Pre-existing cerebrovascular disease and poor outcomes of COVID-19 hospitalized patients: a meta-analysis

Journal of Neurology - Due to pro-inflammatory and hypercoagulation states, COVID-19 infection is believed to increase the risk of stroke and worsen the outcomes of the patients having pre-existing...     

Utility of a smartphone assisted direct ophthalmoscope camera for a general practitioner in screening of diabetic retinopathy at a primary health care center

Purpose:To assess the use of smartphone-based direct ophthalmoscope photography for screening of diabetic retinopathy (DR) in known diabetic patients walking into a general practitioner''s clinic and referring them to a vitreoretinal specialist for further evaluation and management if required.Methodos:The study included 94 eyes of 47 walk-in patients in a general practitioner''s OPD who were known to have type 2 diabetes mellitus and were already on treatment for the same.Results:The study included 47 patients with diabetes with a mean age of 56.2 ± 9.4 years. The Cohen''s kappa values revealed that the diagnosis related to the DR status made using a camera was in substantial agreement with the clinical diagnosis (Kappa value: 0.770). The Cohen''s kappa values revealed that the diagnosis related to the DME made using a camera was in moderate agreement with the clinical diagnosis (Kappa value: 0.410). The agreement between the findings of the camera and clinical diagnosis was statistically significant (P < 0.05).Conclusion:Direct ophthalmoscope-based smartphone imaging can be a useful tool in the OPD of a general practitioner. These images can be assessed for retinopathy, and patients can be referred to a vitreoretinal specialist for further evaluation and management if needed. Hence, the burden of vision loss due to complications of DR in the rural sector can be abridged.     

In vitro and in vivo techniques to assess the performance of gastro-retentive drug delivery systems: a review

Background: Interest in gastro-retentive drug delivery systems (GRDDS) can be attributed to the desire for increased patient convenience (once daily dosing) and to increase the therapeutic index (reduced C(max), increased C(min)). A range of evaluation techniques for GRDDS exist for in vitro and in vivo evaluation. Objective: The aim of the present review is to describe the methodologies used for in vitro and in vivo evaluations of GRDDS. Methods: The proposed critical parameters for floating and swelling types of GRDDS are discussed. Modifications in dissolution testing and improved biorelevant testing methods are also described. The in vivo techniques for measuring gastro-retentive performance are also summarised. Conclusion: The described methods can be used as assessment techniques for the evaluation and development of GRDDS. With these techniques, it is possible (with appropriate controls) to determine if a GRDDS provides hope for advantages of extended residence time in the stomach.     

Achoo - God bless you!

Background:“Achoo” is the sound that is correlated with sneezing. A sneeze, in rare occasions, it can cause Valsalva retinopathy. Usually, small bleeding gets absorbed with time. But if the haemorrhage stays for a longer period of time, it can lead to de-hemoglobinization of blood which can cause damage to the photoreceptors. If such a damage occurs over the macula, it can cause irreversible visual loss. Hence, prompt and meticulous treatment is indicated in such cases. One such case is described here where a lady suffered from a sudden bout of sneezing and presented to us after a month later. A large sub-internal limiting membrane (ILM) bleed was noted over the macula. Hence a vitrectomy with ILM peeling with drainage of blood was advised. She recovered 20/40 visual acuity one month following surgery.Purpose:This video emphasizes on diagnosis of sub-ILM hemorrhage and the technique in which the sub-ILM bleed can be drained in the modern era of microincision vitreoretinal surgeries.Synposis:A key aspect in such cases is to distinguish sub-ILM from sub-hyaloid bleed. Subtle differentiating points on imaging are described in the video. In cases of sub-ILM hemorrhage, the most important surgical step after performing a core vitrectomy is a good posterior vitreous detachment (PVD) induction. After that, ILM peeling is carried out with the help of finesse loop and ILM peeling forceps. Using proportional vacuum and aspiration alternatively from the cutter, the hemorrhage is displaced and drained. This step can prevent damage to the underlying retinal tissue. After the macula hemorrhage is completely cleared, an air-fluid exchange is done.Highlights:Teaching points include: 1. Diagnostic markers for sub-ILM hemorrhage; 2.The method of PVD induction in cases of Sub ILM hemorrhage; and 3.Technique of drainage of sub-ILM hemorrhage using proportional vacuum and aspiration function of the cutter.Video link: https://youtu.be/hBhfLDy9o-Y     

Correction to: Pre-existing cerebrovascular disease and poor outcomes of COVID-19 hospitalized patients: a meta-analysis

Journal of Neurology - The original version of this article unfortunately contained a mistake. The correct information is given below.     

Vitreomacular traction release: Finding the edge

Background:Vitreomacular traction (VMT) is a commonly encountered entity in our routine practice. The key question is whether to observe or operate by clinical and imaging based judgement of the visual prognosis in every case.Purpose:This video encapsulates diagnostics, surgical method, and prognosis in a case of VMT released with vitrectomy.Synopsis:A 56-year-old businessman was diagnosed with VMT in the OPD and was advised surgical release of the same. The patient was extremely keen to know the visual prognosis, where the OCT imaging helped. The surgical method demonstrates the method to find the edge of the PVD to release the traction. Also, a simple ILM peel procedure has been described to reduce recurrences in cases like these.Highlights:1. Judging the prognosis in VMT cases on basis of imaging. 2.Finding the edge (FTE) method of inducing the PVD. 3. ILM peeling simplified.Online Video Link: https://youtu.be/oSZQGQgYmQ8