Factors Associated with Axial Length Elongation in High Myopia

Abstract Background: To investigate the impact of axial length (AL) and ocular factors on axial length elongation (ALE). Methods: A retrospective chart review of patients who underwent more than two axial length examinations using a single instrument Results: The mean age of the participants was 47.21 ± 7.79 years. Eyes were classified into four groups according to their initial AL measurement. AL remained almost unchanged in the groups with AL < 26mm. On the contrary, AL increased by 0.011mm/year in the group with 26 ≤ AL < 28mm and 0.035mm/year in the group with AL ≥ 28mm (P < .001). In high myopia, ALE increased in eyes with longer axial lengths (r = 0.003, P = .024), females (r = 0.014, P = .019), eyes with larger peripapillary chorioretinal atrophic areas (r = 0.002, P = .019), and smaller vascular arcade angles (r = -0.004, P = .006). The risk of elongation 0.03mm/year in high myopia was increased in females (OR = 2.265, P = .040), and gradually increased in eyes with large peripapillary chorioretinal atrophy area (OR = 5.604, 6.939, and 7.470, respectively; P = .001, < .001, and .008, respectively) Conclusions: AL remained almost unchanged in the group with AL < 26mm. On the contrary, ALE was observed in the group with AL ≥ 26mm. AL elongated significantly in eyes with longer AL, female, and eyes with larger atrophic areas and smaller arcade angles on fundus photographs.

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Factors associated with axial length elongation in high myopia in adults

International Journal of Ophthalmology ◽

10.18240/ijo.2021.08.15 ◽

2021 ◽

Vol 14 (8) ◽

pp. 1231-1236

Author(s):

Hong Kyu Kim ◽

Keyword(s):

Axial Length ◽

High Myopia ◽

Chart Review ◽

Retrospective Chart Review ◽

Female Gender ◽

Fundus Photography ◽

Fundus Photograph ◽

Factors Associated ◽

Vascular Arcade ◽

The Mean

AIM: To investigate the association of axial length (AL) and ocular factors on AL elongation. METHODS: A retrospective chart review of patients who underwent two or more AL examinations for more than two years. Totally 4 groups were divided according to initial AL (<24 mm, 24-26 mm, 26-28 mm, ≥28 mm). Initial fundus photograph was used to find risk factors associated AL elongation. RESULTS: The mean age of the patients was 47.21±7.79y. AL remained almost unchanged in the groups with AL<24 mm and 24≤AL<26 mm. On the contrary, AL increased by 0.011 mm/y in the group with 26≤AL<28 mm and 0.035 mm/y in the group with AL≥28 mm (P<0.001). In high myopia, AL elongation increased in eye with longer AL (r=0.003, P=0.024), female gender (r=0.014, P=0.019), eye with larger peripapillary chorioretinal atrophic area (r=0.002, P=0.019), and smaller vascular arcade angle (r=-0.004, P=0.006). The risk of elongation 0.03 mm/y in high myopia was increased in female gender (P=0.040), and gradually increased in eye with large peripapillary chorioretinal atrophy area (P<0.01). CONCLUSION: AL elongate significantly in the eye with longer AL, female gender, and the eye with larger atrophic area and smaller arcade angle on fundus photography.

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Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

European Journal of Ophthalmology ◽

10.1177/1120672120976044 ◽

2020 ◽

pp. 112067212097604

Author(s):

Reem R Al Huthail ◽

Yasser H Al-Faky

Keyword(s):

Chart Review ◽

Retrospective Chart Review ◽

Tertiary Hospital ◽

Nasal Endoscope ◽

Long Term Follow Up ◽

Mean Size ◽

External Dacryocystorhinostomy ◽

The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

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Pediatric Organ Donor Maintenance: Pathophysiologic Derangements and Nursing Requirements

PEDIATRICS ◽

10.1542/peds.84.4.688 ◽

1989 ◽

Vol 84 (4) ◽

pp. 688-693

Author(s):

N. Kissoon ◽

T. C. Frewen ◽

M. Bloch ◽

M. Gayle ◽

C. Stiller

Keyword(s):

Chart Review ◽

Premature Ventricular Contraction ◽

Retrospective Chart Review ◽

Stability Index ◽

Organ Donor ◽

Pulmonary Insufficiency ◽

Organ Donors ◽

Maintenance Time ◽

Donor Support ◽

The Mean

A retrospective chart review was conducted of 26 organ donors to determine hemodynamic and metabolic derangements encountered and nursing requirements for donor organ maintenance. There were 15 boys and 11 girls with a mean age 6.57 ± 5.46 years. Mean donor maintenance time was 10.5 ± 6.7 hours. Cardiorespiratory derangements included hypotension in 16, hypertension in 6, arrhythmias in 17 (premature ventricular contraction in 4, bradycardia in 8, paroxysmal atrial tachycardia in 3, and ventricular tachycardia in 2), asystolic events in 5, pulmonary insufficiency in 6, anemia in 8, and thrombocytopenia in 8. Metabolic and hormonal derangements included hyperglycemia in 18, hypokalemia in 20, hyperkalemia in 4, hyponatremia in 3, hypernatremia in 17, metabolic acidosis in 10, and diabetes insipidus in 15. Hypothermia (temperature 33.3°± 0.4°C, mean ± SD) occurred in 14 donors. The mean physiologic Stability Index score was 22.2 ± 4.7 and mean Therapeutic Intervention Score was 46.7 ± 5.8. Total number of nursing hours spent in donor maintenance was 424.5 hours. Therapies offered included diuretics in 10, sodium bicarbonate in 8, antibiotics in 6, insulin in 12, pitressin in 13, verapamil in 3, isoproterenol in 3, dopamine in 17, and intravenous potassium boluses in 14. Of the potential 26 donors, 46 kidneys, 8 hearts, 14 livers, 3 pancreas, and 9 corneas were retrieved in transplantable condition. With appropriate donor maintenance, organs suitable for transplantation can be retrieved despite significant pathophysiologic derangements. Physicians intending to provide donor support should be comfortable with invasive monitoring and cardiorespiratory support and be prepared to provide a nurse to patient ratio of 2:1 at the bedside.

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Abstract P305: Post-Stroke Aphasia as a Predictor of 30-Day Readmission Associated With Infection: A Retrospective Chart Review

Stroke ◽

10.1161/str.52.suppl_1.p305 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Emma M Loebel ◽

Mary Rojas ◽

Connor Mensching ◽

Danielle Wheelwright ◽

Laura K Stein

Keyword(s):

Chart Review ◽

Retrospective Chart Review ◽

Mount Sinai Hospital ◽

Index Admission ◽

Negative Consequences ◽

Medical Comorbidities ◽

Post Stroke ◽

Increased Risk ◽

Adjusted Model ◽

The Impact

Introduction: Studies have demonstrated that aphasia may negatively impact morbidity and mortality among ischemic stroke (IS) patients. However, the association between post-stroke aphasia and readmission with infection (RI) is poorly understood. We sought to assess the impact of aphasia on post-stroke RI. We hypothesized that aphasic patients are at increased risk of infection in the 30-day post-stroke period. Methods: We performed retrospective chart review of the Mount Sinai Hospital IS patients with 30-day all cause readmission from January 2016 - December 2019. All variables were abstracted from the index admission (IA) electronic medical records except for aspects related to the readmission (RA). Aphasia was present if a neurologist diagnosed the patient with acquired language dysfunction during IA. We performed chi square and logistic regression analyses to compare readmitted patients with and without aphasia at IA. Our fully adjusted model controlled for age, sex, medical comorbidities, NIHSS ≥ 8, IA LOS > 7, IA infection, discharge to facility. We completed all analyses with SPSS. Results: During IA, 36% (n=42) were diagnosed with aphasia. At IA, there were no significant differences in age (dichotomized at 65), sex, or medical comorbidities between aphasic and non-aphasic cohorts. However, more aphasic patients had admission NIHSS ≥ 8 (89% vs 35%, p<0.0001), LOS > 7 (76% vs 42%, p=0.0004), discharge to facility (79% vs 49%, p=0.0016), and RI (52% vs 19%, p=0.002). The presence of aphasia predicted RI in both unadjusted (OR=4.6, p<0.001) and adjusted (OR= 3.3, p=0.014) multivariate analyses. The Kappa inter-reliability ranged from 0.7-1.0 for the key variables included in our adjusted model. Conclusions: The adjusted odds of 30-day readmission with infection were significantly greater in those with diagnosis of aphasia at the time of index admission compared to those without. Our study provides preliminary evidence that the presence of aphasia may have negative consequences on a patient’s health beyond the language disturbance. Further study is needed to better understand the reasons and risk reduction strategies in this vulnerable population.

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Prevalence of amblyopia and patterns of refractive error in the amblyopic children of a tertiary eye care center of Nepal

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v5i1.7820 ◽

2013 ◽

Vol 5 (1) ◽

pp. 38-44 ◽

Cited By ~ 7

Author(s):

K Sapkota ◽

A Pirouzian ◽

NS Matta

Keyword(s):

Visual Acuity ◽

Refractive Error ◽

Chart Review ◽

Care Center ◽

Retrospective Chart Review ◽

Ophthalmological Examination ◽

Eye Care ◽

Common Cause ◽

Ocular Pathology ◽

The Mean

Introduction: Refractive error is a common cause of amblyopia. Objective: To determine prevalence of amblyopia and the pattern and the types of refractive error in children with amblyopia in a tertiary eye hospital of Nepal. Materials and methods: A retrospective chart review of children diagnosed with amblyopia in the Nepal Eye Hospital (NEH) from July 2006 to June 2011 was conducted. Children of age 13+ or who had any ocular pathology were excluded. Cycloplegic refraction and an ophthalmological examination was performed for all children. The pattern of refractive error and the association between types of refractive error and types of amblyopia were determined. Results: Amblyopia was found in 0.7 % (440) of 62,633 children examined in NEH during this period. All the amblyopic eyes of the subjects had refractive error. Fifty-six percent (248) of the patients were male and the mean age was 7.74 ± 2.97 years. Anisometropia was the most common cause of amblyopia (p < 0.001). One third (29 %) of the subjects had bilateral amblyopia due to high ametropia. Forty percent of eyes had severe amblyopia with visual acuity of 20/120 or worse. About twothirds (59.2 %) of the eyes had astigmatism. Conclusion: The prevalence of amblyopia in the Nepal Eye Hospital is 0.7%. Anisometropia is the most common cause of amblyopia. Astigmatism is the most common types of refractive error in amblyopic eyes. Nepal J Ophthalmol 2013; 5(9):38-44 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7820

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The Administration of Prehospital Ketamine for Chemical Restraint does not Prolong On-Scene Times Compared to Haloperidol Based Sedation

Australasian Journal of Paramedicine ◽

10.33151/ajp.12.1.8 ◽

2015 ◽

Vol 12 (1) ◽

Cited By ~ 2

Author(s):

Aaron Burnett ◽

Dolly Panchal ◽

Bjorn Peterson ◽

Eric Ernest ◽

Kent Griffith ◽

...

Keyword(s):

Emergency Medical Services ◽

Chart Review ◽

Retrospective Chart Review ◽

T Test ◽

Medical Services ◽

Demographic Differences ◽

Chemical Restraint ◽

Emergency Medical ◽

Clinically Significant ◽

The Impact

IntroductionAgitated patients who present a danger to themselves or emergency medical services (EMS) providers may require chemical restraints. Haloperidol is employed for chemical restraint in many EMS services. Recently, ketamine has been introduced as an alternate option for prehospital sedation. On-scene time is a unique metric in prehospital medicine which has been linked to outcomes in multiple patient populations. When used for chemical restraint, the impact of ketamine relative to haloperidol on on-scene time is unknown.Objective: To evaluate whether the use of ketamine for chemical restraint was associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.MethodsPatients who received haloperidol or ketamine for chemical restraint were identified by retrospective chart review. On-scene time was compared between groups using an unadjusted Student t-test powered to 80% to detect a ≥5 minute difference in on-scene time.Results110 cases were abstracted (Haloperidol = 55; Ketamine = 55). Of the patients receiving haloperidol, 11/55 (20%) were co-administered a benzodiazepine, 4/55 (7%) received diphenhydramine and 34/55 (62%) received the three drugs in combination. There were no demographic differences between the haloperidol and ketamine groups. On-scene time was not statistically different for patients receiving a haloperidol based regimen compared to ketamine (18.2 minutes, [95% CI 15.7-20.8] vs. 17.6 minutes, [95% CI 15.1-20.0]; p = 0.71).ConclusionsThe use of prehospital ketamine for chemical restraint was not associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.

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Low-Dose Aminophylline for the Treatment of Neonatal Non-Oliguric Renal Failure—Case Series and Review of the Literature

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-13.2.80 ◽

2008 ◽

Vol 13 (2) ◽

pp. 80-87

Author(s):

Bethany A. Lynch ◽

Peter Gal ◽

J. Laurence Ransom ◽

Rita Q. Carlos ◽

Mary Ann V.T. Dimaguila ◽

...

Keyword(s):

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Chart Review ◽

Low Dose ◽

Case Series ◽

Retrospective Chart Review ◽

Review Of The Literature ◽

Oliguric Renal Failure ◽

The Impact

OBJECTIVE Aminophylline is a methylxanthine with multiple physiologic actions. At low doses, aminophylline can antagonize adenosine and improve renal function via increased glomerular filtration rate. Despite its clinical use, little data exists in neonates for this indication. Therefore, the objective of this report is to describe the impact of aminophylline on renal function indices in a series of neonates with acute renal failure. MATERIALS AND METHODS This was a retrospective chart review of 13 neonates with acute renal failure who received aminophylline during a 15-month study period. Aminophylline was administered at 1 mg/kg intravenously or orally every twelve hours. Forty-six percent (n = 6) of the patients received a 5 mg/kg loading dose before initiation of maintenance therapy. Most patients had already received other treatments for renal failure, including diuretics and dopamine. RESULTS Resolution of acute renal failure (with normalization of serum creatinine and blood urea nitrogen) was documented in 10 patients (77%). Four of the thirteen patients died from complications due to their prematurity. Failure of low-dose aminophylline was observed in 3 of the 4 patients who died. CONCLUSIONS Low-dose aminophylline in neonates with acute renal failure is associated with an improvement in renal function indices.

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Retrospective Chart Review of Cryopreserved Amniotic Membrane for Knee Pain

Journal of Regenerative Biology and Medicine ◽

10.37191/mapsci-2582-385x-2(6)-047 ◽

2020 ◽

Author(s):

Ruben Berrocal Timmons

Keyword(s):

Quality Of Life ◽

Adverse Events ◽

Amniotic Membrane ◽

Chart Review ◽

Retrospective Chart Review ◽

Final Analysis ◽

Mean Values ◽

Number Of Patients ◽

The Impact

Objective: Treatment of joint pain with an injection of the amniotic membrane has not been adequately studied. This study retrospectively reviewed Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and analgesic usage data from patients treated with the injection of cryopreserved amniotic membrane (CAM) in their knees to determine the impact of treatment on patients’ pain, quality of life, and analgesic usage. Methods: Chart review was conducted on 40 patients. Institutional Review Board (IRB) approval was obtained prior to initiation of the project. The membrane was utilized as per the FDA guidance of 21CFR1271. Retrospective data, including demographics, medical history, pain score, quality of life score, analgesic usage and adverse events, were collected from their medical records for each consenting patient through 6 months after CAM injection. Results: A total of 40 patients were considered in the final analysis. Mean VAS for pain level improved from 7.0 to 2.6 (p<0.001). WOMAC daily activity function score improved from a mean score of 52 to 28 (p<0.001). Opioid and non-steroidal anti-inflammatory drug (NSAID) usage decreased from 97% to 25% (p<0.001). No adverse events were reported. Conclusion: Mean values for VAS and WOMAC scores significantly improved at all time points and the number of patients who used analgesics decreased as compared to baseline. CAM injection into painful knee joints decreases pain, improves physical function, and decreases the use of analgesics in the absence of adverse events.

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Abstract WMP89: Stroke Code De-escalation: Safety and Outcomes

Stroke ◽

10.1161/str.48.suppl_1.wmp89 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jessica Jarnot ◽

Christopher Streib ◽

Angela Heyer ◽

Amy Reichert ◽

David Anderson ◽

...

Keyword(s):

Chart Review ◽

Healthcare Providers ◽

Retrospective Chart Review ◽

Before And After ◽

Chi Squared ◽

Cost Implications ◽

The Impact ◽

Timely Treatment ◽

Iv Tpa ◽

Missed Opportunity

Introduction: “Stroke codes” (SCs) facilitate the timely treatment of acute ischemic stroke (AIS) with IV tPA or intra-arterial thrombectomy (IAT), but are inherently resource-intensive and can expose patients to unnecessary and potentially harmful interventions. While all healthcare providers are encouraged to activate SCs, this might lead to low SC-to-treatment-ratios (SCTR). We examined the impact of de-escalation of stroke codes (DSCs) on SCTR. Methods: DSCs were initiated in our institution in January 2015. All DSCs were reviewed for the patient’s eligibility for IV tPA or IAT, and reason for de-escalation. We reviewed all stroke codes 12 months before and after the initiation of this process and compared the SCTR by chi-squared testing. Results: In 2014, prior to DSCs, 253 SCs resulted in 22 AIS interventions (22 IV tPA) for a SCTR of 8.7%. In 2015, 348 SCs were activated with 64 subsequent DSCs (18.4%) and 45 AIS interventions (38 IV tPA, 7 IAT, 7 both), for a SCTR of 15.8%. The improvement in SCTR after introducing DSCs was statistically significant (p=0.012). When restricting the analysis to IV tPA interventions alone, there remained a trend (p=0.068) towards improvement in SCTR. Retrospective chart review did not reveal any DSC cases that resulted in missed opportunity for IV TPA or IAT treatment. No DSCs were due to an acute ICH. Justifications for de-escalations are summarized in figure 1. Conclusions: The introduction of DSCs resulted in a statistically significant absolute improvement in SCTR of 7.1%. Importantly, DSCs did not result in any eligible AIS patient forgoing IV tPA or IAT, nor missed ICH. More research is needed to increase the yield of stroke codes, refine the criteria for both activating and de-escalating them, and quantify the resource and cost implications of such de-escalations.

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2532. Identifying Educational Needs and Improving Provider Knowledge Regarding the Management of Febrile Neutropenia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2210 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S880-S880

Author(s):

Amy Chang ◽

Stan Deresinski ◽

Aruna Subramanian ◽

Bruno Medeiros ◽

Emily Mui, PharmD ◽

...

Keyword(s):

Medical Students ◽

Febrile Neutropenia ◽

Chart Review ◽

Retrospective Chart Review ◽

Empiric Therapy ◽

Myelogenous Leukemia ◽

Front Line ◽

National Guidelines ◽

Gram Positive ◽

The Impact

Abstract Background In a retrospective chart review of 211 first episodes of febrile neutropenia (FN) in in-patients with acute myelogenous leukemia evaluating rates of appropriate vs. inappropriate management, we identified frequent noncompliance with national guidelines for the management of FN. We utilized these data to develop an educational intervention targeting front-line providers. Methods Based on findings from our chart review, we developed and implemented an interactive, case-based didactic session for advanced practice providers (APPs) and medical students/residents rotating on hematology, targeting inappropriate antibiotic use. Pretest questions were embedded into the lecture, preceding content related to each learning objective. Lecture material included content from national guidelines, literature addressing misconceptions (e.g., vancomycin usage for persistent fever), and data from our institutional antibiogram (Figure 1). A post-test was given directly after the lecture to evaluate knowledge gained. Results Five inappropriate behaviors were identified (Figure 2): (1) changing empiric therapy despite clinical stability, (2) misunderstanding piperacillin/tazobactam’s spectrum of activity, (3) inappropriate initiation of antibiotics active against resistant Gram-positive organisms; (4) failure to de-escalate therapy at 72 hours and (5) failure to add Gram-positive coverage when using aztreonam. Lectures were provided to 13 APPs and 17 medical students/residents over 6 sessions. An improvement in knowledge was noted for most learning objectives except for the third, for which misconceptions remained, especially regarding need for vancomycin in the setting of mucositis (Figures 3 and 4). Higher baseline knowledge was noted for medical students/residents than APPs. 93% of learners rated the lecture very/extremely helpful. Learners recommended future content focus on antifungal therapy. Conclusion We utilized local practice data to develop educational content for front-line providers. We will convert this lecture into a video-format to be incorporated into hematology rotations to reinforce key concepts. A prospective cohort study to evaluate the impact on prescribing behavior is underway. Disclosures All authors: No reported disclosures.

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