Quality of care, maternal attitude and common physician practices across the socio-economic spectrum: a community survey

Purpose  

To evaluate the quality of maternity care, women’s perception of the quality of care and factors influencing the same in Delhi.     

The impact of caregiver post‐traumatic stress and depressive symptoms on pediatric transplant outcomes

PTSS as well as symptoms of depression have been reported in children who experience a serious medical adversity as well as their caretakers. The adverse effects of PTSS, when experienced by the patients, on medical outcomes have been clearly documented. However, the impact of those symptoms, if any, when experienced by the caretakers on child outcomes has not been investigated prospectively. We evaluated whether caregiver PTSS and depression symptoms predict adherence to medications and medical outcomes in a prospective multisite study. Four hundred children participated in MALT. Caretaker PTSS were assessed by the IES and depressive symptoms by CES‐D. During 2 years of follow‐up, the MLVI was used to determine adherence. Centrally read, biopsy‐confirmed organ rejection was the primary medical outcome. IES scores were not associated with either adherence or rejection outcomes. In contrast, there were significant correlations between CES‐D (depression) scores and lower adherence, r = .13, P < .001, and a trend toward higher scores on the CES‐D among those whose children had experienced rejection, 12.4 (SD = 10.9) versus 9.1 (SD = 8.6), P = .077. Caregivers' PTSS were not a risk factor for poor child outcomes in this cohort, whereas depression symptoms were associated with non‐adherence and possibly increased rates of rejection. Further study can validate if caregivers' depression as opposed to PTSS confers greater risk and should be a focus during the clinical care of medically ill children.     

Orbital apex syndrome secondary to myocysticercosis: a rare case report

AIM: To compare surgical outcomes of phacoemulsification combined with glaucoma surgical techniques performed with either Kahook Dual Blade (KDB) or iStent for Japanese patients with either primary open-angle glaucoma or exfoliation glaucoma.METHODS: We retrospectively evaluated the surgical outcomes of 129 eyes of 84 Japanese patients with glaucoma who underwent KDB or 44 eyes of 34 patients who underwent phacoemulsification with iStent procedures combined with cataract surgery. The primary outcome was surgical success or failure [with surgical failure being indicated by <20% reduction from preoperative intraocular pressure (IOP) or IOP >18 mm Hg, criterion A; IOP >14 mm Hg, criterion B; or reoperation requirement]. In addition, we assessed the number of postoperative glaucoma medications and the resulting complications. RESULTS: The probability of success was significantly higher in the KDB group than in the iStent group for criterion A (60.2% vs 46.4%, P=0.019). In the KDB group, the mean preoperative IOP of 19.7±7.2 mm Hg decreased significantly to 13.0±3.1 mm Hg (P<0.01), and the mean number of glaucoma medications at 2.5±1.4 decreased significantly to 1.6±1.6 (P<0.01) 12mo postoperatively. In the iStent group, the mean preoperative IOP of 17.8±2.9 mm Hg significantly decreased to 14.3±2.3 mm Hg (P<0.01), and the mean number of glaucoma medications at 2.2±1.1 decreased significantly to 0.9±1.4 (P<0.01) 12mo postoperatively. The overall IOP reduction percentage was higher in the KDB group (26.2%) than in the iStent group (19.0%) 12mo postoperatively (P=0.03). Hyphema occurred significantly more frequently in the KDB group (16.3%) than in the iStent group (2.3%; P=0.017).CONCLUSION: KDB and iStent procedures combine with cataract surgery both resulted in significant IOP and glaucoma medication reductions after the 12-month follow-up. The patients in the KDB group have a higher success rate for the target IOP of less than 18 mm Hg and a higher complication rate than those in the iStent group.