Development of a PICU in Nepal: the experience of the first year.

OBJECTIVE: Analysis of hospitalization data can help elucidate the pattern of morbidity and mortality in any given area. Little data exist on critically ill children admitted to hospitals in the resource-limited nation of Nepal. We sought to characterize the profile, management, and mortality of children admitted to one PICU. DESIGN: Retrospective analysis. SETTING: A newly established PICU in Nepal. PATIENTS: All patients between the ages of 0 to 16 years admitted to the PICU from July 2009 to July 2010. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: In 12 months, 126 children were admitted to the PICU including 43% female patients. Sixty-three percent were under 5 years. Twenty-nine percent came from tertiary care hospitals and 38% from rural areas outside Kathmandu. Only 18% were transported by ambulance. Median distance travelled to be admitted was 30 km (interquartile range, 10-193). Highest number of admissions were in spring (40%) followed by summer (25%). Almost half were admitted for shock (45%), particularly septic shock (30%). The second commonest reason for admission was neurologic etiologies (15%). Neonatal admissions were also significant (19%). Mortality was 26% and was significantly associated with septic shock (p < 0.01), mechanical ventilation (p < 0.01), and multiple organ dysfunction (< 0.05). Almost one third of patients required mechanical ventilation; median duration was 4 days (interquartile range, 2-8). Mean length of stay in the hospital was 6.2 days (± 5.3) and median 4 (interquartile range, 2.5-9.0). Median Pediatric Risk of Mortality II score for nonsurvivors was 12 (interquartile range, 7-21), and median Pediatric Index of Mortality II for nonsurvivors was 10 (interquartile range, 3-32). CONCLUSIONS: Within a short time of opening, the PICU has been seeing significant numbers of critically ill children. Despite adverse conditions and limited resources, survival of 75% is similar to many units in developing nations. Sepsis was the most common reason for PICU admission and mortality.

Detection, localization, and characterization of vision-threatening features of microaneurysms using optical coherence tomography angiography in diabetic maculopathy.

INTRODUCTION: Diabetic maculopathy is a leading retinal cause of blindness. This study was conducted using optical coherence tomography angiography and noninvasive imaging modalities. Microaneurysms were evaluated for location, flow, and adjacent retinal tissue changes to establish knowledge of possible vision-threatening features.Methodology: This is a hospital-based, cross-sectional observational study. Eighteen patients with diabetic maculopathy were included in the study. Fundus photo, red-free filter image, infrared images with shadowgrams, optical coherence tomography cross sections, and optical coherence tomography angiography were analyzed. Mean, standard deviation, odds ratio, and 95% confidence interval were used for statistical analysis, and p-value of <0.05 was considered statistically significant where applicable. RESULTS: A total of 64 microaneurysms were evaluated. Forty-six (71.8%) microaneurysms were identifiable in all imaging modalities. In total, 53 (82.8%) were high-flow microaneurysms and 11 (17.2%) were low-flow microaneurysms. Thirty-eight of the high-flow microaneurysms (71.6% of the high-flow microaneurysms) were found in the deep capillary plexus, while only 15 (28.4% of the high-flow microaneurysms) were found in the superficial capillary plexus. Twenty-seven (71%) of the high-flow microaneurysms in deep capillary plexus were present in the areas of retinal thickening (odds ratio: 4.5, 95% confidence interval: 1.26-16.0, p = 0.02). A total of 11 microaneurysms were classified as low-flow microaneurysms and identified using fundus photo, red-free filter image, infrared images with shadowgrams, and optical coherence tomography-cross sections. They had a tendency to be present in the areas of decreased capillary plexus density (odds ratio: 25.6, 95% confidence interval: 5.09-128.7, p = 0.001). CONCLUSION: Noninvasive imaging modalities combined with optical coherence tomography angiography can provide valuable information regarding microaneurysms. Certain features such as location and flow may help in predicting impending macular edema or ischemia.

A rare entity: Sympathetic ophthalmia presumably after blunt trauma to the phthisical eye and optical coherence tomography angiography metrics to monitor response to treatment.

A blunt trauma to a phthisical eye may elicit sympathetic ophthalmia. Non invasive imaging such as use of optical coherence tomography and angiography metrics of the retinal and choroidal vasculature can help monitor response to the treatment.