iosr-JDMS   Volume-20 ~ Issue-4 ~ April 2021

Abstract: Background: Central venous catheterization of Internal Jugular Vein (IJV) is commonly attempted procedure in anesthesia and intensive care unit. The safe puncture of the IJV is achieved by using anatomical land marks on skin surface, however complications like carotid artery puncture, hematoma, hemothorax, pneumothorax, catheter malposition and even death can occur during the procedure. Some studies have shown that ultrasound guided cannulation could be beneficial in improving the success rate, reducing the number of needle passes, decreasing access time and complications compared......

Keywords: Central venous cannulation, Internal Jugular Vein, Landmark, Ultrasound.

[1]. Karakitsos D, Labropoulos N, De Groot E, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care. 2006; 10(6):R162.
[2]. Dolu H, Goksu S, Sahin L, Ozen O, Eken L. Comparison of an ultrasound-guided technique versus a landmark-guided technique for internal jugular vein cannulation. J Clin Monit Comput. 2015; 29(1):177-182.
[3]. Turker G, Kaya FN, Gurbet A, Aksu H, Erdogan C, Atlas A. Internal jugular vein cannulation: an ultrasound-guided technique versus a landmark-guided technique. Clinics (Sao Paulo). 2009; 64(10):989-992
[4]. Hermosura B, Vanags L, Dickey MW. Measurement of Pressure during Intravenous Therapy. JAMA.1966; 195(4):321.
[5]. Daily PO, Griepp RB, Shumway NE. Percutaneous internal jugular vein cannulation. Arch Surg. 1970; 101(4):534-536.

Abstract: COVID-19 pandemic reached the world causing an enormous health and economic crisis that strickled surprisingly the healthcare workers. An outbreak in public health development affecting the entire society and during this scenario some health workers that before were not paid to much attention begin to show their necessity and importance to population and to the health system. Pharmacies and their pharmaceutical team needed to improve the concept of pharmaceutical care and go beyond their common needs and responsibilities as they were already considered the most accessible professional of the medical community. This article seeks to show the importance of pharmaceutical care not only in normal moments but also in periods considered of crises as coronavirus disease. Pharmacies.....

Keywords: pharmaceutical care, pandemic, coronavirus, COVID-19, pharmacists

[1]. Kretchy, Irene A., Michelle Asiedu-Danso, and James-Paul Kretchy. "Medication management and adherence during the COVID-19 pandemic: perspectives and experiences from low-and middle-income countries." Ress in Soc. and Adm. Pharm. 17.1 (2021): 2023-2026.
[2]. ICTV Code (International Committee on Taxonomy of Viruses). Naming the 2019 coronovirus –267.
[3]. World Health Organization. Addressing Human Rights as Key to the COVID19 Response. In: WHO. Geneva: WHO; 2020.
[4]. Adams, J. G., & Walls, R. M. Supporting the health care workforce during the COVID-19 global epidemic. Jama, 323.15 (2020): 1439-1440.
[5]. Alexander GC, Qato DM. Ensuring Access to Medications in the US During the COVID-19 Pandemic. Jama. 324.1 (2020): 31-32

Abstract: Introduction; An exacerbation of COPD is defined as an acute worsening of respiratory symptoms that results in additional therapy. COPD has eosinophilic airway inflammation both in a stable state and during exacerbations Although the eosinophil threshold associated with clinical relevance in patients with COPD is currently subject to debate, eosinophil counts hold potential as biomarkers to guide therapy. Aims and objectives; To estimate absolute blood eosinophil count and its correlation with in hospital length of stay in COPD-AE. Materials and methods; Pre-treatment laboratory complete blood count with differential, absolute eosinophil count were sent. Pre-treatment absolute blood eosinophil counts analyzed for its association with in hospital length of stay in COPD acute exacerbation.......

Key words: COPDAE; AEC; IN HOSPITAL LENGTH OF STAY; PREDICTOR

[1]. Gold guidelines 2020.
[2]. Lacoste JY, Bousquet J, Chanez P, et al. Eosinophilic and neutrophilic inflammation in asthma, chronic bronchitis, and chronic obstructive pulmonary disease. J Allergy Clin Immunol 1993; 92: 537–548.
[3]. Brightling CE, Monteiro W, Ward R, et al. Sputum eosinophilia and short-term response to prednisolone in chronic obstructive pulmonary disease: a randomised controlled trial. Lancet 2000; 356: 1480–1485.
[4]. Vedel-Krogh S, Nielsen SF, Lange P, Vestbo J, Nordestgaard BG. Blood eosinophils and exacerbations in COPD: the Copenhagen general population study. Am J Respir Crit Care Med. 2015;193(9):965.
[5]. Watz H, Tetzlaff K, Wouters EF, Kirsten A, Magnussen H, Rodriguez-Roisin R, et al. Blood eosinophil count and exacerbations in severe chronic obstructive pulmonary disease after withdrawal of inhaled corticosteroids: a post-hoc analysis of the WISDOM trial. Lancet Respir Med. 2016;4:390–8..

Abstract: Aim: To compare the effect of intravenous Fentanyl with intravenous Dexmedetomidine on haemodynamic response to laryngoscopy & tracheal intubation in patients posted for elective surgical procedures and to study the safety and side effects of these drugs. Settings and Design: Prospective, randomized & double blind study. Methods and Material: 100 elective surgical patients of aged 18 to 65 years were included in study. All patients underwent elective surgical procedures under general anaesthesia. Patients were randomized into two groups. Group F: Received Fentanyl 2μg/kg, Group D : Received Dexmedetomidine.....

Key Word: Dexmedetomidine, Fentanyl, randomization, laryngoscopy, intubation

[1]. Jakusenko N, Kopeika U, Mihelsons M, Nagobade D, Vija Putniña A, Pavārs A. Comparison of stress response performing endotracheal intubation by direct laryngoscopy, fibreoptic intubation and intubation by the glidescope laryngoscope. In Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. 2008 Jan 1 (Vol. 62, No. 4-5, pp. 176-181).
[2]. Reid L C, Brace D E. Irritation of respiratory tract and its reflex effect upon heart. Surg., Gynaec. and Obst. Feb 1940 ; 70 : 157-162.
[3]. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000 Feb;59(2):263-8.
[4]. Gupta S, Tank P. A comparative study of efficacy of esmolol and fentanyl for pressure attenuation during laryngoscopy and endotracheal intubation. Saudi journal of anaesthesia. 2011 Jan 1;5(1):2.
[5]. Kharwar RK, Kumar R, Tiwary PK, Suwalka U, Prakash S. A comparison of intravenous dexmedetomidine v/s inj. fentanyl for attenuation of hemodynamic responses during laryngoscopy and intubation after propofol induction. NJIRM 2014 ; 5:71–5.6

Abstract: Background: Crown is a permanently installed or cemented extra-coronal restoration that coats the outer surface of the clinical crown. The all ceramic crown produces a good and ideal aesthetic, a corresponding level of opacity and translucence, as well as a color that is not easily changed. Retention is considered one of the important factors in the adaptation of crown restoration. Crown retention and stabilization are also affected by internal gaps, internal adaptation ideally improving mechanical properties such as retention, strength and resistance. Crown adaptation is obtained from the impression results. There are two impression techniques, namely conventional impression techniques and digital impression techniques. There are two recommended conventional impression techniques, one-step putty-wash impression.....

Key Word: Retention, all ceramic crown, one-step putty-wash, two-step putty-wash, CAD/CAM

[1]. Hidayatin I, Indiani SR, Ratwita RR. Coping manufactured technique of spinell slip cast all ceramic by conventional methods and CAD/CAM: Literature Review. Journal of Vacational Health Studies 2019. 03:32-36.
[2]. Amelya A. Ketepatan tepi servikal mahkota tiruan all-ceramic hasil rekam digital scanner secara direct dan indirect. Tesis. Jakarta: Program studi pendidikan dokter spesialis prostodonsia Universitas Indonesia 2014:13-4.
[3]. Narula S,dkk. Retention in conventional fixed partial denture: a review. Journal of Clinical and Diagnostic Research 2011; 5(5): 1128-1132.
[4]. Carvalho BG, Ribeiro MST, Brasil LR, Alencar MJS. Marginal and internal fit of CAD/CAM fabricated all-ceramic restorations: a literature review. Revistas 2017. 74: 229-30.
[5]. Budiono,dkk. Pengembangan instrument penilaian kinerja keterampilan mencetak rahang bergigi teknik mukostatik. JERE 2016. 5(1): 49-55.

Abstract: Aim: To analyze of intraocular pressure and central corneal thickness associated with glycemic control in Indonesian type 2 diabetes mellitus patients. Materials and Methods: A prospective, analytical observational with cross sectional study was conducted in Universitas Sumatera Utara Hospital, Medan, Indonesia from February 2020 to May 2020. The study included 66 participants with type 2 DM. The patients were investigated for HbA1c level and ophthalmology examination including visual acuity (VA), intraocular pressure (IOP) measurement by Goldmann Applanation Tonometer, central corneal thickness with SD Optovue OCT. Results: This study showed a significant correlation between HbA1c variations with IOP (p=0.037) and CCT (p= 0.045). There is also significant correlation between HbA1c with VA (r =0.245; p=0.048), IOP (r=0.270; p=0.028), CCT (r=0.308; p=0.012) and duration of DM (r=0.414; p= 0.001) Conclusion: Higher HbA1c correlated with elevated IOP and thicker CCT as a risk factor for glaucomatous damage in Type 2 Diabetes Mellitus patients.

Key Word: IOP, CCT, HbA1c, Type 2 Diabetes Mellitus.

[1]. World Health Organization & International Diabetes Federation. Definition And Diagnosis Of Diabetes Mellitus And Intermediate Hyperglycemia: report of a WHO/IDF consultation. WHO; 2006.
[2]. Nabyl RA. Cara Mudah Mencegah dan Mengobati Diabetes Mellitus. Yogyakarta: Aulia Publishing; 2009.
[3]. Bommer C, Sagalova V, Heesemann E, et al. Global Economic Burden of Diabetes in Adults: Projections From 2015 to 2030. Diabetes Care. 2018;41(5):963-970.
[4]. Perkumpulan Endokrinologi Indonesia. Konsensus Pengendalian dan Pencegahan Diabetes Mellitus Tipe 2 di Indonesia 2015. Jakarta: PB. PERKENI; 2015.
[5]. Aiello LP, Silva PS, Sun JK. Eye Complications of Diabetes. In: Skyler JS. Atlas of Diabetes Fourth Edition. Miami: Springer; 2012:249-275.

Abstract: Introduction: Cutaneous hyperesthesia is a neurological symptom that manifests itself as exacerbated sensitivity in the skin. This symptom has been shown to be present in a small percentage of cases of patients with Covid-19; however, research has yet to demonstrate its relationship to prognosis. Treatment is multimodal in nature, ranging from expectant conduct to psychological approach associated with physical methods, use of antidepressants or anticonvulsants and surgery, if there is no spontaneous resolution after the disease is cured.
Case report: A 48-year-old male patient presented with significant rhinorrhea and cutaneous hyperesthesia on the back after having contact with a confirmed case of Covid-19; when performing the exam on the fourth day of symptoms he tested positive for SARS-Cov-2 infection......

Key Word: Coronavirus Infections; Hyperesthesia; Skin Abnormalities

[1]. FELDMAN, Steven R; FREEMAN, Esther E. Coronavirus disease 2019 (COVID-19): Cutaneous manifestations and issues related to dermatologic care. Uptodate, 2019. https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-cutaneous-manifestations-and-issues-related-to-dermatologic-care/print. [2]. HADLEY, Graham R. et al. Post-herpetic Neuralgia: a Review. Nacional Library of Medicine, 2016, 20(17). https://pubmed.ncbi.nlm.nih.gov/26879875/. [3]. HARSCH, Igor A.; ATUDOREI, Irina; FRANK, Kathrin. Is there a link between COVID-19 and cutaneous hyperesthesia? Confirmation of a recent observation. GMS hygiene and infection control, 2021. 16; Doc01. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818658/.
[4]. HUDSPITH, M. J.; SIDDALL, P. J.; MUNGLANI, R. Physiology of pain. In: HEMMINGS, H. C.; HOPKINS, M. Foundations of Anesthesia, 2.ed. Elsevier Mosby:Philadelphia, 2006, 848p. [5]. INTERNATIONAL ASSOCIATION FOR THE STUDY OF PAIN (IASP). Guide to Pain Management in Low-Resource Settings. 2009.

Abstract: Wernicke encephalopathy is a rare, treatable, reversible yet serious neurological disease due to vitamin B1 deficiency. It is usually associated with heavy alcohol consumption. Other causes are malnutrition due to hyperemesis gravidarum, starvation, anorexia nervosa, cancer chemotherapy, HIV infection, bariatric surgery. It is characterized by classic triad of encephalopathy, ophthalmoparesis/nystagmus and ataxia. We now report two cases of Wernicke's encephalopathy due to hyperemesis gravidarum. Early diagnosis and treatment is necessary to prevent maternal and fetal mortality and permanent amnesic neurological sequelae

Key Word: Wernicke encephalopathy, hyperemesis gravidarum, early diagnosis,treatable .

[1]. Adams and Victor's Principles of Neurology,11 th edition, Diseases of Nervous System Caused by Nutritional Deficiency.
[2]. M.E. Michel, E.Bois, N. Gavillon, and O. Graesslin, "Wernicke encephalopathy complicating hyperemesis gravidarum: a case report," European Journal of Obstetrics Gynecology & Reproductive Biology , vol.149,no.1.pp.117-123,2010. https://doi.org/10.1016/j.ejogrb.2009.10.018
[3]. R.Galvin, G. Brathen, A. Ivashynka, M. Hillbom, R. Tanasescu, and M. A. Leone "EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy" European Journal of Neurology, vol.17,no.12,pp.1408-1418,2010. https://doi.org/10.1111/j.1468-1331.2010.03153.x
[4]. G. Sechi and A. Serra, "Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management," The Lancet Neurology, vol.6, no.5,pp.442-455,2007. https://doi.org/10.1016/s1474-4422(07)70104-7
[5]. G. Chiossi, I. Neri, M. Cavazzuti, G. Basso, and F. Facchinetti, " Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report and review of literature,"Obstetrical and Gynecological Survey,vol.61,no.4,pp.255-268,2006. https://doi.org/10.1097/01.ogx.0000206336.08794.65

Abstract: Objectives: To study the efficacy and safety of laser photocoagulation in patients with diabetic retinopathy. Place and Duration of Study: This study was conducted at Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India from May 2019 to June 2020 for a period of 14 months. Study design: Prospective cross-sectional type of study. Materials and Methods: A clinical study to assess the efficacy and safety of laser photocoagulation in patients of diabetic retinopathy in Department of Ophthalmology, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh From May 2019 to June 2020. A total 100 patients fulfilled the inclusion criteria. Out of which 94 patients were included in the study (6 patients were dropped out). Thus, study was conducted as per declaration of Helsinki 2000 and institutional Ethical Committee as needed......

Key Word: Proliferative Diabetic Retinopathy, pan retinal photocoagulation, central macular thickness, spectral Domain Optical Coherence Tomography.

[1]. Brett J. Rosenblatt, William E Benson, Diabetic retinopathy, chapter 117,Textbook of ophthalmology, 2nd edition, Myron Yanoff, Jay. S. Duker, 879, Philadelphia, Mosby, 2004.
[2]. L'Esperance FA Jr (1989) Ophthalmic lasers, vol 1, 3rd edn. Mosby, St. Louis.
[3]. Karlin DB (1995) Lasers in ophthalmic surgery. Blackwell Science, Cambridge.
[4]. Archana Seethala1*, Steven Ness2 and Manju Subramanian2. Current Treatments in Diabetic Macular Edema. February 12, 2015; Accepted: April 23, 2015; Published: May 07, 2015.
[5]. Larsen M, Wang M, Sander B. Overnight thickness variation in diabetic macular edema. Invest Ophthalmol Vis Sci. 2005 Jul;46(7):2313-6. PubMed PMID: 15980216.

Abstract: Background: Circadian variation of acute coronary syndrome has been matterof interest for long time in different parts of worldwith variable results. Understanding the time cycle of onset can help in its effective management. Material & Methods:A prospective cross-sectional study conducted at ShahidGangalal National Heart Centre from July 2020 to September 2020. A total of 127 cases of acute coronary syndrome were included. They were interviewed regarding exact time of onset of symptom. It was categorized into 8 groups of 3 hours interval each. Participants were interviewed, examined and investigated for conventional risk factors. Results: Ninety five (74.80%) participants were male. Mean age was 59.07±12.09 years. Among them 40.15% were hypertensive, 31.49% were diabetics, 24.40%were smoker....

Key Word: Acute coronary syndrome, Circadian variation, Morning peak

[1]. Ghous Z, Naseer N, Hassan A. Circadian variation in acute coronary syndromes among patients presenting in a tertiary care hospital in Lahore. ANNALS. 2015;21(4):269-273.
[2]. Gopal M, Boopathy N, Venkatesan R, Jagannathan V. Circadian Variation In Acute Coronary Syndromes. WebmedCentral CARDIOLOGY. 2010;1(9):1-7.
[3]. Cannon CP, McCabe CH, Stone PH, Schactman M, Thompson B, Theroux P, et al. Circadian variation in the onset of unstable angina and non-Q-wave acute myocardial infarction (the TIMI III Registry and TIMI IIIB). Am J Cardiol. 1997;79:253-258.
[4]. Kanth R, Ittaman S, Rezkalla S.Circadian Patterns of ST Elevation Myocardial Infarction in the New Millennium. Clinical Medicine & Research. 2013;11( 2):66-72.
[5]. D'Negri CE, Nicola-Siri L, Vigo DE, Girotti LA,Cardinali DP.Circadian analysis of myocardial infarction incidence in an Argentine and Uruguayan population. BMC Cardiovasc Disorders. 2006;6:1.

Abstract: Background and Aims: Cardiac electrophysiological study (EPS) and Radiofrequency Ablation (RFA) is now a well recognized method for treatment of cardiac arrhythmias. The most common form of arrhythmias which are treated by EPS & RFA includes Paroxysmal supraventricular tachycardia (PSVT), Wolff-Parkinson-White (WPW) syndrome, atrial tachycardia and atrial flutter. Aims and objectives: The aim of our study is to study the profile and immediate outcomes of electrophysiological studies and Radiofrequency ablation procedure in Shahid Gangalal National Heart Centre, Kathmandu, Nepal Materials and Methods: It was a retrospective cross-sectional study. Patient's data were collected from the hospital records. All patients who underwent Electrophysiological study and Radiofrequency ablation (EPS and RFA) from 2018 June to 2020 May were included and their data were analyzed.....

Key Word: Electrophysiological study, PSVT, Radiofrequency ablation, WPW syndrome

[1]. Morady F. Radio-frequency ablation as treatment for cardiac arrhythmias. N Engl J 1999; 340: 534-44 https://doi.org/10.1056/NEJM199902183400707 PMid:10021475
[2]. Tischenko A, Fox DJ, Yee R, Krahn AD, Skanes AC, Gula LJ, Klein GJ. When should we recommend catheter ablation for patients with the Wolff-ParkinsonWhite syndrome? CurrOpinCardiol 2008; 1: 32-7.
[3]. Leather RA, Leitch JW, Klein GJ, Guiraudon GM, Yee R, Kim YH. Radiofrequency catheter ablation of accessory pathways: a learning experience. Am J Cardiol 1991; 68: 1651-5 https://doi.org/10.1016/0002-9149(91)90324-E
[4]. Rajbhandari S, et al. Cardiac EPS and RFA in Nepal :JAIM;jan-jun2012.
[5]. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia: European Heart Journal, Vol41,issue5 feb2020.

Abstract: AIM :- To study the functional outcome of treating diaphyseal fractures both bones forearm withLocking Compression Plates. To analyse the complications of using Locking Compression Plates. To study the duration of union using LCP METHODS :- Over a period of one and a half years starting from August 2013 to July 2015 30 cases of fracture both bones of forearm were included in the study. All cases were treated by open reduction and internal fixation with 3.5mm LCP by a single surgeon. The functional outcome was assessed using "Anderson et al, scoring system'' RESULT :- Using the Anderson et al scoring system 70.4% of the patients had excellent results, 25.9% with satisfactory results and 3.7% non union. Conclusion :- We observed that the 3.5mm LCP, properly applied, is an excellent method for internal fixation of fractures of the forearm bone.

Key Word: Both bones, diaphyseal, LCP

[1]. Shew-Ping Chow,Frankie Leung,Rockwood and Green–Fractures in adults,Radius and ulna shaft fractures.2010;7(31):882-904
[2]. Leung F, Chow SP, A Prospective Randomized trial comparing the limited dynamic compression plate with the point contact fixator for forearm fracture, J bone and joint Surg.Am.2003;85:2343-2348.
[3]. Michael Wagner,General principles for the clinical use of the LCP. Int.J.Care injuried. 2003;(34):S-B31-S-B42.
[4]. C.A.Goldfarb,W.M.Ricci,F.Pull,D.Ray,J.Borrelli Jr,functional outcome of fractures both bones forearm.J.bone and joint Surg.br.2005;87B:374-9.
[5]. Anderson LD,Sisk D,ToomsRE,Park WI,Compression plate fixation in acute diaphyseal fractures of the radius and ulna.J.bone and joint Surg.Am. 1975 Apr;57(3):287-97.

Abstract: Background: The objectives of this study was to evaluate the advantage of pigtail catheter insertion in liver abscess which reduces the morbidity and covid exposure during the procedure. Methods: This is a retrospective study conducted in madras medical college and Rajiv Gandhi government general hospital,Chennai between january 2020 and December 2020 . It included 50 patients who are all diagnosed to have Liver abscess.Thisstudy was conducted during noblecoronavirus pandemic with utmost precautions. Results: All patients undergone pigtail catheter drainage.None of the patients neeeded laparotomy. No post procedure complications were noted .Age group varied from 25 to 50 yrs. Out of 50 patients45 patients were male ,5 patients were female. Conclusion: The study concludes drainage of liver abscess by pigtail drainage reduced the complications associated with open drainage .

Key Word: pigtailcatheter,liverabscess,coronavirus pandemic.

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Abstract: Diabetic retinopathy is one of the common complications of diabetes. In many cases the patient is not aware of any symptoms until it is too late for effective treatment. Through fundoscopy, early diagnosis of diabetic retinopathy and prognosis during the treatment process can be known. Diabetic retinopathy (DR) is a micro-vascular complication of diabetes affecting nearly all persons with a duration of diabetes of ≥15 years; and is the most common cause of blindness in the working-age adult population in developed countries. Vision loss results mainly from macular oedema, macular capillary non-perfusion, vitreous haemorrhage, and tractional retinal detachment. Timely and appropriate care at early stages of DR can significantly reduce visual loss over time, improve patients' quality of life, and reduce the financial burden associated with the complications of visual impairment......

Key Word: Diabetic retinopathy, Complication, Hypertension

[1]. Vemparala R, Gupta P. National Programme for control of blindness (NPCB) in the 12th five year plan: an overview. DJO 2017;27:290–2.
[2]. Vision 2020 India, 2008. Guidelines for the comprehensive management of Dr in India. Available: https://www. iapb. org/ wpcontent/ uploads/ Guidelines- for- the- Comprehensive- Managementof- DR- in- India. pdf [Accessed 10 Jun 2018]. [3]. Gadkari SS, Maskati QB, Nayak BK. Prevalence of diabetic retinopathy in India: The all India ophthalmological society diabetic retinopathy eye screening study 2014. Indian journal of ophthalmology. 2016 Jan;64(1):38.
[4]. Jonas JB, Nangia V, Khare A, et al. Prevalence and associated factors of diabetic retinopathy in rural central India. Diabetes Care 2013;36:e69.
[5]. Raman R, Rani PK, ReddiRachepalle S, et al. Prevalence of diabetic retinopathy in India: SankaraNethralaya Diabetic Retinopathy Epidemiology and molecular Genetics study report 2. Ophthalmology 2009;116:311–8.