Visual loss with inner retinal dysfunction, after snake bite: two case reports

Purpose

To report two cases of visual loss following snake bite.

Method

Retrospective review of medical records including history, examination finding, fundus details and investigation reports (visual field, electroretinogram, visual evoked potential and optical coherence tomogram) at two centers.

Result

Two cases of snake bite presented to us with reduction of vision at 1 and 3 months after the incident. The subnormal b wave and abnormal pattern electroretinography in one case pointed at inner retinal dysfunction and neurotoxicity as the cause of visual loss in an apparently normal-looking fundus. The electronegative b wave in the other gave us a clue that the optic atrophy was consecutive (secondary to inner retinal dysfunction due to central retinal artery occlusion).

Conclusion

When presented late, diagnosis of visual loss secondary to snake bite becomes difficult and puzzling due to the absence of classical findings. Electrophysiological tests in such cases give us important clue to reach at a definite diagnosis.     

Sperm preparation: DNA damage by comet assay in normo- and teratozoospermics

The present study was carried out on semen samples of human fertile and infertile subjects, teratozoospermics (TZs) and idiopathics (IDs), with neat semen and sperm prepared by swim up or Percoll density gradient centrifugation procedures. Sperm morphology analysis revealed that only head and midpiece defects in TZs and IDs were significantly (P < 0.001) higher compared to fertile subjects. Infertile subjects indicated significantly higher (P < 0.001) sperm DNA damage compared to fertile subjects. Fertile subjects with sperm prepared from neat and Percoll density gradient centrifugation exhibited a comet tail DNA percentage of 20% and 15%, respectively. The TZs and IDs infertile subjects had higher levels of comet tail DNA of 33% and 25% and 25% and 19%, respectively. A significant (F = 24.01; P = 0.0059) decrease in mean comet head DNA percentage or sperm DNA integrity was observed in neat samples from fertile and infertile subjects by Repeated Measures ANOVA. In Percoll prepared samples from fertile, TZs, and IDs, there was a significant increase in sperm DNA integrity. Similarily, there was a decrease in abnormal sperm morphology in swim up and Percoll prepared sperm compared to neat samples. The Percoll density gradient centrifugation procedure yields sperm with an increase in sperm DNA integrity relative to swim up. Sperm DNA damage of TZs with both sperm preparation methods was significantly (P < 0.01) higher when compared to fertile and IDs. But the level of DNA damage was higher in IDs compared to fertile subjects. Compared to the other methods tested, the Percoll method yielded sperm with improved DNA integrity. In conjunction with semen analysis, the assessment of nuclear integrity improves the characterization of the semen sample and may be used as a tool for allocating the patients to specific assisted reproductive treatments.     

Evaluation of 'partnership care model' in the control of hypertension

One of the shared common goals of World Hypertension League (WHL) and World Health Organization (WHO) is the control of hypertension. Despite many local and international interventions, the goal has not been achieved. This study evaluated an intervention based on the partnership care model to control hypertension in a rural population in the north of Iran. The results showed that the intervention was effective in decreasing systolic and diastolic blood pressure and in increasing the rate of controlled hypertensives (based on criteria of WHO/WHL). The intervention also had positive effects on health-related quality of life, body mass index, anxiety, high density lipoprotein level and compliance score. Based on these results, the partnership care model is effective in hypertension control and is recommended as a model to replace previous approaches in hypertension control.     

FDG PET during radiochemotherapy is predictive of outcome at 1 year in non-small-cell lung cancer patients: a prospective multicentre study (RTEP2)

Purpose

To assess prospectively the prognostic value of FDG PET/CT during curative-intent radiotherapy (RT) with or without concomitant chemotherapy in patients with non-small-cell lung cancer (NSCLC).

Methods

Patients with histological proof of invasive localized NSCLC and evaluable tumour, and who were candidates for curative-intent radiochemotherapy (RCT) or RT were preincluded after providing written informed consent. Definitive inclusion was conditional upon significant FDG uptake before RT (PET₁). All included patients had a FDG PET/CT scan during RT (PET₂, mean dose 43 Gy) and were evaluated by FDG PET/CT at 3 months and 1 year after RT. The main endpoint was death (from whatever cause) or tumour progression at 1 year.

Results

Of 77 patients preincluded, 52 were evaluable. Among the evaluable patients, 77 % received RT with induction chemotherapy and 73 % RT with concomitant chemotherapy. At 1 year, 40 patients (77 %) had died or had tumour progression. No statistically significant association was found between stage (IIIB vs. other), histology (squamous cell carcinoma vs. other), induction or concomitant chemotherapy, and death/tumour progression at 1 year. The SUV_max in the PET₂ scan was the single variable predictive of death or tumour progression at 1 year (odds ratio 1.97, 95 % CI 1.25 – 3.09, p?=?0.003) in multivariate analysis. The area under the receiver operating characteristic curve was 0.85 (95 % CI 0.73 – 0.94, p?<?10^?4). A SUV_max value of 5.3 in the PET₂ scan yielded a sensitivity of 70 % and a specificity of 92 % for predicting tumour progression or death at 1 year.

Conclusion

This prospective multicentre study demonstrated the prognostic value in terms of disease-free survival of SUV_max assessed during the 5th week of curative-intent RT or RCT in NSCLC patients (NCT01261598; RTEP2 study).     

Impact of the day-30 screening strategy on the disease presentation and outcome of retinopathy of prematurity. The Indian twin cities retinopathy of prematurity report number 3

Context:

Outcomes of various screening strategies in retinopathy of prematurity are not well reported.

Aim:

To assess the impact of a city-wide, ROP screening strategy, on the disease presentation and treatment outcome.

Materials and Methods:

A retrospective case-control study from a prospectively collected ROP data-base was analyzed. Cases (group 1a) included ROP babies that were screened directly in neonatal intensive care units, and controls (group 1b) were babies referred directly to the institute from other neonatal centers during the same period. Historical controls (group 2) were ROP cases seen in the years preceding establishment of this ROP program and database. Primary outcome measure was the risk of eyes presenting with stage 4 or worse ROP, and main secondary outcome measure was the final anatomic outcome.

Results:

Of the 643 cases screened, 322 eyes of 161 babies had ROP. The median age of 7.19 months at presentation for the 46 patients (92 eyes) in group 2 was higher than the median age of 1.29 months for the 115 patients (230 eyes) in group 1. Within the group 1, group 1a had lower median age at presentation than group 1b (0.91 months versus 2.30 months). The relative risk of an eye presenting in the stage 4 and 5 in group 2 was 4.7 times higher (95% confidence interval 3.07 -7.32) than in group 1. Eyes that could be given treatment in group 2 were significantly less (P < 0.0005) than in group 1. The relative risk of poor outcome in group 2 was 3.83 times higher (95% confidence interval 2.75 -5.34) than in group 1. Group 1a eyes had the best outcomes.

Conclusion:

Early screening before one month of age in neonatal centers detects the disease early where prompt treatment can lead to favorable outcomes. The study provides early results of a model strategy for ROP screening.     

Acute generalized exanthematous pustulosis due to thallium

Acute generalized exanthematous pustulosis (AGEP) is characterized clinically by fever, pruritus and acute pustular eruption. Usually a drug is found to be the responsible agent. We present a patient who experienced an acute generalized exanthematous pustulosis due to radioactive thallium. The eruption cleared rapidly after discontinuation of the drug and systemic corticosteroid therapy.     

Prevalence and factors associated with pressure injury in patients undergoing open heart surgery: A systematic review and meta-analysis

Pressure injuries (PIs) are one of the major and costliest medical problems with severe implications for patients. Cardiovascular surgery patients are at the higher risk of developing surgery-related PIs. So this study was conducted with the aim of investigating the prevalence and factors associated with PIs in patients undergoing open heart surgery. We identified articles through electronic databases such as Web of Science, Scopus, PubMed, ProQuest; and Persian Databases: SID, Magiran and Irandoc without restriction on language or publication period (from inception through June 2022). Finally, 17 studies that fulfilled eligibility criteria were included in final systematic review and meta-analysis. Data analyses were conducted using STATA version 14. The pooled prevalence of PI in patients undergoing open heart surgery was 24.06% (95% CI: 17.85–30.27). High heterogeneity was observed across the included studies (I² = 96.0, P < 0.000). The prevalence by gender was reported as 25.19% (95% CI: 13.45–36.93) in men and 33.36% (95 CI%: 19.99–46.74) in women. The result showed there was statistically significant association between PI and Female sex (Pooled Est: 1.551, 95% CI: 1.199–2.006, z = 3.345, P = 0.001), diabetes (Pooled Est: 1.985, 95% CI: 1.383–2.849, z = 3.719, P = 0.000), advanced age (SMD: 0.33 years; 95% CI: 0.09–0.57), Duration of surgery (SMD: 0.47; 95% CI: 0.19–0.75) and preoperative serum albumin level (SMD: 0.56; 95% CI: 0.14–0.98). The relatively high PIs incidence among patients undergoing open heart surgery suggests that typical PI prevention methods are insufficient for this population. Targeted prevention measures must be developed and implemented.     

The genetics of tethered cord syndrome

We describe three patients with Malpuech syndrome from two families. Previously, 10 patients from 6 families have been reported. Consanguinity in two families suggests autosomal recessive inheritance. Growth retardation, mental retardation, cleft lip, and/or palate, hypertelorism, urogenital abnormalities, and caudal appendage are the key features. Although the spectrum of the features in the reported patients is variable, we do think this syndrome represents a distinct entity. Chromosomal anomalies should be carefully searched for. We discuss differential diagnosis and possible candidate genes and propose diagnostic criteria for Malpuech syndrome.