Impact of age-related macular degeneration on diabetic retinopathy: An electronic health record based big data analysis from a tertiary eye centre in South India

Purpose:To determine whether the presence of age-related macular degeneration (AMD) decreases the risk of diabetic retinopathy.Methods:This was a retrospective, case-cohort study performed in patients with a systemic diagnosis of diabetes at a tertiary health care center from May 2011 to April 2020. A total of 43,153 patients (1,024 AMD patients and 42,129 non-AMD patients) were included in the analysis. A total of 1,024 age and diabetes mellitus (DM) duration-matched controls were chosen from the non-AMD group for risk factor analysis. The severity of diabetic retinopathy was compared between the patients with AMD and the patients without AMD.Results:Out of the enrolled 43,153 diabetic patients, 26,906 were males and 16,247 were females. A total of 1,024 patients had AMD and 42,129 had no AMD. The mean age of the cohort was 58.60 ± 0.09 years. The overall prevalence of DR was noted to be 22.8% (9,825 out of 43,153 eyes). A significantly lower prevalence of diabetic retinopathy (DR) (23% in non-AMD, 11.4% in AMD, OR = −0.43, P < 0.001), non-proliferative diabetic retinopathy (NPDR) (12% in non-AMD, 8.2% in AMD, OR = −0.66, P < 0.001), and proliferative diabetic retinopathy (PDR) (11% in non-AMD, 3.2% in AMD, OR = −0.27, P < 0.001) was seen in the AMD patients. No significant difference was seen between the dry and wet AMD. On multivariate logistic regression analysis, the lower age, absence of AMD, and male gender were associated with a higher risk of PDR.Conclusion:The presence of AMD was noted to statistically reduce the risk of DR. Our results may be useful in the field of resource allocation and awareness of DR.     

Einflu? des vergetativen Nervensystems auf die Darmmikroflora

Zusammenfassung Zur Erkl?rung der Tatsache des Einflusses der R?ntgentherapie auf den Zustand der Darmmikroflora hatNemenow eine Hypothese vorgeschlagen, nach der die Ver?nderungen der Mikroflora nicht durch die unmittelbare Wirkung der R?ntgenstrahlen auf die Mikroflora erzeugt werden, sondern die Folge ihrer Einwirkung auf das vegetative Nervensystem seien. Im Zusammenhange damit warfen wir die allgemeine Frage über die M?glichkeit der Beeinflussung der Mikroflora auf das vegetative Nervensystem auf. Bei 65 Katzen untersuchten wir die Darmmikroflora vor und nach der Reizung des vegetativen Nervensystems. Zu diesem Zwecke wurden die Katzen dezerebriert, bei ihnen die Bauchh?hle er?ffnet und die Mikroflora des Dick- und Dünndarmes sowohl vor als auch nach der Pilocarpineinführung erforscht. Da wir dabei schroffe Ver?nderungen feststellten, führten wir um den Einflu? der Peristaltik auszuschlie?en, die Unterbindung verschiedener Darmabschnitte aus. Auf Grund dieser Versuche halten wir die Tatsache für festgestellt, da? das vegetative Nervensystem die Darmmikroflora beeinflusse. Was die Frage über den Mechanismus dieses Einflusses anbelangt, so kommen wir nur durch Ausschlu? anderer M?glichkeiten zu dem Ergebnis, da? unter dem Einflusse des vegetativen Nervensystems sich der Zustand der Darmmucosa ver?ndert und auf Mikroflora einwirkende Produkte ausgeschieden werden.     

Patient reported outcome measures in septorhinoplasty surgery

IntroductionSurgical procedures incorporating a cosmetic element such as septorhinoplasty and otoplasty are currently under threat in the National Health Service (NHS) as they are deemed to be procedures of ‘limited clinical benefit’ by many primary care providers. Patient reported outcome measures (PROMs), which assess the quality of care delivered from the patients’ perspective, are becoming increasingly important in documenting the effectiveness of such procedures.MethodsThe Rhinoplasty Outcomes Evaluation (ROE) questionnaire, a validated PROM tool, was used to assess patient satisfaction in 141 patients undergoing septorhinoplasty surgery over a 90-month period at the University Hospital Southampton NHS Foundation Trust.ResultsOverall, 100 patients with a mean follow-up period of 36 months completed the study. The mean ROE score was 73.3%. In addition, 75% of patients questioned were happy with the final result of their operation and 83% would undergo the procedure again if required. These benefits occurred irrespective of age, sex and primary versus revision surgery, and were maintained for up to 71 months following surgery.ConclusionsThis study has shown that patients are generally satisfied with their functional and cosmetic outcomes following septorhinoplasty surgery. These results help support the case for septorhinoplasty surgery to continue being funded as an NHS procedure.     

Nodding syndrome: origins and natural history of a longstanding epileptic disorder in sub-Saharan Africa

Background

Repetitive involuntary head nodding was first reported in the 1960s in the Wapogoro tribe of Tanzania.

Objectives

We describe the natural history of head nodding in the Wapogoro tribe, with special reference to the earliest reported dates of onset.

Methods

We analyzed clinical data from 150 historical patients seen between 1960 and 1971.

Results

Head nodding with or without grand mal convulsions was present in 33/150 (∼20%) cases, was mostly familial and equally distributed by gender. Age at onset of head nodding ranged from 2–22 years (mean: ∼10 years) in the period 1934–1962. Head nodding preceded onset of grand mal convulsions by up to 12 months, and motor and psychomotor deficits indicative of brain damage developed with time. Fourteen of the 33 cases died at 13–39 years of age (mean: ∼20 years) while nineteen aged 16–28 years (mean: ∼16 years) were still alive.

Conclusion

Historical accounts of head nodding (amesinzia kichwa, Swahili) among the Wapogoro tribe fit the August 2012 World Health Organization (WHO) case definition of probable Nodding Syndrome. Reported to have existed in this population for at least 80 years, Nodding Syndrome is a progressive seizure disorder that leads to generalized convulsions (kifafa), brain damage and death.     

MM:12008 Fred P. Sage Award WinnerHome exercise therapy program for pediatric brachial plexus palsy

Patient Program Participants and Their Families High Point School, Washtenaw Intermediate School District; Faculty and Staff of the University of Michigan Brachial Plexus Program; Evolution Media Funding generously provided by: Carls Foundation FRIENDS of the University of Michigan Hospitals.     

Evaluation of vitreous substitutes in managing complicated vitreo-retinal surgeries

Background: Vitreous substitutes presently in use for intraoperative tamponade are perfluorocarbon liquids (PFCL) and for post operative tamponade are silicon oil (SO), sulphur hexafluoride (SF₆) and perfluorocarbon gas (PFC). Several factors are important for a thorough understanding of each of these vitreous substitutes. The absorption or necessity for removal, indications for use (including clinical studies and special surgical methods), additives and complications of use have to be considered.