Causes of severe visual impairment in infants and methods of management

ObjectivesTo examine the causes of severe visual impairment (SVI) in infants below the age of 2 years and to review management methods.MethodsThe data of 2657 patients followed between January 2014 and July 2019 were reviewed, and 148 (5.6%) infants who had SVI were enrolled. Data including age, gender, affected anatomical site, diagnosis, presence of any non-ophthalmological deficiencies, and methods of management were reviewed. The diagnoses were investigated in the categories of avoidable and unavoidable basis. The methods of management were analysed from the perspective of low vision habilitation.ResultsThe mean age at first eye examination was 6.61 ± 5.25 months, and 84 (56.7%) infants were male. Of the 148 infants, 69 (46.6%) were premature. Cerebral visual impairment (CVI) was the most common diagnosis in both preterm (39.1%) and term (11.4%) infants. Delayed visual maturation, optic nerve pathologies, oculocutaneous albinism, and congenital cataract were the other frequent causes. The rate of multiple disabilities was 30% in the whole group and 94% in infants with CVI. Most of the babies had a normal-appearing globe (43.3%). Retina was affected in 23.7% of the infants. Avoidable causes were identified in 79.7% of the infants. The used methods of management were optic interventions, visual stimulation therapy, medical and/or surgical treatment.ConclusionsCVI was found the most common cause of SVI in both preterm and term-born infants, and the higher rate of multiple disabilities in these infants was remarkable. Optic interventions and visual stimulation therapy were the most common methods of management.Subject terms: Epidemiology, Vision disorders, Epidemiology, Paediatrics     

Impact of the Training on the Compliance and Persistence of Weekly Bisphosphonate Treatment in Postmenopausal Osteoporosis: A Randomized Controlled Study

Long-term patient adherence to osteoporosis treatment is poor despite proven efficacy. In this study, we aimed to assess the impact of active patient training on treatment compliance and persistence in patients with postmenopausal osteoporosis. In the present national, multicenter, randomized controlled study, postmenopausal osteoporosis patients (45-75 years) who were on weekly bisphosphonate treatment were randomized to active training (AT) and passive training (PT) groups and followed-up by 4 visits after the initial visit at 3 months interval during 12 months of the treatment. Both groups received a bisphosphonate usage guide and osteoporosis training booklets. Additionally, AT group received four phone calls (at 2^nd, 5^th, 8^th, and 11^th months) and participated to four interactive social/training meetings held in groups of 10 patients (at 3^rd, 6^th, 9^th, and 12^th months). The primary evaluation criteria were self-reported persistence and compliance to the treatment and the secondary evaluation criteria was quality life of the patients assessed by 41-item Quality of Life European Foundation for Osteoporosis (QUALEFFO-41) questionnaire.. Of 448 patients (mean age 62.4±7.7 years), 226 were randomized to AT group and 222 were randomized to PT group. Among the study visits, the most common reason for not receiving treatment regularly was forgetfulness (54.9% for visit 2, 44.3% for visit 3, 51.6% for visit 4, and 43.8% for visit 5), the majority of the patients always used their drugs regularly on recommended days and dosages (63.8% for visit 2, 60.9% for visit 3, 72.1% for visit 4, and 70.8% for visit 5), and most of the patients were highly satisfied with the treatment (63.4% for visit 2, 68.9% for visit 3, 72.4% for visit 4, and 65.2% for visit 5) and wanted to continue to the treatment (96.5% for visit 2, 96.5% for visit 3, 96.9% for visit 4, and 94.4% for visit 5). QUALEFFO scores of the patients in visit 1 significantly improved in visit 5 (37.7±25.4 vs. 34.0±14.6, p<0.001); however, the difference was not significant between AT and PT groups both in visit 1 and visit 5. In conclusion, in addition to active training, passive training provided at the 1^st visit did not improve the persistence and compliance of the patients for bisphosphonate treatment.     

羟乙基淀粉溶液对猪小肠移植缺血再灌注损伤的保护作用

目的 探讨羟乙基淀粉溶液做为器官灌洗液对猪小肠移植缺血再灌注损伤的保护机制。方法 建立同种异体猪原位节段性小肠移植模型。对照组和实验组分别采用0．9％生理盐水（n=6）和3％羟乙基淀粉氯化钠溶液（n=6）灌洗,移植小肠（截取供体约500cm小肠）保存于4℃0．9％生理盐水2h。分别于移植前30mim和再灌注后30min采取肠液和血清,检测ALT、CK、LDH的变化;测定再灌注后肠液分泌量;检测血清肿瘤坏死因子-α（TNF—α）、白细胞介素-1（IL-1）、IL-6的含量。同时取移植小肠行病理学检查。结果 再灌注30min后,实验组肠液分泌量明显少于对照组（P〈0．05）,两组肠液中CK水平较术前明显增加（P〈0．05）,实验组肠液中CK水平明显低于对照组（P〈0．01）;对照组再灌注30min后血清TNF—d、IL-6、IL-1的含量较术前明显增加（P〈0．05）,实验组与术前无明显变化（P〉0．05）;两组再灌注30min后肠液和血清ALT、LDH的水平与术前无明显变化（P〉0．05）;对照组血清中CK明显低于实验组（P〈0．05）;实验组肠黏膜的组织损伤程度较对照组减轻。结论 3％羟乙基淀粉氯化钠溶液可能通过抑制TNF—d、IL-6、IL-1水平,阻止毛细血管渗漏,减轻细胞水肿,防止肠缺血再灌注损伤,再灌注后肠液分泌量及肠液CK水平可用来判定肠组织损伤程度。     

Transoesophageal needle aspiration using a convex probe ultrasonic bronchoscope

Background and objective:   Although endoscopic ultrasound-guided fine needle aspiration can be helpful when combined with bronchoscopic procedures, endoscopic ultrasound-guided fine needle aspiration is not available as a conjunctive procedure with bronchoscopy at many institutions. This study evaluated the feasibility and the additional role of transoesophageal fine needle aspiration using a convex probe ultrasonic bronchoscope (EUS-B-FNA).
Methods:   We analysed 84 patients who underwent EUS-B-FNA between Oct 2007 and May 2008. Bronchoscopy and/or endobronchial ultrasound-guided transbronchial needle aspiration was performed on 83 patients prior to EUS-B-FNA.
Results:   EUS-B-FNA was performed on 89 lesions (1.7 aspirations/lesion) including three lung masses and 86 lymph nodes (nodal stations 1, 3P, 4L, 5, 7, 8, 9 and 10L) without complication. Sample adequacy was 95.4% for each aspiration and 100% for each lesion. Of the 89 lesions, 39 malignant lesions were confirmed by EUS-B-FNA. EUS-B-FNA provided additional diagnostic gain to bronchoscopic procedures in 16 patients (19.0%): 3 lung cancers were upstaged, 11 lung cancers were pathologically confirmed, and 2 patients were diagnosed with mediastinal metastasis from an extrathoracic malignancy. This gain was obtained by the sampling of inaccessible ( n  = 4) or difficult lesions by endobronchial ultrasound-guided transbronchial needle aspiration ( n  = 2) or when bronchoscopy was difficult due to dyspnoea, cough, brain metastasis or other conditions ( n  = 10).
Conclusions:   EUS-B-FNA is a technically feasible and safe procedure, which may be an alternative to endoscopic ultrasound-guided fine needle aspiration as a procedure that complements bronchoscopy. Additional diagnostic yield can be obtained by combining EUS-B-FNA with bronchoscopic procedures.     

Exercise-induced pulmonary arterial hypertension in patients with systemic sclerosis

INTRODUCTION: Pulmonary arterial hypertension (PAH) is the most common cause of scleroderma-related deaths. New medications for PAH patients make it necessary to identify patients with high risk factors for PAH. This study looks at the use of an exercise echocardiogram in identifying patients who may have PAH and may be candidates for early therapeutic intervention. METHODS: This study included 54 scleroderma patients with symptoms suggesting they were at risk for pulmonary hypertension, including dyspnea on exertion, diffusing capacity of the lung for carbon monoxide (Dlco)<60% of predicted, FVC<70% of predicted, percentage of predicted FVC/percentage of predicted Dlco (FVC%/Dlco%) ratio>1.6, or resting right ventricular systolic pressure (RVSP)>35 mm Hg. The exercise echocardiogram protocol involved the standard Bruce stress echocardiogram protocol with remeasurement of the RVSP within 1 min of stopping exercise. A positive exercise test result was defined as an increase of at least 20 mm Hg in the RVSP with exercise. Right-heart catheterization with exercise was performed in those with a positive exercise test result. RESULTS: Resting mean RVSP was 34.5 mm Hg, which increased to 51.4 mm Hg with exercise; 44% had at a positive exercise test result, which correlated with a low Dlco, high FVC%/Dlco% ratio (p<0.001), a positive anti-centromere antibody, and RVSP>35 mm Hg (p<0.05). PAH was confirmed by right-heart catheterization in 81% of patients: 19% at rest and 62% of patients with exercise. CONCLUSIONS: Exercise-induced pulmonary hypertension is a common finding in patients at high risk for PAH. This may be a sensitive way to identify patients with early PAH. Long-term follow-up and early treatment should be studied in these patients.     

Comparison of non-cycloplegic photorefraction, cycloplegic photorefraction and cycloplegic retinoscopy in children

AIM: To compare the results of noncycloplegic photorefraction, cycloplegic photorefraction and cycloplegic refraction in preschool and non-verbal children. METHODS: One hundred and ninety-six eyes of 98 children (50 females, 48 males) were included in the study. Firstly, non-cycloplegic photorefraction was achieved with Plusoptix A09; secondly, cycloplegic photorefraction was carried out with Plusoptix A09 after 10 min cyclopentolate. Finally, 30min after instillation of twice cyclopentolate, cycloplegic refraction was obtained with autorefraction and/or standard retinoscopy. Spheric equivalent, spheric power, cylindric power and cylindrical axis measurements were statistically compared. RESULTS: The mean age was 28.8±18.5mo (range 12-72mo). The differences in spherical equivalent, spheric power and cylindrical power measured by the three methods were found statistically significant (P<0.05). The spherical equivalent and spheric power measured by cycloplegic photorefraction were statistically higher than the measurements of the other methods (P<0.05). The cylindrical power measured by cycloplegic refraction was statistically lower than the measurements of the photorefraction methods (P<0.05). There was no significant difference in cylindrical axis measurements between three methods (P>0.05). CONCLUSION: For the determination of refractive errors in children, the Plusoptix A09 measurements give incorrect results after instillation of cyclopentolate. Additionally, the cylindrical power measured by Plusoptix A09 with or without cycloplegia is higher. However, the non-cycloplegic Plusoptix A09 measures spheric equivalent and spheric power similar to cycloplegic refraction measurements in preschool and non-verbal children.     

Late Tourniquet Release and Drain Clamping Reduces Postoperative Blood Loss in Total Knee Arthroplasty

Background

Many studies have investigated the effect of tourniquet release time and closed suction drainage in total knee arthroplasty (TKA). However, controversy remains as to the advisability of preclosure tourniquet release and the advisability of closed suction drain use following total knee arthroplasty.

Questions/Purposes

The aim of the study was to investigate if there is a benefit of performing tourniquet release after skin closure, along with drain clamping, for the first 6h following TKA.

Methods

Ninety-six patients underwent TKA between May 2009 and April 2010. Fourteen of these were excluded because of systemic diseases and simultaneous bilateral TKA. Twenty-nine of these were excluded due to use of a patellar component and posterior cruciate ligament (PCL)-sacrificing systems. Thus, 53 patients that underwent PCL-retaining cemented TKA were reviewed retrospectively. In the control group (group C), the tourniquet was released before skin closure, an attempt at hemostasis was made, and a compressive bandage was applied. The drain was not clamped in these patients. The test group of 23 patients (group T) had tourniquet release after skin closure and after the compressive bandage was applied. The drain was clamped for the first 6h after surgery. The two groups were compared as to the amount of drained blood, postoperative change in hemoglobin, postoperative complications, and knee function.

Results

We found that drained blood and hemoglobin drop were significantly lower in group T compared with group C. There was no difference regarding postoperative complications and knee function.

Conclusion

We conclude that tourniquet release after skin closure and compressive dressing followed by 6h of drain clamping reduces postoperative blood loss in TKR surgery.     

The short-term and long-term adverse ocular effects of fesoterodine fumarate

Aim: To evaluate the short-term and long-term effects of fesoterodine fumarate treatment which is used for overactive bladder (OAB) on pupil diameter (PD), intraocular pressure (IOP) and accommodation amplitude (AA).

Method: Ophthalmic examination was performed before and after receiving medication (on the 30th and 90th day) on 120 eyes of 120 women whom were planned to begin anticholinergic treatment (fesoterodine fumarate, 4?mg/day, peroral) for OAB, prospectively. The changes in PD, IOP and AA were analyzed statistically.

Results: The mean age of 120 women was 52.06?±?9.39 years (30–70 years). The mean PD, IOP and AA values were 4.12?±?0.61?mm (3.00–5.70?mm), 15.58?±?1.74?mmHg (11–20?mmHg) 2.28?±?1.26?Diopter (D) (0.50–5.50?D) at baseline; 4.68?±?0.65?mm (3.20–5.80?mm), 16.11?± 1.72?mmHg (11–20?mmHg), 1.68?±?1.04?D (0.25–4.50?D) at 30th day; and 4.28?±?0.58?mm (3.10–5.70?mm), 16.09?±?1.96?mmHg (11–19?mmHg), 2.18?±?1.19?D (0.50–5.00?D) at 90th day, respectively. Although increases in PD values and decreases in AA values were statistically significant (p?<?0.001 for each), the changes in IOP values were not as such (p?=?0.642). Visual complaint was not observed in any patient.

Discussion: The newest anticholinergic medication in women with OAB increased the PD and decreased the AA statistically significantly. Clinically, it seems to be well-tolerated by the patient.