Corneal Trauma

Trauma is often the main cause of unilateral loss of vision in developing countries. Although corneal trauma can range from tiny corneal abrasions to sight-threatening and penetrating ocular injuries, even minor corneal trauma that breaches the epithelium has the potential to result in microbial keratitis and its associated complications, up until complete loss of vision. Even though ocular trauma is a global problem, blindness from eye injuries occurs mostly in developing countries, especially those where wars and civil conflicts bring around eye traumas from various weapons such as land mines, chemical substances, etc. Chemical injuries from both acids and alkalies are common causes of corneal injury due to their easy availability and soft regulations regarding their use. This chapter includes photos of trauma cases of the anterior segment, corneal and conjunctival foreign bodies, sequelae of blunt and penetrating trauma, chemical injuries, as well as a case of posttraumatic iris cyst.

Outcome of Amniotic Membrane Transplant in Persistent Corneal Epithelial Defects

Purpose: To determine the outcome of amniotic membrane transplant in patients with ocular surface disease. Study Design: Interventional Case series study Place and Duration of Study: Layton Rahmatullah Benevolent Trust Eye Hospital, Korangi 2½, Karachi, from January, 2019 to July 2019. Methods: Patients with an age range of 20–45 years, either gender and who had persistent corneal epithelial defects as a consequence of keratitis, chemical injuries, bullous keratopathy and Mooren’s ulcers were included. Informed consent was obtained. Preserved amniotic membrane was used in all patients and they were followed at 1 week, 1, 3 and finally at 6 months and results were evaluated in terms of stable, healed and pain-free cornea. Results: Mean age of the patients was 37.94 ± 6.78 years. Majority of the patients (60.0%) were less than 40 years of age. Out of 58 patients, 45 (77.6%) were males and 13 (22.4%) were females. Mean duration of injury was 7.67 ± 2.28 weeks with majority of patients i.e. 62% were with less than 8 weeks of duration. Most common cause of persistent corneal epithelial defect was bacterial keratitis (17.2%) followed by vegetative trauma (13.8%). Successful surgical outcome as healed cornea was observed in 53 (91.4%) patients. Conclusion: Amniotic membrane transplant is an effective treatment for persistent corneal epithelial defects unresponsive to standard medical treatment. This surgical technique is effective in terms of healing and resolving the inflammation and preserving the useful vision. Key Words: Persistant corneal epithelial defect, Amniotic Membrane, Bullous keratopathy.

The Biology of the African Bonytongue Heterotis niloticus (Cuvier, 1829) from the Lower Niger River at Agenebode in Edo State, Nigeria

Background. The African bonytongue, Heterotis niloticus, is readily accommodated in the fresh water of the Niger River. It is available all year round with a large population of juveniles and adults due to its fast growth and versatile feeding habits. This commercial fish is a highly preferred source of food because of its high protein content and hardy flesh, thus forming a very important component in the diet of many Nigerians. It is highly valued because of its socioeconomic importance and benefits. Hence, this research is designed with the aim of studying the biology of the African bonytongue, Heterotis niloticus, and providing viable information about its importance in fish culture in order to make an available added variety of culturable and affordable fish species in Nigeria. Results. The oesophagus is a muscular organ that is short and distensible. The oesophagus leads to the gizzard-like stomach, a reddish bilobed organ that is muscular and tough. H. niloticus is an omnivorous macrophage detritor, consuming a wide variety of bottom-dwelling food items. The histology of the gastrointestinal tract reveals four conspicuous layers from the inside to the outside: mucosa, submucosa, inner circular layer and outer longitudinal layer of muscularis, and serosa. The presence of numerous mucus glands and longitudinal folds with a prominent columnar epithelium provides durable length or an extension of the gut mucus to aid lubrication and easy passage of food materials, protecting the mucosal epithelium from mechanical or chemical injuries arising from interactions with digestive tract contents or enzymes. In addition, the presence of absorptive cells helps in the absorption of valuable nutritive substances. Conclusions. The anatomy of the mouth and gut and the aforementioned histology are modified to accommodate the feeding habits. H. niloticus has a single ovary that rests on the right side of the fish; it is reproductively active as the flood plains rise and peaks at the peak of the rains, being a moderately fecund fish. The high fecundity is complemented with peaks of GSI observed during the months of September, October, and November, which reveals spawning periods. Hence, the aforementioned attributes of H. niloticus make the fish a viable fish species for culture.

DEMOGRAPHIC, SOCIOECONOMIC AND CLINICAL PROFILE OF OCULAR CHEMICAL INJURIES IN TERTIARY CARE CENTRE IN CENTRAL INDIA

PURPOSE: To identify risk factors of Ocular chemical injuries by studying demographic, socio-economic and clinical characteristics of patients and suggest preventive measures. DESIGN: Prospective hospital-based study. PARTICIPANTS: Patients who presented to tertiary care hospital in central India with ocular chemical burns during February 2019-2020.METHODS:In this study a total of 41 patients (49 eyes) were included.Patient data recorded were Age, Gender, Occupation, Education, socio-economic status, location and mode of injury, type of chemical, use and awareness of Personal Protective Equipment (PPE) and first aid.Clinical characteristics studied were initial and final Best corrected visual acuity (BCVA), grade of injury, Intra- ocular pressure (IOP) at presentation, management and complications.The variables were evaluated for potential relationships with visual outcome.RESULTS:Average age was 32.05+15.1 years with Male:Female ratio of 1.9:1.Total of 13 patients (31.7%) were illiterate,belonged to Upper Lower IV socio-economic class (n=20, 48.8%). Most were semi-skilled workers (n=19, 46.3%) and 61% of the total injuries occurred at workplace.Accidental mode of injury was more prevalent (n=38,92.7%),most common causative chemical was alkali (n=27 eyes,55.1%).Low grade burns (Grade 1,2 and 3) were most observed (n=34,69.38%).Majority of eyes (n=39,79.6%) were medically managed.Risk factors for poor final BCVA using multivariate logistic regression analysis was poor initial BCVA (p =0.011) and grade of chemical injury (p =0.007).Conclusion:Chemical injuries are commonly encountered by patients of low Socio-Economic Status (SES), who are mostly illiterate. Most sustained injury at workplace and were not using PPE.These findings identify need for awareness programs with audio-visual components that are easily understood.It also highlights need for safer workplace practices.

Features of Providing Emergency Medical Care to Patients with Thermal and Chemical Injuries during the Spread of COVID-19: Providing Antiviral Protection for Medical Workers and Developing Practical Treatment Protocols

In modern conditions, the burden on the staff of medical institutions has increased many times. This is due to the fact that for more than a year and a half, the planet has been overwhelmed by waves of the coronavirus pandemic. Having come from China, this virus spread like lightning across the planet, causing an economic crisis, violation of the usual foundations of human life, etc. However, despite the undulating incidence of COVID-19 and a significant number of cases, other diseases and medical emergencies also occur, and doctors need to provide patients with the necessary assistance. It should be said that, despite the high level of protective measures in medical institutions, the provision of emergency medical care to patients is associated with a certain risk for doctors, since assistance should be provided to such patients immediately, and it is not always possible to quickly assess whether they are carriers of the virus, unfortunately. For this reason, the risk of infection to medical workers providing emergency care to patients, especially surgical ones, is extremely high. During the epidemic, the treatment of burn patients who have not confirmed the absence or presence of a coronavirus infection, the processes of establishing intravenous access, endotracheal intubation or tracheostomy, wound treatment and surgical intervention are the points of risk of infection. The introduction of an effective, appropriate degree of protection and the development of practical medical procedures will increase the level of protection of the medical worker and reduce the risk of infection with COVID-19. The aim of the work is to investigate the features of providing antiviral protection for medical workers and to study the existing practical treatment protocols for providing emergency medical care to patients with thermal and chemical injuries during the spread of COVID-19.

A laser management in cases of laryngeal stenosis due to corrosive poisoning

Background: Post corrosive poisoning result in serious chemical injuries and complications to the gastrointestinal tract and a high mortality rate. Post corrosive Complications that include respiratory injuries are especially significant for determining the severity of acute corrosive poisonings. Mortality is most often caused by tracheal necrosis, perforation of esophagus or stomach, followed by Mediastinitis or peritonitis. Results: Herewith presenting nine cases of laryngotracheal stenosis following corrosive poisoning ingestion. The purpose of this study is to upper aerodigestive tract complications and its Management. Stricture can be managed by endoscopic dilatation, oesophageal Stents, surgery. In our experience we planned for laser release of cricopharyngeal stricture with oesophageal dilatation. Diode laser isused for release of cricopharyngeal. Conclusions: Good postoperative outcome can be achieved and patient can be without tracheostomy for life long living near normal life. Pre and post operative psychological analysis and counselling is also very important for better functional outcome.Giving general anaesthesia is challenging in these cases hence experienced Team of anaesthetist is required to prevent mortality.