Jet stream related iatrogenic retinal breaks during vitreo-retinal surgery

Purpose:To evaluate the causes of jet stream injury (JSI)-related iatrogenic retinal breaks (IRBs) during vitreoretinal surgery (VRS).Methods:The precise surgical environment, which includes the indication and type of surgical procedure, retina status, details of instrumentation and fluidic parameters, and characteristics of the jet responsible for the IRB, was noted from case records. The nature of IRB and its healing and impact on anatomical and visual outcomes were analyzed.Results:Five eyes of five patients with complete documentation of both the JSI and the IRB were included. Two cases were operated for macular hole, and one each for vitreous hemorrhage, retinal detachment, and endophthalmitis. One case had infusion-fluid-related JSI, while four developed it because of injection of surgical adjuncts (drugs, PFCL, and dye). JSI developed in two cases when the vitreous cavity was filled with fluid, while it was air-filled in three cases. In four cases, the fluid migrated into subretinal space, necessitating further maneuvers following which the breaks healed, but were directly responsible for vision loss in two cases.Conclusion:JSI related IRBs are rare but may be directly responsible for vision loss if they impact the macula. The balance between jet stream velocity, its distance from the retinal surface, the intervening media (vitreous cavity), and retinal health play an important role. It can occur because of both infusion as well as injection jets. Precautions must be taken in cases vulnerable to complications with suggested modifications in the surgical technique.     

Evaluation of retinopathy of prematurity screening in reverse Kangaroo Mother Care: a pilot study

Purpose

To evaluate retinopathy of prematurity (ROP) screening practice in reverse Kangaroo Mother Care (R-KMC) with respect to stress and pain to the infant.

Methods

In a pilot study we evaluated ROP screening practice in R-KMC in 20 babies at risk of ROP. The R-KMC differed from the conventional KMC with respect to the baby position where the baby lay supine on mother''s chest. With the mother lying supine and the baby in R-KMC position, screening examinations were done with indirect ophthalmoscope. The outcome measures included stress (quantified by pulse, respiration, and oxygen saturation) and pain to the baby by observing facial expression (eye squeezing, crying, and brow bulge). The heart rate, respiratory rate, and SpO2 (%) were compared before and immediately after the procedure using paired t-test.

Result

Mean (±SD) gestational age and birth weight were 30.8±2.3 weeks and 1362.5±253.9 g, respectively. During examination in R- KMC position 8 babies (40%) were completely relaxed (no eye squeezing and crying), 10 (50%) were partially relaxed (no brow bulge) and 2 babies (10%) were not relaxed. A change in heart and respiration rate both by 10 per minute was recorded in 12 (60%) and 10 (50%) babies, respectively. Five babies (25%) had reduction in blood oxygen concentration below 92%. The majority of the mothers (19 of 20) were relaxed.

Conclusion

ROP screening in R-KMC can be a baby friendly screening practice with respect to stress and pain to the infant and needs further evaluation in a larger cohort.     

ZnO thin film-nanowire array homo-structures with tunable photoluminescence and optical band gap

The growth and optical behavior of ZnO thin film-nanowire array homo-structures is reported. The ZnO films are deposited on glass substrates by thermal evaporation and subjected to heat treatment at 400 °C for 2 h to achieve crystallinity and stoichiometry. The surface comprises spherical grains or elongated flakes depending on thickness of films. These films are introduced in to a hydrothermal reactor in a medium of zinc acetate and HMTA to realize the nanostructures. The process results in the formation of ZnO nanowires with dimensions that are strongly dependent on the surface microstructure of the ZnO films. The role of temperature (90–180 °C) and duration (10 min to 10 h) of hydrothermal processing is investigated in detail. It is demonstrated that low temperature and short duration are ideal for producing nanowires with diameter < 100 nm, while longer durations and higher temperatures lead to large diameter and long length nanowires. Interestingly, all wires converge to a hexagonal shape with increase in duration or temperature. The lowest diameter of the vertically aligned nanowires is 50 nm and length upto 10 μm is achieved. Optical band gap of the homo-structures is of the order of 3.4–3.5 eV. Raman and photoluminescence spectra indicate the presence of defects in the films. The thin films exhibit a strong defect related photoluminescence peak centred around 550 nm. The nanowires grown on the films display both the UV-near band edge peak as well as the defect related peak. However, the intensity of the defect peak decreases with increase in length of the nanowires indicating that the photoluminescence of the homo-structures can be tuned by changing the surface microstructure of the films and also the aspect ratio of the nanowires.

ZnO homo-structures with tunable photoluminescence and band gap.     

Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study

BackgroundWith ever-increasing demand for total knee arthroplasty (TKA), most healthcare systems around the world are concerned about its socioeconomic burden. Most centers have universally adopted well-defined clinical care pathways to minimize adverse outcomes, maximize volume, and limit costs. However, there are no prospective comparative trials reporting benefits of these risk mitigation (RM) strategies.MethodsThis is a prospective cohort study comparing post-TKA 90-day complications between patients undergoing RM before surgery and those following a standard protocol (SP). In the RM group, we used a 20-point checklist to screen for modifiable risk factors and evaluate the need for optimizing non-modifiable comorbidities. Only when optimization goals were achieved, patients were offered TKA.ResultsTKA was performed in 811 patients in the SP group and in 829 in the RM group, 40% of which were simultaneous bilateral TKA. In both groups, hypertension was the most prevalent comorbidity (48%), followed by diabetes (20%). A total of 43 (5.3%) procedure-related complications were seen over the 90-day postoperative period in the SP group, which was significantly greater than 26 (3.1%) seen in the RM group (p = 0.039). The commonest complication was pulmonary thromboembolic, 6 in each group. Blood transfusion rate was higher in the SP group (6%) than in the RM group (< 1%).ConclusionsScreening and RM can reduce 90-day complications in patients undergoing TKA.     

Avian influenza A (H5N1): a preliminary review

Humanity has been at the receiving end of many viral diseases since ages. Sudden emergence and re-emergence of new viral diseases in human beings has surprised the medical scientists from time to time. "Avian influenza" or "Bird flu" by H5N1 epidemics is one such surprise. Although many aspects about this disease are clear, there are some dark areas regarding vaccine development that need to be further explored and understood, so as to effectively contain the spread of this disease. The present article details out almost everything known about this interesting disease along with the review of the recent literature.     

The role of MBL,PCT, CRP,neutrophil–lymphocyte ratio,and platelet lymphocyte ratio in differentiating infections from flares in lupus

Clinical Rheumatology - The distinction between infection and flare in systemic lupus erythematosus (SLE) has always been a dilemma for clinicians as the clinical and biochemical profiles overlap....