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Journal of Surgical Case Reports Jun 2024Wound burping is a technique used to treat intraocular pressure spikes in the immediate postoperative period after cataract surgery. A 55-year-old man with no history of...
Wound burping is a technique used to treat intraocular pressure spikes in the immediate postoperative period after cataract surgery. A 55-year-old man with no history of glaucoma presented with painless blurring of vision in his left eye following cataract surgery 20 days earlier. Ophthalmic examination disclosed elevated intraocular pressure, mild conjunctival hyperemia, corneal microcystic epithelial edema, and mild anterior chamber reaction. In an attempt to lower the intraocular pressure quickly, the corneal wound was 'burped' at the slitlamp. Upon burping the wound, a large epithelial bulla formed instantly in the cornea. The patient's blinking caused the corneal epithelial bulla to burst and collapse. Examination the next day disclosed the detached epithelium had sloughed off completely. The epithelial defect healed gradually over 10 days. Wound burping to release aqueous humor after the corneal epithelium has healed over the surgical incision can result in corneal epithelial detachment and should be avoided.
PubMed: 38912434
DOI: 10.1093/jscr/rjae244 -
International Journal of Surgery Case... Jun 2024Dog bites are a common presentation in emergency departments. However, scrotal injuries with complete testicular avulsion are exceedingly rare.
INTRODUCTION
Dog bites are a common presentation in emergency departments. However, scrotal injuries with complete testicular avulsion are exceedingly rare.
CASE PRESENTATION
We present a case of a dog bite to the scrotum with complete detachment of the testis and right hemiscrotum in an intoxicated 48-year-old man, who was treated with wound irrigation, debridement, antibiotic prophylaxis, tetanus and rabies vaccination, and a covering scrotoplasty.
DISCUSSION
Testicular avulsion following a dog bite to the scrotum is a urologic emergency. Management requires a multidisciplinary approach to address bleeding control, testicular function preservation, infection prevention, and scrotal reconstruction.
CONCLUSION
Dog bites to the scrotum can lead to serious and irreversible complications, underscoring the need for every urologist to be aware and prepared to manage such injuries.
PubMed: 38909389
DOI: 10.1016/j.ijscr.2024.109942 -
The American Journal of Hospice &... Jun 2024The experience of a patient's death on medical students is powerful and may entail distress and anxiety. We review the experience of death and dying as perceived by...
The experience of a patient's death on medical students is powerful and may entail distress and anxiety. We review the experience of death and dying as perceived by medical students. Students are exposed to death and dying while dissecting cadavers in pre-clinical years, following patient death in clinical years, and commonly as a result of personal exposure. Students report sadness and anger in response to patient death, particularly following their first experience. The patient's identity and the student's past exposure to death were found to influence the way students experience death and dying. Coping methods may include conversation, reflection, and religion as well as detachment and avoidance. Although time and resources are invested in preparing students for a patient's death, many of them feel inadequately prepared. Greater understanding of and investment in processing medical students' experience of patient death may be helpful in their personal and professional development.
PubMed: 38906091
DOI: 10.1177/10499091241264523 -
International Journal of Medical... 2024To compare the clinical outcomes, feasibility, and safety between groups with sutured and sutureless wound closure in congenital ectopia lentis (CEL) patients....
To compare the clinical outcomes, feasibility, and safety between groups with sutured and sutureless wound closure in congenital ectopia lentis (CEL) patients. Patients with CEL who received phacoemulsification combined with intrascleral fixation of capsular hook (CH) and implantation of capsular tension ring (CTR) and in-the-bag intraocular lens (IOL) were included in this study. A total of 68 eyes of 34 patients aged 18 years or younger were enrolled in this study. Incisions of 21 patients (34 eyes) did not require sutures while sutures were applied in 21 patients (34 eyes). Postoperative uncorrected distance visual acuity, best corrected distance visual acuity and intraocular pressure measurements were comparable on follow-up visits (P > 0.05). The magnitude of surgically induced astigmatism was significantly greater (P = 0.001) in the suture group (Median: 0.47; IQ: 1.63, 2.97) than in the sutureless group (Median: 0.88; IQ: 0.63, 1.35). No cases of endophthalmitis and retinal detachment were found postoperatively in either group, while suture-related complications were observed in the sutured group, including loose suture with discomfort in 5 (14.71%) eyes, loose suture with mucus infiltration in 3 (8.82%) eyes. In total, 22 sutures (64.71%) of 34 eyes required removal. Sutureless clear corneal incision in CEL patients can achieve satisfactory clinical results comparable to sutured wound closure in terms of the efficacy and safety. Advantages of this approach are the reduced risk of suture-related complications, no need for additional surgery under general anesthesia for suture removal, and less cost.
Topics: Humans; Female; Male; Ectopia Lentis; Adolescent; Visual Acuity; Child; Lens Implantation, Intraocular; Sutureless Surgical Procedures; Cornea; Phacoemulsification; Suture Techniques; Treatment Outcome; Feasibility Studies; Sutures
PubMed: 38903929
DOI: 10.7150/ijms.93994 -
Cureus May 2024Retinopathy of prematurity (ROP) affects premature low birth-weight infants with potentially blinding complications. Early diagnosis and treatment for indicated cases...
BACKGROUND
Retinopathy of prematurity (ROP) affects premature low birth-weight infants with potentially blinding complications. Early diagnosis and treatment for indicated cases are essential to prevent unfavorable effects of the disease.
OBJECTIVES
To determine the awareness and the level of knowledge of ROP among pediatricians in all regions of Saudi Arabia who worked at neonatal intensive care units.
DESIGN AND SETTING
This was a cross-sectional study. This study was undertaken in the Kingdom of Saudi Arabia.
MATERIALS AND METHODS
A semi-self-structured online questionnaire was designed to study the awareness and knowledge of ROP. The questionnaire contained items related to demographic data, participants' level of understanding and knowledge of ROP, and items related to hospital facilities, the availability of a trained ophthalmologist, and the source of knowledge.
MAIN OUTCOME MEASURES
The awareness and knowledge of ROP among pediatricians of the Kingdom of Saudi Arabia.
SAMPLE SIZE
The study included 145 pediatricians.
RESULTS
Awareness of ROP was found in 138 participants (95.2%). Seven participants (4.8%) were not aware of ROP and were excluded from further analysis. Of the participants, 116 (84.0%), 127 (92.0%), and 130 (94.3%) had knowledge about the stages, treatment, and precautions of treatment of ROP, respectively. Of the participants, 77 (55.8%), 63 (45.7%), 113 (81.9%), and 56 (40.6%) gave the correct answer about the indications of fundus examination, exact time of the first fundus examination, place of fundus examination, and minimum number of screening fundus examination for ROP, respectively.
CONCLUSIONS
The awareness and knowledge of ROP among pediatricians of Saudi Arabia is good, but knowledge about the indications and proper time of first referral to an ophthalmologist should be improved.
PubMed: 38903318
DOI: 10.7759/cureus.60754 -
Journal of Pediatric and Adolescent... Jun 2024Omphalocele is an abnormality where fetal abdominal organs protrude through the abdominal wall. We report a case of a 13-year-old female with a history of omphalocele...
Omphalocele is an abnormality where fetal abdominal organs protrude through the abdominal wall. We report a case of a 13-year-old female with a history of omphalocele repair who presented with acute periumbilical pain, nausea, and vomiting. Computed Tomography scan showed a para-ovarian cyst and mild dilation of the small bowel. During laparoscopy, the right ovary and fallopian tube were detached from the uterus and located behind the cecum. Despite this displacement, the ovary appeared to have retained functionality with intact blood supply. Authors hypothesize that surgical repair led to pelvic adhesion that caused torsion and avulsion of the fallopian tube and utero-ovarian ligament that led to the displacement. This anatomical change should be taken into consideration in surgical patients with history of omphalocele repair.
PubMed: 38901668
DOI: 10.1016/j.jpag.2024.06.003 -
Investigative Ophthalmology & Visual... Jun 2024To analyze the natural history of EFEMP1-associated autosomal dominant drusen (ADD). (Observational Study)
Observational Study
PURPOSE
To analyze the natural history of EFEMP1-associated autosomal dominant drusen (ADD).
METHODS
In this retrospective observational study of molecularly confirmed patients with ADD, data and retinal imaging were extracted from an in-house database. The main outcome measurements were best-corrected visual acuity (BCVA), refraction, and retinal imaging, including quantitative analyses of the outer nuclear layer (ONL) thickness and pigmented epithelium detachment area, as well as qualitative analyses.
RESULTS
The study included 44 patients (34 females and 10 males). The mean ± SD age of symptom onset was 40.1 ± 6.59 years of age (range, 25-52). Fourteen patients were asymptomatic during their entire follow-up. The most common symptoms at presentation were reduced vision (70%) and distortion in central vision (53%). Most subjects were emmetropic. The mean BCVA (logMAR) at baseline was 0.27 ± 0.41 (range, -0.1 to 2.1) in right eyes and was 0.19 ± 0.32 (range, -0.2 to 1.3) in left eyes. After a mean follow-up of 7.9 years, BCVA was reduced to 0.59 ± 0.66 (range, -0.1 to 2.1) in right eyes and 0.5 ± 0.72 (range, -0.1 to 2.4) in left eyes, values that were significantly different than baseline (P < 0.0001 and P < 0.0014, respectively). Fifteen eyes showed active or inactive choroidal neovascularization (CNV). BCVA differed significantly (P = 0.0004) between eyes with and without CNV at a comparable mean age. The ONL had a slow rate of thinning longitudinally, which significantly correlated with BCVA.
CONCLUSIONS
Despite the late onset and relatively good prognosis of ADD, CNVs are more frequent than previously reported and are associated with a worse prognosis. Further research is necessary to elucidate gender associations.
Topics: Humans; Male; Female; Retrospective Studies; Adult; Middle Aged; Visual Acuity; Follow-Up Studies; Retinal Drusen; Extracellular Matrix Proteins; Tomography, Optical Coherence; Refraction, Ocular
PubMed: 38899960
DOI: 10.1167/iovs.65.6.31 -
Cureus May 2024A 12-year-old boy with underlying severeand poorly controlled atopic dermatitis (AD) associated with atopic conjunctivitis and rhinitis presented with a right...
A 12-year-old boy with underlying severeand poorly controlled atopic dermatitis (AD) associated with atopic conjunctivitis and rhinitis presented with a right painless blurring of vision for two weeks. On examination, his right eye visual acuity was 1/60,with grade 1 relative afferent pupillary defect (RAPD). Anterior segment examination revealed anterior uveitis with dense posterior subcapsular cataract and hazy fundus view. B-scan ultrasound suggested a shallow total retinal detachment. Intraoperatively, a large retinal dialysis was found. This paper highlights the need for a high index of suspicion of retinal dialysis in a child with underlying AD and the importance of good control of this systemic condition to prevent ocular morbidity.
PubMed: 38899264
DOI: 10.7759/cureus.60660 -
Journal of Ophthalmology 2024Ocular trauma is a common cause of permanent vision loss in adults. The combination of an accurate clinical examination and imaging offers the best prognostic indicators...
INTRODUCTION
Ocular trauma is a common cause of permanent vision loss in adults. The combination of an accurate clinical examination and imaging offers the best prognostic indicators for patients and helps to navigate treatment modalities. This is a retrospective chart review of examination and imaging findings for ocular trauma and how they correlate with treatment course and visual acuity (VA) outcomes.
METHODS
Adult patients with ocular trauma presenting to a single institution between January 2013 and December 2020 were evaluated. Initial examination and imaging findings were compared for associations with each other and with VA outcomes.
RESULTS
136 ocular traumas on 134 patients were included. The median presenting logMAR VA was 2.7 (interquartile range (IQR) 1.2-3.7) with 62% open globe injuries. The most commonly reported finding on initial CT scan was globe deformity (30%), on B-scan was choroidal detachment (20%), and on ultrasound biomicroscopy was intraocular foreign body, ciliochoroidal effusions, or angle recession (21% each). Worse vision was observed for patients positive for retinal detachment on initial B-scan compared to those negative for this finding at 6-month (median logMAR 2.7 vs. 0.5; < 0.0001) and at final post-injury evaluation (median logMAR 3.7 vs. 0.4; < 0.0001). Similarly, worse VA was observed for patients with choroidal detachment on initial B-scan compared to those without this finding at 6-month (median logMAR 1.4 vs. 0.5; = 0.002) and at final post-injury evaluation (median logMAR 2.0 vs. 0.4; < 0.0001). If positive conjunctiva/sclera examination findings were identified, 66% had positive findings on B-scan, whereas if the conjunctiva/sclera examination findings were absent, 41% had positive findings on B-scan ( = 0.005). If anterior chamber (AC) examination findings were positive, 59% had positive findings on B-scan, whereas if the AC examination findings were absent, 37% had positive findings on B-scan ( = 0.03). . The predictive value of examination findings in this study may offer insight as to long-term visual prognosis. Positive B-scan or CT findings should increase suspicion for open globe injuries.
PubMed: 38899051
DOI: 10.1155/2024/8871776 -
Scientific Reports Jun 2024Ultrasound (US) has gained popularity as a guidance modality for percutaneous needle insertions because it is widely available and non-ionizing. However, coordinating...
Ultrasound (US) has gained popularity as a guidance modality for percutaneous needle insertions because it is widely available and non-ionizing. However, coordinating scanning and needle insertion still requires significant experience. Current assistance solutions utilize optical or electromagnetic tracking (EMT) technology directly integrated into the US device or probe. This results in specialized devices or introduces additional hardware, limiting the ergonomics of both the scanning and insertion process. We developed the first ultrasound (US) navigation solution designed to be used as a non-permanent accessory for existing US devices while maintaining the ergonomics during the scanning process. A miniaturized EMT source is reversibly attached to the US probe, temporarily creating a combined modality that provides real-time anatomical imaging and instrument tracking at the same time. Studies performed with 11 clinical operators show that the proposed navigation solution can guide needle insertions with a targeting accuracy of about 5 mm, which is comparable to existing approaches and unaffected by repeated attachment and detachment of the miniaturized tracking solution. The assistance proved particularly helpful for non-expert users and needle insertions performed outside of the US plane. The small size and reversible attachability of the proposed navigation solution promises streamlined integration into the clinical workflow and widespread access to US navigated punctures.
Topics: Humans; Electromagnetic Phenomena; Needles; Ultrasonography, Interventional; Miniaturization; Equipment Design; Phantoms, Imaging
PubMed: 38898086
DOI: 10.1038/s41598-024-64530-6