Dissecting the complex sex-based associations of myopia with height and weight.

OBJECTIVES: To assess height and weight as possible sex-specific risk factors for bilateral myopia among young adults. METHODS: We conducted a cross-sectional study including 101,438 pre-enlisted young adult males and females, aged 17.4 ± 0.6 and 17.3 ± 0.5 years, respectively, and born during 1971-1994. Categories of BMI (body mass index) were defined according to sex-related percentiles for 17-year-olds following U.S. Centers for Disease Control and Prevention growth charts, and subjects were divided into five height and weight categories according to sex-adjusted percentiles. Data included best-corrected visual acuity, diverse socio-demographic variables, anthropometric indices, and refractive errors, namely bilateral myopes and emmetropes. RESULTS: The prevalence of bilateral myopia in males and females was 19.1% and 26.0%, respectively. Bilateral myopia displayed a J-shaped associated with BMI, achieving statistical significance only among males (p < 0.0001). Weight displayed a U-shaped association with bilateral myopia among both young males (p < 0.0001) and females (p < 0.005). A higher prevalence of bilateral myopia was observed only among males of the lower height category (p < 0.0001), even when controlling for BMI (from normal to obesity). In a multivariable regression model, obesity was associated with higher prevalence of bilateral myopia (OR: 1.21; 95% CI: 1.07-1.38, p = 0.002), only among males. There were no interactions of BMI with height or weight. Bilateral myopia was also associated with prehypertension among males (OR: 1.10, 95% CI: 1.04-1.15, p < 0.001). CONCLUSIONS: A higher risk for bilateral myopia was associated with either BMI solely or height and weight, as well as pre-hypertension, in males. The possible association with low height requires further research.

Characteristics of pediatric ocular trauma in a tertiary hospital in Israel 2011-2020 - How can public prevention policy be improved?

PURPOSE: To describe and analyze characteristics and trends of pediatric ocular trauma during 2011-2020. METHODS: Retrospective descriptive study. Data were collected on all pediatric ocular trauma cases that presented to a Rambam Health Care Campus during 2011-2020. Data included age, gender, visual acuity, diagnosis, injury mechanism and surgical repair. RESULTS: Median BCVA at presentation was 0.96 (logMAR). Males and non-adolescent males specifically were the most prominent groups (70.6% and 44.7%, respectively). The ratio of ocular trauma cases to total pediatric emergency department (ED) visits was stable during 2011-2020 (p = 0.714) regardless of gender (p = 0.832 and p = 0.545 for boys and girls, respectively). The leading causes were partial thickness eyelid laceration, periorbital hematoma, and extraocular muscle contusion, all of which were stable over the study period (p = 0.678, p = 0.203 and p = 0.398, respectively). Falls and children play were the most common mechanisms (25.8% and 18.4%, respectively), but differed between age groups. Most patients did not require consecutive operation and were treated conservatively (p < 0.01). CONCLUSION: Pediatric ocular injuries to pediatric ED visits ratio remained stable during 2011-2020, regardless of gender. Non-adolescent males accounted for nearly half of all cases, with different mechanisms for each age group. Consecutive surgery was rarely necessary.

Characteristics and differences of strabismus surgeries performed in private versus public settings: a national multicenter study.

PURPOSE: To investigate and compare the demographics, diagnoses, and surgical procedure types of strabismus repair in public and private hospitals in Israel in order to highlight possible disparities between them. METHODS: Retrospective descriptive study included all strabismus surgeries in seven private hospitals, compared with two large public university-affiliated hospitals from June 2016 to June 2021. Electronic medical records were directly retrieved to produce an anonymized database. RESULTS: During the study period 2420 operations were performed. Patients who underwent strabismus surgery in public hospitals were older and had shorter procedures (p < 0.001 and p = 0.004, respectively). The median number of operated muscles and the prevalence of bilateral procedures were higher in private hospitals (p < 0.001 and p < 0.001, respectively). Surgery for common strabismus, especially esotropia, was more prevalent in private (p < 0.001), whereas surgery for vertical strabismus, cranial nerve palsies and complex syndromes were performed more often in public hospitals (p < 0.001, p = 0.008, and p < 0.001, respectively). Rectus recession and inferior oblique (IO) anteriorization were more predominant in private hospitals (p = 0.002 and p < 0.001, respectively), while recuts advancement and IO myectomies were more prevalent in public ones (p = 0.001 and p < 0.001, respectively). Reoperations were far more common in public hospitals (27.2% vs 6.2%, p < 0.0001). This was true across most age groups. CONCLUSIONS: Candidates for strabismus surgery in private hospitals in Israel are often younger, with more common diagnoses, and are usually referred for simpler procedures.

Analysis of Prognostic Factors Impacting Pediatric Acute Mastoiditis Outcomes.

BACKGROUND: This study aimed to investigate the outcomes of pediatric patients with acute mastoiditis while examining the role of intravenous steroid therapy, patient demographics, and serum inflammatory values as prognostic factors. METHODS: This study is a single-center retrospective observational study including 73 consecutive patients treated for acute mastoiditis in the course of the 10-year study period (January 2010 to December 2019). RESULTS: Data analysis showed that patients requiring surgical treatment (14%) had a 3-fold higher C-reactive protein value at admission compared to those treated conservatively (P < .001). Receiver operating characteristic analysis revealed that a C-reactive protein cut-off of ≥98.7 had a sensitivity and specificity of 100% and 74.6%, respectively, for predicting the need for surgery (area under the curve=0.927, P < .001). The duration of symptoms before hospitalization was nearly 2 days shorter in male patients (P=.031), and the use of intravenous steroid therapy significantly shortened the length of hospitalization (P=.023), by 1.4 days on average. CONCLUSION: Intravenous steroid therapy may be useful in decreasing the length of hospital stay. Mastoiditis tends to present more severely in male patients, and monitoring C-reactive protein values during treatment correlated well with the need for surgery.

Childhood blindness incidence and aetiologies trends in Israel 2014-2020: what should we focus on?

OBJECTIVES: Analyse trends in incidence and aetiologies of childhood blindness (CHB) in Israel during 2014-2020, with comparison to the previous decade. METHODS: Descriptive, retrospective population-based trend study using Poisson regression. Data retrieved from the Israeli National Registry of the Blind included demographics, registration-years, and aetiologies. Primary and secondary outcomes were incidence of new certified blindness cases and its comparison with the previous decade, respectively. RESULTS: In total, 4.19 new CHB certificates per 100,000 were issued in Israel during 2014-2020, with a slight non-significant increase (p = 0.31). Males and younger children had higher incidence rates (p = 0.0008 and p = 0.0002, respectively). Leading causes were optic nerve anomalies (ONA), retinal dystrophies (RDYS), other retinal disorders (ORD) and cerebral visual impairment (CVI) (16.9%, 15.1%, 12.4% and 10.5%, respectively). Compared with the previous decade: ONA rates remained unchanged (p = 0.13) as did some other main aetiologies (i.e., albinism, CVI and nystagmus), while rates of RDYS and ORD increased (by 21.9%, p = 0.001 and 9.9% p = 0.02, respectively). Rates of retinopathy of prematurity (ROP), glaucoma, cataract and amblyopia remained very low (weighted average of 0.15, 0.14, 0.09 and 0.03 per 100,000, respectively). CONCLUSIONS: The incidence of CHB certifications in Israel remained stable with a slight increase, stemming chiefly from RDYS resurgence and an increase in ORD. Main causes remained ONA and RDYS. The most common avoidable cause, ROP, remained scarce, maintaining the reduction seen in the earlier decade, as did cataract, glaucoma, and amblyopia. This may support future nationwide prevention policies to decrease the incidence of RDYS and ORD.

The Effect of Meibomian Gland Dysfunction on Laser-Assisted In Situ Keratomileusis in Asymptomatic Patients.

INTRODUCTION: To evaluate the impact of asymptomatic meibomian gland dysfunction (MGD) on laser-assisted in situ keratomileusis (LASIK) outcomes and dry eye signs and symptoms. METHODS: A retrospective analysis of patients who underwent LASIK surgery between July 2017 and February 2018 at Care Vision Refractive Clinic, Tel Aviv, Israel, was done. Patients were divided into those who had preoperative asymptomatic significant MGD (MGD group) and those who did not have preoperative significant MGD (control group). Outcomes were the postoperative presence of punctate epithelial erosions, dry eye symptoms, the number of postoperative visits as a measure of adverse events, visual acuity, spherical equivalent, safety index, efficacy index, and the type of refractive error (myopia or hyperopia). RESULTS: A total of 497 eyes were included in this study. Both groups had similar rates of punctate epithelial erosions, 30 (12.9%) patients vs. 39 patients (14.8%) (p = 0.31); postoperative complaints of dryness, 75 patients (32.3%) vs. 90 patients (34.2%) (p = 0.36); and postoperative number of visits, 3.15 ± 0.75 vs. 3.12 ± 0.54 (p = 0.59). Uncorrected visual acuity (logMAR) at 1 month (0.026 ± 0.09 vs. 0.026 ± 0.17, p = 0.99) after surgery was similar in both groups. Mean spherical equivalent was 0.03 ± 0.17 and - 0.03 ± 0.18 (p = 0.99) in both groups. Safety index was 1.024 ± 0.06 in the clinically significant MGD group and 1.029 ± 0.07 in the control group (p = 0.45). Efficacy index was also similar in both groups (0.966 ± 0.155 and 0.979 ± 0.14, respectively, p = 0.31). No differences were found between patients with myopia and hyperopia. CONCLUSIONS: Patients with preoperative asymptomatic MGD have similar LASIK outcomes to patients without preoperative asymptomatic MGD. Accordingly, no preoperative MGD treatment or special caution is needed in these cases.

The correlation between shoulder pathologies and sleep disorders.

OBJECTIVE: To assess and characterize the correlation between shoulder pathologies and sleep disturbances. METHODS: Participants enrolled into this case-control study were divided into two groups: patients with an established clinical diagnosis of active shoulder pathology (study group), and patients without any shoulder pathology (control group). All patients completed the Insomnia Severity Index (ISI) questionnaire, in addition to questions related to participant demographics, health status, medication, and other known insomnia risk factors. RESULTS: A total of 98 patients were included (46 in the study group and 52 controls). Mean ISI score was significantly higher (indicating more severe insomnia) in the study group versus control group (t[96] = -9.67), even after correcting for confounders (t[53.1] = -8.61). Additionally, in patients with shoulder pathology, those with comorbidities experienced more sleep disturbances than those without comorbidities (ß = 0.36). Lastly, the shoulder pathology group was at a higher risk of having sleep disturbances compared with controls (relative risk 4.86, 95% confidence interval 2.24, 10.55). CONCLUSIONS: Sleep disturbances are more common among patients with shoulder pathologies. Comorbidities and a shorter duration of pathology may predict more severe sleep disturbances.

Sex-Differences in Atrial Fibrillation Patients: Bias or Proper Management?

Background: Studies analyze the degree to which gender-based differences are affected by age and comorbidities show mixed results. Methods: Using a retrospective cohort study, we analyzed 327 consecutive patients who presented to the emergency department (ED) due to Atrial Fibrillation (AF) from 2014 to 2017 with follow-up at one year. Results: Females with AF were older (p < 0.001), with higher Body Mass Indexes (BMI) (p < 0.001), and a higher rate of hypertension (p < 0.001), hyperlipidemia (p = 0.01), diabetes mellitus (p = 0.05), valvular heart disease (p = 0.05), and thyroid dysfunction (18.3% vs 1.8%, p < 0.001). AF males had higher rate of coronary artery disease (p < 0.001) and heart failure with reduced ejection fraction (p < 0.001). Females were managed with rate control medications more frequently than with antiarrhythmic (p < 0.001). After adjusting gender to age and comorbidities, females continued to have higher rates of heart failure hospitalization (Odds Ratio (OR) 2.73 95% Confidence Interval (CI) 1.04-5.89, P-value <0.001) and recurrent AF (OR 3.86, P-value=0.02). Thyroid dysfunction and the lack of antiarrhythmic treatments significantly increased the risk of AF (OR 5.95 95% CI 3.15-9.73, OR 3.42, respectively, P-value <0.001 for both) regardless of gender. The mortality rate differs only in a sub-group of females ≥75 years of age (OR 1.60, P < 0.001). Conclusion: AF males and females differ significantly in baseline characteristics and tend to be treated unnecessarily differently for AF. Heart failure hospitalizations and recurrent AF continued to be associated with female AF patients, even after adjusting gender to age and comorbidities. Thyroid dysfunction and AF treatment may explain the higher rates of recurrent AF in female patients.

Time Trends of Etiologies of Blindness in Israel 2009-2020:Have Methods to Decrease Leading Causes of Blindness Been Exhausted?

PURPOSE: To perform a nationwide analysis of trends in the incidence of etiologies for legal blindness in Israel during 2009-2020, and to compare the results with those of the previous decade. DESIGN: Descriptive, retrospective population-based trend study. METHODS: Data were retrieved from the Israeli National Registry of the Blind during 2009-2020. Data obtained included demographics, years of registration, and causes. Primary and secondary outcomes were the incidence of new certified blindness cases and its comparison with that of the previous decade, respectively. RESULTS: The age-standardized incidence rate of blindness in Israel decreased from 15.76 per 100,000 residents in 2009 to 11.83 in 2020, a 24.9% drop. The mean annual decline was evident until 2013 (P < .001, 6.15%), but subsequently flattened (P = .71, 0.42%). Age-related macular degeneration (AMD), glaucoma, optic atrophy, and cataract decreased until 2014, and reached a plateau that was maintained until the end of the study period. Diabetic retinopathy (DR) incidence rates diminished throughout the decade (P < .001, 9.2%), with attenuation of the rate of decline after 2014. CONCLUSIONS: The impact of efforts to reduce the incidence of preventable causes of blindness may have nearly reached saturation for most of the leading causes of blindness in Israel, namely, AMD, glaucoma and cataract. The incidence of DR has been maintained; however, attenuation has been observed. New modalities to detect and treat these causes may have to emerge before a resurgence of improvement can occur.

Predicting Post-Cataract Surgery Visual Acuity in Vitrectomized Eyes: The Efficacy and Accuracy of "Lambda" Retinometry.

BACKGROUND AND OBJECTIVE: Determine the ability of Lambda retinometry to predict post-cataract surgery visual acuity in vitrectomized eyes. PATIENTS AND METHODS: Prospective study including 47 cataract surgery candidates with a history of pars plana vitrectomy (PPV). Lambda retinometry using a hand-held Lambda retinometer and best-corrected visual acuity (BCVA) were measured preoperatively, and BCVA was reassessed postoperatively. RESULTS: Lambda predictions strongly correlated with postoperative BCVA (logarithm of the minimum angle of resolution [logMAR]) (P < .001, r2 = 0.57), especially combined with preoperative BCVA (logMAR) (P < .001, r2 = 0.65). In 89% of cases, postoperative BCVA was equal to or higher than the prediction. Neither cataract grades nor indications for PPV were associated with the accuracy of Lambda predictions (P = .882 and P = .790, respectively). Underestimation of visual outcome was more common than overestimation. A Lambda prediction of ≥ 20/40 (Snellen) had a positive predictive value of 85.7% and a negative predictive value of 73.6% for the postoperative outcome. CONCLUSIONS: Lambda retinometry can reliably predict the postoperative BCVA in cataract patients who previously underwent PPV, with a tendency towards underestimation. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:535-542.].

Clinical Efficacy of Topical Nasal Pomegranate Fruit Extract for Chronic Rhinitis and Chronic Rhinosinusitis.

Objective: To evaluate the clinical efficacy of topical nasal Pomegranate Fruit Extract (PFE) for Chronic Rhinitis (CR), Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP), and Chronic Rhinosinusitis without Nasal Polyposis (CRSsNP). Methods: Prospective, double-blinded, randomized study including 111 consecutive patients, between April 2012 and January 2017, afflicted by CRSwNP, CRSsNP, and CR. Patients from each group were randomly assigned to either PFE treatment or placebo twice daily for 30 days. Therapeutic efficacy was assessed by Ear Nose and Throat, blood and tomographic examinations, and the SNOT-20 questionnaire. Results: CR patients treated with PFE suffered significantly less from thick nasal discharge, difficulty falling asleep, reduced productivity, reduced concentration, and sadness (P = .004, P = .02, P = .03, P = .007 and P = .02, respectively). Conclusions: Topical nasal PFE was found to have some benefits for CR patients, however, not for CRS with or without Nasal Polyposis.

Clinical and echocardiographic trends in percutaneous balloon mitral valvuloplasty.

BACKGROUND: The prevalence of Rheumatic Mitral Stenosis (MS) has significantly changed over the last decades. We intend to examine patient demographics, Echocardiographic characteristics, procedural success rates, and complications throughout 30-years. METHODS: We conducted a single-center descriptive observational study. The study population consists of patients undergone percutaneous balloon mitral valvuloplasty (PBMV) at Emek Medical Center in Israel from January 1990 to May 2019. RESULTS: Four hundred seventeen patients underwent PBMV during the study period and were eligible for the study. Age did not change significantly over time (p = 0.09). The prevalence of Male and patients who were smoking and had multiple comorbidities such as hypertension, dyslipidemia, ischemic heart disease, and chronic kidney disease became increases over time (p = 0.02, p = 0.02, p = 0.001, p = 0.01, p = 0.02, and p = 0.001, respectively). Wilkins score and all its components increased over time, and the total score was higher in females (p = 0.01). Seventy-nine (18.9%) patients had complications. The rate of complications did not change over decades. Patients with Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 had the highest risk for the need of Mitral valve replacement (MVR) surgery in 2 years following PBMV (3.64, 4.03, 2.44, respectively, CI 95%, p < .0001 for all). The median time in these patients was 630 days compared to 4-5 years in the entire population. Patients with Post-procedural MR of ≥2 and post-procedural MVA < 1.5 had ten times risk for developing heart failure (HR 9.07 and 10.06, respectively, CI 95%, P < .0001). CONCLUSION: Our research reveals trends over time in patients' characteristics and echocardiographic features. Our study population consists of more male patients with multiple comorbidities and more complex and calcified valvular structures in the last decade. Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 cm2 were in-depended predictors for the time for surgery and heart failure hospitalization.

Postoperative New-Onset Atrial Fibrillation following Noncardiac Operations: Prevalence, Complication, and Long-Term MACE.

BACKGROUND: Postoperative new-onset atrial fibrillation (POAF) is a common complication following cardiothoracic surgery, but little is known regarding its occurrence and outcome following noncardiothoracic surgery. This study was intended to examine the incidence of POAF in noncardiothoracic surgeries performed under general anesthesia and its effects on the length of hospitalization stay, short-term and long-term morbidity, and mortality. Methodology. We conducted a retrospective observational descriptive study. The study population consists of patients hospitalized in surgical wards from January 2014 to December 2017. Surgery was defined as noncardiac or thoracic procedure conducted under general anesthesia. RESULTS: A total of 24,125 general anesthesia operations were performed at 7 surgical wards. About two-fifth of the operations (40%) were operated electively, and the rest underwent emergency surgery. The mean age was 63.78 ± 11.50, and more than half (56.9%) of the participants were female. The prevalence of POAF was 2.69 per 1000 adult patients (95% CI: 2.11-3.43) and vary significantly among wards. The highest prevalence was observed after hip fixation and laparotomy surgeries (54.9 and 26.7 per 1000 patients, respectively). The median length of hospitalization was significantly higher in POAF patients (21.0 vs. 4.8 days, p < 0.001). Patients who developed POAF had significantly higher mortality rates, both inhospital (200 vs. 7.56 deaths per 1000, p=0.001) and 1 year (261.5 vs. 33.3 per 1000, p=0.001, respectively). There was no significant association between outcome and treatment modalities such as rate or rhythm control and anticoagulant use. CONCLUSION: New-onset AF following noncardiac surgery is rare, yet poses significant clinical implications, both immediate and long-term. POAF is associated with a longer length of hospitalization and a significantly higher mortality rate, both in short- and long-term.