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Biomedical subjects

S Jalali

Publications and source records attributed to S Jalali.

At least 19 recordsLinked to original sources
PubMed2002

Retinal detachment in developing countries.

Treatment of retinal detachment has been a low priority in developing countries. It is thought to be less common in India and Africa than in Europe and N America. The aetiology and presentation of retinal detachment in the Third World are affected by genetic and environmental factors. In general, patients are more likely to present late, and complex detachments are relatively more common. Despite these problems, the results of surgery are encouraging, with more than 80% final anatomical success, and over 60% of re-attached retinas obtaining vision of 6/60 or better. The management of retinal detachment in developing countries can be improved by strengthening training programmes and by developing and equipping centres to carry out retinal surgery.

Developing Countries↗
PubMed2001

Integrin-mediated mechanotransduction requires its dynamic interaction with specific extracellular matrix (ECM) ligands.

The aim of this study is to elucidate the role of integrins in transducing fluid shear stress into intracellular signals in vascular endothelial cells, a fundamental process in vascular biology. We demonstrated that shear stress activates specific integrins in endothelial cells plated on substrates containing the cognate extracellular matrix (ECM) ligands. The shear stress-induced mechanotransduction, as manifested by integrin-Shc association, was abolished when new integrin-ECM ligand interactions were prevented by either blocking the integrin-binding sites of ECM ligands or conjugating the integrins to immobilized antibodies. Our results indicate that the dynamic formation of new connections between integrins and their specific ECM ligands is critical in relaying the signals induced by shear stress to intracellular pathways.

Adaptor Proteins, Signal Transducing↗
PubMed2001

Clinical profile and outcome in Bacillus endophthalmitis.

OBJECTIVE: To study the clinical presentation, microscopic and organismal culture correlation of vitreous, and species-specific outcome in Bacillus endophthalmitis DESIGN: Retrospective noncomparative case series. INTERVENTION: Thirty-one culture proven Bacillus endophthalmitis patients between January 1991 and February 1998 underwent vitrectomy and intravitreal antibiotic injection. Lensectomy was combined when considered essential, and on a few occasions intravitreal dexamethasone was added. The patients also received topical and systemic antibiotics. The undiluted vitreous biopsy was the source for microbiologic evaluation (microscopy and culture sensitivity). MAIN OUTCOME MEASURES: The duration of symptoms, the presenting visual acuity, and influence of intravitreal dexamethasone with intravitreal antibiotics were examined for any statistical correlation with the final visual acuity. RESULTS: Trauma was the major cause of infection. Vitreous biopsy microscopy demonstrated gram-positive bacillus in 28 of 31 cases, and polymicrobial infection was seen in 12 instances. All Bacillus species were sensitive to gentamicin, followed by vancomycin and ciprofloxacin. Clinical treatment within 7 days of symptoms, use of intravitreal vancomycin, and absence of polymicrobial infection were associated with better visual outcome. CONCLUSIONS: With appropriate treatment that essentially consists of vitrectomy and intravitreal antibiotics, patients with Bacillus endophthalmitis are likely to benefit in many instances. Gram-positive bacilli detected on vitreous microscopy should be empirically treated as Bacillus species unless otherwise proved.

Adolescent↗
PubMed2001

Enucleation in a tertiary eye care centre in India: prevalence, current indications and clinicopathological correlation.

PURPOSE: Enucleation is a standard surgical treatment modality for many end-stage eye diseases. Indications for enucleation vary with changing trends in disease management. Few studies have addressed the issue of the frequency and indications of enucleation of eyes in India. We aimed to determine the frequency and the current clinical indications for enucleation in patients at a tertiary eye care centre in India, and attempted a clinicopathological correlation. METHODS: Medical records of patients undergoing enucleation at a tertiary eye care centre over a period of 3 1/2 years (January 1995 to July 1998) were reviewed to obtain patients' demographic data and socio-economic status. The clinical indications and predisposing factors were assessed. The formalin-fixed, paraffin-embedded sections of all enucleated eyes were re-evaluated and histopathological findings were correlated with the clinical diagnosis. The prevalence of enucleation was calculated, and age adjustments were done using the Indian population data from 1998 mid-year statistics. RESULTS: Enucleation of the eye was performed in 150 patients (151 eyes) out of 88,991 new ophthalmic cases, constituting 0.17% of the cases seen in the hospital, and amounting to a prevalence of 0.33% (95% CI, 0.27-0.40). Males outnumbered females in a ratio of 1.85:1 (98 males, 53 females). The median age was 8 years (mean 16.8 +/- 18.3 years). Children below 15 years of age constituted 85.2% (95% CI, 81.2-89.21%) of cases that underwent enucleation. Clinical indications for enucleation included tumours in 74 (49%); staphyloma in 38 (25%); acute injury in 20 (13%); absolute glaucoma in 9 (6%); painful blind eye in 5 (3%); phthisis bulbi in 1 (1%); and others in 4 (3%). Of the 74 cases with a clinical diagnosis of tumour, histopathology revealed retinoblastoma in 55 (74%) cases, melanoma in 6 (8%) and ocular surface tumours in 4 (6%). Clinico-pathological correlation was 100% in cases with a definite clinical diagnosis of retinoblastoma and melanoma. Nine blind eyes (6%) in which an intraocular tumour was one of the differential diagnoses, were negative for a tumour on histopathology. Staphyloma was more prevalent in the low socio-economic group (p = 0.0004), with a history of childhood trauma in 34% cases. CONCLUSIONS: The prevalence of enucleation in the population reporting to this tertiary eye care centre was 33 per 10,000 population over the study period of 3 1/2 years. Major indications for enucleation were tumours, staphyloma and trauma (88% of all cases). Increased frequency in the young was due to the high proportion of retinoblastoma and staphyloma. Childhood trauma, inflammation and malnutrition may together play a role in the pathogenesis of staphyloma. Awareness at the level of primary health care providers, paediatricians and general practitioners should be promoted to identify the disease process at an early stage and facilitate early intervention measures that could result in eye and vision salvage.

Adolescent↗
PubMed2000

Prolonged survival and tissue trafficking following adoptive transfer of CD4zeta gene-modified autologous CD4(+) and CD8(+) T cells in human immunodeficiency virus-infected subjects.

We have genetically engineered CD4(+) and CD8(+) T cells with human immunodeficiency virus (HIV) specificity by inserting a gene, CD4zeta, containing the extracellular domain of human CD4 (which binds HIV env) linked to the zeta (zeta) chain of the T-cell receptor (which mediates T-cell activation). Twenty-four HIV-positive subjects received a single infusion of 2 to 3 x 10(10) autologous CD4zeta-modified CD4(+) and CD8(+) T cells administered with (n = 11) or without (n = 13) interleukin-2 (IL-2). Subjects had CD4 counts greater than 50/microL and viral loads of at least 1000 copies/mL at entry. T cells were costimulated ex vivo through CD3 and CD28 and expanded for approximately 2 weeks. CD4zeta was detected in 1% to 3% of blood mononuclear cells at 8 weeks and 0.1% at 1 year after infusion, and survival was not enhanced by IL-2. Trafficking of gene-modified T cells to bulk rectal tissue and/or isolated lamina propria lymphocytes was documented in a subset of 5 of 5 patients at 14 days and 2 of 3 at 1 year. A greater than 0.5 log mean decrease in rectal tissue-associated HIV RNA was observed for at least 14 days, suggesting compartmental antiviral activity of CD4zeta T cells. CD4(+) counts increased by 73/microL at 8 weeks in the group receiving IL-2. There was no significant mean change in plasma HIV RNA or blood proviral DNA in either treatment arm. This sustained, high-level persistence of gene-modified T cells demonstrates the feasibility of ex vivo T-cell gene therapy in HIV-infected adults and suggests the importance of providing HIV-specific T-helper function.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Effect of buffering systems on post-thaw motion characteristics, plasma membrane integrity, and acrosome morphology of buffalo spermatozoa.

This study was carried out to identify the suitable buffer for cryopreservation of buffalo semen. Semen was collected with artificial vagina (42 degrees C) from four buffalo bulls. Split pooled ejaculates (n=5), possessing more than 60% visual sperm motility, were extended at 37 degrees C either in tri-sodium citrate (CITRATE), Tris-citric acid (TCA), Tris-Tes (TEST) or Tris-Hepes (HEPEST). Semen was cooled to 4 degrees C in 2 h, equilibrated at 4 degrees C for 4 h, filled in 0.5 ml straws and frozen in a programmable cell freezer before plunging into liquid nitrogen. Thawing of frozen semen was performed after 24 h at 37 degrees C for 15 s. Sperm motion characteristics, plasma membrane integrity, and acrosome morphology of each semen sample were assessed by using computer-assisted semen analyzer (CASA), hypo-osmotic swelling (HOS) assay, and phase-contrast microscope, respectively. Analysis of variance revealed that percent post-thaw visual motility tended (P=0.07) to be higher in HEPEST (61.0+/-2.9) and lowest in CITRATE (48.0+/-2.5). Computerized motility did not vary due to buffering system. Percent post-thaw linear motility tended (P=0.09) to be higher in TCA (78.2+/-5.5) and lower in TEST (52.0+/-6.9). Circular motility (%) was significantly lower (P<0.05) in TCA (11.6+/-2.8) and higher in TEST (29.8+/-5.6). Curvilinear velocity (microm s(-1)) was lower (P<0.05) in TCA (69.4+/-2.0) than in CITRATE (79.0+/-5.8), TEST (87. 2+/-1.6) and HEPEST (82.6+/-3.0). Lateral head displacement (microm) was lowest (P<0.05) in TCA (1.7+/-0.2) and highest in TEST (3.7+/-0. 6). Plasma membrane integrity and normal acrosomes of buffalo spermatozoa did not differ due to buffering system and averaged 40. 0+/-2.7% and 61.4+/-4.6%, respectively. Based upon lower circular motility, curvilinear velocity, and lateral head displacement, it is concluded that post-thaw quality of buffalo semen can be improved using the Tris-TCA buffering system.

Acrosome↗
PubMed2000

Effect of highly active antiretroviral therapy on the incidence of HIV-related cytomegalovirus retinitis and retinal detachment.

Cytomegalovirus retinitis (CMVR) is the most common intraocular infection encountered in ophthalmic practices. To assess the impact of highly active antiretroviral therapy (HAART) on the incidence of CMVR and subsequent retinal detachments, a retrospective review of the HIV+ patients seen at a single university and community-based practice between 1992-1993 (group 1), before the advent of protease inhibitors, was compared with the data obtained from October 1996 to October 1997 (group 2) and October 1997-1998 (group 3), after the widespread use of HAART. The incidence of CMVR and retinal detachment rates for each group was calculated and compared. Twenty five (2.6%) of 974 HIV+ patients in group 1 developed CMVR. Of these, four patients developed retinal detachment (16%). Group 2 had a total of 1084 HIV+ patients, 18 (1.7%) of whom developed CMVR, which indicates a 35% decline of the incidence of CMV retinitis at our institution (p = 0.052, Odds ratio = 0.533, Confidence interval 0.28-1.01) and three patients (20%) developed retinal detachment. Only 1 patient (0.07%) of 1274 patients in group 3 developed CMVR, which represents a 99% reduction since 1993 (p = 0.0000000456). We conclude that the incidence of CMVR at this institution has decreased significantly with the recent use of HAART therapy. This effect may be related to the aggressive use of HAART and associated immune recovery in this population of AIDS patients. In this small series, however, the rate of retinal detachment appeared unchanged, but was only observed in those individuals who were not on HAART or who had just recently started.

AIDS-Related Opportunistic Infections↗
PubMed2000

Self-reported sleep quality and quality of life for individuals with chronic pain conditions.

OBJECTIVE: To determine the sleep quality and quality of life for individuals with degenerative spinal disease or failed back surgery syndrome. DESIGN: Cross-sectional survey design utilizing standardized instruments. Data were analyzed with use of hierarchical stepwise multiple regression analyses. PATIENTS: One hundred sixty-seven individuals with degenerative spinal disease or postlaminectomy syndrome who presented to a tertiary care outpatient patient pain center. OUTCOME MEASURES: The Center for Epidemiological Studies Depression Index measured depressive symptomatology. A modified Pittsburgh Sleep Quality Index (PSQI) measured sleep quality. The arithmetic average of least and usual VAS ratings of pain measured everyday pain. A visual analog scale rating of highest pain during the past 2 weeks measured highest pain. The Epworth Sleepiness Scale measured daytime sleepiness. The Medical Outcome Study-Short Form-Health Survey (SF-36) measured the mental health and general health components of quality of life. RESULTS: Higher overall sleep quality and lower sleep latency primarily were related to higher ratings of physical functioning and shorter duration of pain. Ratings of the highest pain, but not everyday pain, were independent predictors of overall sleep quality and sleep latency. Daytime sleepiness was associated with younger age and depressed mood. Pain was not associated independently with daytime sleepiness. The quality of life related to mental functioning was associated positively with depressed mood and with the interaction of pain and depressed mood. None of the variables in the model (i.e., pain intensity, sleep quality, depression, and demographic variables) predicted quality of life related to overall general health. CONCLUSIONS: These data suggest that physical functioning, duration of pain, and age may be more important than pain intensity and depressed mood in contributing to decreased overall sleep quality and sleep latency. The contribution of physical functioning was particularly strong and should be included in subsequent studies of sleep, pain, and mood. The SF-36 should be compared to pain-specific quality-of-life measures to further evaluate the usefulness of this instrument with outpatients with chronic nonmalignant pain conditions.

Adult↗
PubMed2000

Management of diabetic retinopathy.

Diabetic retinopathy remains a major cause of blindness despite increased understanding of this disease and identification of successful treatments. The Diabetic Retinopathy Study identified risk factors associated with a high risk of blindness and confirmed the benefits of panretinal photocoagulation. The Early Treatment Diabetic Retinopathy Study defined the retinal characteristics, indications of treatment and results of laser treatment of clinically significant macular oedema. The Diabetic Retinopathy Vitrectomy study established the benefits and timing of vitrectomy for non-clearing vitreous haemorrhage and severe proliferative diabetic retinopathy. The Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study have also demonstrated the value of tight control of blood sugar and blood pressure in diabetic retinopathy. These studies developed specific recommendations for the management of diabetic retinopathy. Optimum use of this information can minimize visual loss due to diabetic retinopathy.

Diabetic Retinopathy↗
PubMed1999

The transplantation of human fetal neuroretinal cells in advanced retinitis pigmentosa patients: results of a long-term safety study.

The purpose of this study was to determine the long-term safety of transplanting human fetal neuroretinal cells (14 to 18 week gestational age) into a series of patients with advanced retinitis pigmentosa (RP). After obtaining informed consent, both hosts and mothers of donors were screened for transmissible diseases. Pre- and postoperative clinical exams, visual acuity, electroretinograms, and fluorescein angiograms were performed and visual field testing was attempted in each case. Surgically, an anterior approach through pars plana ciliaris was used. A retinotomy was performed in the paramacular area and a two-function cannula was introduced into the subretinal space to deliver a suspension of donor cells. The cell suspension carried approximately 4000 cells/microl; the volume injected did not exceed 150 microl. The patients were examined for periods ranging from 12 to 40 months posttransplantation. To date, no evidence of inflammation, infection, or overt rejection of the graft was noted in the host eye, neither was any change observed in the contralateral, unoperated eye. In conclusion, neuroretinal cells were injected into the subretinal space of 14 patients with advanced RP with no clinical appearance of detrimental effects at the time of surgery or up to 40 months postinjection except in 1 patient who developed retinal detachment. This sets the stage for a phase II clinical trial to determine the possible beneficial effects of this procedure in patients blinded by degenerative retinal disease.

Adult↗
PubMed1999

Microbiologic spectrum and susceptibility of isolates: part I. Postoperative endophthalmitis. Endophthalmitis Research Group.

PURPOSE: To present the microbial spectrum and susceptibilities of isolates in postoperative endophthalmitis. METHOD: Isolates from 206 eyes of 206 patients who underwent vitrectomy for postoperative endophthalmitis were examined. RESULTS: One-hundred twelve (54.4%) of 206 vitreous samples were culture positive and 14 (12.5%) of 112 culture-positive cases were polymicrobial, yielding a total of 126 isolates. Isolates included 59 (46.8%) gram-positive cocci, eight (6.3%) gram-positive bacilli, 33 (26.2%) gram-negative organisms, five (4.0%) Actino-mycetes-related organisms, and 21 (16.7%) fungi. Susceptibilities to amikacin, ceftazidime, chloramphenicol, cefazolin, ciprofloxacin, gentamicin, and vancomycin are reported. CONCLUSIONS: This is the largest, single-center, prospective series on microbial susceptibilities in postoperative endophthalmitis. We report a high prevalence of gram-negative species and fungi, suggesting that empiric therapy should include coverage for gram-negative pathogens and for fungal pathogens in appropriate settings.

Anti-Bacterial Agents↗
PubMed1999

Microbiologic spectrum and susceptibility of isolates: part II. Posttraumatic endophthalmitis. Endophthalmitis Research Group.

PURPOSE: To present the microbial spectrum and susceptibilities of isolates in posttraumatic endophthalmitis. METHOD: Isolates from 182 eyes of 182 patients who underwent vitrectomy for posttraumatic endophthalmitis were examined. RESULTS: One hundred thirteen (62.1%) of 182 vitreous samples were culture-positive, and 23 (20.4%) of 113 culture-positive cases were polymicrobial, including three (2.7%) trimicrobial cases, yielding a total of 139 isolates. Isolates included 63 (45.3%) gram-positive cocci, 24 (17.3%) gram-positive bacilli, 25 (18.0%) gram-negative organisms, seven (5.0%) Actinomycetes-related organisms, and 20 (14.4%) fungi. Susceptibilities to amikacin, ceftazidime, chloramphenicol, cefazolin, ciprofloxacin, gentamicin, and vancomycin are reported. CONCLUSIONS: This study represents a large series on microbial spectrum and susceptibilities in posttraumatic endophthalmitis. We report a high prevalence of gram-positive bacilli species and polymicrobial infections containing gram-negative species, underscoring the importance of broad-spectrum, combination antibiotics in the empiric treatment of posttraumatic endophthalmitis.

Anti-Bacterial Agents↗
PubMed1999

Role of intravitreal dexamethasone in exogenous fungal endophthalmitis.

PURPOSE: To determine the effects of intravitreal dexamethasone in patients with exogenous fungal endophthalmitis. METHODS: Twenty cases of culture-proven exogenous fungal endophthalmitis following cataract surgery (11/20) and trauma (9/20) were retrospectively analysed for pre- and postoperative visual acuity, anterior chamber and vitreous inflammation and media clarity. All patients were managed with pars plana vitrectomy with intravitreal amphotericin B and oral ketoconazole with (steroid plus group) or without (steroid minus group) intravitreal dexamethasone. Results were analysed by Fisher's exact test. RESULTS: Following vitrectomy 9 of 20 patients (45%) achieved a visual acuity better than counting fingers at 3 m. No statistically significant difference was observed in anatomical and visual outcome between the steroid plus and steroid minus groups, though the number of patients with favourable visual outcome was greater in the steroid plus group. Rate of clearance of inflammation was better in the steroid plus group (40 +/- 15.5 vs 55 +/- 8.6 days). All patients (6/20) with pre-operative vision better than counting fingers showed good anatomical and visual outcome in both groups. CONCLUSIONS: The results of our retrospective study suggest that steroids may be beneficial in promoting faster clearance of inflammation in fungal endophthalmitis. Sensitivity of the fungi to antifungals, dose and timing of steroid and institution of effective antifungal medication prior to the use of steroids are the essential factors which need to be examined further in a prospective manner.

Administration, Topical↗
PubMed1999

Demography and prognostic factors of ocular injuries in South India.

PURPOSE: To evaluate the extent of visual recovery after multi-disciplinary approach of treatment in serious ocular injuries; to determine the prognostic factors associated with poor final visual outcome and suggest adequate precautionary measures. METHODS: A retrospective analysis of 325 consecutive patients with direct ocular trauma who were examined and treated at a tertiary eye care centre in South India over a 3-year period was undertaken. RESULTS: Males (86.8%) outnumbered the females (13.2%) and children (< 16 years) constituted 46.8% of the total affected population. Anterior segment was involved in 51.1%, the posterior segment in 8.9% and both anterior and posterior segments were involved in 31.4% of patients. Prompt and meticulous surgical treatment restored useful vision (better than or equal to 6/18) in 60.5% of patients. Post-treatment, a reduction in blindness and visual impairment rates in the affected eye with respect to WHO classification was 66.7 and 54.1% respectively (P < 0.0001). Two eyes needed prompt enucleation. The factors associated with visual impairment (visual acuity less than 6/18) were poor initial visual acuity, full chamber hyphema, endophthalmitis, retinal detachment, and vitreous haemorrhage. CONCLUSIONS: Direct ocular trauma remains an important potentially preventable cause of ocular morbidity, but the advent of modern surgical techniques can often restore useful vision in such situations. Mandatory use of protective eye wear at work, public health education including awareness on the part of parents to the potential dangers of some childrens' toys can to an extent help reduce ocular morbidity due to direct ocular trauma.

Accidents, Home↗
PubMed1999

Intravitreal dexamethasone in exogenous bacterial endophthalmitis: results of a prospective randomised study.

AIM: To evaluate the efficacy of intravitreal dexamethasone co-administered with intravitreal antibiotics along with vitrectomy in the management of exogenous bacterial endophthalmitis. METHODS: In a prospective randomised clinical trial, 63 patients (63 eyes) with suspected bacterial endophthalmitis (postoperative and post-traumatic) were treated with vitrectomy and intravitreal antibiotics and randomised to intravitreal dexamethasone (IOAB with = 29 eyes) and no dexamethasone (IOAB without = 34 eyes). Inflammation score (IS) and visual acuity were measured by two masked observers before surgery, and at 1, 4, and 12 weeks after surgery in both the groups. RESULTS: There was significant reduction (p <0.0001) in IS at 1, 4, and 12 weeks after the surgery in the "IOAB with" group; there was temporary but significant increase (p <0.01) in IS at 1 week in the "IOAB without" group, before decline (p <0.001) of IS at 4 and 12 weeks. The magnitude and relative percentage change in IS between the two groups were found to be significant at 1 (p <0.0001), and 4 (p <0.01) weeks, and not at 12 weeks. The visual acuity at 12 weeks was comparable in both the IOAB with and IOAB without groups. CONCLUSION: Intravitreal dexamethasone helps in early reduction of inflammation in exogenous bacterial endophthalmitis, but has no independent influence on the visual outcome. In selected patients with endophthalmitis where oral corticosteroids cannot be given for medical reasons intravitreal corticosteroids could be beneficial; in other situations they could be complementary to oral corticosteroid therapy.

Administration, Topical↗