Poor prognostic factors in post-traumatic endophthalmitis following open globe injury

The use of personal protective equipment (PPE) for ophthalmologists caring for asymptomatic patients remains controversial. This commentary reviews the latest emerging evidence. This is paramountly important in shaping health policies in countries which is not currently recommended.     

Echocardiography and fetal heart sounds in the diagnosis of fetal heart block.

A 32-week fetus was demonstrated phonocardiographically and echocardiographically to have a regular atrial rate of 150 per minute and a regular ventricular rate of 39 per minute, indicating complete heart block. The diagnosis was suspected when two groups of heart sounds at two distinct rates were heard on auscultation, and was confirmed by the postnatal ECG. The maternal history was significant for the presence of systemic lupus erythematosus. The basis for the echocardiographic diatnosis of complete heart block, the presence of atrial heart sounds in complete heart block, and the relationship of maternal SLE to congenital heart block are discussed.     

The incidence,risk factor,and time to develop rheumatologic diseases after isolated inflammatory eye diseases: a 12-year cohort study

Clinical Rheumatology - The incidence, risk factors, and time to diagnosis of rheumatologic disease (RD) in patients with isolated inflammatory eye diseases (IED) were investigated. A 12-year...     

Capacity building in screening and treatment of diabetic retinopathy in Asia-Pacific region

The focus of capacity building for screening and treatment of diabetic retinopathy (DR) is on health professionals who are nonophthalmologists. Both physicians and nonphysicians are recruited for screening DR. Although there is no standardization of the course syllabus for the capacity building, it is generally accepted to keep their sensitivity >80%, specificity >95%, and clinical failure rate <5% for the nonophthalmologists, if possible. A systematic literature search was performed using the PubMed database and the following search terms: diabetic retinopathy, diabetic retinopathy screening, Asia, diabetic retinopathy treatment, age-related macular degeneration, capacity building, deep learning, artificial intelligence (AI), nurse-led clinic, and intravitreal injection (IVI). AI may be a tool for improving their capacity. Capacity building on IVIs of antivascular endothelial growth factors for DR is focused on nurses. There is evidence that, after a supervision of an average of 100 initial injections, the trained nurses can do the injections effectively and safely, the rate of endophthalmitis ranges from 0.03 to 0.07%, comparable to ophthalmologists. However, laws and regulations, which are different among countries, are challenges and barriers for nonophthalmologists, particularly for nonphysicians, for both screening and treatment of DR. Even if nonphysicians or physicians who are nonophthalmologists are legally approved for these tasks, sustainability of the capacity is another important challenge, this may be achieved if the capacity building can be part of their career development. Patient acceptability is another important barrier for initiating care provided by nonophthalmologists, particularly in Asia. There are also collaborations between national eye institutes of high-income countries, nongovernment organizations, and local eye institutes to improve both the quality and quantity of ophthalmologists and retinal specialists in low-income countries in Asia. This approach may require more labor, cost, and time consuming than training nonophthalmologists.     

Sexual behavior and HIV infection among pregnant hilltribe women in northern Thailand

A case-control study was carried out to determine factors associated with HIV infection among pregnant hilltribe women who attended the antenatal clinics of six hospitals in northern Thailand (Mae Suai, Wieng Pa Pao, Mae Sai, Mae Chan, Wieng Kaen, Mae Fa Luang, and Chiang Rai hospitals) between 1 January 2005- 31 May 2007. Data were collected using questionnaires and analysis was by univariate (p-value = 0.100) and multivariate analysis (p-value = 0.050) in the model of unconditional multiple logistic regression. The ratio of cases to controls was 1:4. The sample consisted of 255 subjects; 51 cases and 204 controls. The mean age of the women was 26.9 years (min = 15, max = 52, and SD 7.3). The majority of the women were Lahu (49.8%) or Akha (36.9%). Nearly half the women were Christian (48.2%), followed by Buddhist (42.4%). Most of the women were not educated (60.4%). The largest group for family income was 10,000-49,999 baht/year (62.6%). After controlling for family income, family debt, education, occupation and household members, the findings showed that the "not married to debut partner" group were at greater risk than the "married to debut partner" group by 6.6 times (OR(adj) = 6.6, 95% CI = 2.9-14.9). The "use of alcohol" group were at higher risk by 4.5 times (OR(adj) = 4.5, 95% CI = 2.0-10.3) compared to the no alcohol use group, and a history of genital ulcer group had an increased risk of 6.3 times (OR(adj) = 6.3, 95% CI = 1.2-31.1) the chance of having HIV infection compared to no history of genital ulcers in pregnant hilltribe women.     

Pacemakers of the 1980s. An overview

Methods and devices for permanent cardiac pacing remained relatively stable for over two decades with use of the single-chamber ventricular demand (VVI) pacemaker. However, changes have occurred in the 1980s and are expected to continue with the availability of more advanced technology and with increasing knowledge about cardiac pacing. The physiologic benefit of the newer dual-chamber atrial synchronous (VDD) and fully automatic, universal (DDD) pacemakers over the VVI pacemaker in patients with permanent complete heart block and normal sinus node function has been established. These newer units not only reestablish atrioventricular synchrony but also are physiologically rate-responsive. The VDD pacemaker is expected to be phased out in favor of the DDD pacemaker. When the atrial rate or interval is lower than the lower rate limit, the VDD pacemaker functions as a VVI, whereas the DDD pacemaker functions as an atrioventricular sequential (DVI) pacemaker to maintain continuous atrioventricular synchrony. Contrary to general belief, patients with complete heart block and normal sinus node function may gain very little physiologic benefit, if any, from DVI pacing. The sinus node will compete with the pacemaker's atrial stimulation when the sinus rate is faster than the DVI pacemaker rate (which usually occurs during activity). Also, the ventricular pacing rate will not vary with physiologic change. The DVI and atrial demand (AAI) pacemakers have been used in some patients with sinus node dysfunction. Increasing exercise tolerance should not be expected in the majority of patients because they are not pacemaker-dependent during activity, ie, their heart rate is higher than the pacemaker rate. However, these pacemakers appear to help in eliminating pacemaker syndrome, which does not infrequently occur with VVI pacemakers. Patients with sinus node dysfunction but without atrioventricular block do not gain more physiologic benefit with a DDD than with a DVI pacemaker. Whether these patients have severe sinus node dysfunction all the time or adequate sinus node function most of the time during follow-up, the DDD pacemaker will function as a noncommitted DVI with atrial sensing (DDI). The early report of DVI pacemaker-induced atrial fibrillation during follow-up has been refuted by more recent works. If the DDD pacemaker is significantly more expensive than the DVI pacemaker, the latter type may be a good alternative for this condition.