Best age for surgery for infantile esotropia

Infantile esotropia (IE) is defined as an esotropia before the age of 6 months, with a large angle, latent nystagmus, dissociated vertical deviation, limitation of abduction, and reduced binocular vision, without neurological disorder. Prematurity, low birth weight, and low Apgar scores are significant risk factors for IE. US standard age of first surgery is 12–18 months, in Europe 2–3 years. The only study to date with prospectively assigned early- and late-surgery groups and evaluation according to intention-to-treat, was the European Early vs. Late Infantile Strabismus Surgery Study (ELISSS). In that study 13.5% of children operated around 20 months vs. 3.9% (P = 0.001) of those operated around 49 months had gross stereopsis (Titmus Housefly) at age 6. The reoperation rate was 28.7% in children operated early vs. 24.6% in those operated late. Unexpectedly, 8% in the early group vs. 20% in the late group had not been operated at age 6, although all had been eligible for surgery at baseline at 11 SD 3.7 months. In most of these children the angle of strabismus decreased spontaneously. In a meta-regression analysis of the ELISSS and 12 other studies we found that reoperation rates were 60–80% for children first operated around age 1 and 25% for children operated around age 4. Based on these findings, the endpoints to consider when contemplating best age for surgery in an individual child with IE should be: (1) degree of binocular vision restored or retained, (2) postoperative angle and long-term stability of the angle and (3) number of operations needed or chance of spontaneous regression. IE is characterized by lack of binocular connections in the visual cortex that cannot develop, e.g. because the eyes squint, or do not develop, e.g. after perinatal hypoxia. As the cause of IE, whether motor or sensory, is a determinant of surgical outcome, a subdivision of IE according to cause is needed. As similarities exist between IE and cerebral palsy we propose to adapt the working definition formulated by the Surveillance of Cerebral Palsy in Europe and define IE as “a group of permanent, but not unchanging, disorders with strabismus and disability of fusional vergence and binocular vision, due to a nonprogressive interference, lesion, or maldevelopment of the immature brain, the orbit, the eyes, or its muscles, that can be differentiated according to location, extent, and timing of the period of development.”

source: European journal of pediatric neurology

Vitamin D Levels Associated With Age-Related Macular Degeneration

Women under the age of 75 with high vitamin D status were less likely to have early age-related macular degeneration (AMD), the leading cause of irreversible vision loss in adults, a University at Buffalo study has shown. The disease affects approximately 9 percent of Americans aged 40 and older.

The paper is published in the April issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

Vitamin D status was assessed using the blood measure of 25-hydroxyvitamin D or 25 (OH) D. The 25 (OH) D level is generally considered the means by which nutritional vitamin D status is defined.

“In women younger than 75, those who had 25-hydroxyvitamin D concentrations lower than 38 nanomoles per liter were more likely to have age-related macular degeneration than women with concentrations greater than 38 nanomoles per liter,” says Amy E. Millen, Ph.D., assistant professor in the UB School of Public Health and Health Professions and lead author. “Blood concentrations above 38 nanomoles per liter were associated with at least a 44 percent decreased odds of having AMD.”

She notes that the Institute of Medicine considers an adult with a blood 25 hydroxyvitamin D concentration of lower than 30 nanomoles per liter to be at increased risk of vitamin D deficiency and a person with a concentration of less than 50 nanomoles per liter to be at increased risk for vitamin D inadequacy.

Millen’s “Carotenoids in Age-Related Eye Disease Study (CAREDS)” involved data from 1,313 women. The purpose of the study was to investigate if serum 25 hydroxyvitamin D levels in the blood, the preferred biomarker for vitamin D, were associated with early age-related macular degeneration. CAREDS is an ancillary study within the Women’s Health Initiative (WHI) Observational Study, which was conducted at WHI clinic centers in Oregon, Iowa and Wisconsin. UB is a major participating center in the WHI.

“The take- home message from this study is that having very low vitamin D status (25-hydroxyvitamin D blood concentrations lower than 38 nanomoles per liter) may be associated with increasing your odds of developing age-related macular degeneration,” says Millen. “But based on these study findings, being at a higher vitamin D level than 38 nanomoles per liter does not appear to be more protective,” she cautions.

Vitamin D status may be increased by spending moderate amounts of time outside, and eating foods rich in vitamin D, such as fatty fish from cold waters, and foods fortified with vitamin D, such as milk and fortified cereal, or by taking supplements.

“This is a promising study, but more still needs to be done,” says Millen. “We still don’t understand all of the effects of Vitamin D on health.”

source: macular degeneration research

Aspirin Linked to Lower Pancreatic Cancer Risk

Study Shows Association Between Regular Aspirin Use and Reduced Risk of Pancreatic Cancer
close up of generic aspirin bottle

Preventing pancreatic cancer may be an additional health benefit of using aspirin to treat everyday aches and pains or prevent heart disease.

A new study shows people who took aspirin at least once a month were 29% less likely to develop pancreatic cancer than those who used other types of pain relievers or nothing at all.

Researchers also found people who regularly take low-dose aspirin to reduce their risk of heart disease had a 35% lower risk of pancreatic cancer.

But researchers are quick to point out that aspirin may not be for everyone, and these results need to be confirmed by further studies. The study shows an association but is not designed to show cause and effect.

“The results are not meant to suggest everyone should start taking aspirin once monthly to reduce their risk of pancreatic cancer,” says researcher Xiang-Lin Tan, of the Mayo Clinic College of Medicine in Rochester, Minn., in a news release. “Individuals should discuss use of aspirin with their physicians because the drug carries some side effects.”

Comparing Pain Relievers

The study, presented this week at the American Association for Cancer Research 102nd Annual Conference in Orlando, Fla., examined the relationship between the use of three common types of pain relievers (aspirin, NSAIDs, and acetaminophen) and pancreatic cancer.

Researchers compared pain reliever use in 904 people who had been diagnosed with pancreatic cancer and 1,223 similarly matched healthy adults 55 years or older. The study showed that those who regularly used aspirin were less likely to develop pancreatic cancer.

After adjusting for other factors known to affect pancreatic cancer risk, such as body mass index (BMI) and smoking status, the study showed people who used aspirin at least at least one day during a month had a 29% lower risk of cancer compared with those who did not take aspirin regularly.

Researchers found no association between NSAID or acetaminophen use and pancreatic cancer risk.

source: webMD

Strawberries May Help Prevent Esophageal Cancer

Small Study Shows Slowing of Precancerous Lesions for People Who Ate Freeze-Dried Strawberries
freeze dried strawberries

Eating freeze-dried strawberries may help prevent esophageal cancer, according to new but preliminary research.

”Eating strawberries may be a way for people at high risk for esophageal cancer to protect themselves from the disease,” says researcher Tong Chen, MD, PhD, assistant professor of medicine at The Ohio State University Comprehensive Cancer Center, Columbus.

She presented the results of her small study at the American Association for Cancer Research meeting in Orlando, Fla. The study was funded by the California Strawberry Commission.

After an animal study showed strawberries might have some cancer-fighting benefits for esophageal cancer, Chen decided to study their effect in people.

She evaluated the use of freeze-dried strawberries in 36 men and women who had precancerous lesions of the esophagus.

Their average age was about 54. All were at high risk for cancer of the esophagus, the tube that connects the throat to the stomach. It allows food to enter the stomach for digestion.

In 2010, 16,640 new cases of esophageal cancer were diagnosed in the U.S. and 14,500 people died of it, according to the American Cancer Society. Risk factors for esophageal cancer include tobacco use and the combination of smoking and drinking alcohol heavily. A diet low in fruits and vegetables may also increase risk.

Slowing Down Precancerous Lesions

Chen instructed the men and women in the study to eat about 2 ounces of freeze-dried strawberries a day. The freeze-dried form was used to boost the potential cancer-fighting ingredients, she says.

“By removing the water from the strawberries we concentrated the components by tenfold,” Chen says.

Participants kept records daily of their strawberry intake. They were not instructed to change anything else in their diet or lifestyle. Most participants smoked, Chen says.

All had a biopsy of the esophagus before and after the study. At the study start, 31 had the precancerous condition known as mild dysplasia and five had moderate dysplasia.

Doctors can predict the chances that precancerous lesions will develop into cancer, Chen says. “If they have mild dysplasia, about 25% will develop cancer in about 15 to 20 years. If they have moderate, 50% will develop cancer over the next 15 or 20 years.”

The strawberries appeared to slow progression of the lesions in most. “Twenty nine of the 36 experienced a decreased level of precancerous lesions,” Chen tells WebMD.

Overall, six had no change and one had an increase in lesion development.

A cancer-causing agent known as N-NMBA (nitrosomethylbenzylamine) is linked with esophageal cancer, Chen says.

It’s found in some pickled vegetables, fried bacon, and other foods, she says. Tobacco smoke also contains nitrosamine cancer-causing agents.

”We think the strawberries can inhibit the activation of the NMBA,” she says.

Among the substances in the strawberries that may help, she says, are vitamins, folic acid, and minerals.

The new research is interesting but preliminary, according to Stephen Shibata, MD, clinical professor of medical oncology at the City of Hope Comprehensive Cancer Center in Duarte, Calif. He reviewed the study findings for WebMD.

Many questions remain to be answered, he tells WebMD. “The basic idea [for future study] would be to make sure this isn’t chance — to observe a number of patients who did not get strawberries but got medical advice.”

It’s possible, he says, that the patients in the study made other lifestyle changes once they joined the study.

Other questions to be answered, he says, are figuring out the best dose of strawberries and for how long they should be eaten.

“I would not recommend people go out and eat a lot of strawberries based on this,” he says.

More research is needed, including studies that compare eating strawberries with not eating strawberries, says Marji McCullough, RD, ScD, an epidemiologist with the American Cancer Society. Meanwhile, including plenty of fruits and vegetables in your diet is a good idea, she says.

“Studies show that eating a wide variety of non-starchy fruits and vegetables, and avoiding tobacco, alcohol, and obesity, are important ways to reduce the risk of esophageal cancer,” McCullough says.

source: webMD

Vitamin E, Metformin Do Not Improve Liver Enzymes in Pediatric Nonalcoholic Fatty Liver Disease

Neither vitamin E nor metformin reduces liver enzyme levels in children with nonalcoholic fatty liver disease (NAFLD), according to a JAMA study.

Some 170 children (aged 8 to 17 years) with NAFLD were randomized to receive vitamin E (800 IU/day), metformin (1000 mg/day), or placebo for 96 weeks. At the end of the study, the primary outcome — a sustained decrease in serum alanine aminotransferase level — did not differ significantly between the treatment and placebo groups. Resolution of steatohepatitis (a secondary outcome) did, however, favor vitamin E over placebo.

Noting the negative primary outcome, the authors stress the importance of lifestyle changes for children with NAFLD. They add that “the role of treatment with vitamin E in those who have a biopsy demonstrating borderline or definite [steatohepatitis] remains to be determined.”


Omega-3s Associated with Some Prostate Cancers

Patients may ask about a study that unexpectedly links anti-inflammatory omega-3 fatty acids with high-grade prostate cancer. Proinflammatory trans-fatty acids showed — also unexpectedly — a protective effect. The results appear in the American Journal of Epidemiology.

In a nested, case-control study within the Prostate Cancer Prevention Trial, researchers examined the proportions of serum fatty acids in 1800 men with invasive prostate cancer and 1800 matched controls. At the outset of the 7-year study, all participants had been cancer-free.

For the omega-3 fatty acid docosahexaenoic acid, each quartile of serum concentration above the lowest quartile “was associated with an approximate doubling of high-grade disease.” For the 18:1 and 18:2 trans-fatty acids, a protective effect was found.

Calling their findings “disconcerting,” the authors say that much more study will be needed before changing dietary recommendations.

Source:American Journal of Epidemiology article

Reform the PhD system or close it down

Reform the PhD system or close it down

There are too many doctoral programmes, producing too many PhDs for the job market. Shut some and change the rest, says Mark C. Taylor.

Mark Taylor

The system of PhD education in the United States and many other countries is broken and unsustainable, and needs to be reconceived. In many fields, it creates only a cruel fantasy of future employment that promotes the self-interest of faculty members at the expense of students. The reality is that there are very few jobs for people who might have spent up to 12 years on their degrees.

Most doctoral-education programmes conform to a model defined in European universities during the Middle Ages, in which education is a process of cloning that trains students to do what their mentors do. The clones now vastly outnumber their mentors. The academic job market collapsed in the 1970s, yet universities have not adjusted their admissions policies, because they need graduate students to work in laboratories and as teaching assistants. But once those students finish their education, there are no academic jobs for them.

“Most doctoral programmes conform to a model defined in the middle ages.”

Universities face growing financial challenges. Most in the United States, for example, have not recovered from losses incurred on investments during the financial fiasco of 2008, and they probably never will. State and federal support is also collapsing, so institutions cannot afford to support as many programmes. There could be an upside to these unfortunate developments: growing competition for dwindling public and private resources might force universities to change their approach to PhD education, even if they do not want to.

There are two responsible courses of action: either radically reform doctoral programmes or shut them down.

The necessary changes are both curricular and institutional. One reason that many doctoral programmes do not adequately serve students is that they are overly specialized, with curricula fragmented and increasingly irrelevant to the world beyond academia. Expertise, of course, is essential to the advancement of knowledge and to society. But in far too many cases, specialization has led to areas of research so narrow that they are of interest only to other people working in the same fields, subfields or sub-subfields. Many researchers struggle to talk to colleagues in the same department, and communication across departments and disciplines can be impossible.

If doctoral education is to remain viable in the twenty-first century, universities must tear down the walls that separate fields, and establish programmes that nourish cross-disciplinary investigation and communication. They must design curricula that focus on solving practical problems, such as providing clean water to a growing population. Unfortunately, significant change is unlikely to come from faculty members, who all too often remain committed to traditional approaches. Students, administrators, trustees and even people from the public and private sectors must create pressure for reform. It is important to realize that problems will never be solved as long as each institution continues to act independently. The difficulties are systemic and must be addressed comprehensively and cooperatively. Prestige is measured both within and beyond institutions by the number and purported strength of a department’s doctoral programmes, so, seeking competitive advantage and financial gain from alliances with the private sector, universities continue to create them. As is detailed  that has led most fields to produce too many PhDs for too long.

The solution is to eliminate programmes that are inadequate or redundant. The difficult decisions should be made by administrators, in consultation with faculty members at their own and other universities, as well as interested, informed and responsible representatives beyond the academic community who have a vested interest in effective doctoral education. To facilitate change, universities should move away from excessive competition fuelled by pernicious rating systems, and develop structures and procedures that foster cooperation. This would enable them to share faculty members, students and resources, and to efficiently increase educational opportunities. Institutions wouldn’t need a department in every field, and could outsource some subjects. Teleconferencing and the Internet mean that cooperation is no longer limited by physical proximity.

Consortia could contain a core faculty drawn from the home department, and a rotating group of faculty members from other institutions. This would reduce both the number of graduate programmes and the number of faculty members. Students would have access to more academic staff with more diverse expertise in a wider range of fields and subfields. Faculty members will resist, but financial realities make a reduced number of posts inevitable.

Higher education in the United States has long been the envy of the world, but that is changing. The technologies that have transformed financial markets and the publishing, news and entertainment industries are now disrupting the education system. In the coming years, growing global competition for the multibillion-dollar education market will increase the pressure on US universities, just when public and private funding is decreasing. Although significant change is necessary at every level of higher education, it must start at the top, with total reform of PhD programmes in almost every field. The future of our children, our country and, indeed, the world depends on how well we meet this challenge.

Mark C. Taylor is chair of the department of religion at Columbia University in New York and the author of Crisis on Campus: A Bold Plan for Reforming Our Colleges and Universities (Knopf, 2010).

source: nature


Atul Tyagi, PhD

Consultant Physicist
BLK Memorial Hospital, New Delhi