Search PubMed⌕ Search

Biomedical subjects

S Jalali

Publications and source records attributed to S Jalali.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1999

Hypodermic needles: a new source of penetrating ocular trauma in Indian children.

PURPOSE: To study the clinico-microbiologic profile and visual prognosis of ocular injuries caused by disposable hypodermic needles used by children to squirt water. METHODS: We analyzed 19 consecutive cases of hypodermic needle injury seen at our institute. RESULTS: The average age of the patients was 10.3 years (range, 4-20 years). A small self-sealed corneal or scleral laceration was seen in 11 eyes; in 8 eyes, the site of injury was occult. Initial visual acuity was no light perception (3 eyes) or hand motion or light perception (16 eyes). Surgery in 18/19 eyes included vitrectomy with intraocular antibiotic injections for endophthalmitis (14 eyes), evisceration for panophthalmitis (2 eyes), and cataract extraction for traumatic cataract (2 eyes). Final visual acuity was no light perception or light perception only in 10 eyes, 20/400-20/60 in three eyes, and 20/40 or better in six eyes. CONCLUSIONS: Severe ocular morbidity may result from improper disposal of hypodermic needles.

Adolescent↗
PubMed1998

Diagnosis of Fusarium keratitis in an animal model using the polymerase chain reaction.

AIMS/BACKGROUND: The purpose of this study was apply the polymerase chain reaction (PCR) to develop a sensitive, specific, and rapid test to diagnose Fusarium keratitis. Fusarium is the most common cause of fungal corneal infection in some parts of the world. It is often difficult to establish that a keratitis is due to fungal infection. METHODS: Fusarium solani keratitis was induced in three eyes of three rabbits by injection of a suspension of the fungus into the anterior corneal stroma. In one rabbit the contralateral eye served as a control. From four to 28 days after inoculation, the corneas were scraped for culture, then scraped and swabbed for PCR analysis. The PCR was performed with primers directed against a portion of the Fusarium cutinase gene, and the presence or absence of this amplified target sequence was determined by agarose gel. RESULTS: The amplified DNA sequence was detected in 25 of 28 samples from the corneas infected with Fusarium, for a sensitivity of 89%. Only three of the 14 samples from these eyes with Fusarium keratitis were positive by culture, for a sensitivity of 21%. Seven of eight control samples were negative by the PCR based test, for a specificity of 88%. CONCLUSION: This PCR based test holds promise of being an effective method of diagnosing Fusarium keratitis as well as Fusarium infections at other sites.

Animals↗
PubMed1998

Shear stress activates p60src-Ras-MAPK signaling pathways in vascular endothelial cells.

The aim of this study was to elucidate the upstream signaling mechanism that mediates the fluid shear stress activation of mitogen-activated protein kinases (MAPKs), including c-Jun NH2-terminal kinase (JNK) and extracellular signal-regulated kinases (ERKs), in vascular endothelial cells (ECs). Our results indicate that p60src is rapidly activated by fluid shear stress in bovine aortic endothelial cells (BAECs). Shear stress induction of the hemagglutinin (HA) epitope-tagged HA-JNK1 and the Myc epitope-tagged Myc-ERK2 was significantly attenuated by v-src(K295R) and c-src(K295R), the kinase-defective mutants ofv-src and c-src, respectively. HA-JNK1 and Myc-ERK2 were activated by c-src(F527), a constitutively activated form of p60src, and the activation was abolished by RasN17, a dominant-negative mutant of p2lras. In contrast, although HA-JNK1 and Myc-ERK2 were also activated by RasL61, an activated form of p21ras, the activation was not affected by v-src(K295R). These results indicate that p60src is upstream to the Ras-JNK and Ras-ERK pathways in response to shear stress. The shear stress inductions of the promoters of monocyte chemotactic protein-1 (MCP-1) and c-fos, driven by TPA-responsive element (TRE) and serum-responsive element (SRE), respectively, were attenuated by v-src(K295R). This attenuation is associated with decreased transcriptional activities of c-Jun and Elk-1, the transcription factors targeting TRE and SRE, respectively. Thus, p60src plays a critical role in the shear stress activation of MAPK pathways and induction of Activating Protein-1 (AP- 1)/TRE and Elk-1/SRE-mediated transcription in ECs.

Animals↗
PubMed1998

Choroidal neovascular membrane.

Choroidal neovascular membrane in the macular area is one of the leading causes of severe visual loss. Usually a manifestation in elderly population, it is often associated with age-related macular degeneration. The current mainstay of management is early diagnosis, usually by fundus examination, aided by angiography and photocoagulation in selected cases. Various other modalities of treatment including surgery are being considered as alternate options, but with limited success. The purpose of this review is to briefly outline the current concepts and the management strategy from a clinician's viewpoint.

Aged↗
PubMed1997

Fluid shear stress activation of focal adhesion kinase. Linking to mitogen-activated protein kinases.

Shear stress, the tangential component of hemodynamic forces, activates the extracellular signal-regulated kinase (ERK) and c-Jun NH2-terminal kinase (JNK) signal transduction pathways in cultured vascular endothelial cells to induce the transcriptional activation of many immediate early genes. It appears that integrins, protein-tyrosine kinases, and the structural integrity of actin are important factors involved in these shear stress-induced responses. The underlying molecular events were investigated by the application of a shear stress of 12 dyn/cm2 on bovine aortic endothelial cells (BAEC). We found that such a shear stress increased the tyrosine phosphorylation and the kinase activity of focal adhesion kinase (FAK) and its association with growth factor receptor binding protein 2 (Grb2) in a rapid and transient manner, suggesting that FAK may be linked to these mitogen-activated protein kinase signaling pathways through a Grb2. Son of sevenless (Sos) complex. FAK(F397Y), which encodes a dominant negative mutant of FAK, attenuated the shear stress-induced kinase activity of Myc epitope-tagged ERK2 and hemagglutinin epitope-tagged JNK1. DeltamSos1, encoding a dominant negative mutant of Sos in which the guanine nucleotide exchange domain has been deleted, also attenuated shear stress activation of Myc-ERK2 and hemagglutinin-JNK1. Pretreating the confluent BAEC monolayers with a blocking type anti-vitronectin receptor monoclonal antibody had similar inhibitory effects in these shear stress-activated ERKs and JNKs. Confocal microscopic observation further demonstrated that FAK tended to cluster with vitronectin receptor near the abluminal side of the sheared BAEC. These results demonstrate that FAK signaling is critical in the shear stress-induced dual activation of ERK and JNK.

Actins↗
PubMed1996

Presumed noninfectious endophthalmitis after cataract surgery.

PURPOSE: To study the clinical features and results of conservative management in cases of presumed noninfectious endophthalmitis after cataract surgery. SETTING: L.V. Prasad Eye Institute, Hyderabad, India. METHODS: This retrospective study evaluated cases of presumed noninfectious endophthalmitis occurring after cataract surgery in a hospital-based population. Patients with minimal hypopyon and decreased visual acuity unassociated with pain, lid edema, conjunctival chemosis, corneal abscess, and obvious vitreous involvement were treated conservatively. The mainstays of treatment were topical and systemic steroids. Four eyes with clinical evidence of worsening required surgical intervention. Main outcome measures were resolution of inflammation and final visual acuity. RESULTS: In 23 of 27 patients, the inflammation resolved with medical therapy alone; 21 had a final visual acuity of 20/50 or better. In 3 of the 4 eyes that had surgery, the culture was positive for low virulent organisms; all had a satisfactory outcome. One eye with preoperative glaucoma developed absolute glaucoma with resolution of inflammation. CONCLUSION: Noninfectious endophthalmitis invariably presents with hypopyon and decreased vision unassociated with pain and lid edema. A trial of medical therapy with corticosteroids as the mainstay of treatment is often rewarding. Frequent monitoring and preparation for surgical intervention if required are key.

Adolescent↗
PubMed1996

Sensitivity and predictability of vitreous cytology, biopsy, and membrane filter culture in endophthalmitis.

PURPOSE: Forty-seven consecutive patients with endophthalmitis were prospectively studied to: 1) compare the undiluted vitreous biopsy culture and membrane filter culture of vitrectomy cassette fluid; 2) determine the sensitivity and specificity of initial smear examinations in relation to final culture; and 3) characterize vitreous cytology in culture positive and negative endophthalmitis. METHODS: Examinations included smears (Gram stains, Diff Quik [Bacto Laboratories Pvt. Ltd., Liverpool, Australia] and unstained) and aerobic/anaerobic culture of undiluted vitreous biopsy specimens and diluted vitreous collected in the cassette. The cassette fluid was passed through 5-microns polycarbonate filter for cytology and a 0.22-microns polyvinylidene difluoride millipore filter for culture. RESULTS: By either method culture results were positive in 27 (57.4%) patients. Culture positive of the vitreous biopsy alone was 44.6% and cassette fluid alone was 49% (P > 0.05). In the initial smear examination the sensitivity and specificity of the Gram stain were 66.6% and 84.2%, respectively. comparatively, Diff Quik provided lower sensitivity and specificity at 40.7% and 80.9% respectively. Examination of wet film of vitreous samples did not provide any useful information. Although polymorphs were seen in large numbers in all cultures that yielded positive results on examination, they also were seen in 80% of the sterile samples. There was no significant difference in the quantity of macrophages observed in infected and noninfected samples. CONCLUSIONS: Initial smear examination and cytology have limited roles in the diagnosis of infectious endophthalmitis. Obtaining cultures of both an undiluted vitreous biopsy sample and the vitrectomy cassette fluid has a significant advantage compared with culture of only one sample.

Adolescent↗
PubMed1996

Pneumatic retinopexy: principles and practice.

Pneumatic retinopexy (PR) is an alternative to scleral buckling for the surgical repair of selected retinal detachments. A gas bubble is injected into the vitreous cavity, and the patient is positioned so that the bubble closes the retinal break (s), allowing absorption of the subretinal fluid. Cryotherapy or laser photocoagulation is applied around the retinal break(s) to form a permanent seal. The procedure can be done in an outpatient setting, and no incisions are required. A multicenter randomized controlled clinical trial has demonstrated that the anatomic success rate is comparable to scleral buckling, but the morbidity is significantly less with PR. If the macula was detached for less than two weeks, the visual results are significantly better with PR than with scleral buckling. Cataract surgery was required significantly more often following scleral buckling than following PR. Two independent reports have shown that an attempt with PR does not disadvantage the eye; such that the results of scleral buckling after failed PR are not significantly different than primary scleral buckling. A comprehensive review of the world literature on PR revealed 27 statistical series totaling 1,274 eyes. These combined series had a single-operation success rate of 80%, and 98% were cured with reoperations. Pneumatic retinopexy should be considered in cases without inferior or extensive retinal breaks and without significant proliferative vitreoretinopathy. The cost of buckling varies from 4 to 10 times that of PR.

Air↗
PubMed1995

Postsurgical endophthalmitis: diagnosis and management.

Infectious endophthalmitis following intraocular surgery is a complication that could cause severe visual loss or loss of the eye. The categorisation of the event that led to intraocular infection will help the clinician to predict the infectious agent and begin appropriate therapy. Most of the cases of postsurgical endophthalmitis are seen following cataract surgery. It is important for all ophthalmologists, irrespective of specialisation and areas of interest, to be familiar with the management of endophthalmitis. This review briefly describes the facets of clinical and laboratory diagnosis, pathology, and management. While the different viewpoints in the management of endophthalmitis are mentioned in appropriate places, more attention is paid to present a rational approach to the management of endophthalmitis.

Anti-Bacterial Agents↗
PubMed1994

Penetrating keratoplasty in xeroderma pigmentosum. Case reports and review of the literature.

Xeroderma pigmentosum is an uncommon inherited disorder characterized by hypersensitivity to ultraviolet radiation, with defective repair of DNA damage caused by short-wavelength radiation. Corneal complications of this disorder may require penetrating keratoplasty for visual rehabilitation. Surgery is rarely undertaken in these eyes due to multiple associated problems involving the ocular surface and the lids. We report three cases of successful penetrating keratoplasty in xeroderma pigmentosum and review nine cases reported earlier. Successful grafts were achieved in all 12 eyes initially. Persistent superficial punctate keratopathy was observed in one eye and graft rejection episodes in five eyes. However, graft failure occurred due to an untreated rejection episode in only one eye. Another eye was treated by exenteration for recurrent ocular malignancies. This report highlights the encouraging results of penetrating keratoplasty in carefully selected patients of xeroderma pigmentosum with corneal pathology.

Adult↗
PubMed1994

Selection of surgical technique for retinal detachment with coloboma of the choroid.

Four eyes with rhegmatogenous retinal detachment and coloboma of the choroid were managed by conventional scleral buckling (one eye); scleral buckling combined with lensectomy, vitrectomy, and fluid-air exchange (two eyes); and vitrectomy, silicone oil injection without scleral buckling (one eye). Retinal break was seen within the coloboma in two eyes, at the periphery in one eye, and, both in the coloboma and periphery in one eye. At a follow-up of 15 months, the retina was found attached in all the patients. The success of these surgical procedures could be attributed to careful preoperative/intraoperative fundus examination and individualised surgical planning.

Adult↗
PubMed1994

Laser-aided external drainage of subretinal fluid: prospective randomized comparison with needle drainage.

In a prospective randomized study of 50 consecutive eyes, we compared the safety and efficacy of draining subretinal fluid transchoroidally in primary scleral buckling for rhegmatogenous retinal detachment using a needle, with the safety and efficacy of the same procedure using an angulated endolaser probe set at 1 W for 0.2 seconds, using an average of 2.4 laser burns. There were no significant complications associated with the laser-aided drainage procedures (25 eyes). In the transchoroidal needle drainage procedures (25 eyes), subretinal hemorrhage occurred in three eyes and retinal incarceration in one. Thus, though our numbers are small, there appears to be some advantage of laser-assisted drainage in terms of a lower incidence of complications.

Adult↗