Factors predicting screen time related to physical and behavioural complaints in primary school children.

BACKGROUND AND OBJECTIVE: Physical and behavioural problems from extended usage of electronic devices are issues among primary school children. This study is aimed to investigate the prevalence of physical and behavioural complaints arising from the electronic device usage and to identify the potential factors that predicted the complaints. METHODS: This was a primary school-based cross-sectional study using multistage cluster sampling, conducted at Bau district in Sarawak, Malaysia in 40 primary schools. A questionnaire was used to collect information of usage pattern in insufficient lighting, timing and position. The physical and behavioural complaints were traced. Data analysis was performed using SPSS version 22. A p-value < 0.05 with 95% CI was considered as statistically significant. RESULTS: About 52.8% of the 569 students used digital devices in a bright room, 69.8% in the day time and 54.4% in sitting position. The physical complaints were headache (32.9%), neck, shoulder and back pain (32.9%) followed by by eye strain (31.8%). Regarding behavioural problems, 25.7% of the students had loss of interest in study and outdoor activities (20.7%), skipped meals (19.0%) and arguments/disagreements with parents (17.9%). After logistic regression analysis, the lying position (OR=1.71, 95% CI: 1.096, 2.688) and darkroom lighting (OR=2.323 95% CI: 1.138, 4.744) appeared to be potential predictors of the complaint. CONCLUSION: One-quarter of the students studied experienced physical complaints, and one-fifth had behavioural problems associated with the use of electronic devices. Lying position and darkroom lighting are the potential predictors of complaints. Therefore, we suggest that the children should use electronic devices in the sitting position with adequate room lighting.

Wavelength-tunable single longitudinal mode fiber optical parametric oscillator.

We demonstrate a ring cavity single longitudinal mode fiber optical parametric oscillator using a passive sub-ring cavity and an unpumped erbium doped fiber configured with an external fiber mirror for single mode selection. The unpumped erbium doped fiber uses its saturable absorption characteristic to generate a self-induced narrowband filter when two counter-propagating waves interfere inside the fiber. A single longitudinal mode laser is obtained with a linewidth of 17.35 kHz at a pump power of 31.2 dBm. A 3.8 nm tuning range from 1536.5 nm to 1540.3 nm is achieved with a signal-to-noise ratio of about 60 dB. The power stability of the single longitudinal mode laser is 2.07 dB over a period of 30 minutes.

Preseptal Cellulitis Or Orbital Cellulitis?

Preseptal cellulitis and orbital cellulitis can both present with increasing swelling, tenderness and redness around the eye, but their management differs. Preseptal cellulitis is more common and much less aggressive than orbital cellulitis. In contrast, orbital cellulitis is a medical emergency requiring urgent management. In this article, we provide a systematic approach to distinguish between preseptal cellulitis and orbital cellulitis at presentation, as the distinction between the two entities and the prompt recognition of orbital cellulitis can be potentially life-saving.

Giant Cell Arteritis - Who to Refer to?

Giant cell arteritis is a systemic immune-mediated vasculitis affecting the medium and large arteries. Typical symptoms include new headache, jaw claudication, tender temporal artery, polymyalgia rheumatica, fever and anorexia. Visual loss resulting from giant cell arteritis is an ophthalmic emergency and requires immediate assessment and referral to the ophthalmologist for prompt treatment with steroids. This article provides a systematic approach to the diagnosis and management of giant cell arteritis.

Extended nonlinear parametric process in anomalously pumped linear cavity oscillator.

We demonstrate a linear cavity fiber optical parametric oscillator with extended pump-signal separation of 14.3 THz (116 nm). The signal laser is provided by a pair of 1675nm fiber Bragg gratings and a tunable idler from 1456.12 nm to 1462.48 nm is generated by detuning the pump wavelength in the anomalous dispersion regime of a highly nonlinear fiber. At such large pump-signal separation, we are still able to record a parametric conversion efficiency of more than -35 dB and idler optical signal-to-noise-ratio of 50 dB on average. The stability of the lasing signal and idler is examined and result shows both signal and idler peak power fluctuation is less than 1 dB over a period of 30 minutes.

Correction: Self-assembled fibrillar networks comprised of a naturally-occurring cyclic peptide-LOB3.

[This corrects the article DOI: 10.1039/C6RA05154E.].

Temperature dependence of solvation forces as measured in atomic force microscopy.

An atomic force microscope (AFM) has been used to study the effect of temperature on solvation forces in the liquids octamethylcyclotetrasiloxane, n-hexadecane, and n-dodecanol confined between the AFM tip and a graphite surface. Discrete solvation layers can be observed for all three liquids at all the temperatures measured (298-348K). However, with increasing temperature there is a significant decrease in the magnitude of the measured solvation forces and a reduction in the number of solvation oscillations which can be observed. Solvation forces per se are only weakly temperature dependent and the most plausible explanation is that we are measuring how the layers are squeezed from the tip-sample gap. The squeeze out process is a thermally activated phenomenon and gives rise to the large change in the magnitude of the force oscillations with temperature. A simple analysis is provided based on transition rate theory. The large change in solvation force with temperature has implications for the measurement of localized forces using AFM, particularly in interpreting biological interactions and single asperity friction.

An eye on sexually transmitted diseases: sexually transmitted diseases and their ocular manifestations.

Ocular examination should be a part of the routine assessment of the patients seen at sexually transmitted diseases (STD) clinics due to the importance of these organs in the general wellbeing of patients. It is essential to keep an open eye on ocular signs and symptoms of patients with a history of exposure to common STD pathogens, to ensure prompt investigation and management of ocular complications of the STDs, which, if left unnoticed, otherwise could subject the patients to a great deal of anxiety and distress.

What you can see in your patient's eyes? Review of ocular manifestations of HIV in HAART era.

The early diagnosis and treatment of ocular disease to prevent morbidity and mortality of patients with human immunodeficiency virus (HIV) is of paramount importance. Since the advent of highly active antiretroviral therapy (HAART), the incidence of ocular complications of HIV has decreased and their manifestations and natural course are also modified. This has been observed in the face of emerging immune recovery, which per se has brought new difficulties in the process of diagnosing and management of the ocular disease. Conditions such as immune recovery uveitis could affect eyes with history of opportunistic disease with a potential to cause vision loss; with this regard, differentiation of the inflammatory process from infective causes is essential. The other sexually contracted diseases are also to be included in this complex picture because of their contribution to the clinical picture and also sharing common routes of transmission with HIV. There is very little doubt that visual deterioration would further deteriorate the already compromised quality of life of this group of patients. In this review, authors wish to provide evidence available in the medical literature around the visual health issues in HIV-infected patients and raise awareness towards the changing pattern of the ocular disease in the HAART era.

The effect of carotid siphon stenosis on stroke rate, death, and relief of symptoms following elective carotid endarterectomy.

It has been suggested that carotid endarterectomy for carotid bifurcation disease may be contraindicated in the presence of carotid siphon lesions. This study was undertaken to assess any difference in stroke rate, mortality, or relief of symptoms in patients with and without such "tandem" lesions following elective carotid endarterectomy. Ninety-one bifurcation endarterectomies were performed in 79 patients. The patients were divided into two groups. Group I (44 patients, 47 endarterectomies) had carotid bifurcation stenosis only; group I (35 patients, 44 endarterectomies) had siphon stenosis plus bifurcation stenosis. All patients in both groups who were symptomatic before operation were relieved of their symptoms. In group I there were no intraoperative or perioperative strokes, four late strokes (8.7%), one operate death (2.1%), and no late deaths. Group II patients had two intraoperative strokes (4.5%), three perioperative strokes (6.8%), two late strokes (5.1%), four operative deaths (9.1%), and three late deaths (7.5%). Eighteen of the 35 patients in group II had a greater degree of carotid siphon stenosis than bifurcation stenosis. In this subgroup, there was one operative stroke (5.6%), only perioperative stroke (5.6%), one late stroke (5.9%), one postoperative death (5.6%), and one late death (5.6%). None of these differences were statistically significant. Relief of symptoms was the same in patients with and without tandem carotid lesions, and there was no significantly increased risk of stroke or death following bifurcation endarterectomy in patients with tandem carotid lesions.

The necessity of mandatory exploration of penetrating zone II neck injuries.

To reevaluate the validity of our policy of mandatory surgical exploration of penetrating zone II neck injuries, the charts of 110 patients who underwent surgical exploration for such injuries were reviewed. Fifty-three percent of the patients had normal findings at exploration, whereas 33% had injuries involving vascular structures of the neck and 14% had nonvascular injuries. Injuries were not suspected on clinical grounds preoperatively in 23% of the patients in whom surgical exploration revealed injury. The injuries most likely to escape preoperative diagnosis were isolated venous injuries and isolated pharyngoesophageal injuries. Arteriography yielded false-negative results in two arterial injuries. No deaths and only a 5% incidence of minor complications occurred in the group with no injuries detected at exploration. We conclude that surgical exploration of penetrating zone II neck injuries is safe and appropriate.

Jejunoaortic fistula from ingested seamstress needle.

A 27-year-old man was evaluated for sudden onset of massive hematemesis and hematochezia. A bleeding site was not seen on esophagogastroduodenoscopy. There was little blood in the stomach, which suggested that the bleeding site was below the ligament of Treitz. Angiography demonstrated the presence of an intra-aortic metallic foreign body that resembled a sewing needle. At operation, a chronic jejunoaortic fistula that contained the sewing needle was found and repaired. The patient had no recollection of having swallowed the needle, and it is presumed that he ingested it in infancy. He had an uneventful recovery.

Popliteal artery trauma. 31 consecutive cases without amputation.

Injury to the popliteal artery is the most common cause of amputation in injured extremities. A six-year experience (1974-1979) at Cook County Hospital, Chicago, involved 31 popliteal artery injuries without amputation. Penetrating trauma was the most frequent cause of injury; however, a considerable number of blunt trauma injuries with fractures and dislocations were also present. Prolonged ischemic time was not a deterrent to successful vascular reconstruction. The recognition of compartmental hypertension and performance of fasciotomy before vascular repair were credited as major factors in our success. The use of interposition saphenous vein graft in the arterial reconstruction, repair of concomitant popliteal vein injuries, initial bone fixation of fractures with external fixators, and the performance of intraoperative arteriography were all important steps taken to ensure a 100% limb salvage.

Elimination of iatrogenic impotence and improvement of sexual function after aortoiliac revascularization.

One hundred ten men who underwent revascularization for aortoiliac occlusive disease by either aortic reconstruction (n = 66), crossover femorofemoral bypass (n = 38), or axillofemoral bypass (n = 6) were examined with regard to preoperative and postoperative sexual function. Aortic reconstructions were performed using a nerve-sparing technique, and special emphasis was placed on preservation or improvement of pelvic blood supply. Thirty patients (27%) were impotent preoperatively and postoperatively, 67 patients (61%) had normal sexual function preoperatively and postoperatively, and 13 patients (12%) who were impotent preoperatively regained sexual function as a result of revascularization, indicating that 30% (13/43) of all patients with preoperative impotence regained sexual function. No patient with normal preoperative sexual function was impotent postoperatively. Nerve-sparing aortic dissections, attention to preservation or improvement of pelvic blood flow, and, when appropriate, extra-anatomic bypass are essential in the preservation or improvement of sexual function after aortoiliac revascularization.

Peripheral vascular trauma from close-range shotgun injuries.

This report summarizes an eight-year experience (1976 to 1983) with 49 close-range shotgun blasts with associated major vascular injuries seen in a large urban hospital. Injuries to the upper extremity (40%), lower extremity (56%), and neck (4%) were seen. A high frequency of associated deep venous injury (82%), nerve injury (37%), fracture (33%), massive soft-tissue loss (43%), and compartmental hypertension (39%) was observed. There were no deaths in this series, and the limb salvage rate was 96%. Neither patient with multiple carotid artery injuries suffered a neurologic deficit. We attribute our success in the management of these complex injuries to rapid fracture immobilization, early and aggressive use of fasciotomy, adequate débridement of devitalized tissue, repair of deep venous injuries, arterial repair with autogenous tissue, and extra-anatomic bypass grafting in selected cases.

Results of venous reconstruction after civilian vascular trauma.

The treatment of venous injuries remains controversial. In an attempt to evaluate the results of current management of venous injuries, we retrospectively reviewed our experience between 1979 and 1984. During this period 142 patients had sustained injuries to 158 veins in the neck (31 patients), abdomen (45 patients), upper extremity (20 patients), and lower extremity (62 patients). Overall, 90 venous injuries (61%) were repaired, including 83% of caval and iliac vein injuries and 90% of injuries to the common femoral, superficial femoral, and popliteal veins. There was no morbidity after repair of 73 major veins. Morbidity occurred in four of 11 patients after ligation of major veins (edema in two patients and above-knee amputation in two others). Both ligation (N = 51) and repair (N = 17) of lesser veins (jugular, brachial, profunda femoral, tibial, and minor abdominal veins) resulted in no morbidity. Overall mortality was 6% with all deaths occurring in patients with abdominal venous trauma. These data indicate that repair of venous injuries can be performed without morbidity and that minor veins can be ligated without adverse sequelae. However, in view of the morbidity associated with ligation of major veins, efforts to restore flow to these injured vessels appear appropriate unless contraindicated by life-threatening injury.

The treatment of cerebral ischemia by external carotid artery revascularization.

Thirteen patients with internal carotid artery occlusion and symptomatic external carotid artery stenosis underwent external carotid artery revascularization by means of endarterectomy (n = 10) or subclavian artery--external carotid artery bypass (n = 3). All patients but one were followed up, for five to 46 months (mean, 20 months). There were no operative deaths or complications and no late strokes. One patient (7.7%) required early extracranial-intracranial (EC-IC) bypass for failure of the external carotid artery endarterectomy to relieve the initial symptoms. All remaining patients were completely (n = 9) or partially (n = 2) relieved of symptoms, and EC-IC bypass was not required. There were no criteria identified by either oculopneumoplethysmography or angiography that could reliably predict the need for subsequent EC-IC bypass. Ninety-two percent of the patients were adequately treated with external carotid artery revascularization alone, suggesting that subsequent EC-IC bypass is seldom required in patients with ipsilateral internal carotid artery occlusion and external carotid artery stenosis.

Intraoperative assessment of limb revascularization by Doppler-derived segmental blood pressure measurements.

Prompt recognition and correction of technical errors in vascular procedures in the lower extremities decreases patient morbidity and improves the chances for successful revascularization. A simple, versatile technique for intraoperative hemodynamic assessment of lower extremity revascularization procedures is described. Salient features include ability to detect and correct technical errors without reoperation and its associated morbidity, use of commonly available, inexpensive equipment, and ease of performance without involvement of either specifically trained or inexperienced personnel.

The therapy of peripheral vascular ulcers--surgical management.

Venous ulcers are a common malady of the civilized world. The etiology and its pathogenesis has been presented for a better understanding of its appropriate therapy. A conservative and surgical approach is necessary for effective treatment, of which the final goal is to reduce ambulatory venous hypertension and the prevention of venous ulcer formation. An effective regime of elastic support, periodic leg elevation and surgery for incompetent perforators is highly rewarding. The good results in the use of dextranomer for highly exudative ulcers have also been presented as another adjunct in the local care of venous ulcers.