Investigation of fluorescein stain–based tear film breakup time test reliability in dogs in a clinical setting

OBJECTIVE To determine intra- and interobserver reliability of a fluorescein stain–based tear film breakup time (TFBUT) test as performed in a clinical environment with and without administration of a topical anesthetic. ANIMALS 21 privately owned dogs. PROCEDURES A randomized study design was used. Two independent observers that commonly perform the TFBUT test in clinical practice read the same description of TFBUT. Observers performed TFBUT testing for each dog before and after topical administration of 0.5% proparacaine solution in 4 testing periods with a 1-hour interval between periods. Intraclass correlation coefficient (ICC) analysis was used to assess inter- and intraobserver test reliability. Linear mixed models were used to assess the main effects of testing period, observer, eye, and presence of ophthalmic disorders and their interactions on TFBUT. RESULTS Mean TFBUT measurements performed by observer 1 and observer 2 were 5.9 seconds and 8.6 seconds, respectively, when adjusted for other effects in the model. Intraobserver ICC was poor for one observer and moderate for the other. Interobserver ICC was poor without use of topical anesthetic and slightly lower when anesthetic was used. Observer and testing period were each significantly associated with TFBUT; the measurements decreased and were more variable after multiple applications of fluorescein stain and proparacaine. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested tear film stability is negatively affected by topical administration of 0.5% proparacaine solution and repeated applications of fluorescein stain. The TFBUT test as performed in this study had poor to moderate reliability.

Preliminary study on the potential of topical anaesthesia from betel leaf and clove leaf extract

Introduction: Betel leaf (Piper betle Linn.) and clove leaf (Syzygium aromaticum) are Indonesian herbs which are known to cause a numb sensation. The main ingredients of betel leaf, which act as an anesthetic, are caryophyllene, eugenol, methyl eugenol, eucalyptol (1.8-cineol), linalool, α-Pinene, estragole, while cloves have local anesthetic effects through their ingredients, namely eugenol, and β-Caryophyllene. Research on the benefits of these two ingredients as topical anesthetics in Indonesia is still rare. This study was aimed to describe the potential of betel leaf and clove leaf extract as a topical anesthetic in Wistar rats. Methods: This research was a laboratory experimental research with simple randomized controlled design. The sample consisted of 6 male Wistar rats, each of which was given four treatments, namely extract with a concentration of 50%, 75%, and 100%, and topical anaesthetic benzocaine 20% as a control. Each treatment was tested using an electric stimulator and observed onset, duration of action, and depth of topical anaesthesia. The data were processed using descriptive statistics with tables and graphs. Results: Betel leaf extract with a concentration of 100% had a better mean onset, duration of work, and depth of anesthesia than the 20% benzocaine control, whereas 75% clove leaf extract had the longest duration of action compared to 20% benzocaine and 100% concentration was the topical anesthetic agent with the highest anesthetic depth. Conclusion: Based on the onset, duration of action, and depth of anesthesia, betel leaf, and clove leaf have potential as topical anesthetic agents.

Determining the mean difference in central corneal thickness measured by applanation ultrasound and oculus Wavelight Occulyzer II

Objective: The objective is to determine the mean difference of central corneal thickness measurements by using ultrasound pachymeter and oculus Wavelight Occulyzer II. Patients & Methods: This prospective cross-sectional comparative study was conducted at Department of Ophthalmology, Liaquat National Hospital, Karachi for 6 months duration, after the approval from ethical committee. Patients were included in our study on the basis of inclusion & exclusion criteria. Central corneal thickness measurements was taken by using ultrasound pachymeter & oculus Wavelight Occulyzer II. All the data was collected by single researcher. The results were plotted, compared & analyzed. Results: 130 patients attending ophthalmology department and fulfilling the inclusion criteria were assessed. One eye of each patient was measured (65 were right eye and 65 were left eye). 73(56.2%) were male and 57(43.8%) were females. Mean age of these patients was 33.9 ±8.9 years. The mean ± SD thinnest oculus Wavelight Occulyzer II measurement was 538.61±23.46 ?m and ranged between 476.0 and 619.0 ?m whereas the mean thinnest ultrasound pachymeter measurement was 535.1±21.816?m and ranged between 482 and 601 ?m. There was highly significant correlation of central corneal thickness between both the instruments. (r=0.96, p<0.001) Conclusion: According to the results of our study there is a highly correlation of central corneal thickness was found between the readings obtained from both UP and oculus Wavelight Occulyzer II. So we concluded that oculus Wavelight Occulyzer II can be used as an alternative technique to ultrasound pachymetry while assessing CCT in clinical settings to decrease the risk of procedure associated problems with UP like epithelial trauma and infection, to decrease the frequent use of topical anesthetic agents, for early detection and management of glaucoma & in anxious patients also. Keywords: Central corneal thickness, ultrasound pachymeter, oculus Wavelight Occulyzer II

Leech Infestation in the Vulvar Region: Causes of Vaginal Bleeding in a Six years old Child

Background: Leeches are hermaphroditic rare blood-sucking human endoparasitesof phylum Annelida and class Hirudinea. Leech infestation is a zoonotic disease acquired by drinking contaminated water, swimming in ponds and streams .1Epidemiology of leech bites in literature is limited and the majority of existing data are case reports from the tropics or subtropics.2–4 Leech bites can occur on various orifices of the body including internal body cavities and orifices, such as the uterus, rectum, urinary bladder, vulva, nasal cavity, peritoneal cavity, nasopharynx, oropharynx, oesophagus, trachea, bronchi and the vagina.5 Different chemicals for leech removal have been utilized and include anesthetics drugs like lidocaine and topical anesthetic spray. Salt, saline, vinegar, alcohol, and heat are also viable options. Of these, saltwater has been shown to be effective in causing the leech to relax and release.Vaginal bleeding resulting from leech bite is rare, but when it occurs, it may be of severe morbidity.2–4 In the present case report that happened at Kabaya district hospital, a six year old child with vaginal bleeding that turned out to be caused by vaginal leech infestation is presented. Kabaya district hospital is a rural hospital with 144-bed capacity and serves 188,902 inhabitants and is geographically difficult to access due to the lack of reliable roads and bridges, especially in the rainy season.

35 Implementation of a quality improvement initiative to reduce pain and anxiety associated with needle-related procedures in a Canadian paediatric emergency department

Primary Subject area Emergency Medicine - Paediatric Background Needle-related procedures such as intravenous (IV) insertion, venipuncture, and lumbar puncture (LP) are commonly performed in children, particularly in the emergency department (ED). Children consistently rate these needle-related procedures as very distressing. While topical anesthetics have been shown to be highly effective and are available, they are inconsistently used. The Children’s Comfort Promise was originally developed at the Minnesota Children’s Hospital. It requires nursing staff to use four strategies for children undergoing needle-related procedures: (1) topical anesthetic, (2) sucrose or breastfeeding if ≤ 12 months, (3) Comfort positioning (swaddling, skin-to-skin, or facilitated tucking if ≤ 12 months and sitting upright for children &gt; 12 months), and (4) age-appropriate distraction. Objectives We sought to evaluate compliance with all 4 Comfort Promise strategies for managing children’s pain and anxiety during needle-related procedures in a Canadian paediatric ED. Design/Methods Implementation of The Comfort Promise in March 2020 included a focus group to perform a root cause analysis, designation of nurse champions, monthly steering committee and ED working group meetings, and didactic education sessions. Our institution’s decision support unit identified all encounters of children 0-17 years who underwent at least one needle-related procedure at our paediatric ED from January 1 to November 30, 2020. The outcome was compliance with all 4 Comfort Promise strategies. Balancing measures included adverse drug reactions and vasoconstriction. We used statistical process control to analyze the outcome from 2 months preceding and 7 months following implementation. Results From January 1 to November 30, 2020, 21,600 encounters were identified, of which 10,294/21,600 (47.7%) were female. Age ranged from 0-17 years with a mean (SD) of 6.9 (5.5) years. Needle-related procedures were performed in 730/21,600 (3.4%) encounters, most commonly IV insertion (289/730, 39.6%) and venipuncture for blood sampling (232/730, 31.8%). Half of all encounters had no compliance strategies electronically recorded (363/730, 49.7%). Compliance with all Comfort Promise strategies increased over the study period (Figure 1). Topical anesthetic increased from 3/35 (8.6%) to 35/83 (42.2%). Sucrose or breastfeeding increased from 0/6 (0%) to 2/16 (12.5%). Comfort positioning increased from 0/35 (0%) to 26/83 (31.3%). Distraction increased from 0/35 (0%) to 22/83 (26.5%). There were no adverse drug reactions or vasoconstriction. Conclusion Implementation of The Comfort Promise in a Canadian paediatric ED resulted in greater use of strategies, particularly topical anesthetic, to reduce needle-related distress in children. Ongoing compliance will depend on consistent electronic recording and provider education.

Extracoporeal shockwave treatment decreases pain, functional limitations and medial collateral ligament thickness in subjects aged 50-70 years with knee osteoarthritis

BackgroundPain from knee and hip osteoarthritis (OA) can have a significant impact on the physical function and quality of life of affected individuals worldwide. The objective of this study was to evaluate the effect of extracorporeal shockwave therapy (ESWT) on pain, flexibility, function, and medial collateral ligament (MCL) thickness in knee osteoarthritis (KOA). MethodsA study of quasi experimental design was performed involving 15 subjects aged 50 – 70 years with Kellgren-Lawrence grade 2-3 KOA. All subjects were evaluated regarding baseline -pain using visual analogue scale (VAS), range of motion (ROM), functional outcome using Western Ontario and McMaster Universities Arthritis Index (WOMAC), and MCL size. Extracorporeal shock wave therapy was given 3 times, at baseline, and 4 and 8 weeks after intervention. All subjects were given 4000 shocks at intensities of 1.5 – 4 Bar (raised gradually) per session. The shocks were given in the supine position, knee flexed 90o, without topical anesthetic. Statistical analyses were conducted using a dependent t-test. ResultsAfter 8 weeks of intervention, ESWT significantly improved pain score (p<0.01), WOMAC (p<0.01) and MCL thickness (p<0.01) in patients with OA of the knee. However, there was no significant difference in knee ROM, both for degree of flexion and extension (p>0.05). ConclusionThe use of ESWT for treatment of knee OA had a beneficial effect on pain relief, function outcome and MCL thickness. However, there remains a lack of clarity regarding the frequency and dosage levels of ESWT required to achieve maximum improvement.