Assessment of the eye surface and subjective symptoms after using 0.1% dexamethasone drops with and without preservatives in patients after cataract surgery.

Cataract surgery can cause dry eye symptoms. One of the many factors compromising the ocular surface is the use of benzalkonium chloride (BAC)-preserved topical eye drops administered during the postoperative period. In this open-label, prospective, randomized, comparative clinical trial, 40 patients not previously affected by dry eye disease were assigned to receive either preservative-free (PFD) or preserved (PD) dexamethasone 0.1% eye drops for two weeks after a standard phacoemulsification procedure. Fluorescein break-up time, ocular surface staining score, Schirmer test, Ocular Surface Disease Index and anterior chamber (AC) cells were evaluated at baseline prior to the surgery and 2 weeks after surgery. No statistically significant differences in baseline assessments were observed between groups. At week 2, a significant increase in corneal staining scores (p = 0.003) and foreign body sensation (p = 0.04) was observed for the PD group only. The conjunctival staining score was significantly higher in both groups. The mean AC cell grading was higher in the PFD group than in the PD group (0.28 ± 0.30 and 0.07 ± 0.18, respectively; p = 0.013). Preservative-free dexamethasone eye drops after cataract surgery caused milder dry eye symptoms as compared with preserved dexamethasone. The AC inflammation control comparison may require a larger study group. Trial registration: ClinicalTrials.gov identifier NCT05753787, 03/03/2023.

The corneo-scleral junction assessed with optical coherence tomography.

PURPOSE: To evaluate corneo-scleral junction (CSJ) using anterior segment optical coherence tomography (AS-OCT) and describe the pattern of cornea and sclera interfusion based on tissue reflectivity. METHODS: This prospective observational study enrolled candidates for vision correction. Eyes with previous ocular surgery or irregular corneas were excluded. Temporal and nasal CSJ width and reflectivity patterns were assessed with AS-OCT horizontal scans. Correlations between manual and automated variables and multivariate linear regression analyses with age and spherical equivalent were performed. RESULTS: 101 right eyes were analysed. Temporal CSJ was wider (median 1.62; 1.13 to 2.22 mm) compared to the nasal side (median 1.18; 0.73 to 1.80 mm) (p<.0001). The temporal CSJ width showed negative correlation with ipsilateral anterior chamber angle measurements and positive correlation with horizontal visible iris diameter (HVID). These relationships were not statistically significant for the nasal CSJ width. No significant correlations with age or refractive error were observed at both sides. The pattern of temporal CSJ reflectivity was mostly V- or U-shaped. The eyes with V-shaped temporal CSJ had significantly larger HVID than the eyes with irregular temporal CSJ. The nasal CSJ presented irregular reflectivity in 47% of cases. CONCLUSIONS: The temporal CSJ was wider and had regular (V or U-shaped) reflectivity patterns, while nasal CSJ was narrower and more irregular. The CSJ width was independent of age and refractive error and could not be predicted from other parameters. The HVID measurement accuracy may benefit from CSJ analysis based on AS-OCT.

Analysis of management protocols regarding ineffective maintenance of organ functions in patients treated at the Intensive Care Unit of the University Hospital in Wroclaw.

BACKGROUND: Prolonged support of organ functions without therapeutic benefit represents a serious problem of therapy in intensive care units (ICUs). This kind of treatment, called "futile therapy", prolongs the process of dying and should be avoided. In Poland, the guidelines and protocol defining the best clinical practice for the avoidance of futile therapy in ICUs was published in 2014. The aim of study was to analyse the protocols concerning futile therapy in the general ICU in the University Hospital in Wroclaw, Poland during the years 2015-2018. METHODS: The content of protocols was analysed. The protocols contained information on clinical problems, ethical and social aspects, data on communication with relatives, and therapeutic procedures regarded as futile and consequently withheld or withdrawn. RESULTS: During the study 1660 patients were treated in the ICU, of whom 557 patients died. Protocols regarding futile therapy were analysed in 146 patients. The diagnosis before starting the protocol was multiorgan failure (56%), permanent CNS injury (39%), respiratory failure (3%), and circulatory failure (2%). The withholding of therapeutic procedures was preferred, and the cases of withdrawal were rare. All patients with protocols died during hospital stay, 81.5% of them in the ICU. CONCLUSIONS: The protocols concerning futile therapy were instituted in 1 in 10 patients treated in the ICU in Wroclaw, which comprised was nearly one-fifth of all ICU deaths. The withholding of futile therapeutic procedures was preferred in comparison to withdrawing. Communication with relatives was essential to the process of avoiding futile therapy.

Effect of universal chlorhexidine decolonisation on the infection rate in intensive care patients.

BACKGROUND: Healthcare-associated infections (HAIs), particularly intensive care unit-acquired infections (HAI-ICU), are an important cause of morbidity and mortality in hospitals. Most of these infections are caused by multidrugresistant organisms. The results of recent studies have suggested that daily bathing with chlorhexidine (CHX)-universal decolonisation can prevent ICU infections. The purpose of the study was to determine the influence of CHX bathing on the rate and type of HAI-ICU in critically ill patients. METHODS: This observational study, conducted in a mixed, 16-bed tertiary ICU, compared the following three 3-month periods: I) pre-intervention (traditional soap-water bathing), II) intervention (bathing with 2% CHX clothes), and III) post-intervention (soap-water bathing). The type and rate of HAI-ICU were registered according to the European Centre for Disease Prevention and Control (ECDC) guidelines. RESULTS: A total of 272 patients were included in the study. During the intervention period, the total infection rate was significantly lower than in the pre-intervention period (12.7% vs 22.2%, respectively). Significant decreases in the rate and density of catheter-related infections (CRI) were observed during the intervention period. A decrease in the isolation rate of multidrug-resistant bacteria was also observed during the intervention and post-intervention periods. CONCLUSIONS: Daily bathing of ICU patients with chlorhexidine-impregnated clothes significantly decreased the rate of HAI-ICU and the acquisition of CRI. This simple hygienic approach can be an important adjunctive intervention with the capability of reducing the burden of healthcare-associated infections in ICUs.

Comparison of anaesthetic gas consumption and stability of anaesthesia using automatic and manual control over the course of anaesthesia.

BACKGROUND: The automatic control module of end-tidal volatile agents (EtC) was designed to reduce the consumption of anaesthetic gases, increase the stability of general anaesthesia and reduce the need for adjustments in the settings of the anaesthesia machine. The aim of this study was to verify these hypotheses. METHODS: The course of general anaesthesia with the use of the EtC module was analysed for haemodynamic stability, depth of anaesthesia, end-expiratory concentration of anaesthetic, number of ventilator key presses, fentanyl supply, consumption of volatile agents and anaesthesia and operation times. These data were compared with the data obtained during general anaesthesia controlled manually and were processed with statistical tests. RESULTS: Seventy-four patients underwent general anaesthesia for scheduled operations. Group AUTO-ET (n = 35) was anaesthetized with EtC, and group MANUAL-ET (n = 39) was controlled manually. Both populations presented similar anaesthesia stability. No differences were noted in the time of anaesthesia, saturation up to MAC 1.0 or awakening. Data revealed no differences in mean EtAA or the fentanyl dose. The AUTO-ET group exhibited fewer key presses per minute, 0.0603 min⁻¹, whereas the MANUAL-ET exhibited a value of 0.0842 min⁻¹; P = 0.001. The automatic group consumed more anaesthetic and oxygen per minute (sevoflurane 0.1171 mL min⁻¹; IQR: 0.0503; oxygen 1.8286 mL min⁻¹, IQR: 1,3751) than MANUAL-ET (sevoflurane 0.0824 mL min⁻¹, IQR: 0.0305; oxygen 1,288 mL min⁻¹, IQR: 0,6517) (P = 0.0028 and P = 0.0171, respectively). CONCLUSION: Both methods are equally stable and safe for patients. The consumption of volatile agents was significantly increased in the AUTO-ET group. EtC considerably reduces the number of key presses.

The Formation of Blood Vessel After the Administration of the Plasmid Encoding Ang-1 Gene in Fischer Rats.

BACKGROUND: Chronic limb ischemia is a serious clinical problem. Patients who do not qualify for standard treatment may benefit from novel gene therapies. OBJECTIVES: This study evaluated angiogenesis following intramuscular injections of angiogenic plasmid Ang-1 in Fisher rats. MATERIAL AND METHODS: Twenty rats had plasmids injected intramuscularly in their hind limbs. The study group consisted of 10 animals which received the Ang-1 plasmid, while the control group consisted of 10 rats that received an empty plasmid. All the animals were euthanized after 12 weeks and tissue samples from the hind limb thigh muscles and internal organs were harvested for histological and immunohistochemical examinations. To assess the angiogenesis the number of vessels in the hind limb muscles visualized by the SMA and FVIII markers was counted for each animal in five separate microscopic fields. RESULTS: There were no pathological lesions or any signs of neoplastic angiogenesis in any of the 20 rats. The number of vessels visualized by the FVIII marker in the study group was two times higher than in the control group (median: 12, range: 7-25 vs. median: 6, range: 2-15; p < 0.0001). The median estimated that the number of vessels visualized by the SMA marker is 63% higher in the study group compared to the control group (median: 6.5, range: 1-12 vs. median: 4, range: 0-10; p = 0.0008). CONCLUSIONS: Intramuscular injections of Ang-1 plasmids induced angiogenesis in the rat hind limb muscles.

End-of-life attitudes of intensive care physicians in Poland: results of a national survey.

PURPOSE: This study was designed to assess the ethical attitudes and practices of intensive care physicians regarding life-sustaining treatment in intensive care units (ICUs) in Poland. METHODS: A questionnaire was distributed to intensive care physicians taking part in a national medical congress. Participation in the study was voluntary and anonymous. RESULTS: A total of 400 questionnaires were distributed, of which 217 (54%) were returned completed. Almost all respondents (93%) reported having withheld therapy, and 75% of respondents reported withdrawing therapy. Physicians aged 40 years and over who had no religious affiliation more frequently reported withholding treatment. Only 5% of physicians reported deliberately administering drugs until death ensued. Respondents from large hospitals (more than 400 beds) more easily accepted foregoing life-sustaining therapy in ICU patients. In clinical scenario in which the family demanded the maximum available treatment, physicians reported that they were considerably influenced to modify decisions concerning life-sustaining therapy. CONCLUSIONS: The ethical attitudes of intensive care physicians regarding end-of-life decisions are similar to the opinion presented in other European survey studies. The practice of withholding and withdrawing therapy in ICU patients is common in Poland. Actively shortening life is considered unacceptable. The request of the family even without legal consultation can influence physicians' decisions.