The influence of etiology on surgical outcomes in neovascular glaucoma

Abstract Background The authors sought to evaluate visual outcomes in patients with varying etiologies of neovascular glaucoma (NVG), who were treated with glaucoma drainage devices (GDD). Methods This was a retrospective case series of patients at a large academic teaching institution who had surgical intervention for neovascular glaucoma between September 2011 and May 2019. Eyes were included if there was documented neovascularization of the iris/angle with an intraocular pressure (IOP) > 21 mmHg at presentation. Eyes must also have been treated with surgical intervention that included a GDD. Primary outcome measure was visual acuity at the 1-year post-operative visit. Secondary outcome measure was qualified success after surgery defined by: pressure criteria (5 mmHg < IOP ≤ 21 mmHg), no re-operation for elevated IOP, and no loss of LP vision. Results One hundred twenty eyes met inclusion criteria. 61.7% had an etiology of proliferative diabetic retinopathy (PDR), 23.3% had retinal vein occlusions (RVO), and the remaining 15.0% suffered from other etiologies. Of patients treated with GDD, eyes with PDR had better vision compared to eyes with RVO at final evaluation (p = 0.041). There was a statistically significant difference (p = 0.027) in the mean number of glaucoma medications with Ahmed eyes (n = 70) requiring 1.9 medications and Baerveldt eyes (n = 46) requiring 1.3 medications at final evaluation. Conclusions In our study, many patients with NVG achieved meaningful vision, as defined by World Health Organization (WHO) guidelines, and IOP control after GDD. Outcomes differed between patients with PDR and RVO in favor of the PDR group. Different GDD devices had similar performance profiles for VA and IOP outcomes. Direct prospective comparison of Baerveldt, Ahmed, and cyclophotocoagulation represents the next phase of discovery.

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Success of trabeculectomy surgery in relation to cataract surgery: 5-year outcomes

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312972 ◽

2018 ◽

Vol 103 (10) ◽

pp. 1395-1400 ◽

Cited By ~ 2

Author(s):

Rashmi G Mathew ◽

Sahar Parvizi ◽

Ian E Murdoch

Keyword(s):

Cataract Surgery ◽

Outcome Measure ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Risk Of Failure ◽

Increased Risk ◽

Significant Difference ◽

Measure Change ◽

Group 2

AimsTo compare success proportions at 5 years in three surgical groups: group 1, trabeculectomy alone; group 2, trabeculectomy followed by cataract surgery within 2 years; and group 3, trabeculectomy performed on a pseudophakic eye.MethodsA retrospective cohort study. 194 eyes of 194 patients were identified with at least 5 years’ follow-up post trabeculectomy (N=85, 60 and 49 in groups 1, 2 and 3, respectively).Main outcome measures1. Primary outcome measure: intraocular pressure (IOP) at 5 years post-trabeculectomy surgery, 2.Secondary outcome measure: change in visual acuity at 5 years.ResultsAt 5 years, the mean IOP (SD) was 12.9 (3.5), 12.5 (4.8) and 12.7 (4.8) mm Hg in groups 1, 2 and 3, respectively. Overall success was almost identical, 58%, 57% and 59% in groups 1, 2 and 3, respectively. There was no significant difference between the groups in terms of percentage IOP reduction, number of medications, proportion restarting medication and reoperation rates at 5 years. Logistic regression for an outcome of failure showed men to be at increased risk of failure OR 1.97 (95% CI 1.10 to 3.52, p=0.02). Nearly 80% of patients retained or improved their vision following their initial trabeculectomy.ConclusionsThe sequence in which surgery is carried out does not appear to affect trabeculectomy function at 5 years, success being similar to trabeculectomy alone. In our study, men may be at increased risk of failure.

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Impact of blood group on survival following critical illness: a single-centre retrospective observational study

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2019-000426 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000426

Author(s):

Robert Slade ◽

Raza Alikhan ◽

Matt P Wise ◽

Lam Germain ◽

Simon Stanworth ◽

...

Keyword(s):

Intensive Care ◽

Critical Illness ◽

Blood Group ◽

Outcome Measure ◽

Tertiary Hospital ◽

Current Data ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Transfusion Requirements ◽

Significant Difference

BackgroundPredicting patient outcomes following critical illness is challenging. Recent evidence has suggested that patients with blood group AB are more likely to survive following major cardiac surgery, and this is associated with a reduced number of blood transfusions. However, there are no current data to indicate whether a patient’s blood group affects general intensive care outcomes.ObjectiveThe objective of this study was to determine if ABO blood group affects survival in intensive care. The primary outcome measure was 90-day mortality with a secondary outcome measure of the percentage of patients receiving a blood transfusion.DesignRetrospective analysis of electronically collected intensive care data, blood group and transfusion data.SettingGeneral intensive care unit (ICU) of a major tertiary hospital with both medical and surgical patients.PatientsAll patients admitted to ICU between 2006 and 2016 who had blood group data available.InterventionNone.Measurements and main results7340 patients were included in the study, blood group AB accounted for 3% (221), A 41% (3008), B 10.6% (775) and O 45.4% (3336). These values are similar to UK averages. Baseline characteristics between the groups were similar. Blood group AB had the greatest survival benefit (blood group AB 90-day survival estimate 76.75, 95% CI 72.89 to 80.61 with the overall estimate 72.07, 95% CI 71.31 to 72.82) (log-rank χ2 16.128, p=0.001). Transfusion requirements were similar in all groups with no significant difference between the percentages of patients transfused (AB 23.1%, A 21.5%, B 18.7%, O 19.9%, Pearson χ2 5.060 p=0.167).ConclusionAlthough this is primarily a hypothesis generating study, intensive care patients with blood group AB appeared to have a higher 90-day survival compared with other blood groups. There was no correlation between blood group and percentage of patients receiving transfusion.

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Therapeutic effects of vitamin D as adjunctive therapy to fluoxetine in patients with major depressive disorder

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867412465022 ◽

2012 ◽

Vol 47 (3) ◽

pp. 271-275 ◽

Cited By ~ 79

Author(s):

Nayereh Khoraminya ◽

Mehdi Tehrani-Doost ◽

Shima Jazayeri ◽

Aghafateme Hosseini ◽

Abolghassem Djazayery

Keyword(s):

Vitamin D ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Outcome Measure ◽

Secondary Outcome ◽

Therapeutic Effects ◽

Secondary Outcome Measure ◽

Depression Severity ◽

Major Depressive ◽

Significant Difference

Objective: To compare the therapeutic effects of vitamin D3 plus fluoxetine and fluoxetine alone in patients with major depressive disorder. Methods: In the present double-blind, randomized, placebo-controlled trial, 42 patients with a diagnosis of major depressive disorder based on DSM-IV criteria were randomly assigned into two groups to receive daily either 1500 IU vitamin D3 plus 20 mg fluoxetine or fluoxetine alone for 8 weeks. Depression severity was assessed at 2-week intervals using the 24-item Hamilton Depression Rating Scale (HDRS) as a primary outcome measure and the 21-item Beck Depression Inventory (BDI) as a secondary outcome measure. Serum 25(OH) vitamin D was measured at baseline and after intervention. Results: Forty patients completed the trial. A two-way repeated-measures analysis of variance showed that depression severity based on HDRS and BDI decreased significantly after intervention, with a significant difference between the two groups. The vitamin D + fluoxetine combination was significantly better than fluoxetine alone from the fourth week of treatment. Conclusions: In the present 8-week trial, the vitamin D + fluoxetine combination was superior to fluoxetine alone in controlling depressive symptoms.

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Face-to-face versus telehealth consultations during COVID-19 in australian general practice: comparison of medication prescribing

BJGP Open ◽

10.3399/bjgpo.2021.0132 ◽

2021 ◽

pp. BJGPO.2021.0132

Author(s):

Nasir Wabe ◽

Judith Thomas ◽

Gorkem Sezgin ◽

Muhammad Kashif Sheikh ◽

Emma Gault ◽

...

Keyword(s):

General Practice ◽

Outcome Measure ◽

Anatomical Therapeutic Chemical ◽

System Level ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Face To Face ◽

Significant Difference ◽

Australian General Practice ◽

Medication Prescribing

BackgroundThere has been a precipitous rise telehealth use in general practice during the COVID-19 pandemic. Understanding differences between face-to-face and telehealth consulting is an important component for planning the future use of telehealth services beyond the pandemic. However, there is limited evidence on whether telehealth consulting impacts medication prescribing under pandemic circumstances.AimTo compare medication prescribing in face-to-face versus telehealth consultations during the COVID-19 pandemic in Australian general practice.Design and SettingThis multisite, retrospective observational study used de-identified routinely collected electronic health data extracted from 806 general practices in Victoria and New South Wales (NSW), Australia between April-December 2020.MethodThe primary outcome measure was whether at least one medication was prescribed following a telehealth or face-to-face consultation. Data are reported by medication and for each of the Anatomical Therapeutic Chemical (ATC) Classification System level one groups. The secondary outcome measure was first-time prescribing. Telehealth included both telephone and video consultations.ResultsA total of 13,608,216 consultations satisfied the inclusion criteria (61% face-to-face and 39% telehealth). Most telehealth consultations were conducted via telephone (97.8%). Overall, 39.3% of face-to-face and 33.0% of telehealth consultations prescribed at least one medication– a statistically significant difference (adjusted OR 1.38; 95% CI 1.379–1.381). The prescribing rate was greater for face-to-face vs telehealth consultations for all drug groups except ATC level 1N (nervous system).ConclusionUnder COVID-19 restrictions in the states of Victoria and NSW, Australia, medication prescribing was higher in face-to-face consultations when compared to telehealth consultations in the study population.

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Combined Standard Medication and Acupuncture for Copd: A Case Series

Acupuncture in Medicine ◽

10.1136/acupmed-2011-010112 ◽

2012 ◽

Vol 30 (2) ◽

pp. 96-102 ◽

Cited By ~ 8

Author(s):

Masao Suzuki ◽

Kenji Namura ◽

Yasushi Ohno ◽

Masato Egawa ◽

Takako Sugimoto ◽

...

Keyword(s):

Outcome Measure ◽

Acupuncture Treatment ◽

Case Series ◽

Secondary Outcome ◽

Chronic Obstructive ◽

Secondary Outcome Measure ◽

Obstructive Pulmonary Disease ◽

Medication Therapy ◽

Bode Index ◽

Standard Medication

Background Traditional acupuncture has been used in patients with chronic obstructive pulmonary disease (COPD). However, only a few studies have been performed to determine the efficacy of this treatment. Objective To observe changes in the symptoms of COPD during acupuncture treatment in patients with COPD stratified according to the severity of the disease. Methods A prospective case series of 26 patients with dyspnoea on exertion due to COPD was followed from October 2004 to October 2008 in the Departments of Respiratory Internal Medicine, Gifu University of Medicine and Meiji University of Integrative Medicine, Japan. All participants received acupuncture treatments once a week for 10 weeks in addition to standard medication therapy. The main outcome measure was the modified Borg dyspnoea scale after the 6 min walk test (6MWT) and the secondary outcome measure was the BODE index. Results All 26 patients showed significant improvement in the Borg dyspnoea scale after 10 weeks of acupuncture treatment (from 4.02 (2.85) to 1.96 (1.97), mean difference −2.06, 95% CI −3.03 to −1.09, p=0.0002, paired t test). Improvements in the BODE index, 6MWT and oxygen saturation during exercise, which indicates better reduced dyspnoea on exertion and prognosis, were also found. Conclusion The results of this study suggest that acupuncture treatment has clinically useful effects, at least in the short term, in reducing dyspnoea on exercise in patients with COPD, particularly in those more severely affected.

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Use of proton pump inhibitors to treat persistent throat symptoms: multicentre, double blind, randomised, placebo controlled trial

BMJ ◽

10.1136/bmj.m4903 ◽

2021 ◽

pp. m4903

Author(s):

James O’Hara ◽

Deborah D Stocken ◽

Gillian C Watson ◽

Tony Fouweather ◽

Julian McGlashan ◽

...

Keyword(s):

Confidence Interval ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Primary Outcome ◽

Outcome Measure ◽

Randomised Trial ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Double Blind ◽

Significant Difference

Abstract Objective To assess the use of proton pump inhibitors (PPIs) to treat persistent throat symptoms. Design Pragmatic, double blind, placebo controlled, randomised trial. Setting Eight ear, nose, and throat outpatient clinics, United Kingdom. Participants 346 patients aged 18 years or older with persistent throat symptoms who were randomised according to recruiting centre and baseline severity of symptoms (mild or severe): 172 to lansoprazole and 174 to placebo. Intervention Random blinded allocation (1:1) to either 30 mg lansoprazole twice daily or matched placebo twice daily for 16 weeks. Main outcome measures Primary outcome was symptomatic response at 16 weeks measured using the total reflux symptom index (RSI) score. Secondary outcomes included symptom response at 12 months, quality of life, and throat appearances. Results Of 1427 patients initially screened for eligibility, 346 were recruited. The mean age of the study sample was 52.2 (SD 13.7) years, 196 (57%) were women, and 162 (47%) had severe symptoms at presentation; these characteristics were balanced across treatment arms. The primary analysis was performed on 220 patients who completed the primary outcome measure within a window of 14-20 weeks. Mean RSI scores were similar between treatment arms at baseline: lansoprazole 22.0 (95% confidence interval 20.4 to 23.6) and placebo 21.7 (20.5 to 23.0). Improvements (reduction in RSI score) were observed in both groups—score at 16 weeks: lansoprazole 17.4 (15.5 to19.4) and placebo 15.6 (13.8 to 17.3). No statistically significant difference was found between the treatment arms: estimated difference 1.9 points (95% confidence interval −0.3 to 4.2 points; P=0.096) adjusted for site and baseline symptom severity. Lansoprazole showed no benefits over placebo for any secondary outcome measure, including RSI scores at 12 months: lansoprazole 16.0 (13.6 to 18.4) and placebo 13.6 (11.7 to 15.5): estimated difference 2.4 points (−0.6 to 5.4 points). Conclusions No evidence was found of benefit from PPI treatment in patients with persistent throat symptoms. RSI scores were similar between the lansoprazole and placebo groups after 16 weeks of treatment and at the 12 month follow-up. Trial registration ISRCTN Registry ISRCTN38578686 and EudraCT 2013-004249-17.

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Prospective, randomised controlled trial comparing intense endoscopic cleaning versus minimal intervention in the early post-operative period following functional endoscopic sinus surgery

The Journal of Laryngology & Otology ◽

10.1017/s0022215111000508 ◽

2011 ◽

Vol 125 (6) ◽

pp. 585-589 ◽

Cited By ~ 10

Author(s):

J M Fishman ◽

S Sood ◽

M Chaudhari ◽

P Martinez-Devesa ◽

L Orr ◽

...

Keyword(s):

Endoscopic Sinus Surgery ◽

Outcome Measure ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Minimal Intervention ◽

Post Operative Period ◽

Significant Difference ◽

Randomised Controlled

AbstractObjective:There is currently no standardised management protocol following functional endoscopic sinus surgery. This study assessed frequent endoscopic cleaning versus minimal intervention in the early post-operative period following such surgery.Study design:Prospective, randomised controlled, single-blinded, within-subject trial involving 24 patients with bilateral chronic rhinosinusitis undergoing bilateral functional endoscopic sinus surgery.Main outcome measure:The primary outcome measure was ethmoid cavity healing, based on endoscopic appearance, graded using a modified Lund–MacKay endoscopic score.Secondary outcome measure:Lund–MacKay symptom score before and after surgery.Results:There was no overall statistically significant difference between the two groups (p = 0.37). Subgroup analysis revealed a significant effect of regular suction clearance on adhesions at three months (p = 0.048), but not on oedema, polyps, granulation, discharge or crusting.Conclusion:There is no evidence from this study to support frequent endoscopic cleaning in the early post-operative period after functional endoscopic sinus surgery. Less intensive post-operative management is recommended, resulting in decreased patient morbidity and fewer post-operative follow-up appointments.

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Comparative study on management of acute moderate and severe lateral ankle sprain using immobilization in below knee slab versus stirrup ankle brace

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v18i1.17208 ◽

2017 ◽

Vol 18 (1) ◽

pp. 10-16

Author(s):

Prawesh Singh Bhandari ◽

G. KC ◽

S. Uprety

Keyword(s):

Ankle Joint ◽

Outcome Measure ◽

Functional Improvement ◽

Secondary Outcome ◽

Lateral Ligament ◽

P Value ◽

Secondary Outcome Measure ◽

Joint Function ◽

Ankle Brace ◽

Significant Difference

Introduction: Amongst musculoskeletal injuries, ankle ligament sprains are the single most common sports injury. However, there often appears to be no common regimen for their management, with a wide spectrum of treatment options available. The purpose of this study is to determine the functional outcome of the ankle joint after a moderate or severe inversion injury, comparing standard treatment with a Below Knee Slab Splint against a Stirrup ankle brace.Method: Prospective study conducted at the emergency department at Tribhuvan University Teaching Hospital. Fifty patients presenting consecutively were randomized into two equal groups: one group was treated with Below Knee Slab Splint and the other with an Stirrup ankle brace. All patients were given a standardized advice sheet referring to rest, ice, compression, and elevation, NSAIDS and support. Patients were reviewed after 48–72 hours, 14 days, and 3 week. Primary outcome measure: Ankle joint function assessed at 3 week using the modified Karlsson scoring method (maximum score 90). Secondary outcome measure: The difference in ankle girth (swelling) at 3 weeks. Results: Twenty-five patients in Below Knee Slab Splint group and twenty-five patients in the stirrup ankle brace group. The age of the patients ranged from 16 to 55 years with the mean of 30.68±9.33 years.The difference in mean age in years was not different in both groups (P>0.05).The distribution of gender and occupation in both groups were homogeneous (P>0.05). The karlsson’s score mean for brace group is 79.8±5.3 and for other group is 72.0±10.3 (p-value: 0.002). Thus there was a significant difference in Karlssons score between the two groups showing better functional improvement in patients receiving Stirrup ankle brace. There is significant difference in the swelling of clients in between application of the brace (1.00±0.48 and slab (1.70±0.50) the at end of the third week with p value 0.000.Conclusion: The use of Stirrup ankle brace for the treatment of lateral ligament ankle sprains produces a significant improvement in ankle joint function at three weeks compared with standard management with aimmobilization in below knee posterior slab splint.JSSN 2015; 18 (1), Page: 10-16

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Double blinded randomized placebo-controlled comparative study between sucralfate ointment and lidocaine ointment after Milligan Morgan hemorrhoidectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20175111 ◽

2017 ◽

Vol 4 (12) ◽

pp. 3822

Author(s):

Yahia Alkhateep ◽

Abdelmieniem Fareed

Keyword(s):

Wound Healing ◽

Postoperative Pain ◽

Pain Intensity ◽

Outcome Measure ◽

Secondary Outcome ◽

Control Group ◽

Secondary Outcome Measure ◽

Lidocaine Group ◽

Significant Difference ◽

Double Blinded

Background: Post haemorrhoidectomy pain and delayed wound healing are the most annoying drawbacks to the patients and the surgeons. Topical application of sucralfate or lidocaine may help in reducing postoperative pain and promoting wound healing after Milligan Morgan hemorrhoidectomy.Methods: This study was designed as a single-center double blinded randomized placebo controlled trial at the Department of general Surgery Menoufia University, immediately after Milligan Morgan Hemorrhoidectomy, a total of 150 patients were randomly assigned to receive either 10% Sucralfate ointment, 5% lidocaine ointment or placebo ointment (control group). The primary outcome measure was pain intensity measured by a visual analogue scale at different time points after hemorrhoidectomy and the secondary outcome measure was wound healing.Results: There was no significant difference in age, gender, and number of excised hemorrhoid piles between the two groups. At the 1st ,3rd and 7th days after surgery pain intensity was significantly lower in sucralfate group (4.18±0.82, 3.92±0.72, 3.56±0.67) when compared to lidocaine group (5.06±1.11, 4.70±0.84, 3.93±0.75) and placebo group (6.17±1.26, 5.42±0.98, 4.55±0.84). At the 21st and 28th days no significant difference in pain intensity between groups (p > 0.05) with better wound healing in sucralfate group (P<0.05).Conclusions: Sucralfate was able to reduce the acute postoperative pain and improve wound healing after hemorrhoidectomy, local anesthetic lidocaine could help in pain control but without effect on healing.

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Silver diamine fluoride as a minimally invasive and aerosol free approach in pediatric dentistry: An extensive case series

Contemporary Pediatric Dentistry ◽

10.51463/cpd.2021.51 ◽

2021 ◽

Vol 2 (2) ◽

pp. 42-54

Author(s):

Abhishek Soni ◽

Sanchit Paul ◽

Priyanka Sachdeva

Keyword(s):

Minimally Invasive ◽

Outcome Measure ◽

Age Groups ◽

Case Series ◽

Pediatric Dentistry ◽

Permanent Teeth ◽

Secondary Outcome ◽

Clinical Approach ◽

Secondary Outcome Measure ◽

Silver Diamine Fluoride

The current pandemic of COVID-19 warrants a repeal from conventional dentistry to an aerosol free, minimally invasive yet maximally effective clinical approach. Silver diamine fluoride (SDF) is an established modality for caries arrest in children fulfilling all the above. This extensive 25 case series highlights various clinical situations in which SDF was successfully used in children between 1-12 years of age with asymptomatic carious lesions of ICDAS score 2 or more in primary and permanent teeth. Primary outcome measure was caries arrest in the form of the hard and shiny lesion with no/minimal sensitivity. The secondary outcome measure was the zombie effect which was the residual staining on other tooth surfaces and indications of substantivity. SDF can be effectively and efficaciously used across different behaviour patterns and age groups of children in a various clinical scenario for both primary and permanent teeth routinely experienced in a paediatric dental office especially during these pandemic times with minimal aerosol generation.

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