Long term outcomes of bilateral congenital and developmental cataracts operated in Maharashtra,India. Miraj pediatric cataract study III

Aim:

To study long term outcome of bilateral congenital and developmental cataract surgery.

Subjects:

258 pediatric cataract operated eyes of 129 children.

Materials and Methods:

Children who underwent pediatric cataract surgery in 2004-8 were traced and examined prospectively in 2010-11. Demographic and clinical factors were noted from retrospective chart readings. All children underwent visual acuity estimation and comprehensive ocular examination in a standardized manner. L. V. Prasad Child Vision Function scores (LVP-CVF) were noted for before and after surgery.

Statistics:

Statistical analysis was done with SPSS version 16 including multi-variate analysis.

Results:

Children aged 9.1 years (std dev 4.6, range 7 weeks-15 years) at the time of surgery. 74/129 (57.4%) were boys. The average duration of follow-up was 4.4 years (stddev 1.6, range 3-8 years). 177 (68.6%) eyes had vision <3/60 before surgery, while 109 (42.2%) had best corrected visual acuity (BCVA) >6/18 and 157 (60.9%) had BCVA >6/60 3-8 years after surgery. 48 (37.2%) had binocular stereoacuity <480 sec of arc by TNO test. Visual outcome depended on type of cataract (P = 0.004), type of cataract surgery (P < 0.001), type of intra-ocular lens (P = 0.05), age at surgery (P = 0.004), absence of post-operative uveitis (P = 0.01) and pre-operative vision (P < 0.001), but did not depend on delay (0.612) between diagnosis and surgery. There was a statistically significant improvement for all the 20 questions of the LVP-CVF scale (P < 0.001).

Conclusion:

Pediatric cataract surgery improved the children''s visual acuity, stereo acuity and vision function. Developmental cataract, use of phacoemulsification, older children and those with better pre-operative vision had betterlong-termoutcomes.     

Self-reported assistive technology outcomes and personal characteristics in college students with less-apparent disabilities

ABSTRACT

The impact of assistive technology (AT) services for college students with less-apparent disabilities is under-reported. Using the Canadian Occupational Performance Measure (COPM), we assessed student Performance and Satisfaction ratings of common academic tasks at the start and end of a semester during which 105 student-clients with less-apparent disabilities received AT services. We examined if COPM scores related to personal characteristics of gender, class-level (e.g., Sophomore), and STEM education; if personal characteristics predicted a student’s follow-through with an AT service referral (n=231); and if personal characteristics and initial COPM scores predicted dropout from AT services (n=187). COPM ratings significantly increased in all academic tasks (p<.001). Gender predicted initial Satisfaction (male ratings > female ratings; p=.01), and Performance changes (females were more likely to have a service-meaningful change; p=.02). Higher class-level predicted better follow-through with a referral for AT services (p=.006). Increasing class-level (p=.05) and higher initial studying (p<.006) and reading (p<.029) ratings predicted a lower likelihood for dropout. These findings demonstrate that college students with less-apparent disabilities experience substantial improvements in their self-ratings of academic performance and satisfaction following AT services. Gender, class-level, and initial self-perceived reading and studying abilities may influence if and how the student participates with AT services.     

Language Barriers as a Reported Cause of Prehospital Care Delay in Minnesota

Objective. Although anecdotal reports exist, the frequency of language barriers encountered between EMS providers andpatients/families in the prehospital environment remains unknown. The purpose of this study was to determine the frequency of EMS provider-reported perceived delays in care due to language barrier andto characterize the nature of calls involved.Methods. Retrospective analysis of the Minnesota State Ambulance Reporting system (MNSTAR) database, a mandated statewide EMS data collection tool. All EMS run reports submitted between January 1, 2004, andJune 30, 2005, were reviewed to identify instances of reported treatment delay secondary to a language barrier.Results. During the 18-month study period, 629,738 patient encounter reports were submitted to MNSTAR, of which 2,052 identified treatment delays secondary to language. The rate of language barrier care delays in the state of Minnesota is 3.3 per 1,000 prehospital patient encounters.Conclusion. EMS responses troubled by delays in care secondary to language barriers represent a small percentage of total runs in Minnesota. However, approximately 1,370 cases per year occur.     

不同顺应性微量注射泵泵用延长管阻塞报警延迟时间的研究

目的提高微量注射泵使用的安全性。方法采用2×3析因设计,用医用三通人为制造阻塞模型,记录不同顺应性微量注射泵泵用延长管在不同泵注速度下的阻塞报警延迟时间,并进行统计分析。结果两种泵用延长管在不同的泵注速度下均存在阻塞报警时间延迟,最短为（414．43±64．67）s,最长为（2770．16±420．20）S;泵速越慢,报警延迟时间越长（P〈0．05）。当泵速为5ml／h和10ml／h时,泵速相同使用软硬管的报警延迟时间差异无统计学意义（P〉0．05）。但当以2ml／h的速度泵注药物时,软管报警延迟时间较硬管长（P〈0．05）。结论护士要正确认识微量注射泵泵注阻塞报警延迟并及时干预处理,合理选择泵用延长管类型,合理调节微量注射泵泵注速度,减少各种阻塞导致的报警延迟,提高微量注射泵使用的安全性,保证病人安全。     

M-banding characterization of a 16p11.2p13.1 tandem duplication in a child with autism, neurodevelopmental delay and dysmorphism

We describe a partial duplication of the chromosome 16 short arm [46,XY,dup(16)(p11.2p13.1)] in an Iranian girl with autism, neurodevelopmental delay, mental retardation, very poor memory, and dysmorphism including sparse hair, upslanting palpebral fissures, long philtrum, micrognathia, hypotonia, small feet and hands, syndactyly of the fingers, and hypoplastic thumbs. The patient now four years old, has a normal twin sister, and the parents are unrelated. The abnormal 16p was originally detected by banding cytogenetic techniques, and was characterized by multicolour banding fluorescence in situ hybridization (MCB). The MCB pattern on the derivative chromosome 16 indicated a direct duplication of the region 16p11.2 to 16p13.1.     

Variability in the secretion of corticotropin-releasing hormone, adrenocorticotropic hormone and cortisol and understandability of the hypothalamic-pituitary-adrenal axis dynamics--a mathematical study based on clinical evidence

Samrat Chatterjee and J. Chattopadhyay Agricultural and Ecological Research Unit, Indian Statistical Institute, 203, B.T. Road, Kolkata 700 108, India Email: nbairagi{at}math.jdvu.ac.in Email: samrat_ct{at}rediffmail.com Corresponding auhor. Email: joydev{at}isical.ac.in Received on September 4, 2006. Revised on October 19, 2007. Accepted on December 13, 2007. In this article, we have developed a simple mathematical modelthat captures the vital mechanisms of the hypothalamic-pituitary-adrenal(HPA) axis self-regulatory activities. For this, a system ofthree-component non-linear delay differential equations hasbeen proposed and analysed to observe the ultradian and circadianvariabilities of the hormone secretion of the HPA axis in normalsubjects. Our analysis reveals that a feedback mechanism issufficient to show the ultradian variability of the hormonesecretion pattern but fails to show the circadian variability.A central nervous system-driven pulse generator coupled withthe primary feedback mechanism can exhibit the ultradian aswell as circadian variability in the hormone secretion of theHPA axis. The model can also predict different dynamics of thenormal HPA axis following physiological changes (viz. adrenalectomyand hypophysectomy) and pathological changes (viz. infusionof different hormones).     

Sleep difficulties in infants at risk for developmental delays: a longitudinal study

Objectives We compared the sleep of infants at risk forneuromotor delays to that of infants without such risks, andexamined the predictive validity of risk indicators to the developmentof sleep problems. Methods Conveniently recruitedinfants (n = 142) were assessed for neuromotor achievementsand sleep behaviors at 4–6 months and 10–12 monthsof age. Assessment tools were the Harris Infant Neuromotor Testand Morrell's Infant Sleep Questionnaire. Based on a cumulativerisk index, three groups were defined: higher risk (n = 28),lower risk (n = 42), and no risk (n = 72). Results Atboth ages, the sleep scores were similar among the groups. Inthe no risk and lower risk group, sleep difficulties decreasedwith age, while for infants in the higher risk group, more difficultieswere reported over time. Overall, the neuromotor attainmentswere not related to sleep fragmentation or settling difficulties. Conclusions Ina diverse sample of infants, with and without risks for developmentaldelays, overall, sleep patterns were similar. It appears thatthe neuromotor achievements are not associated with sleep-wakeregulation, as measured by caregivers’ report.     

IMAGING DIAGNOSIS OF THORACOLUMBAR BURST FRACTURES

Objective To review imaging use in the diagnosis of thoracolumbar burst fractures and to determine the diagnostic value of different imaging methods. Methods One hundred and fourteen patients with 120 thoracolumbar burst fractures were retrospectively reviewed. Plain radiographs were available in all cases; CT scans and MRI were obtained in 96 and 74 cases, respectively. Results A total of 27 burst fractures were misdiagnosed as other types of fractures on radiographs alone, and accounted for 22.5% of all fractures. The results indicated that plain radiographs often fail to delineate the pathological features of thoracolumbar burst fractures, leading to delay in diagnosis. Conclusion In regard to thoracolumbar injury diagnosis, burst fractures should be differentiated from compression fractures. CT should be routinely indicated and MRI examination, when necessary, may be simultaneously considered.     

Utility of MRI in detecting obstacles to reduction in developmental dysplasia of the hip: comparison with two-directional arthrography and correlation with intraoperative findings

We studied the utility of magnetic resonance imaging (MRI) in detecting obstacles to reduction in developmental dysplasia of the hip (DDH) by comparing MRI findings with two-directional arthrograms and intraoperative findings. In 36 patients there were 38 DDHs; 23 complete dislocations and 15 residual subluxations. Coronal and transverse sections of T1-weighted images were used. Interpositions in the acetabulum and the anterior, superior, and posterior portions of the limbus, which were intracapsular obstacles to reduction, were evaluated. MRI and arthrography were useful for assessing the shape of the anterior portion of the limbus. In complete dislocations, MRI findings proved more valuable to detect deformities of the posterior portion of the limbus. Four of ten limbus excisions showed intermediate intensity signals on MRI. The histology was characterized by reparative granulation tissue with new capillary formation and organized thrombi. MRI proved useful for detecting obstacles to reduction, as well as for assessing morphological and histological abnormalities. Received for publication on June 12, 1998; accepted on Dec. 24, 1998     

Impact of postnatal blockade of N-methyl-D-aspartate receptors on rat behavior: a search for a new developmental model of schizophrenia

The malfunction of glutamatergic neurotransmission in the neonatal or postnatal periods may be a risk factor for the appearance of neuroanatomical, neurochemical or functional changes that are characteristic of schizophrenia. Thus, the present study was undertaken to investigate whether blockade of N-methyl-d-aspartate (NMDA) receptors in the postnatal period influences rat behavior in tests characterizing schizophrenia-like deficits such as psychomotor agitation, impairments of sensorimotor gating, working memory, and intensity of social interactions. (E)-2-amino-4-methyl-5-phosphono-3-pentenoic acid (CGP 40116), a competitive antagonist of NMDA receptors, was given postnatally (1.25 mg/kg on days 1, 3, 6, 9; 2.5 mg/kg on days 12, 15, 18; and finally 5 mg/kg on day 21, all injections s.c.), and rats were tested at 60 days old. We found that blockade of NMDA receptors in the postnatal period led to an enhancement of exploration, mimicking psychomotor agitation, impairments in sensorimotor gating as measured by a prepulse-evoked inhibition of acoustic startle response, and an impaired working memory, as measured by an increase in the latency to achieve accurate rate of response in the delayed alternation task. Decreases in non-aggressive social interactions and increases in aggressive interactions were also observed. In addition to cognitive deficits typical of schizophrenia, rats treated postnatally with NMDA receptor antagonists also showed higher level of fear exhibited in the elevated plus maze. Thus, the blockade of NMDA receptors in the postnatal period may model deficits that are characteristic of schizophrenia.