Corneal Astigmatism Changes After Ptosis Correction in Two Age Groups of Patients with Congenital Ptosis

Purpose: To evaluate postoperative corneal astigmatism changes after ptosis correction in groups of young and older patients with congenital ptosis.Patients and Methods: A prospective cohort study of 28 patients (56 eyes) with congenital ptosis enrolled at Ramathibodi Hospital was performed from April 2018 to June 2019. Within this group of patients there were 6 cases of bilateral congenital ptosis and 22 unilateral cases of congenital ptosis forming a total of 34 individual ptotic eyes for the study. The patients were categorized into two groups: early-age group (aged ≤5 years,) comprising of 14 eyes and older-age group (aged >5 years) comprising of 20 eyes. The preoperative visual acuity, amblyopic status, ptosis severity, and refractive error of both groups were evaluated prior to ptosis correction. All patients underwent ptosis correction with either levator resection or frontalis sling. Following the correction, the refractive error was measured after a follow-up period of at least 6 months. The astigmatism results were classified into three subgroups: with-the-rule, against-the-rule and oblique astigmatism.Results: The mean age at diagnosis was 8.91 ± 7.05 years. From the study group, amblyopia was found in 13 out of 28 patients (46.4%). The most common type of astigmatism was with-the-rule astigmatism, making up 24 out of 34 ptotic eyes (70.6%). A postoperative astigmatism change of >0.50 diopters was found in 4 out of14 eyes (28.6%) in the early-age group and in 6 out of 20 eyes (30.0%) in the older-age group (Rate ratio, 1.43; 95% CI, 0.34–6.07). Conclusion: Astigmatism was reduced following ptosis correction, with no statistically significant difference in the amount of reduction between the two age groups. As there is no significant difference, surgical correction can be deferred in patients of all age groups with anisometropic amblyogenic ptosis until appropriate surgical planning is possible.

Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial

Background The efficacy and cost-effectiveness of prophylactic thrombolytic locks in hemodialysis patients at high-risk of thrombotic dialysis catheter dysfunction is uncertain. We investigated this question in a double-blinded randomized controlled study. Methods Prevalent hemodialysis patients from 8 Belgian hemodialysis units, with ≥2 separate episodes of thrombotic dysfunction of their tunneled cuffed catheter during the 6 months before inclusion, were randomized to either: taurolidine heparin locks thrice weekly (control arm) or the same locks twice a week combined with taurolidine urokinase locks once a week before the longest interval without HD (TaurolockU arm). The primary efficacy outcome was the incidence rate of catheter thrombotic dysfunction requiring thrombolytic locks to restore function. Results 68 hemodialysis patients (32 controls, 36 urokinase) were followed during 9875 catheter days between May 2015 and June 2017. Incidence rate of thrombotic catheter dysfunction was 4.8 in TaurolockU vs 12.1/1000 catheter days in control group (rate ratio 0.39; 95%CI 0.23–0.64). 15/36 (42%) catheters in the treatment group required at least one therapeutic urokinase lock vs 23/32 (72%) in the control group (P = 0.012). The two groups did not differ significantly in catheter-related bloodstream infection and combined cost of prophylactic and therapeutic catheter locks. The TaurolockU group had a numerically higher number of episodes of refractory thrombosis. Conclusions Prophylactic use of urokinase locks is highly effective in reducing the number of thrombotic catheter dysfunctions in catheters with a history of recurring dysfunction. Prophylactic use of urokinase locks did not reduce the overall costs associated with catheter locks and was associated with a numerically higher number of episodes of refractory thrombosis. Trial registration ClinicalTrials.gov Identifier: NCT02036255.

The Effects of Delivering Personalized Course Recommendations at Scale on Advanced Placement Participation and Performance

Gaps in advanced high school coursework by socioeconomic status and geography persist in the United States, even among students with the ability and access to succeed in them. Lack of information on course availability and inaccurate self-perceptions may contribute to these inequities. We report on a large-scale experiment designed to increase Advanced Placement (AP) participation among underrepresented minority students and students attending rural high schools. Students and parents assigned to treatment received personalized outreach via multiple communication channels about APs offered at their high school in which they demonstrated potential to succeed. Outreach increased the probability of AP Exam participation in subjects in which students demonstrated potential to succeed by 1.1 percentage points, a 2.5 percent increase over the control group rate. This, in turn, increased the probability that students scored 3 or higher on those AP Exams by 0.5 percentage points, a 1.4 percent increase over the control group rate. Intervention effects were concentrated among underrepresented minority students attending non-rural schools and relatively less academically prepared students. The findings indicate that personalized course recommendations can increase equity in advanced high school course participation; however, designing outreach campaigns at scale that engage students is a crucial challenge to their efficacy.

Analysis of postpartum intrauterine contraceptive devices

Background: PPIUCDs are the only postpartum family planning method for couples requesting a highly effective and reversible, yet long acting, family planning method that can be initiated during the immediate postpartum in lactating women. The public health benefits from PPIUCDs stemmed from the women’s increased accessibility to PPIUCDs following facility births, as PPIUCDs could be offered at health facilities after childbirth. It is an attempt to reduce unmet family planning need. The specific aims of this study were to assess the acceptability, feasibility expulsion rate and complications of PPIUCD insertion among women delivering at term in our institute who were eligible and counselled for PPIUCD.Methods: Prospective study undertaken at Dr. Vaishampayan memorial government medical college, Solapur, Maharashtra conducted from September 2015 to August 2017. All women undergoing delivery at term in this institute and not having any contraindications for postpartum IUCD insertion were counseled for PPIUCD.Results: A total 3032 were eligible for PPIUCD insertion and were counseled for the same. 1.97% women accepted PPIUCD insertion while 98.03% of them declined insertion. 1124 underwent caesarean section while 1908 had vaginal delivery. Among vaginal delivery group rate of acceptance was 1.20% while that in caesarean section group was 3.29%.Conclusions: The present study concluded that overall acceptance of PPIUCD in our institute is 1.97 %. Considering fear of complications related to IUCD and partner refusal as major causes of refusal for PPIUCD in our study, emphasis on this aspect during counseling can improve acceptance.

Immunoregulatory Therapy in Frozen Embryo Transfer Cycle Improved Reproductive Outcomes of Women with Elevated Peripheral Blood Th1/Th2 Ratios

Backgrounds: Little observational data exist describing prednisone+ hydroxychloroquine+cyclosporine (PDN+HCQ+CsA), prednisone+ hydroxychloroquine (PDN+HCQ), prednisone (PDN) therapy for improving IVF-ET outcomes in patients with elevated peripheral Th1/Th2 ratio.Methods: Retrospectively collected patients who was failed in IVF-ET and had elevated Th1/Th2 ratio between 1/2019 and 3/2020. Based on researches, elevated Th1/Th2 ratio was defined as equal to 10.3 or above. Patients were assigned into treatment group and control group based on whether received immunoregulatory treatment (PDN+HCQ+CsA/PDN+HCQ/PDN) during frozen transfer cycle. Results: Forty-one patients (PDN+HCQ+CsA/PDN+HCQ/PDN=21/9/11) in treated group and 30 patients in control group were enrolled in the study. No differences were found of baseline characteristics between treated group and untreated group. Rate of live birth was higher in treated group compared with untreated patients (41.5% vs. 16.7%, P=0.026). Rate of biochemical pregnancy (56.1% vs. 40%, P=0.18), implantation (36.5% vs. 23.9%, P=0.15), clinical pregnancy (51.2% vs. 30%, P=0.0743) were higher than control group but there were no statistical significances. Conclusions: Use of prednisone+ hydroxychloroquine+ cyclosporine or prednisone+ hydroxychloroquine, or prednisone during frozen embryo transfer cycle for patients with past implantation failure and elevated peripheral Th1/Th2 ratio improved live birth rate compared to those untreated.

Hazards and benefits of elective induction of labor at term

Background: The objective of this study was to compare the rates of caesarean section and neonatal outcome in patients with elective induction of labor compared to patients with spontaneous onset of labor.Methods: Authors studied 200 patients with 100 in elective induction group and 100 in spontaneous onset laboring group. Two groups were compared with respect to demographic profile, basic examination, ultrasound findings, P/A, P/V findings, duration of labor, mode of delivery and neonatal outcome.Results: Various parameters like age residence, per abdominal findings were comparable in two groups. Labor was not prolonged in study group compared to control group. Rate of caesarean section remained high in induction group (21%) in comparison to spontaneous laboring group (4%). Rate of instrumental deliveries did not differ significantly between the groups. 5 min Apgar score did not vary significantly; however, the NICU admission was higher in induction group compared to spontaneous laboring group. Duration of hospital stay was longer in study group.Conclusions: Elective induction of labor has higher rates of caesarean deliveries. NICU admission was also longer in induction group.

The Level of Effectiveness Use of Quinoline Drugs in COVID-19: A Literature Review

ABSTRACT Chloroquine is the first line of medicine in the treatment of malaria. Besides being antimalaria, the chloroquine also can be used as the anti-inflammation in the medicine of arthritis rheumatoid arthritis and lupus erythematosus discoid. Hydroxychloroquine sulfate is 4-aminoquinolin with hydroxylated chloroquine analog, having the same pharmacokinetic as chloroquine which is given orally in hydroxychloroquine sulfate form, processed by gastrointestinal absorption and very faster kidney elimination. The effectiveness of chloroquine and hydroxychloroquine towards COVID-19 in the in vitro experiment showed it could inhibit the duplication of the SARS-CoV-2 virus. The chloroquine function is to stop COVID-19 infection with (EC50) 1,13 μM and (CC50) larger than 100 μM. Meanwhile, the hydroxychloroquine function is to inhibit the attachment and entry of the virus into the host’s cell by enzymatic activation which is the lysosome acidification disorder and antigen presentation as the result of pH increase. Based on the clinical study, the 10 of 12 patients who have lopinavir/ritonavir therapy by virology, the chloroquine group showed RT-PCR negative on day 7, 10, and 14 in compare to lopinavir/ritonavir that showed RT-PCR negative on day 14. On the 9th day, 60% of the patients of chloroquine group showed the CT scan of Lungs image normal instead of the lopinavir/ritonavir at 25%. In the day 14 based on the CT test result, the pulmonary improvement increased twice rather than chloroquine group (Rate Ratio 2.21). It proved that the chloroquine role showed the result of the medicine has a significant effect by cleaning the virus or other clinical matters. The purpose of this literature review is to know the effectiveness quinoline class of drugs which is chloroquine and hydroxychloroquine in COVID-19 disease.Keywords: effectiveness, chloroquine, COVID-19Correspondence: [email protected]

Comparative study of induced and spontaneous labour in nulliparous women using modified WHO partograph

Background: Induced or spontaneous labour has implication on the eventual mode of delivery and neonatal outcome. The aim of study is to compare mean duration of labour andmaterno-foetal outcome of induced versus spontaneous labour among nulliparous women using modified WHO partograph.Methods: The study was conducted in nulliparous women coming at term in active phase of labour (with cervical dilatation at least 4 cm) either spontaneous or induced, both labouring women were monitored using modified WHO partograph. Outcomes measures include requirement of augmentation of labour with oxytocin, mean duration of labour, eventual mode of delivery and the materno foetal outcome.Results: A total 100 women were compared in each group. There was no difference in mean age group, BMI, gestational age. More women had spontaneous vaginal delivery among those with spontaneous labour (76% versus 58%) (p=0.033). The mean duration of second stage of labour was significantly more in induced labour (16.25 minutes) than in spontaneous labour (14.60 minutes) (p=0.0212). The mean Apgar scores were comparable in two groups. Induced labour is comparable to spontaneous labour regarding fetomaternal outcomes but with increased rate of caesarean deliveries.Conclusions: Study concluded from our study that in spontaneous group mean duration of labour was less than induced group and most of the patient delivered vaginally. In induced group rate of caesarean was higher and requirement of oxytocin for labour augmentation was also more than spontaneous group. Maternal complications were also found more in induced group than spontaneous group whereas neonatal outcome was similar in both the groups. We observed in our study that induced labour can be a safe procedure among nulliparous women if labour is partographically monitored by WHO modified partograph.

Research on China’s Ecological Welfare Performance Evaluation and Improvement Path from the Perspective of High-Quality Development

Based on the data of China’s ecological environment from 2006 to 2018, the paper uses the super-efficiency DEA and Malmquist index methods to evaluate China’s ecological welfare performance from a static and dynamic perspective. Based on this, the Theil index is used to analyze the group’s ecological welfare performance. The internal and intergroup differences show that, from the static evaluation results, China’s ecological welfare performance is in a situation of “high in the east, low in the west, and average in the central region.” There is not much difference between the eastern and central regions, while the ecological welfare performance in the western region is low. From the results of dynamic evaluation, the overall level of regional ecological welfare performance in China has improved in recent years, and the average Malmquist index has exceeded 1, indicating that the growth pattern of ecological welfare performance has shifted to high quality, but the degree of increase in each region is different. There is still much room for improvement in ecological welfare performance; from the perspective of intragroup and intergroup differences, the intragroup differences and intergroup differences in the three major regions have generally maintained a continuous downward trend, and the contribution of the differences in ecowelfare performance between group rate has a clear advantage. Finally, corresponding suggestions are put forward based on the empirical results of the paper.