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Arjun Srirampur, Shalini Kumari Agrawal, Veerendranath Pesala Anand Eye Institute, Hyderabad 500007, IndiaCorrespondence: Arjun SrirampurAnand Eye Institute, Nagendranagar Colony, Hyderabad 500007, IndiaTel +91 998 922 9832Fax +91 040 2 715 1999Email sarjuneye@gmail.com I have read with great interest the review article by Walkden et al on “Brittle Cornea Syndrome: Current Perspectives”.1 I would like to express my appreciation to the authors for an elaborate and comprehensive review of this complex disease which has devastating complications. I agree with the authors on various surgical techniques to manage the eyes with brittle cornea syndrome(BCS).I have managed a few children with BCS in our hospital with spontaneous corneal ruptures after a trivial trauma. Based on our experience, I would like to add a few surgical tips in managing a corneal tear in patients with BCS. View the original paper by Srirampur A and colleagues

The causes of pulmonary arterial hypertension (PAH) are diverse and include multiple congenital and acquired cardiac diseases as well as diseases primarily affecting the pulmonary vasculature, lung, pleura and chest wall. The traditional role of CT in evaluating PAH includes assessment of pulmonary vasculature and lung parenchyma with limited assessment of the heart. Advances in multidetector CT technology with improved spatial and temporal resolution now permit accurate delineation of cardiac morphology. CT pulmonary angiography (CTPA) is widely utilised in the workup of patients with suspected pulmonary vascular disease and can identify both pulmonary and cardiac causes. As the initial presentation for CTPA is often precipitated by nonspecific, unexplained symptoms and therefore undertaken by a general radiologist, it is important that a systematic approach to the interpretation of these studies, including cardiac evaluation, is routinely adopted. This paper reviews the CT evaluation in pulmonary hypertension with a particular focus on the cardiac causes, their subclassification into congenital systemic to pulmonary shunts and secondary to left heart disease, and their imaging features. It emphasises the use of a systematic approach to interpretation of CTPA examinations both in patients with known PAH and those with previously unsuspected disease. [ABSTRACT FROM AUTHOR]

Rationale: This case report describes the application of a novel gait retraining approach to an individual with poststroke hemiparesis. The rehabilitation protocol combined a specially designed leg orthosis (the gravity-balanced orthosis), treadmill walking, and functional electrical stimulation to the ankle muscles with the application of motor learning principles.Case: The participant was a 58-year-old man who had a stroke more than three years before the intervention. He underwent gait retraining over a period of five weeks for a total of 15 sessions during which the gravity compensation provided by the gravity-balanced orthosis and visual feedback about walking performance was gradually reduced.Outcomes: At the end of five weeks, he decreased the time required to complete the Timed Up and Go test; his gait speed increased during overground walking; gait was more symmetrical; stride length, hip and knee joint excursions on the affected side increased. Except for gait symmetry, all other improvements were maintained one month post-intervention.Conclusions: This case report describes possible advantages of judiciously combining different treatment techniques in improving the gait of chronic stroke survivors. Further studies are planned to evaluate the effectiveness of different components of this training in both the subacute and chronic stages of stroke recovery. [ABSTRACT FROM AUTHOR]

Background: The performance of daily tasks, such as stair climbing or lifting an object, requires both muscle strength and power. Age-associated reductions in strength and power can affect an older adult's ability to complete daily tasks such as stair climbing and lifting a child.Methods: The purposes of this study were to determine whether power training was more efficacious than strength training for improving whole-body physical function in older adults and to examine the relationship between changes in anaerobic power and muscle strength and changes in physical function. Thirty-nine men and women (mean age +/- SD = 72.5 +/- 6.3 years) with below-average leg extensor power were randomly assigned to control (C, n = 15), strength-training (ST, n = 13) or power-training (PT, n = 11) groups. The ST and PT groups met 3 days per week for 16 weeks; the C group maintained usual activity and attended three lectures during the course of the study. Primary outcome measures included the Continuous Scale Physical Functional Performance test, maximal strength, and anaerobic power.Results: After baseline was controlled for, the Continuous Scale Physical Functional Performance test total score was significantly greater for the PT group than for the ST (p =.033) and C (p =.016) groups. Maximal strength was significantly greater for the ST group than for the C group (p =.015) after the intervention. There was no significant difference between groups for peak anaerobic power.Conclusions: Power training was more effective than strength training for improving physical function in community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Hypernatremic dehydration in breast fed neonates is a rare but increasingly recognized problem. If not identified early, it may lead to potentially life threatening complications. The authors describe a neonate who developed thrombosis and lower limb ischemia secondary to hypernatremic dehydration. Peripheral gangrene, as a result of hypernatremic dehydration is extremely uncommon and has rarely been reported before. [ABSTRACT FROM AUTHOR]

In this open-labeled study, 77 men with BPH received an intraprostatic injection of 200 units of Botulinum toxin A (BT-A, Botox) using an ultrasound-guided transperineal approach. The American Urological Association (AUA) score, serum prostate-specific antigen (PSA), prostatic volume, residual volume, and peak urinary flow rates were evaluated before and after treatment at 1, 2, 6, 12, 18, 24, and 30 months follow-up. The primary endpoint was symptomatic improvement (AUA score) and peak urinary flow rates. The secondary endpoint was the evaluation of prostatic volume, serum PSA, and residual urinary volume. At an evaluation after 1 month, 41 patients had subjective symptomatic relief. Compared with baseline values, the AUA score was reduced from 24.1 ± 4.6 to 12.6 ± 2.9 (P = 0.00001) and serum PSA was reduced from 6.2 ± 1.7 to 4.8 ± 1.0 ng/mL (P = 0.03). At the same time, the prostatic volume and residual urine volume were reduced by 12.7% and 12.8%, respectively and the mean peak urinary flow rate increased from 8.6 ± 2.9 to 13.1 ± 4.0 (P = 0.01). At an evaluation after 2 months, 55 patients had subjective symptomatic relief. The AUA score was reduced by 63.9% (P = 0.00001) compared with baseline values. In the same patients, serum PSA, prostatic volume, and residual urine volume were reduced by 51.6% (P = 0.00001), 42.8% (P = 0.00001), and 55.9% (P = 0.002), respectively and the mean peak urinary flow rate increased significantly. No local or systemic complications were observed after the treatment and none of the patients required narcotic analgesia after the procedure. At the evaluation after 30 months, all 77 patients continued to have good voiding without worsening of LUTS. Their AUA symptoms score was 11.1 ± 2.7 (P = 0.02 vs. 2-month value) and total PSA was 3.1 ± 0.7 ng/mL (P = 0.7 vs. 2-month value). Authors concluded that intraprostatic Botulinum toxin injection is a promising approach that is safe and effective. [ABSTRACT FROM AUTHOR]

Background: Challenging daily tasks, such as transferring heavy items or rising from the floor, may be dependent on the ability to generate short bursts of energy anaerobically. The purposes of this study were to determine if strength-trained (ST) older adults have higher anaerobic power output compared with non-strength-trained (NST) older adults and to determine the relationship between anaerobic power and performance-based physical function.Methods: Thirty-five men and women (age 71.5 +/- 6.4 years, mean +/- SD; NST: n = 18, ST: n = 17) were grouped by training status. Outcome variables included relative anaerobic power (Wingate test), physical function measured with the Continuous Scale Physical Functional Performance Test (CS-PFP, scaled 0 to 100), and anthropometric lean thigh volume (LTV). Analysis of covariance (with age and sex as covariates) was used to determine group differences in the dependent variables listed above. Pearson's r was used to determine the relationship between anaerobic power, CS-PFP total score (TOT), and CS-PFP lower body strength domain score (LBS).Results: The ST group had significantly higher mean anaerobic power (NST 58.9 +/- 16 W/l, ST 96.3 +/- 23 W/l), CS-PFP total (NST 61.2 +/- 13, ST 73.7 +/- 8), and LBS (NST 54.1 +/- 17, ST 70.9 +/- 8) compared with the NST group (p <.05). However, LTV was similar for both groups (NST 3.323 +/- 0.75; ST 3.179 +/- 0.79), which suggests that the ST group had higher muscle quality compared with the NST group. Anaerobic power was significantly related to TOT (r =.611, p =.001) and LBS (r =.650, p =.001).Conclusions: High levels of physical function in ST older adults may in part be explained by higher levels of anaerobic power associated with strength training. [ABSTRACT FROM AUTHOR]