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Biomedical subjects

J Raina

Publications and source records attributed to J Raina.

9 recordsLinked to original sources
PubMed2000

Decreased visual acuity in patients with cytomegalovirus retinitis and AIDS.

PURPOSE: To investigate the causes of decreased visual acuity in patients with cytomegalovirus (CMV) retinitis in the acquired immunodeficiency syndrome (AIDS). METHODS: All human immunodeficiency virus (HIV)-positive patients seen in two ophthalmology units over a 15 month period from September 1996 were included in this retrospective study. A detailed ophthalmic examination was performed on all patients and in addition those with CMV retinitis underwent serial fundus photography. Decreased visual acuity was defined as a best corrected visual acuity < or = 6/12. CMV and retroviral treatment, CD4+ count and HIV viral load were also documented for each patient. RESULTS: Of 110 patients seen over the 15 month period, 26 (41 eyes) had a diagnosis of CMV retinitis. Twelve patients (16 eyes) with CMV retinitis had decreased visual acuity. The decreased visual acuity in 7 eyes was initially due to the CMV retinitis involving the macula and the optic nerve. Retinal detachment was responsible in 2 eyes and optic nerve atrophy in 1 eye. In 6 eyes (4 patients) the decreased visual acuity was due to a maculopathy--cystoid macular oedema and/or an epiretinal membrane in the presence of an inactive zone 2 or 3 CMV retinitis--with all these patients exhibiting a vitritis of varying grade. The decreased visual acuity in the maculopathy subgroup was irreversible in all except 1 eye, and 2 eyes in this category later developed a cataract. CONCLUSION: In this series, CMV-retinitis-'related' maculopathy was a major (38%) cause of decreased visual acuity, occurring in the absence of zone 1 retinitis and despite inactive peripheral CMV retinitis. A varying degree of vitritis was an associated feature in all these patients. This study therefore highlights maculopathy as an important and previously unrecognised significant cause of visual morbidity in CMV retinitis.

AIDS-Related Opportunistic Infections↗
PubMed1999

Ocular complications of intravenous cidofovir for cytomegalovirus retinitis in patients with AIDS.

PURPOSE: To describe the frequency of anterior uveitis and ocular hypotony in cidofovir-treated patients with acquired immune deficiency syndrome (AIDS)-related cytomegalovirus (CMV) retinitis. METHODS: A retrospective review was performed of all patients with AIDS-related CMV retinitis during a 12-month period. The CMV retinitis activity, concurrent illnesses and medications, and CD4+ lymphocyte count were recorded in addition to the degree of anterior chamber inflammation and intraocular pressure at each visit. The frequency of uveitis and ocular hypotony in cidofovir-treated patients was determined and the possible influence of other ocular and systemic factors considered. RESULTS: Eight of 9 patients on cidofovir developed anterior uveitis. The cellular anterior chamber activity resolved with topical corticosteroid administration in all eyes with uveitis but significant flare persisted despite topical steroids in 3 patients. Posterior synechiae responded poorly to topical mydriatic therapy, resulting in inadequate mydriasis which significantly limited the fundal view. One patient developed a visually significant unilateral hypotonous maculopathy. CONCLUSIONS: Patients treated with intravenous cidofovir for AIDS-related CMV retinitis are at significant risk of ocular adverse effects. Prompt treatment with topical corticosteroids and mydriatics may control uveitis and in some cases cidofovir treatment may be cautiously continued. In the event of ocular hypotony cidofovir should be discontinued in favour of an alternative anti-cytomegaloviral agent.

AIDS-Related Opportunistic Infections↗
PubMed1998

Neuronal apoptosis induced by HIV-1 Tat protein and TNF-alpha: potentiation of neurotoxicity mediated by oxidative stress and implications for HIV-1 dementia.

Apoptosis of neurons and non-neuronal cells has been demonstrated in the brain of AIDS patients with dementia. Previous studies suggest that the apoptotic stimuli are likely to be soluble factors. Several candidates for the soluble factors that lead to neuronal apoptosis in HIV-1 infection have been proposed, including the HIV-1 Tat protein and TNF-alpha. The mechanisms that lead to neuronal apoptosis in the brain of AIDS patients in vivo, may involve the combined effects of more than one pro-apoptotic factor. In this study, we examine whether exposure of primary human neurons to the combination of HIV-1 Tat and TNF-alpha can potentiate the induction of neuronal apoptosis compared with exposure to either factor alone. TNF-alpha was shown to potentiate the induction of neuronal apoptosis by HIV-1 Tat via a mechanism that involves increased oxidative stress. Antioxidants inhibited, but did not completely abolish the induction of neuronal apoptosis by Tat, suggesting that other mechanisms are also likely to be involved. These findings suggest that soluble HIV-1 Tat and TNF-alpha may play a role in neuronal apoptosis induced by HIV-1 infection of the CNS, particularly when present in combination. Our findings further suggest that one mechanism whereby combinations of pro-apoptotic factors may potentiate the induction of neuronal apoptosis in the brain of AIDS patients is by increasing oxidative stress. Understanding the role of oxidative stress and other mechanisms that lead to apoptosis in HIV-1 infection of the CNS may advance the development of new therapeutic strategies to prevent neuronal cell death and improve neurologic function in AIDS patients.

AIDS Dementia Complex↗
PubMed1997

A lipidated anti-Tat antibody enters living cells and blocks HIV-1 viral replication.

We have developed a chemical modification of antibodies, lipidation, which enables their intracellular delivery into living cells. Intracellular localization of lipidated antibodies was demonstrated by confocal microscopy and by measuring cellular uptake of 125I-labeled lipidated antibodies. Functionally, a lipidated monoclonal antibody directed against the Tat protein from human immunodeficiency virus type 1 (HIV-1) inhibited viral replication of several HIV-1 isolates by approximately 85% as shown by increased viability of infected cells and decreased reverse transcriptase activity. The antibody in its native form had no such effect. These data show that lipidated antibodies can reach and functionally inhibit intracellular targets. Lipidation may help to facilitate the development of intracellular immunotherapy for AIDS.

Antibodies, Monoclonal↗
PubMed1996

Obesity as a cause of mechanical entropion.

PURPOSE: Although lower eyelid entropion can result from many conditions, obesity is not a generally recognized factor. We treated a case of recurrent severe entropion that was a result of morbid obesity in a patient with de Morsier's syndrome. METHODS: The patient underwent surgery on both lower eyelids. RESULTS: The entropion was corrected by advancing the lower eyelid retractors and debulking the subcutaneous tissue in the lower eyelids. CONCLUSIONS: Mechanical entropion can occur as a rare complication of morbid obesity and may respond to surgical procedures that address its cause.

Abnormalities, Multiple↗
PubMed1995

Comitant strabismus.

This review reports on articles written on comitant strabismus during the past year. Congenital esotropia was a recurring theme in these publications. Included in this review are articles that provide an insight into the basis for motor epiphenomena such as optokinetic nystagmus asymmetry and latent nystagmus. The optimum window of opportunity to achieve quality binocular vision by surgical alignment in congenital esotropia is discussed. We also report on articles that address various aspects of the management of comitant strabismus including the amount of medial rectus recession for esotropia, the target angle for best results in accommodative esotropia with high accommodation convergence/accommodation ratio, and issues related to comitant exotropia.

Accommodation, Ocular↗
PubMed1992

Identification of HIV-1 envelope glycoprotein in the serum of AIDS and ARC patients.

Binding of the human immunodeficiency virus type 1 (HIV-1) external envelope glycoprotein (gp120) has been reported to alter the function and surface antigen expression of lymphocytes and monocytes in vitro. To determine whether these in vitro findings could be relevant in vivo, we searched for the presence of this antigen in the serum of patients with AIDS and the AIDS-related complex (ARC). Using an antigen capture enzyme-linked immunosorbent assay (ELISA) with polyclonal anti-gp120 antibody, we detected envelope antigens (gp160/120) in serum of 22 of 32 AIDS patients. In contrast, an ELISA using solid-phase recombinant CD4 to capture gp160/120 failed to detect any positives. A modification of the anti-gp120-based ELISA identified gp160/120-IgG immune complexes in all of 11 AIDS patients tested and in 4 ARC patients who were negative for gp160/120 antigen. We conclude that gp160/120, predominantly in the form of immune complexes, can be identified as circulating antigen in patients with AIDS. The potential pathogenic consequences of this antigenemia, its relation to soluble CD4 therapy, and its application as a clinical marker of disease merit further study.

AIDS-Related Complex↗
PubMedDate not supplied

A comparison of Wright card with Teller card for detection of amblyopia.

PURPOSE: Teller acuity cards are used to assess visual acuity in infants but can underestimate amblyopia. In order to improve amblyopia detection, a new luminance balanced checkered card of 4.8 cycles/cm frequency was developed by Wright and Vistech (Dayton, Ohio). The Wright card was compared with a corresponding Teller card (of 4.8 cycles/cm) for detection of amblyopia. METHODS: A prospective masked study of 44 children was carried out. Each was assessed for amblyopia using both the Wright and Teller cards in addition to the Snellen or Allen card (optotype). The results were analyzed statistically using repeated measures of ordinal data. RESULTS: Thirteen eyes were found to be amblyopic with optotype testing, two with the Teller card and 17 with the Wright card. With optotype acuity as the standard, the sensitivity and specificity of the Teller card was 15.3% and 100%, while that of the Wright card was 100% and 94.6%. DISCUSSION: The Teller card is associated with high false negative test rate because it assesses grating acuity and allows spurious resolution possibly due to an edge artifact. This artifact is less pronounced with the Wright card. Further, the stripes on the Teller card require resolution only in horizontal axis, while the checkers requires uniform resolution in all axes. Different pathways for neural processing may also contribute to the disparate results with these methods. CONCLUSIONS: The Wright card was more sensitive than the Teller card for the detection of amblyopia in this study population and has potential value in preverbal children.

Amblyopia↗