not address the extraordinary complexity of human tears. Crudely, human tears with its vast constituents is essentially filtered blood. Blood and several blood-derived products including autologous serum, have been studied as tear substitutes. This study proposes to test the use of whole, fresh, autologous blood obtained from a finger prick for treatment of severe DED.

Methods And Analysis: The research team at the two participating sites will approach patients with severe DED for this study. Recruitment will take place over 12 months and we expect to recruit 60 patients in total. The primary outcome of this feasibility study is to estimate the proportion of eligible patients approached who consent to and comply with study procedures including treatment regimen and completion of required questionnaires. The secondary outcome measures, although not powered for in this feasibility, include corneal inflammation (assessed by the Oxford corneal staining guide), patient pain and symptoms scores (assessed by the Ocular Surface Disease Index Score), and objective signs of DED as indicated by visual acuity (assessed by Schirmer's test, tear break-up time, lower and/or upper tear meniscus height measurement). Other secondary outcomes include patients' quality of life (assessed using the validated EQ-5D-5L Questionnaire), cost to the National Health Service (NHS) and patient (assessed via use of NHS services and privately purchased over-the-counter treatment related to DED) and safety measure of pressure within the eye (assessed by the Intraocular Pressure (IOP) Score).

Ethics And Dissemination: This protocol and any subsequent amendments, along with any accompanying material provided to the participant in addition to any advertising material used in this trial have been approved by the East of England - Cambridgeshire and Hertfordshire Research Ethics Committee (REC reference: 17/EE/0508). Written approval from the committee was obtained and subsequently submitted to the respective Trust's Research and Development (R&D) office with final NHS R&D approval obtained. Data obtained from this study will be published in a suitable peer-review journal and will also presented at international ophthalmic conferences including the American Academy of Ophthalmology, the Royal College of Ophthalmology Annual Congress, the Association for Research and Vision and Ophthalmology, and the European Society of Cataract and Refractive Surgery. Information will be provided to patient groups and charities such as the Sjogren's Society and the Royal National Institute of Blind People. This will also be shared with the study participants as well as with relevant patient groups and charities.

Trial Registration Number: NCT03395431; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2018-026770DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252631PMC
October 2018

Impact of Stainless Steel Exposure on the Oxidation of Polysorbate 80 in Histidine Placebo and Active Monoclonal Antibody Formulation

PDA J Pharm Sci Technol 2018 Mar-Apr;72(2):163-175. Epub 2018 Jan 17.

Protein Characterization, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA.

Rapid oxidation of polysorbate 80 in histidine buffer was observed upon brief exposure to stainless steel. Liquid chromatography-mass spectrometry analysis indicates degradation of both polyoxyethylene sorbitan and polyoxyethylene head groups and unsaturated fatty acid chains, with further confirmation by reversed-phase high-performance liquid chromatography data. Both Fe and Fe were shown to induce polysorbate 80 oxidation. The degree of oxidation in polysorbate 20 and polysorbate 80 are comparable for the head groups and saturated fatty acid esters. However, the same phenomenon was not observed with placebo or monoclonal antibody at a threshold protein concentration, formulated in sodium citrate, in combination with histidine and sodium citrate, or with Na ethylenediaminetetraacetic acid (EDTA). Further, polysorbate 80 oxidation was not observed with Lilly's antibody containing the active ingredient LY2951742, at or above a threshold concentration. Finally, no major polysorbate 80 degradation was observed in histidine buffer, with or without protein, in containers composed of glass or plastic, or when stainless steel exposure was otherwise completely absent. Finally, the 2-oxo oxidation form of histidine was not observed, but the other oxidation products and modifications of histidine were identified. Rapid oxidation of polysorbate 80 in histidine buffer was observed upon brief exposure to stainless steel. The degree of oxidation in polysorbate 80 and polysorbate 20 were comparable. However, the same phenomenon was not observed with placebo when formulated in sodium citrate, in combination with histidine and sodium citrate, or with Na ethylenediaminetetraacetic acid (EDTA). Polysorbate 80 oxidation was not observed with Lilly's antibody containing the active ingredient, LY2951742, at or above a threshold concentration. No major polysorbate 80 degradation in histidine buffer was observed when stainless steel contact was completely absent.
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http://dx.doi.org/10.5731/pdajpst.2017.008284DOI Listing
March 2019

Scaling the punctum and canaliculus in patients undergoing punctoplasty surgery: A prospective cohort study.

Orbit 2017 Dec 16;36(6):436-440. Epub 2017 Aug 16.

a Moorfield's Eye Unit at Bedford Hospital , Bedford , United Kingdom.

Optical Coherence Tomography (OCT) is a safe and non-invasive method of high-resolution cross-sectional imaging of tissue microstructures using infrared radiation. This study investigates how the appearance of the punctum and proximal canaliculus differs pre- and post-operatively in patients undergoing punctoplasty surgery. Patients with symptomatic punctal stenosis warranting punctoplasty surgery were prospectively invited to enrol from a single centre. Spectral OCT images of the lower punctae were captured with a Topcon 3D OCT 2000 machine pre- and post-operatively (at their follow-up appointment). Measurements were made of the maximal punctal diameter, canalicular diameter and canalicular depth. Pre- and post-operative measurements were compared using a paired t-test. Twenty-three punctae of 18 patients with punctal stenosis were included in the study. They were 10 males and 8 females with a median age 71.0 (SD 12.1). Mean canalicular cross-sectional area was 56.9 × 10-3 mm pre-operatively and 267.2 × 10-3 mm post-operatively, showing a statistically significant increase (p = 0.0004). There was an increase in both mean canalicular width (0.253 to 0.524mm (p = 0.0001)) and depth (0.433 to 0.852mm (p = 0.0001)) from pre- to post-operatively. There was a significant improvement in symptoms from pre- to post-operatively, as measured subjectively by the Lac-Q questionnaire (p = 0.021). This study describes the change in the appearance of the punctum and proximal canaliculus in patients undergoing punctoplasty operations, by using spectral OCT to capture in vivo high-resolution images. It demonstrates that punctal OCT can be successfully applied to quantify the morphological changes of the punctum and canaliculus pre- and post-punctoplasty.
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http://dx.doi.org/10.1080/01676830.2017.1343857DOI Listing
December 2017

Man versus Machine: Software Training for Surgeons-An Objective Evaluation of Human and Computer-Based Training Tools for Cataract Surgical Performance.

J Ophthalmol 2016 27;2016:3548039. Epub 2016 Oct 27.

Moorfields Eye Hospital, 162 City Road, London EC1V 2PD, UK; Department of Computer Science, University Of Surrey, Guildford, UK; NIHR Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, UK.

This study aimed to address two queries: firstly, the relationship between two cataract surgical feedback tools for training, one human and one software based, and, secondly, evaluating microscope control during phacoemulsification using the software. Videos of surgeons with varying experience were enrolled and independently scored with the validated PhacoTrack motion capture software and the Objective Structured Assessment of Cataract Surgical Skill (OSACCS) human scoring tool. Microscope centration and path length travelled were also evaluated with the PhacoTrack software. Twenty-two videos correlated PhacoTrack motion capture with OSACCS. The PhacoTrack path length, number of movements, and total procedure time were found to have high levels of Spearman's rank correlation of -0.6792619 ( = 0.001), -0.6652021 ( = 0.002), and -0.771529 ( = 0001), respectively, with OSACCS. Sixty-two videos evaluated microscope camera control. Novice surgeons had their camera off the pupil centre at a far greater mean distance (SD) of 6.9 (3.3) mm, compared with experts of 3.6 (1.6) mm ( ≪ 0.05). The expert surgeons maintained good microscope camera control and limited total pupil path length travelled 2512 (1031) mm compared with novices of 4049 (2709) mm ( ≪ 0.05). Good agreement between human and machine quantified measurements of surgical skill exists. Our results demonstrate that surrogate markers for camera control are predictors of surgical skills.
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http://dx.doi.org/10.1155/2016/3548039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102740PMC
October 2016

In search of a better option: dexamethasone versus methylprednisolone in third molar impaction surgery.

J Int Oral Health 2014 Nov-Dec;6(6):14-7

Reader, Department of Conservative Dentistry and Endodontics, Vydehi Institute of Dental Sciences, Bengaluru, Karnataka, India.

Background: Post-surgical complications like pain, swelling, impaired function cause transient morbidity for the patients leading to refrainment of the treatment. Various preemptive drugs are prescribed to prevent patients from such unpleasant situations. Both dexamethasone and methyl prednisolone can be used for this purpose in surgery of third molar impactions.

Materials And Methods: This was a split-mouth study consisting 25 patients having Pell and Gregory's Class II position B bilateral impactions. About 8 mg dexamethasone and 40 mg methyl prednisolone were prescribed randomly 1 hour prior to the surgery. Pain, swelling and trismus were noted on 1(st), 2(nd), 3(rd) and 7(th) day following surgery. Wilcoxon test was used to assess the significance between the parameters.

Results: Reduction in swelling and trismus was found to be significantly more with dexamethasone than methyl prednisolone. However, no statistical significant difference was found in post-operative pain.

Conclusion: Dexamethasone can be used as a potent preemptive drug for controlling post-operative complications in the removal of third molar impactions.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295447PMC
January 2015

Behavioral changes in preschoolers treated with/without rotary instruments.

J Int Soc Prev Community Dent 2014 May;4(2):77-81

General Practitioner, Shanti Charitable Trust, Bapu Nagar, Ahmedabad, Gujarat, India.

Background: Behavioral dentistry is an interdisciplinary science which needs to be learned, practiced, and reinforced in order to provide quality dental care in children.

Aim: To assess the anxiety experienced during dental treatment in preschool children with/without rotary instruments using behavioral scale.

Study And Design: Sixty pediatric patients of preschool age with bilateral occlusal carious lesions extending into dentin were selected for the study. Carious lesions were removed using conventional rotary instruments on one side and Papacarie - chemomechanical caries removal of approach on contra lateral side. Both cavities were restored with glass ionomer cement (Fuji IX). Anxiety scores were determined using 'Modified Child Dental Anxiety Scale' (Wong et al, 1998) during the various clinical stages of the treatment course.

Results: Children experienced relaxed behavior when subjected to Papacarie method of caries removal compared to conventional method using rotary instruments.

Conclusion: This study helped us to provide behavioral measures and introduce children to dentistry in a nonthreatening setting.
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http://dx.doi.org/10.4103/2231-0762.139427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170548PMC
May 2014

Assessment of intelligence quotient among schoolchildren of fishermen community of Kutch, Gujarat, India.

Int Marit Health 2014 ;65(2):73-8

Department of Public Health Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India.

Background And Aim: The aim of the study was to assess the intelligence quotient of fishermen school children of Kutch, Gujarat, India.

Materials And Methods: A descriptive cross-sectional study was conducted among 8 to 10 years old school children living in Kutch District, Gujarat, India, from January to February 2013. Seguin Form Board Test was used to assess the intelligence quotient (IQ) level of children. Means of groups were compared by independent student t-test. Stepwise multiple linear regression was used to identify predictors for IQ.

Results: The mean average timing taken by fishermen school children to complete the test was 30.64 ± 4.97. Males had significantly lower mean timing scores than females (p < 0.05). Participants with severe dental fluorosis, low socio-economic status (SES), lower education level of both mother and father and those who were overweight had significantly higher mean timing scores for average category.

Conclusions: The present study suggested a low IQ among fishermen school children community of Kutch, Gujarat, India. The major factors which influenced their IQ were dental fluorosis, low SES, low education level of parents and high body mass index.
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http://dx.doi.org/10.5603/IMH.2014.0017DOI Listing
May 2015

Optical coherence tomography imaging of the proximal lacrimal system.

Orbit 2014 Dec 12;33(6):428-32. Epub 2014 Sep 12.

Bedford Hospital NHS Trust , South Wing, Kempston Road, Bedford , United Kingdom .

Introduction: There are currently no routinely used imaging modalities for the proximal lacrimal system. Optical Coherence Tomography (OCT) is a safe and non-invasive method of high resolution cross-sectional imaging of tissue microstructures using infra-red radiation. In this study we investigate whether OCT may be used to image the punctum and proximal canaliculus.

Methods: A cohort of healthy subjects with normal ocular anatomy and no symptoms of epiphora were prospectively invited to enrol. Spectral OCT images of the lower punctae were captured with a Topcon 3D Optical Coherence Tomography 2000 machine. Measurements were made of the maximal punctal diameter, canalicular diameter and canalicular depth. Our data for depth of the vertical canaliculus was compared to the widely quoted figure of 2 mm using a two-tailed t-test to check for a statistically significant difference at p < 0.05.

Results: Thirty-six punctae of 18 subjects were scanned. The punctum was recognisable on the OCT image in all cases. The mean depth, width and cross- sectional area of the visualised canaliculi were 0.753 mm (SD 0.216), 0.110 mm (SD 0.067) and 9.49 × 10(-3)mm(2), respectively. The mean width of the punctum was 0.247 mm (SD 0.078).

Discussion: We have demonstrated the first in-vivo high resolution images of normal punctal and vertical canalicular anatomy using spectral OCT. There is currently no other practical way to accurately image punctal and proximal canalicular morphology in vivo. OCT is a convenient and readily available tool in most eye clinics with resolution ideally suited for imaging of the punctum and proximal canaliculus.
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http://dx.doi.org/10.3109/01676830.2014.949793DOI Listing
December 2014

Hydration of the anterior stroma in phacoemulsification cataract surgery.

J Cataract Refract Surg 2014 May;40(5):702-4

From Moorfields Eye Hospital NHS Foundation Trust (Nithyanandarajah, Athanasiadis, Scollo, A. Sharma), Bedford Hospital and the Bedford School (B. Sharma, Dorgham), Bedford, United Kingdom. Electronic address:

We describe a simple technique to hydrate the anterior stroma in cataract surgery using a 30-gauge needle. At the end of phacoemulsification, the needle is inserted into the stroma to create a watertight seal of the clear corneal incision.
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http://dx.doi.org/10.1016/j.jcrs.2014.02.025DOI Listing
May 2014

Reply: To PMID 24075156.

J Cataract Refract Surg 2014 Apr;40(4):691

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http://dx.doi.org/10.1016/j.jcrs.2014.02.002DOI Listing
April 2014

Reply: Comments on surgical iridotomy technique.

J Cataract Refract Surg 2014 Apr;40(4):690

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http://dx.doi.org/10.1016/j.jcrs.2014.02.003DOI Listing
April 2014

Surgical iridotomy in aphakic eyes and eyes with anterior chamber intraocular lenses.

J Cataract Refract Surg 2013 Oct;39(10):1461-2

From the Moorfields Eye Hospital NHS Foundation Trust (Athanasiadis, Nithyanandarajah, Trivedy, Bishop, A. Sharma) and the Bedford School (B. Sharma), Bedford, United Kingdom.

Unlabelled: We describe a simple technique to create a peripheral surgical iridotomy using a microvitreoretinal blade. The blade passes perpendicular to the iris dilator fibers to create a permanent opening.

Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.
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http://dx.doi.org/10.1016/j.jcrs.2013.07.015DOI Listing
October 2013

Upper extremity venous thrombosis in patients with cancer with peripherally inserted central venous catheters: a retrospective analysis of risk factors.

J Oncol Pract 2013 Jan;9(1):e8-12

University of Texas Southwestern Medical Center, Department of Palliative Care, Dallas, TX 75390-8889, USA.

Purpose: Peripherally inserted central catheters (PICCs) are often used in place of mediport catheters because of cost and lack of operating room time and to prevent delays in therapy. One common complication associated with their use is upper extremity venous thrombosis (UEVT). The purpose of this study was to ascertain risk factors associated with an increased risk of PICC-associated UEVT in patients with cancer.

Methods: Retrospective analysis identified 237 patients with cancer who received PICCs at the Dallas Veterans Affairs Medical Center from 2006 to 2009. We analyzed many risk factors, including PICC infection (PI), use of erythropoiesis-stimulating agents (ESAs), antiplatelet agents (APAs), treatment dose anticoagulation (TDA), and bevacizumab.

Results: Of 237 patients, 36 (15%) were found to have UEVT. Stepwise logistic regression analysis showed risk factors positively associated with UEVT were use of ESAs (odds ratio [OR], 10.66; 95% CI, 2.25 to 50.49), hospitalization (OR, 2.38; 95% CI, 1.05 to 5.39), PI (OR, 2.46; 95% CI, 1.03 to 5.86), and TDA (OR, 8.34; 95% CI, 2.98 to 23.33), whereas patients receiving APAs had a lower risk of UEVT (OR, 0.25; 95% CI, 0.07 to 0.92).

Conclusion: Specific factors significantly increase the risk of UEVT in patients with cancer with PICCs, whereas use of APAs seems to have a protective effect against UEVT. These results may aid in the development of a predictive model for identifying patients at high risk of UEVT who may benefit from APAs, as well as in determining preventive strategies for reducing the risk of PICC-associated UEVT.
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http://dx.doi.org/10.1200/JOP.2012.000595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545673PMC
January 2013

Subconjunctival triamcinolone acetonide in the management of ocular inflammatory disease.

J Ocul Pharmacol Ther 2013 Jul-Aug;29(6):516-22. Epub 2013 Mar 13.

Moorfields Eye Hospital NHS Foundation Trust, Bedford, United Kingdom.

Purpose: To review the existing evidence that supports the subconjunctival use of triamcinolone acetonide (TA) in the treatment of various ophthalmic diseases.

Methods: A literature search was performed for published articles about the pharmacokinetic (PK) and pharmacodynamic characteristics of triamcinolone, as well as its potential ophthalmic use, focused mainly in the subconjunctival mode of delivery. Search terms included corticosteroids, triamcinolone, ocular, subconjunctival, and ophthalmic.

Results: Corticosteroids represent the mainstay of treatment of ocular inflammation, exerting their action by affecting multiple pathways of the inflammatory response, making them particularly effective in the majority of cases. However, due to the number and severity of the side effects associated with their use, they have to be given with caution. Corticosteroids can be given topically, subconjunctivally, intraocularly, and systemically to treat a variety of ocular diseases with specific pharmacological and PK characteristics. Triamcinolone is one of the most widely used corticosteroids in the treatment of ocular inflammation. This glucocorticoid used subconjunctivally was proven to be particularly safe and effective in some common and important inflammatory ophthalmic diseases such as anterior scleritis, uveitis, and corneal graft rejection. Further, there are other indications for its successful use where data exist, but somehow less abundant.

Conclusions: This article highlights the potential of TA to complement the treatment armamentarium of anterior segment inflammation.
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http://dx.doi.org/10.1089/jop.2012.0208DOI Listing
February 2014

Vemurafenib: targeted inhibition of mutated BRAF for treatment of advanced melanoma and its potential in other malignancies.

Drugs 2012 Dec;72(17):2207-22

VA North Texas Health Care System, Dallas, TX 75216, USA.

Vemurafenib is the first molecularly targeted therapy to be licensed in the US and Europe for treatment of advanced melanoma. Its mechanism of action involves selective inhibition of the mutated BRAF V600E kinase that leads to reduced signalling through the aberrant mitogen-activated protein kinase (MAPK) pathway. Its efficacy is restricted to melanomas carrying the BRAF V600E mutation, which is seen in approximately 50% of all melanomas. In a randomized phase III trial, it was superior to dacarbazine in first-line treatment of advanced melanoma, with an overall response rate (ORR) of 48% (95% CI 42, 45), an estimated 6-month progression-free survival (PFS) of 5.3 versus 1.6 months (hazard ratio [HR] 0.26; 95% CI 0.20, 0.33; p < 0.001) and a statistically superior 12-month overall survival (OS) rate of 55% versus 43% (HR 0.62 [95% CI 0.49, 0.77]). Vemurafenib is generally well tolerated, but its use can be associated with development of cutaneous neoplasms such as squamous cell carcinoma (SCC) and keratoacanthoma (KA). These lesions can be excised safely without the need for withholding the drug or reducing its dose. Mechanisms of resistance to vemurafenib do not involve development of secondary mutations in the BRAF kinase domain, but may be related to BRAF V600E over-amplification, bypassing mechanisms via upregulation and overexpression of other components in the MAPK signalling cascade or activation of alternative pathways with potential to enhance cell growth, proliferation and survival. Clinical trials to test the efficacy of vemurafenib in combination with immunomodulatory agents, such as ipilimumab, and MAPK kinase (MEK) inhibitors, such as GDC-0973, in the treatment of advanced melanoma are currently underway. Also under investigation is the use of vemurafenib in other solid tumours with BRAF mutations, such as papillary thyroid cancer.
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http://dx.doi.org/10.2165/11640870-000000000-00000DOI Listing
December 2012

Tear film osmolarity in epiphora.

Ophthalmic Plast Reconstr Surg 2012 Sep-Oct;28(5):338-40

Oculoplastics, Moorfields Eye Hospital, Bedford, United Kingdom.

Purpose: To examine whether patients complaining of epiphora have tears of a lower osmolarity.

Methods: Sixty-three eyes of 39 patients attending an oculoplastic clinic with a primary complaint of epiphora, had their tear osmolarity recorded. Subjects were excluded if they had current or recent topical eye therapy, active ocular infection or allergy, ocular surface scarring, evidence of dry eye, previous laser eye surgery, or a contact lens worn within the previous 12 hours. Patients were divided into 2 groups. The first included those whose primary complaint was of epiphora due to either punctal stenosis, nasolacrimal duct obstruction (partial or complete), or eyelid laxity (without evidence of frank ectropion or entropion). The second group formed the controls, and consisted of the second eye of some of the above patients, or those attending the clinic for other oculoplastic procedures not related to epiphora. Testing of tear osmolarity was performed in the clinic using the TearLab osmometer.

Results: Sixty-three readings were obtained, of which 32 were from patients with a primary complaint of epiphora and 31 were allocated to the control group. Patients with epiphora had a mean tear osmolarity of 291.8 mOsms/l (range, 269-324, standard deviation 16.6), compared with the control group mean of 303.7 mOsms/l (range, 269-354, standard deviation 24.1). This difference was found to be statistically significant (p = 0.025).

Conclusion: Patients complaining of epiphora in the absence of other ocular surface pathology have a significantly lower tear osmolarity.
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http://dx.doi.org/10.1097/IOP.0b013e31825e6960DOI Listing
December 2012

The infusion method trial of void vs standard catheter removal in the outpatient setting: a prospective randomized trial.

BJU Int 2011 Apr;107 Suppl 3:43-6

University of Melbourne, Department of Surgery, Western Hospital, Victoria, Australia.

Objective: • To ascertain if filling the bladder with warm normal saline before trial of void (TOV) reduces time to decision of outcome of TOV and time to discharge compared with standard in-dwelling catheter (IDC) removal in the outpatient setting.

Patients And Methods: • A prospective randomized controlled trial (not blinded) was carried out in the day procedure unit. Randomization was done using computer-generated random numbers. The sample size was calculated based on initial pilot data using α= 0.05 and β= 0.2 and a clinically important reduction of ≥60 min for time to decision of outcome of TOV (primary outcome measure). • In all, 60 consecutive patients were recruited from two referral sources: presentations of acute urinary retention to the emergency department and patients discharged home after failing TOV postoperatively. • The infusion method group (32 patients) had 300-500 mL warm normal saline infused into the bladder before removing their IDC and the control group (28) had standard IDC removal. • Data were collected and analysed using the two-tailed Mann-Whitney U-test. Statistical significance was set at P < 0.05.

Results: • The median time to decision was 135.0 (95% confidence interval CI 95.0-190.0) min in the infusion group and 247.5 (95% CI 189.6-294.1) min in the control group. • Patients undergoing a bladder infusion had a shorter discharge time [180.0 (95% CI 126.0-226.9) min] than patients in the standard-IDC-removal group [262.5 (95% CI 233.8-315.0) min]. • The infusion arm shortened time to decision by 112.5 min (P < 0.001) and time to discharge by 82.5 min (P < 0.001). • Furthermore, patients in the infusion group were 1.56 times more likely to achieve catheter-free state after TOV (risk ratio 1.56, 95% CI 1.03-2.36; P= 0.03).

Conclusion: • The infusion method for TOV is safe and expeditious, making it ideal for the outpatient setting. This randomized study shows that the infusion method enables a rapid determination of outcome of TOV with a greater chance of success and shortened discharge times.
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http://dx.doi.org/10.1111/j.1464-410X.2011.10044.xDOI Listing
April 2011

Subconjunctival injection of triamcinolone acetonide in the management of corneal graft rejection and new vessels.

J Clin Pharmacol 2012 Apr 19;52(4):607-12. Epub 2011 Apr 19.

Moorfields Eye Hospital NHS Foundation Trust at Bedford, Bedford, UK.

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http://dx.doi.org/10.1177/0091270011400073DOI Listing
April 2012

Passive control of quorum sensing: prevention of Pseudomonas aeruginosa biofilm formation by imprinted polymers.

Biomacromolecules 2011 Apr 1;12(4):1067-71. Epub 2011 Mar 1.

Cranfield Health, Cranfield University, Cranfield, Bedfordshire MK43 0AL, United Kingdom.

Here we present the first molecular imprinted polymer (MIP) that is able to attenuate the biofilm formation of the opportunistic human pathogen Pseudomonas aeruginosa through specific sequestration of its signal molecule N-(3-oxododecanoyl)-L-homoserine lactone (3-oxo-C(12)-AHL). The MIP was rationally designed using computational modeling, and its capacity and specificity and that of a corresponding blank polymer toward signal molecule of P. aeruginosa (3-oxo-C(12)-AHL) and its analogue were tested. The biofilm formation in the presence of polymers and without polymers was studied using scanning confocal laser microscopy. Staining with crystal violet dye was used for the quantification of the biofilm formation. A significant reduction of the biofilm growth was observed in the presence of MIP (>80%), which was superior to that of the resin prepared without template, which showed a reduction of 40% in comparison with biofilm, which was grown without polymer addition. It was shown that 3-oxo-C(12)-AHL-specific MIP prevented the development of quorum-sensing-controlled phenotypes (in this case, biofilm formation) from being up-regulated. The developed MIP could be considered as a new tool for the elimination of life-threatening infections in a multitude of practical applications; it could, for example, be grafted on the surface of medical devices such as catheters and lenses, be a component of paints, or be used as a wound adsorbent.
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http://dx.doi.org/10.1021/bm101410qDOI Listing
April 2011

Efficacy and safety assessment of a novel ultraviolet C device for treating corneal bacterial infections.

Clin Exp Ophthalmol 2011 Mar;39(2):156-63

University of Auckland, Auckland, New Zealand.

Background: A prototype solid-state Ultraviolet-C (UVC) LED device may be useful in the treatment of corneal microbial infections, as UVC is commonly used for eradicating bacteria, fungi and viruses in other settings. This study assessed the efficacy of 265 nm UVC from this LED, on four different bacterial strains, and investigated the consequences of corresponding exposures on human corneal epithelial cells in vitro.

Methods: Agar plate lawns of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Streptococcus pyogenes were exposed to a 4.5 mm diameter 265 nm UVC beam at a fixed intensity and distance, for 30, 5, 4, 2 and 1 seconds. Growth inhibition was assessed with a BioRad Gel imager, and the diameter of lucent areas of bacterial inhibition recorded. Human corneal epithelial cells cultured on glass cover-slips were exposed to corresponding doses of UVC from the same device. Live/dead staining was performed and the results quantified.

Results: There was 100% inhibition of growth for all bacteria tested, at all exposure times. A 30-second exposure of human corneal epithelium to UVC gave no statistically significant decrease (P = 0.877) in the ratio of live to dead cells when compared to control cultures.

Conclusion: The results confirmed that a 1 second exposure to germicidal UVC from this LED source was sufficient to inhibit microbial proliferation in the four bacterial strains tested in vitro. The literature suggests UVC at this dose could potentially be beneficial in treating corneal surface infections, without causing significant adverse effects, supported by our findings in human corneal epithelium exposed to UVC.
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http://dx.doi.org/10.1111/j.1442-9071.2010.02471.xDOI Listing
March 2011