Vision loss associated with orbital surgery - a major review.

Purpose: Vision loss after orbital surgery is one of the most dreaded complications faced by the orbitofacial surgeon. This literature review was conducted in an attempt to determine the risk factors for severe vision loss and discuss the applied anatomy related to various types of orbital surgery - orbital tumor excisions, orbital decompression, and post-traumatic orbital reconstruction.Methods: A literature search was conducted via PubMed and Google Scholar. All cases of vision loss following orbital tumor biopsy or excision, orbital decompression, and orbital trauma reconstruction were reviewed.Results: The incidence of postoperative blindness appears to be more after orbital tumor excisions (4.7%), compared to post-traumatic orbital reconstruction (2.08%) and orbital decompressions for thyroid orbitopathy (0.15%).The causes of vision loss include ischemic optic neuropathy, traumatic optic neuropathy, retinal and ophthalmic artery occlusions, and orbital compartment syndrome.Conclusion: Apart from careful patient selection, proper counseling about the risk of postoperative blindness is of utmost importance. Detailed preoperative treatment planning, meticulous atraumatic intraoperative dissection under direct visualization, with attention to the danger zones and vital structures, close intraoperative and postoperative monitoring, and urgent management of potentially reversible compressive causes of vision loss can improve outcomes.

Risk Factors Associated with Diabetic Ketoacidosis at the Onset of Type 1 Diabetes Mellitus.

BACKGROUND: There are various factors which increase the risk of diabetic ketoacidosis at the onset of type 1 diabetes mellitus. There have not been any such studies in our setting. This study was done to find the prevalence and risk factors associated with the development of diabetic ketoacidosis at onset of type 1 diabetes mellitus. METHODS: Children and young adults with type 1 diabetes mellitus being treated at Patan hospital were approached and after obtaining an informed consent, all the patient information on various risk factors for diabetic ketoacidosis were collected in a pre-developed proforma. Data was entered in Microsoft Excel and analysis was done using statistical package for the social sciences-16. Ethical approval was taken from Institutional Review Committee- Patan Academy of Health Sciences. RESULTS: Out of 99 patients with type 1 diabetes enrolled in the study, 52.5% presented in diabetic ketoacidosis at the onset. The duration of symptoms was significantly less in patient presenting with diabetic ketoacidosis than without diabetic ketoacidosis (6.45±7.57 vs 9.13±10.12, p=0.04). There was no significant difference in the mean age, mean glycosylated hemoglobin, mean body mass index, gender, parents' literacy and medical consultations prior to diagnosis. CONCLUSIONS: More than half of the patients with type 1 diabetes presented in diabetic ketoacidosis. The shorter duration of symptoms prior to presentation was the only significant factor leading to presentation as diabetic ketoacidosis.

Clinical Profiles of Neonates Born to COVID-19 Positive Mothers in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Nepal is one of the countries which has been hit hard by the COVID-19 pandemic and has resulted in high morbidity and mortality across all age groups including neonates. There has been a paucity of studies regarding maternal to neonatal COVID-19 transmission and the published studies also have a poor sample size to reach any definite conclusion. Hence this study was carried out to see the clinical profiles of neonates born to COVID-19 mothers. METHODS: It was a descriptive cross-sectional study. The study was conducted at a tertiary care centre over the period of one year from April 2020 to March 2021 after taking ethical clearance from the Institutional Review Committee with reference number drs2105211526. Convenient sampling was done. All neonates born to COVID-19 positive mothers who were diagnosed by a real-time polymerase chain reaction of the nasopharyngeal swab during the time of delivery were included in the study. Data analysis was done using Statistical Package for Social Sciences 20 using appropriate tools. RESULTS: A total of 105 babies born to COVID-19 positive mothers who were tested for COVID-19 infection were included in the study. Ten (9.5%) (3.89-15.10 at 95% Confidence Interval) of neonates born to COVID-19 positive mothers were positive for the COVID-19 virus. All the neonates born to COVID-19 positive mothers were discharged home except one case who had other comorbidities. Fever was present in four (40%) of COVID-19 positive neonates. CONCLUSIONS: There is a possibility of vertical transmission of coronavirus in neonates although the outcome is favourable.

Congenital Tracheoesophageal Fistula in Very Low Birth Weight Preterm Neonate with an Oligohydramnios as a Rare Presentation: A Case Report.

Tracheoesophageal fistula is a challenging anomaly with a rare prevalence with symptoms mainly respiratory, sometimes digestive. We present a rare case of oesophageal atresia with distal Tracheoesophageal fistula in a female child whose mother presented with severe oligohydramnios on ultrasonography with intrauterine growth retardation before cesarean section. After the birth of preterm and very low birth weight neonate, we initially diagnosed as respiratory distress syndrome with a club foot. However, we diagnosed oesophageal atresia with distal Tracheoesophageal fistula on the 2nd day as nasogastric tube insertion was failed beyond 10cm and confirmed by X-ray with a rubber catheter. Right thoracotomy with ligation of the fistula with end to end anastomosis was performed successfully without complications. Breastfeeding initiated and the child discharged after she started gaining weight. Early post-operation complication (anastomotic stricture) was noticed after 2 weeks; however, corrected with endoscopic balloon dilatation. Currently, the child is healthy weighing 10kgs at 18 months of age.

Newborn Screening for Selected Disorders in Nepal: A Pilot Study.

The prevalence of metabolic disorders in Nepal is yet unknown, although many case reports occur in literature. Heel-prick blood samples from newborns were collected on Dried Blood Spot (DBS) collection cards and tested through Tandem Mass Spectroscopy and fluorescence assays for disorders included in the Swiss neonatal screening program; two cases of hypothyroidism and one case of cystic fibrosis were identified. Thyroid stimulating hormone (TSH), immuoreactive trypsinogen (IRT), hydroxyprogesterone (OHP), tyrosine (Tyr), and octanoylcarnitine (C8) showed significant differences with gestation age. Most of the parameters were positively correlated with each other except galactose, galactose 1 phosphate uridyl transferase (GALT), and biotinidase. First and ninety-ninth percentiles in the Nepalese newborns were found to be different when compared with the Swiss newborns. Congenital hypothyroidism and cystic fibrosis are candidates to be considered for a newborn screening program in Nepal. Differences between the Nepalese and Swiss newborns in parametric values that change with gestation age can be attributed to a higher survival rate of pre-term babies in Switzerland. Others could be explained in part by early and exclusive breastfeeding in Nepalese newborns.

Anterior lens capsule rupture following minor blunt trauma with a past history of minimal change glomerulopathy.

INTRODUCTION: Few cases have been reported describing anterior lens capsule ruptures secondary to blunt trauma. CASE: We present an unusual case of anterior lens capsule ruptures following minor trauma from a human elbow with a two-year history of minimal-change glomerulopathy in a 17-year-old male. In addition to having bilateral posterior subcapsular cataracts, he developed an anterior subcapsular cataract underlying the anterior lens rupture in the right eye. He was managed conservatively. OBSERVATIONS: The current case differs from those of the existing literature in terms of the characteristics of the physical insult and the eye on presentation. We suggest there could be a predisposing anterior capsule weakness secondary to the minimal-change glomerulopathy or the associated drug therapy, but there needs to be more evidence to confirm or refute our claim. CONCLUSIONS: Anterior lens capsule may rupture following minor trauma on a background of minimal-change glomerulopathy.