Ocular side effects of isotretinoin therapy

Isotretinoin (Accutane Capsules) is a synthetic vitamin A compound used for treatment of recalcitrant cystic acne. It has numerous ocular toxic side effects which include anterior segment inflammation, dry eye syndrome, contact lens intolerance, altered refraction, photosensitivity, and reduced night vision. Eye care practitioners should be aware of these potential side effects and be prepared to communicate with the prescribing physician if side effects present.     

Programmed stimulation in the evaluation of life-threatening or potentially life-threatening ventricular arrhythmias

Conclusion In conclusion, programmed stimulation is an excellent and appropriate method to guide thrapy for life-threatening and potentially life-threatening arrhythmias that occur infrequently and with unpredictable timing.The sensitivity and specificity of programmed stimulation is excellent in patients whose clinical presentation is by sustained uniform ventricular tachycardia and cardiac arrest. In contrast, such parameters are substantially less in patients with nonsustained ventricular tachycardia and in those who present wit syncope. The predictive accuracy of therapy guided by programmed electrical stimulation in cohorts with cardiac artest and sustained uniform ventricular tachycardia cohorts is reasonably well established and appears to be very good. Although no large randomized controlled comparative study of noninvasive versus PES-guided therapy has yet been completed, preliminary evidence suggests that there is a decreased incidence of arrhythmia recurrence and sudden cardiac death when therapy is guided by PES. In the minority of patients with syncope in whom sustained uniform ventricular tachycardia is induced during PES, therapy may be effectively guided by this modality. PES appears to be of benefit in managing patients with coronary artery disease who present with nonsustained ventricular tachycardia and depressed ejection fraction thereby defining a high risk subset for a subsequent arrhythmic event. However, we have not found electrophysiologic testing postmyocardial infarction to be prognostically useful.Dr. Josephson is the Robinette Foundation Professor of Medicine (Cardiovascular Diseases)Supported in part by grants from the American Heart Association, Southeastern Pennsylvania Chapter, Philadelphia, PA; and National Heart, Lung, and Blood Institute, Bethesda, MD (HL28093, HL07346, HL24278).     

Monovision vs. aspheric bifocal contact lenses: a crossover study

Twenty selected presbyopic patients were fitted with both monovision correction and Hydrocurve bifocal contact lens correction in a crossover study. Eighty percent of the population preferred bifocal correction and 20% preferred monovision. The results suggest that bifocal contact lens correction should be explored prior to considering monovision correction.     

Spoilage of hydrogel contact lenses by lipid deposits. Tear-film potassium depression, fat, protein, and alcohol consumption

"Jelly-bump" deposits, which are composed mainly of lipids, on high water content, extended-wear hydrogel lenses, are a clinically significant problem of unknown etiology. The authors explored the effect of nutrition on the frequency of deposition of these jelly bumps. Forty-three patients were included in this masked case-control study from five contact lens practices in North America. Thirty patients were lipid-depositor cases and 13 were controls. Tear specimens were drawn and analyzed for potassium by atomic-absorption spectrophotometry. Detailed dietary histories were conducted and diet nutrient composition was computed. Patients with diminished tear-potassium concentrations have an increased risk of jelly-bump deposition. Elevated intake of protein, alcohol, and cholesterol also appeared to be correlated significantly with increased jelly-bump deposition. The authors found that diabetics and the use of diuretics, anticholinergics, sympathomimetics, were associated with tear-film potassium depletion and lipid deposit formation.     

Musculoskeletal symptoms and job strain among nursing personnel: a study over a three year period.

OBJECTIVES: To examine the variation of symptoms from the neck, shoulders, and back over a three year period among female nursing personnel and the relation between job strain and musculoskeletal symptoms. METHODS: At a county hospital the female nursing personnel answered a questionnaire at baseline and then once a year over a period of three years. There were 565, 553, 562, and 419 subjects who answered the questionnaire at the first, second, third, and fourth survey, respectively. Of the study group, 285 nursing personnel answered the questionnaire on four occasions. Ongoing symptoms of the neck, shoulders, and back were assessed by means of a 10 point (0-9) scale with the verbal end points "no symptoms" and "very intense symptoms." Cases were defined as nursing personnel reporting ongoing symptoms, score > 6, from at least one of the body regions. For assessments of job strain, a Swedish version of Karasek and Theorell's model was used. RESULTS: Of the 285 subjects, 13% were defined as cases at all four assessments, and 46% varied between cases and not cases during the study period. In the repeated cross sectional surveys the estimated rate ratio (RR) for being a case was between 1.1 and 1.5 when comparing the group with job strain and the group without job strain. For the combination of job strain and perceived high physical exertion the estimated RR was between 1.5 and 2.1. When the potential risk factors were assessed one, two, or three years before the assessment of symptoms the estimated RR for becoming a case was between 1.4 and 2.2 when comparing the group with job strain and the group without job strain. CONCLUSION: Almost half of the healthcare workers varied between being a case and not, over a three year period. The analysis indicated that job strain is a risk factor for musculoskeletal symptoms and that the risk is higher when it is combined with perceived high physical exertion.     

Caring for people with developmental disabilities: survey of nurses about their education and experience

Over 500 nurses in New Jersey responded to a survey on education and training in the area of developmental disabilities. Respondents provided information on their work experience, experience with patients who have developmental disabilities, and opportunities for continuing medical education. Results showed that although many nurses thought educational activities related to developmental disabilities were important, only about 10% said that they received "a lot" of training. Most respondents (almost 60%) said that they received little or no training in the area, and most received no specific training on developmental disabilities since receiving their licenses or in their current job. Implications of these findings in light of the movement of people with developmental disabilities into community-living and managed care plans are discussed.     

Ultrasonography in acute appendicitis. Body mass index as selection factor for US examination

PURPOSE: Acute appendicitis is often difficult to diagnose and a negative laparotomy rate of about 25% is common. At Danderyd Hospital we started routine US in these patients, the aim being to estimate the sensitivity and the specificity for US when compared with the body mass index (BMI) of the patient. MATERIAL AND METHODS: All patient records were examined: During a period of 6 months 142 patients over 14 years of age were investigated with US. Their height and weight were noted and the BMI was calculated. RESULTS: The sensitivity for US examination was 0.76 in patients with a BMI < 25 but only 0.37 in patients with BMI > or = 25. This difference was statistically significant. CONCLUSION: US is a good method for examination of patients with BMI less than 25 but not in patients with BMI over 25.