The Lateral Tarsal Strip Procedure: Reflections by a Specialist With 20 Years of Experience in a Tertiary Medical Center (Cross-sectional Study)

Introduction: Lateral tarsal strip (LTS) is a simple surgical technique that can correct eyelid malposition. Clinical indications vary from involutional entropion and ectropion, lower lid laxity, and lower lid retraction to punctal and paralytic ectropion. LTS mainly treats eyelid malposition by correcting horizontal laxity. Herein, we report the clinical indications for and effects of LTS.Methods: We retrospectively reviewed medical records of patients who underwent LTS by a single oculoplastic surgeon with eight years of experience performing the procedure at Korea University Guro Hospital.Results: We included 247 patients with 325 treated eyelids in the study. Involutional entropion was the most common indication, accounting for 69 patients (27.94%) and 88 eyelids (27.08%). The second most common indication was lower lid laxity (n=44 patients (17.81%) and 68 eyelids (20.92%)). Simultaneous surgery in addition to LTS was performed in 167 patients (67.6%) and 219 eyelids (67.4%); the most common was endoscopic dacryocystorhinostomy (DCR), which was performed in 50 patients (29.94%) and 80 eyelids (36.53%). Conclusion: LTS can be performed alone or simultaneously with oculoplastic procedures for various indications. Overcorrection with fixation above the canthal angle is useful to reduce recurrence. This study aims to explain the clinical importance of the LTS procedure.

Vitrectomy in Lens and Glaucoma Pathologies

Pars plana vitrectomy (PPV) is currently used as an effective method in many posterior segment pathologies. Although the most common indication is retina and vitreous pathologies, PPV is also preferred in some cases associated with lens and glaucoma. In case the crystalline lens or artificial intraocular lens, which is a product of industrial development, falls into the vitreous, it is essential to remove it mostly with the PPV approach. In some types of secondary glaucoma, especially malignant glaucoma, successful results are obtained in terms of visual prognosis and complications with vitreoretinal surgery techniques.

A study of feto maternal outcome in primary caesarean section

Background: Primary caesarean section is defined as caesarean section to be performed in women who have not had previous caesarean delivery. The increase in the rates of primary caesarean section is not only due to increased caesarean section in nulligravida but also due to upward rise in caesarean section rates in parous women. Through this study we aimed to examine the frequency and the indications of primary caesarean section in nulliparous and multiparous women.Methods: A prospective study was carried out in the OBGY department of smt. SCL Hospital, NHL municipal medical college from April 2020 to April 2021. All multiparous women with previous normal vaginal delivery who underwent caesarean section this time were included in this study. Patients with previous caesarean section <28 weeks of gestation, patients who did not give consent were excluded from the study.Results: 92% were 20-30 years and are gravida 2 or 3 patients. 85% patients were booked patients. Most common indication of primary caesarean section in parous women was MSL+FD (31%). Difficulty in delivery of the baby was encountered in 45% of cases. Major cause of admission in NICU was MAS.Conclusions: Primary caesarean section has become a major driver of overall caesarean section rate. Decision making on primary caesarean section should be carefully scrutinized, introducing a diagnostic second opinion for all primary caesarean section. Primary caesarean section in both multigravida and primigravida becomes mandatory in many cases to prevent maternal and feta morbidity.

Antibiotic prescribing patterns in Emergency Department at Regional Hospital in South Africa

Background: Antibiotic resistance is a major public health concern. The Emergency department (ED) is the community gate for healthcare where antibiotics are often prescribed. However, there is a paucity of data regarding antibiotic prescriptionpractices in Africa. Objectives: To describe the use of antibiotics in an ED and level of prescribing adherence to national guidelines. Methods: Retrospective observational study of antibiotic practice in ED. All patients who presented to ED during the study period and were prescribed an anti-microbial agent were included. Data on demographics, working diagnosis, anti-microbialprescribed, dose, route and prescriber level were used to provide descriptive statistics of these parameters. Results: We identified 195 (13.4%) patients who received anti-microbial therapy among 1454 charts reviewed. The mean age was 34.8 with male predominance. The most common indication identified was abscess in 37 (30.8%) patients and in general surgical conditions had the highest rate of antimicrobials prescribed at 54.3%. In addition, co-amoxiclav was the most commonly prescribed anti-microbial (72.15%). We found that combination therapy was not common practice in ED, with majority of the patients having received single anti-microbial therapy (87.18%). The appropriateness of antimicrobial prescriptions was (46.2%) and not statistically significant (P = 0.654). Conclusion: The most commonly prescribed anti-microbial was co amoxiclav and the most common indication was abscess. It was found that antibiotic prescription appropriateness was acceptable when compared to studies conducted in developedcountries. However, further research within other hospital departments will add to the study to determine the adherence as an institution rather than the Emergency department alone, as antimicrobial resistance is a major global healthcare problemand impacts patient care throughout the care pathway. Keywords: Antimicrobial resistance; antibiotic stewardship; emergency department.

Rastelli operation for double outlet right ventricle, pulmonary atresia with ductal dependent pulmonary flow

Double outlet right ventricle (DORV) with or without pulmonary atresia is a common indication for Rastelli operation. We very infrequently perform this surgery in our center. Here, we report a case of a ten-year-old girl who recently underwent Rastelli operation and patent ductus arteriosus (PDA) ligation for DORV, pulmonary atresia with ductal dependent pulmonary circulation by using custom-made valved conduit

Indications for exchange or explantation of phakic implantable collamer lens with central port in patients with and without keratoconus

AIM: To evaluate the causes of phakic implantable collamer lens (ICL) exchange/explantation in patients with and without keratoconus (KC) at two tertiary hospitals in Riyadh, Saudi Arabia. METHODS: A retrospective chart review of all patients who underwent ICL (model V4c with central port) exchange/explantation was performed using the electronic medical record systems. All available preoperative and postoperative data were documented for each patient. RESULTS: Over 7y, 2283 ICL implantation procedures were performed; 46 implants (2%) required exchange (21 implants)/explantation (25 implants), of which 14 cases (30.4%) were patients with KC. Indications for ICL exchange/explantation in non-KC group were vault measurement, cataract formation, increased intraocular pressure, inaccurate refraction, and patient dissatisfaction in 22 (68.75%), 4 (12.5%), 3 (9.37%), 2 (6.25%), and 1 (3.12%) case, respectively. The most common indication for ICL exchange/explantation in the KC group was inaccurate vault sizing in 11 patients (78.57%), inaccurate refraction in 2 patients (14.28%), and patient dissatisfaction postoperatively in 1 (7.14%) case. CONCLUSION: ICL implantation results in predictable refractive outcomes over the long term with exchange/explantation rates comparable to previous literature. Improper vault size is the most common cause of ICL exchange/explantation among patients with or without KC.

Comparison of Endoscopic Activity before and during the Covid Pandemic at a Tertiary Care Hospital in South Punjab

Introduction: Coronavirus disease 2019 (COVID-19) has resulted in dramatic changes to health-care delivery. Endoscopic activity has had frequent disruptions during this pandemic. The objective of the study was to see the influence of pandemic over the endoscopic activity. Methods: This retrospective analysis of endoscopic activity was undertaken at Nishtar Hospital Multan. Procedural analysis was done in the three months immediately after covid lockdown (1st April till 30th June 2020) and was compared to a similar period one year back. Results: Five hundred and fifty-four (68.5%) patients underwent endoscopic procedures during the three months of pre-COVID era, while this number reduced to half (n=255, 31.5%) patients during the covid pandemic. Even though the absolute number of Esophagogastroduodenoscopies (EGDs) reduced during the pandemic, patients were more likely to undergo EGDs during the COVID pandemic in contrast to the era before the pandemic (79% versus 66%, p = 0.002). The most common indication for EGD was upper gastrointestinal bleeding (UGIB). The percentage of EGDs done for UGIB rose from almost 60% to 80% during the covid pandemic (p < 0.001). The most common findings were esophageal varices and portal gastropathy (non-significant difference during and before the pandemic). Percentage of ERCPs done for obstructive jaundice doubled during the COVID pandemic (33% versus 65%, p = 0.002).The most common indication for sigmoidoscopy or colonoscopy was lower gastrointestinal bleeding. However, no significant difference was found before and during the covid pandemic (41.7% and 45.8% respectively, p=0.72). Internal hemorrhoids were the most common endoscopic finding. Colon cancer diagnosis reduced from 10% to undetected during the pandemic period. Conclusion: COVID pandemic resulted in considerable reduction in all type of endoscopic procedures. Majority of procedures were done for emergency indications like gastrointestinal bleeding. Rates of cancer detection was significantly reduced. MeSH: Endoscopy, COVID-19, Gastroenterology

Risk of venous occlusion after lead laser extraction preventing future lead implantation

Background Lead laser extraction is a well-established method for removing unwanted leads with low morbidity and mortality. Objective In this observational study, we documented our experience with venous occlusion after lead laser extraction. Methods Retrospective data of patients who underwent lead laser extraction between May 2010 and August 2018 was analyzed. Two subgroups of patients were identified. First group represented patients after lead laser extraction who suffered postoperative venous occlusion. Second group represents patients after lead laser extraction, who has documented patent venous access after lead laser extraction. Results 219 patients underwent percutaneous laser lead extraction. The mean age of patients was 65 ± 14 years. Of these patients, 74% were male. The Most common indication for extraction was Nonfunctional lead (45.2%, n = 99) followed by pocket infection with 33.8% and endocarditis (17.3%). A total number of 447 leads underwent laser extraction. In 7.8% of the patients, lead extraction was partially successful and lead extraction was not successful in only 2.3% of the patients. Only 13 patients developed a documented venous occlusion postoperatively and 26 patients has documented absence of venous occlusion, of whom 17 were under oral anticoagulation. Conclusion Lead laser extraction may lead to venous occlusion, which is mostly asymptomatic but it prevents future lead implantation. The use of oral anticoagulant may prevent postoperative venous occlusion.

Comparison of endoscopic activity before and during the covid pandemic at a tertiary care hospital in South Punjab

Introduction: Coronavirus disease 2019 (COVID-19) has resulted in dramatic changes to healthcare delivery. Endoscopic activity has had frequent disruptions during this pandemic. The objective of the study was to see the influence of pandemic over the endoscopic activity. Methods: This retrospective analysis of endoscopic activity was undertaken at Nishtar Hospital Multan. Procedural analysis was done in the three months immediately after covid lockdown (1st April till 30th June 2020) and was compared to a similar period one year back. Results: Five hundred and fifty-four (68.5%) patients underwent endoscopic procedures during the three months of pre-COVID era, while this number reduced to half (n=255, 31.5%) patients during the covid pandemic. Even though the absolute number of Esophagogastroduodenoscopies (EGDs) reduced during the pandemic, patients were more likely to undergo EGDs during the COVID pandemic in contrast to the era before the pandemic (79% versus 66%, p = 0.002). The most common indication for EGD was upper gastrointestinal bleeding (UGIB). The percentage of EGDs done for UGIB rose from almost 60% to 80% during the covid pandemic (p < 0.001). The most common findings were esophageal varices and portal gastropathy (non-significant difference during and before the pandemic). Percentage of ERCPs done for obstructive jaundice doubled during the COVID pandemic (33% versus 65%, p = 0.002).The most common indication for sigmoidoscopy or colonoscopy was lower gastrointestinal bleeding. However, no significant difference was found before and during the covid pandemic (41.7% and 45.8% respectively, p=0.72). Internal hemorrhoids were the most common endoscopic finding. Colon cancer diagnosis reduced from 10% to undetected during the pandemic period. Conclusion: COVID pandemic resulted in a considerable reduction in all types of endoscopic procedures. The majority of procedures were done for emergency indications like gastrointestinal bleeding. Rates of cancer detection were significantly reduced. MeSH: Endoscopy, COVID-19, Gastroenterology

Low profile sheaths in pediatric neurointervention: a multicenter experience

BackgroundPediatric neurointervention is challenged by the appropriateness of adult catheters and devices. This multicenter report on the smallest groin access sheaths offers technical notes and clinical outcomes in the pediatric neurointerventional population.MethodsAll pediatric neurointerventional cases from 2019 to 2021 were reviewed for use of a 3.3F Pediavascular or a 4F Merit Prelude Ideal low profile sheath. Hospital records were reviewed for complications and technical notes and compared with arterial groin access with the 4F Terumo Pinnacle in infants less than 1 year old, before the low profile sheaths at one author’s institution were introduced.ResultsFrom January 1, 2019 to March 31, 2021 there were 347 procedures performed at Boston Children’s Hospital and University of Wisconsin. Forty-four procedures in 26 patients were identified in which a 3.3F (38 cases, 20 patients) or 4F (6 cases, 6 patients) sheath was used. The average age was 2.2 years (1.5 days to 18 years). Retinoblastoma intra-arterial chemotherapy infusion (18 of 44) was the most common indication. The remaining procedures comprised vein of Galen embolization (12), diagnostic cerebral angiography (13), and one preoperative tumor embolization. Morbidity included a groin hematoma and decreased pulses (4.5%). No major groin complications occurred. There was no statistically significant difference compared with the historical cohort (132 procedures), which had seven instances of decreased pulses (5.3%, p>0.05).ConclusionThe 3.3F Pediavascular and 4F Merit Prelude Ideal sheaths are easily incorporated into the pediatric neurointerventionalist’s armamentarium for infants and readily accommodate various microcatheters for distal embolization and catheterization.