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“Sean O’Casey, born John Casey in 1880, was a bitter man with much to be bitter about. His father, a Dublin Protestant was a clerk who died when Sean was six and the family then slid into poverty. Protestants were not supposed to be poor. One marked characteristic of Irish poverty was trachoma, endemic since the Great Famine and often leading to blindness. It was eventually brought under control after the Second World War by penicillin, but by then one of O’Casey’s eyes was blind, and the other severely damaged. In his childhood it was incurable. Christopher Murphy, in his new and definitive biography based on a thorough investigation of sources, makes it painfully clear how devastating was the effect of trachoma on the playwright’s life and character. (

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Degenerative joint disease continues to be an increasing problem in ageing populations throughout the world. Obesity also continues to be epidemic in proportion. It is now clear that when these two disorders are combined adverse outcomes may result. In a study of 68 obese patients undergoing knee replacement surgery nine of the 78 joint replacements resulted in failures. In contrast, in a control group of normal weighted individuals no failures occurred. Clearly, controlling obesity has a dramatic effect on knee joint replacement outcomes. (

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Although improvements in the management of breast cancer are encouraging recent data continue to be pessimistic about long term outcomes. Data from 430 510 patients with breast cancer reached the conclusion that the probability of death from breast cancer exceeded the probability of death from all other causes for 28 years after the initial diagnosis. Five year survival rates for breast cancer do not tell the tale of long term outcomes. (

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Cataract surgery is the most common and one of the most successful surgical procedures of any type performed. Complications associated with cataract surgery procedures are few but well known. One of the more important intraoperative complications is vitreous presentation. In a prospective long term clinical trial at 19 departments of Veterans’ Affairs Medical Centers the effect of vitreous presentation during extracapsular surgery on postoperative visual acuity was studied. In this study vitreous presentation during extracapsular cataract surgery led to a somewhat worse overall outcome in patients, although the majority of patients with vitreous presentation did reasonably well. Nevertheless, significantly more patients developed cystoid macular oedema, retinal detachment, and uveitis compared to those patients who underwent uncomplicated cataract surgery. (

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In 18 years excimer laser surgery has been performed on millions of patients. A recent study from St Thomas’ Hospital, London, examined the long term refractive stability of excimer laser myopic photorefractive keratectomy. In this study refractive stability achieved at 1 year was maintained up to 12 years with no evidence of hyperopic shift, diurnal fluctuation, or late regression in the long term. Corneal haze decreased with time, with complete recovery of baseline visual acuity. Night halos, however, remain a significant problem in a subset of patients because of the small ablation zone size. (

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Nevirapine and efavirenz are the most commonly prescribed class of antiretroviral drugs called non-nucleoside reverse transcriptase inhibitors (NNRTIs). Recent studies have shown that both drugs raise high density lipoprotein (HDL) cholesterol, (the so called good type of cholesterol); however, the overall lipid profile appears to be better with nevirapine than with efavirenz. These data would suggest that nevirapine may be preferable to efavirenz in HIV infected adults with other cardiovascular risks factors. However, the authors point out that no vascular functional data are currently available. (Go to: DOI:10.1371/journal.pmed.0010030)

The treatment of amblyopia has been intensely studied. One of the questions that arises is the problem of recurrence once therapy has been discontinued. The Pediatric Eye Disease Investigator Group studied 150 children with successfully treated anisometropic or strabismic amblyopia. In this study approximately one quarter of successfully treated amblyopic children experienced a recurrence within the first year after treatment cessation. Their data also suggest that when 6 hours of daily patching or more was utilised recurrence was greater when patching was abruptly stopped rather than when it was reduced to 2 hours per day before cessation. Clearly, patients who have been treated for amblyopia need careful long term follow up. (

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Better understanding of the pathophysiology of multiple sclerosis continues to be documented. Scientists have found that, in people with multiple sclerosis, astrocytes expressed abnormally high levels of a protein called syncytin. This is a protein remnant produced from a virus that invades humans during primate evolution. Astrocytes expressing syncytin produce compounds that are toxic to human oligodendrocytes. Mice infected with the virus that express syncytin develop a multiple sclerosis-type motor impairment. (

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Many patients use herbal medicines and nutritional supplements without necessarily informing their physician. In a retrospective observational case series of reports of ocular side effects or systemic side effects of medications investigators from the University of Oregon documented 263 reports of ocular side effects related to herbal medicines and nutritional supplements. They identified canthaxanthine, chamomile, Datura, Echinacea, Ginkgo bilboa, licorice, niacin, and vitamin A to have clinically significant ocular side effects. (

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“Scientific Integrity In Policy Making” accuses the Bush Administration, firstly, of deliberately suppressing scientific findings in the interest of its own ideological and political ends and, secondly, of packing various regulatory and review boards with unqualified members who can be counted on to favour industrial profits or conservative ideologies of public health and safety. Manipulation, distortion, and suppression of scientific findings in the interest of industries, the report shows, have affected research results on climate change, mercury emissions and other pollutions, on airborne bacteria, on endangered species, and forest management.” (

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