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Biomedical subjects

R Maini

Publications and source records attributed to R Maini.

At least 19 recordsLinked to original sources
PubMed2004

The risk of complications of uveitis in a district hospital cohort.

AIMS: To establish the frequency and risk factors for visual loss in a primary referral cohort of hospital patients with uveitis. METHODS: 561 consecutive uveitis patients attending three district hospitals were recruited and the acuity at the end of the study period recorded. A retrospective case-control study of risk factors for visual loss (permanent loss of acuity <6/9) was performed. Risk factors examined included type of uveitis, age at onset of uveitis, race, type of systemic inflammatory disease, length of follow up, and treatment variables. RESULTS: Visual loss of at least 6/12 in one eye was found in 111 patients (19.9%). Only four patients (0.7%) suffered severe bilateral visual loss (6/36 or less). Visual loss was associated with age at onset >60 years (odds ratio 3.9, 95% confidence interval (CI) 2.2 to 7.0, long follow up 2.0 (1.2 to 3.3) and a history of cataract surgery 3.9 (2.1 to 7.2). It was less likely in patients with acute anterior uveitis 0.2 (0.1 to 0.3). CONCLUSION: The frequency of visual loss associated with uveitis in a district hospital cohort is less than that found in referral centres and levels of legal blindness are low. Although acute anterior uveitis has a low frequency of visual loss it contributes significantly to the total burden. The ocular co-morbidity of the elderly may contribute to the increased visual loss of late onset uveitis.

Adolescent↗
PubMed2004

The use of porous polyethylene (Medpor) lower eyelid spacers in lid heightening and stabilisation.

BACKGROUND/AIMS: The management of lower eyelid retraction can be challenging, and established techniques to correct it are not always successful. Previous reports have suggested a role for the ultrathin high density porous polyethylene lower eyelid spacer (Medpor LES) in such patients. The authors report the experience of three surgeons implanting Medpor LES over 1 year, and ascertain whether such implants are a safe and effective alternative to autogenous spacers. METHODS: A prospective, interventional, non-comparative case series of consecutive patients. Surgical indications for Medpor LES were noted. Preoperative and postoperative lower marginal reflex distance (L-MRD), vertical palpebral aperture (PA), lagophthalmos, and scleral show inferior to the limbus (LSS) were recorded, together with major and minor complications. RESULTS: 32 patients (35 eyelids) had a Medpor LES inserted, 22/32 under local anaesthetic, and nine with adjunctive procedures. Mean follow up was 22 months (range 15-28 months). The Medpor LES was effective in reducing the palpebral aperture (p<0.001) and lagophthalmos (p = 0.04) and raising the lower eyelid height by reducing both L-MRD (p = 0.006) and LSS (p<0.001). However there were major complications in 7/32 patients and minor complications in 8/32, most requiring further surgery. Final outcome was good in 24/35 eyelids and satisfactory in 5/35. CONCLUSIONS: Despite a good or satisfactory final outcome in the majority of patients, the value of this technique is limited by complications, and should be reserved for those unsuitable for safer techniques.

Adult↗
PubMed2002

Phototherapeutic keratectomy re-treatment for recurrent corneal erosion syndrome.

AIMS: Phototherapeutic keratectomy with an excimer laser is commonly used to treat recurrent corneal erosion syndrome. The aim of this study was to determine the success of a repeat phototherapeutic keratectomy for patients with persistent macroerosions following initial treatment with phototherapeutic keratectomy. METHODS: Eight patients who failed primary phototherapeutic keratectomy for recurrent corneal erosion syndrome were treated with repeat phototherapeutic keratectomy. All patients were treated with a superficial therapeutic ablation profile with a Visx, Nidek, or Summit 193 nm excimer laser. All patients were treated for both their primary treatment and re-treatment by the same surgeon. Retrospective analysis of case records of all patients requiring re-treatment was supplemented with a telephone interview. RESULTS: Over a 5 year period (October 1995 to October 2000) 76 eyes were treated for recurrent erosion syndrome with phototherapeutic keratectomy. All patients had documented macroerosions and had failed previous treatment with a lubricant at night. Eight eyes (11%) continued to have macroerosions after this initial treatment; all opted for re-treatment with phototherapeutic keratectomy. Following re-treatment none reported symptoms consistent with a macroerosion. Six of eight patients (75%) are now symptom free; 2/8 (25%) have an occasional foreign body sensation relieved by lubricants. Follow up ranged from 9-60 months with a mean of 25.5 months. CONCLUSION: Re-treatment with phototherapeutic keratectomy appears to be successful for patients with macroerosions complicating recurrent corneal erosion syndrome who have failed conservative management with ocular lubricants and a primary phototherapeutic keratectomy.

Adult↗
PubMed2001

Patterns of prescription and drug use in ophthalmology in a tertiary hospital in Delhi.

AIMS: The present study was carried out to describe the patterns of prescription and drug use in Ophthalmology in out-patients at Dr Rajendra Prasad (R.P.) Centre for Ophthalmic Sciences of All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi. METHODS: Prescriptions of 1017 out-patients were audited through a specially designed form and analysed for the following: average number of drugs per prescription, duration of treatment (recorded or not), dosage forms prescribed, frequency of administration (recorded or not), number of encounters with antibiotics and percentage of drugs prescribed by generic name. RESULTS: Prescription analysis showed that the average number of drugs per prescription was 3.03. Duration of treatment was recorded for only 26.4% of the drugs prescribed. The maximum number of drugs prescribed were in the form of eye drops (76%), followed by tablets (10.9%), ointments (6.4%), syrups (1%), capsules (0.7%), lotions (0.3%) and injections (0.1%). No dosage form was recorded for 4.6% of the drugs prescribed. The frequency of administration was recorded for only 77.9% of the drugs prescribed. The number of antibiotics prescribed was 1059 which constitutes 34.2% of the total number of drugs prescribed. The percentage of drugs prescribed by generic name was only 35%. CONCLUSIONS: The results obtained in this study indicated an awareness of polypharmacy but a high incidence of common prescription writing errors such as not recording the duration of therapy, frequency of administration and dosage form. Moreover prescribing by generic name was also low.

Drug Prescriptions↗
PubMed2001

Correction of refractive error in the Victorian population: the feasibility of "off the shelf" spectacles.

AIMS: To assess the feasibility of providing a stock of ready made spectacles for correction of refractive error in the general population. METHODS: Data were collected in the Visual Impairment Project, a population based survey of Victorian residents aged 40 years or older in randomly selected urban and rural sample areas. This included a refractive eye examination and the proportion of subjects with hypermetropia, emmetropia (defined as -1.0 to +1.0D spherical equivalent), and myopia documented in the 40-60 year age group. RESULTS: 2595 (54.8%) participants were aged between 40 and 60 years. Those with a best corrected visual acuity of less than 6/12, astigmatism of more than 1.25D, and anisometropia of more than 0.5D were excluded. 516 participants had refractive error which was deemed suitable for correction by "off the shelf" spectacles. This represents 19.9% of all participants between 40 and 60 years of age. Provision of spectacles in 0.5D increments would provide suitable stock spectacles for 85.5% of a -3.0 to +3.0D range or 89.2% of a -3.50 to +3.50D range. CONCLUSIONS: Ready made "off the shelf" spectacles could significantly alleviate visual morbidity due to refractive error in up to 20% of an urban population in Australia. This approach may also be useful in developing countries with poor access to optometric services.

Adult↗
PubMed2001

A comparison of different depth ablations in the treatment of painful bullous keratopathy with phototherapeutic keratectomy.

AIM: To study the efficacy of phototherapeutic keratectomy (PTK) for pain relief for patients with painful bullous keratopathy and poor visual potential. METHODS: Patients with painful bullous keratopathy and poor visual potential were treated with superficial PTK (8-25 microm), intermediate (50-100 microm) or deep PTK (25% stromal thickness) using the Nidek EC5000 excimer laser after manual epithelial debridement. Follow up ranged from 1 to 24 months (mean 6.5 months). Outcome measures included symptomatic relief and need for further treatment. RESULTS: In the superficial PTK group five of eight (62%) patients improved symptomatically after treatment. The three (38%) who did not improve went on to have penetrating keratoplasty for pain relief. In the intermediate depth group only two of five (40%) patients had symptom alleviation. The three others (60%) required further procedures. 20 of 24 (83%) patients treated with deep PTK had significant or total alleviation of symptoms. Of these, one developed acute anterior uveitis 9 months after PTK and two required botulinum ptosis for persistent corneal epithelial defects, one of whom had three consecutive episodes of microbial keratitis. Three of 24 suffered occasional discomfort and one patient required a penetrating keratoplasty for continued pain. CONCLUSION: PTK can be a useful therapeutic measure in painful bullous keratopathy with poor visual potential. Deep PTK appears to be more successful in pain management than superficial treatment.

Adult↗
PubMed1999

Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. ATTRACT Study Group.

BACKGROUND: Not all patients with rheumatoid arthritis can tolerate or respond to methotrexate, a standard treatment for this disease. There is evidence that antitumour necrosis factor alpha (TNFalpha) is efficacious in relief of signs and symptoms. We therefore investigated whether infliximab, a chimeric human-mouse anti-TNFalpha monoclonal antibody would provide additional clinical benefit to patients who had active rheumatoid arthritis despite receiving methotrexate. METHODS: In an international double-blind placebo-controlled phase III clinical trial, 428 patients who had active rheumatoid arthritis, who had received continuous methotrexate for at least 3 months and at a stable dose for at least 4 weeks, were randomised to placebo (n=88) or one of four regimens of infliximab at weeks 0, 2, and 6. Additional infusions of the same dose were given every 4 or 8 weeks thereafter on a background of a stable dose of methotrexate (median 15 mg/week for > or =6 months, range 10-35 mg/wk). Patients were assessed every 4 weeks for 30 weeks. FINDINGS: At 30 weeks, the American College of Rheumatology (20) response criteria, representing a 20% improvement from baseline, were achieved in 53, 50, 58, and 52% of patients receiving 3 mg/kg every 4 or 8 weeks or 10 mg/kg every 4 or 8 weeks, respectively, compared with 20% of patients receiving placebo plus methotrexate (p<0.001 for each of the four infliximab regimens vs placebo). A 50% improvement was achieved in 29, 27, 26, and 31% of infliximab plus methotrexate in the same treatment groups, compared with 5% of patients on placebo plus methotrexate (p<0.001). Infliximab was well-tolerated; withdrawals for adverse events as well as the occurrence of serious adverse events or serious infections did not exceed those in the placebo group. INTERPRETATION: During 30 weeks, treatment with infliximab plus methotrexate was more efficacious than methotrexate alone in patients with active rheumatoid arthritis not previously responding to methotrexate.

Adult↗
PubMed1998

The natural history of epiphora in childhood.

PURPOSE: To investigate the incidence and aetiology of epiphora in a population of 7-year-old children and determine whether a conservative management policy for congenital nasolacrimal duct obstruction (CNLDO) results in excess lacrimal dysfunction in later childhood. METHODS: A postal questionnaire was sent to the parents of a large cohort of 7-year-old children previously investigated to determine the incidence and natural progression of CNLDO. They were asked about the presence of epiphora, and its relationship to atopic disease and the presence of upper respiratory tract infections (URTI). Information on epiphora had also been gathered from the same cohort at age 3 1/2 years at a routine examination. Data were compared with those for epiphora in infancy in the same cohort. RESULTS: The incidence of epiphora at 3 1/2 years was 5.5%, and 7 years 7.7%. At age 7 years 70% of cases were related to atopic disease or URTI. CNLDO was not significantly related to epiphora in later childhood (p = 0.000032). CONCLUSIONS: A policy of delaying nasolacrimal probing in CNLDO until after the age of 1 year does not result in a detectable excess of lacrimal dysfunction in later childhood, when epiphora is more likely to be related to atopic disease or upper respiratory tract infection.

Age Factors↗
PubMed1998

Cytokines in autoimmune disorders.

Cytokines are important protein mediators of immunity, inflammation, cell proliferation, differentiation, fibrosis, etc. (Oppenheim and Saklatvala, 1993). As these are the major biological processes underlying autoimmunity, it is not surprising that there is now convincing evidence that cytokines have an important role in the pathogenesis of autoimmunity (Brennan and Feldmann, 1996; Feldmann et al., 1996). There has been much progress since we first highlighted the role of cytokines such as IFN gamma in autoimmunity in the early 1980s (Bottazzo et al., 1983). The number of cytokines molecularly cloned has increased greatly, and the biochemical and structural basis of their action are partly understood, as cytokine genes and that of their receptors have been cloned. Knowledge of cytokine signalling is rapidly expanding (see Chapter XIII). In medical terms, clear evidence of the importance of cytokines in autoimmunity is demonstrated by therapeutic advances. Thus it is possible to dramatically improve patients with rheumatoid arthritis and Crohn's disease by blocking TNF alpha, and a new target for therapy, TNF alpha, has thus been validated for both these diseases.

Animals↗