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SIGNIFICANCE: This study explores the difference between cycloplegic and noncycloplegic refraction in young adult myopes. PURPOSE: From the available literature, it is unclear whether cycloplegia is necessary when refracting young adults. This study investigates the agreement between noncycloplegic autorefraction and cycloplegic autorefraction and investigates factors affecting the agreement between the two methods. METHODS: In total, 125 myopes with ages ranging between 18 and 26 years were included from Australia and Vietnam. Each participant underwent noncycloplegic autorefraction and cycloplegic autorefraction. Cycloplegia was induced with 1% ophthalmic tropicamide. RESULTS: The mean spherical equivalent difference (95% confidence interval) between noncycloplegic autorefraction and cycloplegic autorefraction was -0.20 D (-0.25 to -0.14 D; t124 = -7.18, p<0.0001 ) . A mean difference of >0.25 D was seen in 46.8% of eyes. The lower and upper limits of agreement were -0.80 and 0.41 D, respectively. With univariate analysis, factors including age, degree of refractive error, accommodation amplitude, and distance phorias showed no impact on the average difference between cycloplegic autorefraction and noncycloplegic autorefraction. Yet, eyes with near exophoria ( F2,120 = 6.63, p=0.0019) and Caucasian eyes ( F3,121 = 2.85, p=0.040) exhibited the smallest paired differences. However, in the multivariate analysis, only near exophoria was associated with a lower mean difference. A significantly smaller proportion (34.9%) of eyes with near exophoria had a paired difference of -0.25 D or more compared with esophoria (50%) and orthophoria (65%; χ2 = 6.6, p=0.038). CONCLUSIONS: Noncycloplegic autorefraction results in more myopic refractive error than cycloplegic autorefraction in young adults.
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Midriáticos , Miopia , Refração Ocular , Tropicamida , Humanos , Refração Ocular/fisiologia , Adulto Jovem , Midriáticos/administração & dosagem , Adulto , Masculino , Adolescente , Feminino , Miopia/fisiopatologia , Miopia/diagnóstico , Tropicamida/administração & dosagem , Pupila/efeitos dos fármacos , Pupila/fisiologia , Acomodação Ocular/fisiologiaRESUMO
SIGNIFICANCE: Studies on adult myopia progression are limited. This retrospective analysis of a large data set of young adult myopes characterizes myopia progression during adulthood. PURPOSE: This study aimed to determine the mean annual progression of myopia and to estimate the proportion of progressors in adult myopes. METHODS: Longitudinal, noncycloplegic subjective refraction data for young adult myopes (spherical equivalent refractive error, -0.5 D or more), age ranging from 18 to 30 years, were retrospectively analyzed. The mean annual progression, as well as the proportion of progressors (at least -0.50 D shift between visits and annualized progression of -0.25 D or more), was estimated. RESULTS: A total of 354 myopes (230 females [64.7%]), with a mean (standard deviation) age of 22.2 (3.8) years, were considered. The mean (standard deviation) annualized progression was -0.10 (0.21), -0.08 (0.2), and -0.04 (0.21) D in the 18- to 21-year, 22- to 26-year, and 27- to 30-year age groups, respectively ( P = .003). The difference between 18- to 21- and 27- to 30-year age groups was significant ( P = .05), whereas all other pairwise comparisons were not significant. The proportion (95% confidence interval) of progressors in the 18- to 21-, >21- to 26-, and >26- to 30-year age groups was 18.3% (14.9 to 21.7%), 10.9% (7.1 to 14.7%), and 8.8% (4.4 to 13.1%), respectively. The proportion of progressors working or studying in a higher learning/academic environment was 16.2% with an odds ratio (95% confidence interval) for progression of 2.07 (1.15 to 3.74) compared with those in nonacademic environments ( P = .02), with no significant effect of sex or ethnicity. CONCLUSIONS: This study is consistent with other studies on myopia in young adults, which show that myopia does not progress by substantial amounts throughout the adult years, particularly after the age of 21 years. Although future studies may be challenged by the small rates of change and the small proportion of progressors, further research is needed to understand the implications of adult myopia progression on clinical management.
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Miopia , Refração Ocular , Feminino , Adulto Jovem , Humanos , Adulto , Adolescente , Estudos Retrospectivos , Miopia/diagnóstico , Miopia/epidemiologia , Miopia/terapia , Testes Visuais , Previsões , Progressão da DoençaRESUMO
Suprachoroidal silicone oil migration is an unusual complication of small gauge 3 ports Pars plana vitrectomy (3PPV) system. Our objective is to report a retrospective, observational case of an intra-operative suprachoroidal silicone oil (SO) migration during 27 gauge 3PPV and its successful surgical management. A 49 years old male patient with type 2 diabetes, presented to the ophthalmology outpatient department with reduced visual acuity in his right eye. He was diagnosed as having tractional retinal detachment involving macula. During combined phaco-vitrectomy following injection of SO, peripheral choroidal elevations were noted suggesting suprachoroidal SO migration. In an attempt to drain this intra-operatively nasal sclerotomy was enlarged. Post-operative B scan showed significant choroidal detachment for which patient was re-scheduled for surgery after 1 day. Three radial trans-scleral incisions (2 nasal and 1 temporal) for drainage were made at the site of maximum choroidal detachment. By massaging and widening these scleral incisions, suprachoroidal haemorrhage and SO was successfully drained with good post-operative visual improvement.
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Efusões Coroides , Diabetes Mellitus Tipo 2 , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Óleos de Silicone/efeitos adversos , Vitrectomia/efeitos adversosRESUMO
OBJECTIVE: To identify modifiable and non-modifiable risk factors among young patients undergoing elective coronary artery bypass graft surgery. METHODS: The descriptive cross-sectional study was conducted at the Department of Adult Cardiac Surgery of the Armed Forces Institute of Cardiology and National Institute of Heart Disease, Rawalpindi, Pakistan, from January 1, 2015, to April 24, 2018, and comprised patients who underwent elective coronary artery bypass grafting. Data was collected using a predesigned questionnaire, and the risk factors studied were hypertension, diabetes, smoking, serum cholesterol, family history and body mass index. Data was analysed using SPSS 23. RESULTS: Of the 1270 patients, 838(66.1%) were males and 432(33.9%) were females. The overall mean age was 39.29±8.64 years (range: 18-49 years). Of the total, 319(25.2%) patients were hypertensive; 170(13.3%) were diabetics; 303(23.9%) had history of smoking; 566(44.6%) were obese. CONCLUSIONS: There was a high prevalence of obesity, hypertension and smoking in the patients undergoing coronary artery bypass graft surgery at age <50 years.
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Cardiologia , Doença da Artéria Coronariana , Cardiopatias , Adulto , Ponte de Artéria Coronária , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/cirurgia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Fatores de Risco , Atenção Terciária à SaúdeRESUMO
The study was aimed to prepare a co-amorphous system of valsartan (VAL) with vanillin (VAN) for improving its solubility and dissolution followed by its confinement in mesoporous silica particles (MSPs) to stabilise the co-amorphous system and prevent its recrystallization. Amorphous VAL and VAN were obtained through quench-cooling and VAL/VAN binary co-amorphous system (VAL/VAN-CAS) was prepared through solvent evaporation technique. The particle size and morphology of VAL/VAN-CAS-MSPs were studied using scanning electron microscopy (SEM) and solid-state characterisation was performed by differential scanning calorimetry (DSC) and X-ray powder diffraction (XRPD). The in vitro dissolution was investigated by dialysis bag diffusion method. SEM analysis revealed irregular shaped VAL/VAN-CAS-MSPs with a size range of 5-25 µm, while outcomes of DSC and XRPD confirmed the formation of VAL/VAN-CAS. The in vitro dissolution profiles demonstrated a significantly increased dissolution in first 60 minutes from VAL/VAN-CAS (â¼68%) and VAL/VAN-CAS-MSPs (â¼76%) compared to powder VAL (â¼25%).
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Anti-Hipertensivos/química , Benzaldeídos/química , Portadores de Fármacos/química , Dióxido de Silício/química , Valsartana/química , Anti-Hipertensivos/administração & dosagem , Benzaldeídos/administração & dosagem , Cristalização , Liberação Controlada de Fármacos , Aromatizantes/administração & dosagem , Aromatizantes/química , Porosidade , Solubilidade , Valsartana/administração & dosagemRESUMO
PURPOSE: To report a case of atypical serpiginous choroiditis with previously unreported findings on optical coherence tomographic angiography. CASE REPORT: A 35-year-old otherwise healthy man had a 1-week history of vision loss in his right eye. The visual acuity in right eye was counting fingers at 1 meter. Fundoscopy showed a classic peripapillary serpiginous lesion and a solitary macular lesion. Fundus fluorescein angiography revealed early hypofluorescence of active lesions with gradual increase in fluorescence across the phase of angiogram. Optical coherence tomography showed hyperreflectivity in outer retinal layers and loss of ellipsoid zone band. The patient was treated with oral prednisone and visual acuity returned to near normal. The inflammation recurred once the patient discontinued corticosteroid therapy. The flare-up was treated with intravenous methylprednisolone followed by oral steroids. Oral azathioprine was added as a steroid-sparing agent and oral prednisone was tapered slowly and discontinued. The visual acuity returned to normal with settlement of all lesions after initiating azathioprine. Optical coherence tomography showed reintegration of retinal anatomy. No recurrence was seen after discontinuation of corticosteroids. Optical coherence tomographic angiography in resolved serpiginous choroiditis was consistent with loss of choriocapillaris homogeneity. CONCLUSIONS: Serpiginous choroiditis may manifest with multifocal lesions and may be confused with relentless placoid chorioretinitis. However, it ends up in a typical geographic scar. Optical coherence tomography can be used to monitor the changes in retinal structure. Choriocapillaris changes as seen on optical coherence tomographic angiography may be a possible mechanism behind the development of choroidal neovascularization in later stages of the disease.
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Corioide/patologia , Corioidite/diagnóstico , Angiofluoresceinografia , Imagem Multimodal/métodos , Oftalmoscopia , Tomografia de Coerência Óptica , Adulto , Corioidite/fisiopatologia , Fundo de Olho , Humanos , Masculino , Recidiva , Retina/patologia , Acuidade VisualRESUMO
PURPOSE: To report a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with atypical features. CASE REPORT: A 30-year-old otherwise healthy woman presented with a 7-day history of visual disturbance in her left eye. The best corrected visual acuity in her left eye was 6/36. Funduscopy revealed multiple cream-colored placoid lesions, serous macular elevation, and papillitis. Fundus fluorescein angiography revealed early hypofluorescence and late hyperfluorescence. Systemic and neurologic assessments were normal. The case shared features with both APMPPE and Harada's disease, making it a diagnostic challenge. However, APMPPE may rarely mimic Harada's disease when it manifests with atypical features, like serous retinal detachment and papillitis. The patient was managed with oral prednisolone with slow tapering. Her visual acuity improved gradually to 6/12. Neither involvement of fellow eye nor recurrence in same eye was noted for a period of 1 year. CONCLUSIONS: Acute posterior multifocal placoid pigment epitheliopathy may rarely manifest with atypical features, including papillitis and serous retinal detachment, perplexing the diagnosis and management.
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Papiledema/diagnóstico , Epitélio Pigmentado Ocular/patologia , Doenças Retinianas/diagnóstico , Doença Aguda , Adulto , Feminino , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Papiledema/tratamento farmacológico , Epitélio Pigmentado Ocular/efeitos dos fármacos , Prednisolona/uso terapêutico , Doenças Retinianas/tratamento farmacológico , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico , Acuidade Visual/fisiologiaRESUMO
Early identification of rib fractures, even in young patients without chronic diseases, is essential. Prompt diagnosis facilitates appropriate management, aiding in pain control and addressing underlying causes such as persistent coughing. Additionally, vigilance for complications such as pneumothorax and rib displacement is crucial for optimizing patient care.
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Key Clinical Message: Ibuprofen single dose may rarely induce Stevens-Johnson Syndrome, emphasizing the vital need for heightened vigilance in healthcare and public awareness for safer medication practices. Abstract: Stevens-Johnson Syndrome (SJS) is a severe and potentially life-threatening skin disorder associated with certain medications, including ibuprofen. We present a case of a 45-year-old woman who developed SJS following a single dose of ibuprofen. Despite its rarity, this case underscores the importance of heightened vigilance in healthcare and public awareness regarding the potential risks of commonly used medications. Prompt recognition of SJS symptoms and immediate medical intervention are crucial for patient outcomes. Healthcare providers should exercise caution when prescribing ibuprofen, particularly in patients with a history of adverse drug reactions. This case emphasizes the need for ongoing monitoring, patient education, and informed decision-making to promote medication safety and optimal patient care.
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De Winter syndrome, though rare, demands heightened clinical suspicion. Recognizing its electrocardiographic subtleties is crucial, as prompt diagnosis allows for life-saving interventions such as percutaneous coronary intervention or thrombolysis.
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Key Clinical Message: Early recognition and management of seronegative celiac disease, even in the absence of typical serological markers, can prevent complications and ensure better health outcomes in pediatric patients. Consideration of a gluten-free diet in similar cases can lead to significant clinical improvement. Abstract: Celiac disease, characterized by its diverse clinical manifestations, often necessitates adherence to a gluten-free diet, particularly in pediatric patients for optimal growth and development. This report presents the case of an 11-year-old male who exhibited recurrent symptoms of fever and diarrhea progressing to edema and pallor, with a history dating back to age 3. Laboratory findings revealed pancytopenia, hypoalbuminemia, and proteinuria. Despite negative serological markers, noninvasive tests, along with clinical improvement on a gluten-free diet and supportive measures within a month, suggested celiac disease complicated by transient protein-losing enteropathy and vitamin B12 deficiency. It is important to note that other malabsorption disorders can also show clinical improvement following a gluten-free diet. Additionally, the antibiotic treatment received by the patient could have addressed other possible causes of malabsorption, complicating the differential diagnosis. This case highlights the importance of early recognition and management of celiac disease, especially in pediatric patients, to prevent complications and promote optimal health outcomes.
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Key Clinical Message: Timely recognition of atypical Takayasu arteritis is crucial. Unusual presentations, such as pericardial effusion, can complicate diagnosis. CT angiogram aids in precise diagnosis, guiding targeted immunosuppressive therapy. Multidisciplinary collaboration is vital for comprehensive management, improving patient outcomes in this challenging condition. Abstract: This case study highlights the diagnostic challenges posed by atypical presentations of Takayasu arteritis (TA), focusing on a 42-year-old male presenting with pericardial effusion. Despite inconclusive initial investigations, a CT angiogram revealed large vessel vasculitis, confirming TA. Management with immunosuppressive therapy led to clinical improvement. This case emphasize the importance of recognizing unusual manifestations of TA for timely diagnosis and appropriate treatment, emphasizing the role of multidisciplinary collaboration in optimizing patient outcomes.
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Objectives: In 2021, large outbreak of Crimean-Congo hemorrhagic fever (CCHF) was reported in Iraq and cases have increased without any significant control measures. To raise awareness about the increasing cases in different regions of Iraq, hence remind the necessity to tackle contributing factors and potential outbreak interventions. Methods: The study included 511 polymerase chain reaction-confirmed CCHF infection cases out of 1827 suspected cases from 18 Provinces from January to August 2023. Approval from the Ministry of Health for data analyzed. Results: Out of 1827 suspected cases, 511 were confirmed positive by polymerase chain reaction. The total case fatality rate (CFR) was 12.7 with varying severity levels among provinces. Erbil had the highest CFR, 38.5, while Sulaimaniya and Anbar report no deaths. Independent t-test showed a significant difference in CFR between provinces west and south of Baghdad compared to north (P <0.05). Trend showed significant surges after Iftar and Adha holidays. Conclusion: Differences in CFR among provinces around the religious ceremonies, highlight the need for one public health intervention strategy. Increased temperatures affected vector behavior. Uncontrolled animal movement with neighboring countries is an important factor. Virus or host determinants can shape the clinical case outcomes, which need clinical and extensive laboratory studies to unravel the reasons leading to death.
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Purpose: To evaluate the effect of mean ocular perfusion pressure on the foveal avascular zone (FAZ) area in eyes with successful retinal detachment (RD) surgery. Methods: This prospective pilot fellow eye-controlled study measured the intraoperative mean ocular perfusion pressure in eyes having surgery for rhegmatogenous RD (RRD). Postoperatively, the FAZ area was measured; the change was calculated as the difference in the FAZ area between the operated eye and the contralateral control eye. Results: The study comprised 8 patients with a mean age (±SD) of 53.38 ± 13.92 years. The mean superficial FAZ area was not different between operated eyes and control eyes, while the deep FAZ area was significantly larger in operated eyes. There was a strong negative correlation between the mean ocular perfusion pressure and the change in the deep FAZ area (Spearman ρ, -0.73; P = .04); the correlation between the mean ocular perfusion pressure and the change in the superficial FAZ area was not significant (Spearman ρ, -0.24; P = .57). A significant linear regression was found between the mean ocular perfusion pressure and the change in the deep FAZ area (R2 = 0.388). The predicted enlargement of the deep FAZ area was 0.03 mm with every 1 mm Hg decrease in the mean ocular perfusion pressure. Conclusions: Lower intraoperative mean ocular perfusion pressure is associated with enlargement of the deep FAZ area in eyes having successful RRD surgery.
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Background and Aims: The present study aims to shed light on the knowledge, attitude, and practice of breast self-examination with breast cancer (BC) among female patients in the oncology department of Baghdad Medical City. Methods: This cross-sectional study involved 100 female participants at the Oncology Teaching Hospital in Baghdad Medical City between June 15 and October 15, 2022. Using convenient sampling, the study targeted females aged 30-75, recently or previously diagnosed with BC, admitted for treatment and follow-ups. Results: Regarding the assessment of knowledge, among the surveyed patients, 71 are aware of breast self-examination (BSE), primarily through social media (42 patients). The study also explores the link between BSE and education levels. While Pearson's chi-square shows no significance (0.107), the likelihood ratio suggests a significant association (0.041). Regarding the analysis of attitudes, the study assessment for the reasons for compliance showed that 19 patients cite medical reasons, and 48 patients attribute noncompliance to a lack of knowledge of how to perform BSE. Regarding the examination of practice, high statistical significance is evident in both Pearson's chi-square (0.000) and likelihood ratio (0.000) tests, emphasizing the substantial relationship between the post-diagnosis initiation timing of BSE and its correct execution. Additionally, a statistically significant association exists between performing BSE correctly and discovering BC (p = 0.000). Conclusion: Regarding the assessment of knowledge, our study found high awareness of BSE within the population, primarily through social media and health organizations. Regarding the analysis of attitudes, a notable proportion refrained from practicing BSE, primarily due to a perceived lack of knowledge about the methods. Regarding the examination of practice, the observed significant associations between performing BSE correctly, discovering BC, and the frequency of examinations underscore the pivotal role of consistent and accurate BSE in early detection.
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Key Clinical Message: This case underscores the atypical presentation of late-onset congenital diaphragmatic hernia in a 9-old with 1p36 deletion syndrome. Recognition of respiratory distress and abdominal symptoms is crucial for intervention. Abstract: Congenital Diaphragmatic Hernia (CDH) is a condition characterized by the protrusion of abdominal contents into the thoracic cavity due to a defect in the diaphragm. While typically observed in the neonatal period, CDH can present in later life. This case report describes the presentation, diagnosis, and management of a nine-year-old boy with 1p36 deletion syndrome who presented with respiratory distress, abdominal pain, vomiting, and anorexia. The initial diagnosis was tension pneumothorax, and thus the patient underwent chest tube placement. However, a high-resolution CT scan revealed a left hemidiaphragmatic hernia, and the patient eventually underwent an emergency laparotomy due to acute-onset respiratory distress. Intraoperatively, a diagnosis of Bochdalek hernia with gastric perforation was made, and the CDH and gastric perforations were resolved successfully. This case highlights the importance of considering late-presenting CDH as a possible diagnosis in pediatric patients with similar symptoms and the radiological findings suggestive of tension pneumothorax. Early recognition and prompt surgical intervention can lead to successful management of such cases.
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Anomaly detection (AD) has witnessed substantial advancements in recent years due to the increasing need for identifying outliers in various engineering applications that undergo environmental adaptations. Consequently, researchers have focused on developing robust AD methods to enhance system performance. The primary challenge faced by AD algorithms lies in effectively detecting unlabeled abnormalities. This study introduces an adaptive evolutionary autoencoder (AEVAE) approach for AD in time-series data. The proposed methodology leverages the integration of unsupervised machine learning techniques with evolutionary intelligence to classify unlabeled data. The unsupervised learning model employed in this approach is the AE network. A systematic programming framework has been devised to transform AEVAE into a practical and applicable model. The primary objective of AEVAE is to detect and predict outliers in time-series data from unlabeled data sources. The effectiveness, speed, and functionality enhancements of the proposed method are demonstrated through its implementation. Furthermore, a comprehensive statistical analysis based on performance metrics is conducted to validate the advantages of AEVAE in terms of unsupervised AD.
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Background: Various factors contribute to the pathogenesis of a disease. These include genetic factors, family history, and some idiopathic causes. Genetic makeup has an important role in the progression of disease. This is due to mutations in genetic material, that is, deoxyribonucleic acid (DNA). Methodology: This is a cross-sectional study that involved 5000 participants distributed across 250 countries. All the participants were randomly selected and asked to fill out the online survey. All the participants were fully informed about the study's purpose before providing their consent. Results: The participants were distributed among 250 countries. Their age mean (standard deviation) is 46.7 (12.4). We discovered a significant difference between those who have genetic or congenital diseases and those who have a family history of the disease. Also, there is a statistically significant difference between the recurrence of the disease and the duration of the visits of close relatives who have the same disease. Conclusion: The study suggests that there might be some ways, through gene waves or the environment, in which a gene changes the expression of other genes of similar sequence in different individuals when the required period of contact is provided. In the future, this theory might explain the idiopathic nature of some diseases.
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Infection with the novel coronavirus that causes coronavirus disease 2019 (COVID-19) results in a variety of clinical symptoms, including various neurological abnormalities. Peripheral nervous system symptoms, such as peripheral neuropathies, were often recorded in the medical literature, primarily as Guillain-Barré syndrome. Mononeuropathy multiplex is a multifocal axonal neuropathy commonly associated with vasculitis or connective tissue disease. Recent evidence about its associations with severe COVID-19 infection and intensive care unit hospitalization is being considered. A 58-year-old man with clinical and electrophysiological confirmation of mononeuropathy multiplex was reported during the peri-COVID-19 illness. He was treated with steroids and achieved a satisfactory response. Therefore, clinical and neurophysiological evaluation is recommended for any patient presenting with neurological manifestations following COVID-19 infection.
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This is a case report of an 83-year-old female who presented to the emergency department within eight hours of symptom onset. A CT angiogram revealed a distal basilar artery occlusion, as well as a perfusion deficit in the right superior cerebellar artery. Her symptoms fluctuated, and she was started on a heparin drip, but later in the evening her symptoms worsened. A mechanical thrombectomy was performed by interventional radiology. The following morning, most of the patient's deficits had resolved, and, when seen in the clinic several weeks later, she continued to be asymptomatic. This case report highlights the importance of timely diagnosis and intervention in the management of distal basilar artery occlusion.