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Biomedical subjects

J Muliyil

Publications and source records attributed to J Muliyil.

At least 37 records · Page 2Linked to original sources
PubMed1997

Releasable suture technique for trabeculectomy.

A retrospective review of 154 trabeculectomies with releasable sutures was performed to assess the effect of suture release on intraocular pressure (IOP) at various postoperative periods. Release of the suture was necessary in 38% of cases. The immediate reduction in IOP was significant (p < 0.01) when the suture was released during the first three postoperative weeks. Seventy percent of eyes had a reduction in IOP more than 5 mmHg if released within the first week compared to 20% after the third week. With suture release after the third postoperative week, there was no clinically significant decrease in IOP. The decrease in IOP was similar in eyes undergoing trabeculectomy alone or when cataract extraction through a separate corneal incision was undertaken simultaneously. The period during which release of suture was effective was not prolonged by use of antimetabolites. Complications included a typical windshield-wiper keratopathy (18 eyes), failure to release the suture (13 eyes), epithelial abrasion (6 eyes) and a sub-conjunctival bleed (1 eye).

Cataract Extraction↗
PubMed1997

VISTECH contrast sensitivity testing in primary open angle glaucoma.

Contrast sensitivity has been recommended as a screening and diagnostic test in primary open angle glaucoma (POAG). We tested contrast sensitivity (CS) using Vistech charts in 184 eyes of 95 patients. Three groups were examined--established primary open angle glaucoma, glaucoma suspects and age matched controls. The distribution of contrast sensitivities amongst the three groups were similar. The median contrast sensitivity of glaucoma suspects and controls were well within normal limits while that of the POAG group fell along the lower limit of normal. In all three groups the younger subjects scored better than the older, indicating a depression of contrast sensitivity with increasing age. Even if depression of any one spatial frequency was considered abnormal, the test yielded a sensitivity of 55.4% and specificity of 69.5%. Similarly contrast sensitivity testing was found to be of little use in detecting field defects a maximum sensitivity of 47.3% and specificity of 73.3%. Vistech contrast sensitivity testing is not a useful test in POAG screening or diagnosis.

Adult↗
PubMed1997

Confidence with confidence intervals.

When considering the results of a study that reports one treatment to be better than another, what the practicing ophthalmologist really wants to know is the magnitude of the difference between treatment groups. If this difference is large enough, we may wish to offer the new treatment to our own patients. Even in well executed studies, differences between the groups (the sample) may be due to chance alone. The "p" value is the probability that the difference observed between the groups could have occurred purely due to chance. For many ophthalmologists assessing this difference means a simple look this "p" value to convince ourselves that a statistically significant result has indeed been obtained. Unfortunately traditional interpretation of a study based on the "p" value at an arbitrary cut-off (of 0.05 or any other value) limits our ability to fully appreciate the clinical implications of the results. In this article we use simple examples to illustrate the use of "confidence intervals" in examining precision and the applicability of study results (means, proportions and their comparisons). An attempt is made to demonstrate that the use of "confidence intervals" enables more complete evaluation of study results than with the "p" value.

Clinical Trials as Topic↗
PubMed1997

Evaluation of the role of syringing prior to cataract surgery.

Patients for cataract surgery in India routinely undergo preoperative syringing to rule out chronic dacryocystitis. We determined the sensitivity and specificity of the clinical test of regurgitation on pressure over the lacrimal sac (ROPLAS) as a screening test for chronic dacryocystitis and compared it to syringing. 621 consecutive outpatients who needed syringing for various reasons (including 318 who had routine syringing prior to cataract surgery) were examined in a masked manner for regurgitation on pressure over the lacrimal sac. They then underwent syringing by a trained (masked) observer. The sensitivity and specificity of ROPLAS were 93.2% and 99.3%, respectively. Using a 6.6% prevalence of chronic dacryocystitis (the prevalence in our cataract population), the negative predictive value of the test was 99.5%. In the presence of regurgitation of pressure over the sac, the high specificity of ROPLAS confirms chronic dacryocystitis. In view of the opportunity costs, when ROPLAS is negative, preoperative syringing in cataract is perhaps unnecessary, unless the findings are equivocal or the index of suspicion for chronic dacryocystitis is very high.

Cataract↗
PubMed1996

The flashlight test and van Herick's test are poor predictors for occludable angles.

OBJECTIVE: To determine the reliability and validity of the flashlight test and van Herick's test in detecting occludable anterior chamber angles. METHODS: The flashlight test, van Herick's test and gonioscopy were performed independently by two observers on 96 consecutive new patients in our outpatient clinic. Interobserver agreement was determined using the weighted Kappa statistic. Using the glaucoma specialist's assessment of occludability of the angle (assessed by gonioscopy) as a gold standard, the sensitivities and specificities of the two tests were calculated. RESULTS: All three tests showed good agreement (Kappa more than 0.75). The sensitivity and specificity on the flashlight test were 45.5% and 82.7% respectively. For the van Herick's test they were 61.9% and 89.3%. CONCLUSION: The flashlight test and van Herick's test are of limited use as screening tests for occludable angles.

Adolescent↗
PubMed1996

Brightness discrimination test is not useful in screening for open angle glaucoma.

PURPOSE: Brightness discrimination test (BDT) is routinely employed to assess asymmetrical optic nerve dysfunction and has been suggested as a screening test for primary open angle glaucoma (POAG). We tested the reliability and validity of BDT in the diagnosis of POAG. METHODS: The study groups included 34 patients with established primary open angle glaucoma, 20 glaucoma suspects, and 33 age-sex matched controls. Cataract was not an exclusion criterion in these groups. The normal brightness score was determined to be 88% (mean score, 94%-2 SD) in a pilot study. Brightness discrimination test was performed in all subjects by two observers independently. BDT showed an excellent interobserver agreement (weighted Kappa 0.84). RESULTS: The presence of a cataract alone increased the risk of brightness impairment twofold, glaucoma alone increased the risk eightfold, and the presence of both conditions by 17 times compared to those with neither condition. BDT was not a useful test in the diagnosis of POAG (sensitivity 67% and specificity 93%); the ability to detect a significant field defect was also poor (sensitivity 53% and specificity 76%). CONCLUSIONS: There was poor association between decreased brightness scores and asymmetrical field defects as determined by the Humphrey's field analyzer (HFA).

Adult↗
PubMed1996

Assessment of clinical significance: the number needed to treat.

The practising ophthalmologist is frequently confronted with treatment options shown to be "statistically significantly better" than those currently in use. Unfortunately what is statistically significant may not necessarily be clinically significant enough for the practitioner to change from the currently preferred method of treatment. In this article we use common ophthalmic examples to introduce the "number needed to treat" (NNT), as a simple clinical approach for the practising ophthalmologist wishing to assess the clinical significance of treatment options.

Eye Diseases↗
PubMed1996

Trends of smoking among medical students.

The overall smoking prevalence among male medical students between the years 1955 and 1988 in a medical college in South India was 39.51 per cent. The trends of smoking appeared to be in three phases. An initial phase comprising of a steady rise to a peak in the late sixties and seventies, followed by a plateau of the prevalence in the next ten years and ultimately a sharp fall in the last five years. Study based on a mailed-in questionnaire to ten batches of students selected randomly, to study the factors affecting initiation and quitting of smoking showed that the peak period of initiation seemed to be in the two years before and after joining the course. There was a significant relationship between the presence of a smoker in the family and picking up the habit. Conversely, no significant relationships were found with respect to quitting.

Education, Medical↗
PubMed1996

Surgical magnification for intracapsular cataract surgery in a rural hospital.

Intracapsular cataract extraction is still the most common type of operation performed in India, especially in eye camps, and most of these are done without magnification. To assess the surgical outcome of intracapsular cataract surgery in a rural hospital with various magnifying systems, 121 consecutive eyes (121 patients) with uncomplicated cataract were randomly allocated to surgery with the operating microscope, binocular loupe or unaided eye. The surgery was performed by either consultants or first year residents. The best corrected vision at least four weeks post-operatively was compared among the three groups. The performance between the consultants and the junior residents was also compared. The improvement of surgical outcome with magnification was statistically significant (p = 0.0045); and clinically important with a relative risk reduction of 60.6%. The comparison between microscope and loupe magnification did not show a significant difference (p = 0.24). However, with an operating microscope, the consultants performed significantly better than the junior residents. These findings suggest that the use of magnification in intracapsular cataract extraction provides a definite advantage over an unaided eye and that the binocular loupe is a good alternative to the operating microscope in this kind of surgery.

Adult↗
PubMed1992

The teaching of behavioural sciences.

Medical science over the last few decades has undergone vast changes. Technologically it has advanced at a rapid pace. There has been a realization as well that the behaviour of individuals and communities also influences the occurrence of disease. Medical schools around the globe have realized the need for incorporating behavioural sciences as an integral part of the basic sciences taught to medical students. This paper presents the experience of Christian Medical College, Vellore in teaching behavioural sciences. Students are taught sociology, psychology and medical anthropology through a community-based, problem-oriented teaching programme. The students have first-hand experience of living in a community and learn by observation and interaction. Pre- and post-assessment has shown a significant improvement of their knowledge and attitude. Feedback from students also indicates that they find this programme relevant and interesting.

Behavioral Sciences↗
PubMed1991

Risk of relapse among non-lepromatous patients released from treatment after dapsone monotherapy.

Information on 14,625 non-lepromatous patients released from treatment after dapsone monotherapy and followed up to a maximum of 15 years at the ILEP project. Dharmapuri, India, was analysed to study the pattern of relapses. The overall relapse rate was 5/1000 person years. Males had a higher relapse rate than females. The risk of relapse increased with age, number of lesions and duration of treatment. The risk for relapse remained constant over several years after release from treatment. Even though the absolute risk for relapse after MDT may be different, the pattern of relapses and the factors affecting it may be similar to what has been shown in this study.

Adolescent↗
PubMed1991

Effect of BCG on the risk of leprosy in an endemic area: a case control study.

The effect of BCG on the risk of leprosy was measured using a case-control design in an area endemic for the disease. In this study, 397 newly diagnosed cases and 669 controls matched for age, sex and locality were selected from a defined population. Information on exposure to BCG, contact with another case of leprosy, and relevant socioeconomic variables were obtained from the subjects. Having infectious (multibacillary) and noninfectious (paucibacillary) contacts in the household increased the risk of disease 11.7 times (p less than 0.001) and 2.7 times (p less than 0.001), respectively. Overall, the protection offered by BCG was not significant (odds ratio = 0.8; p = 0.17). However, BCG appeared to increase the risk for indeterminate leprosy (adjusted odds ratio = 2.7; p = 0.09) while protecting against borderline disease (adjusted odds ratio = 0.39; p = 0.03). It is possible that BCG causes a shift in the overall cell-mediated immune response, thus increasing the risk for milder and transient forms of leprosy while protecting against more serious forms. These findings may have important implications for the design and interpretation of vaccine trials. Namely, trials should be designed to measure the protective efficacy of vaccines against the more serious forms of leprosy, which have the greatest public health significance.

Adolescent↗
PubMed1990

Teaching nutrition to medical students: a community-based problem-solving approach.

This paper presents a community-based problem-solving educational programme which aims at teaching medical and other health science students the importance of nutrition and its application. Through community surveys students assess the nutritional status of children under five using different anthropometric methods. They understand the cultural beliefs and customs related to food fads and the reasons for them. They also acquire the skill to educate the community using the information gathered. They use epidemiological methods such as case control study to find associations between malnutrition and other causative factors. Feedback from students has been positive and evaluation of students' knowledge before and after the programme has shown significant improvement.

Community Medicine↗
PubMed1989

Status of multi bacillary patients "lost to follow up".

Completeness of coverage with MDT is essential if one were to hope for a reduction in the incidence of leprosy in an endemic area. Patients who are lost to follow up are generally declared as "Permanently left" (PL) and deleted from the known case register. A special effort was made to study the true status of multibacillary patients who had been declared "PL" in the leprosy control programme area of the Christian Medical College, Vellore. 38% of the 40 patients followed up were found to be still residing in the same area. 40% of them were BI Positive. The reasons for these erroneous deletions varied. The study shows that declaration of "PL" need to be verified carefully. Further, it was found that the present system of reporting may exaggerate the actual number of patients who have been lost to follow up.

Drug Therapy, Combination↗
PubMed1980

School-survey in a rural leprosy endemic area.

In the Kaniyambadi Panchayat Union area of known leprosy endemic population this study was undertaken. Out of 10,163 students examined, a total of 137 leprosy cases were detected--122 cases (89.1%) belonged to Tuberculoid type and the rest 15 cases (10.9%) belonged to Borderline leprosy. There were no cases of Lepromatous type, and none of them had any deformity. 86.1% had single lesion and the rest multiple lesions. Study of the distribution of patches over the body surface did not reveal any significant difference between covered and uncovered parts of the body.

Adolescent↗
PubMedDate not supplied

Outcome of laser peripheral iridotomy in chronic primary angle closure glaucoma.

BACKGROUND AND OBJECTIVES: To report the effect of laser peripheral iridotomy on the angles of eyes with chronic angle closure glaucoma. PATIENTS AND METHODS: The hospital records of 171 consecutive patients with chronic primary angle closure glaucoma (CPACG) seen between October 1994 and March 1997 were analyzed to study the gonioscopic outcome of laser peripheral iridotomy (LPI). Success was defined as open angles (with or without medications for intraocular pressure (IOP) control) following LPI at the 1 month follow-up. RESULTS: Forty-seven eyes of 34 patients had chronic appositional angle closure glaucoma (CAACG), and 186 eyes of 124 patients had chronic synechial angle closure glaucoma (CSACG). Seventy eyes of 57 patients that underwent primary trabeculectomy for advanced disease were excluded from the study. Two hundred thirty-three eyes of 158 patients underwent LPI; the angles could be opened in 171 eyes (73.4%; confidence interval 67.7% to 79.1%) of 117 patients. Medications to control the IOP were required in 25 eyes (10.7%) of 19 patients. Fifty-four eyes of 34 patients that did not respond to LPI underwent argon laser gonioplasty. Gonioplasty was successful in opening at least 180 degrees of the angle in all eyes. There was no significant difference in success between CAACG (74.5%) and CSACG (73.1%). Age, IOP, and field loss were not predictors of outcome. There was perfect concordance of results between the 2 eyes of patients who had bilateral LPI. CONCLUSIONS: In this series, laser iridotomy was successful in opening the angle in 73.4% of eyes. Gonioplasty opened the angle in all eyes that underwent this procedure. The effect of iridotomy on one eye was predictive of the effect on the fellow eye.

Chronic Disease↗