Purpose:
To compare preoperative and postoperative lower eyelid scleral show in patients with unilateral myogenic (MP) and aponeurotic (AP) ptosis, analyze the factors correlated with them, and assess the rate of postoperative lower eyelid symmetry in both groups.
Methods:
Patients (older than 5 years old) with unilateral MP (58) and AP (20) were included from June 2015 to April 2017. Excluded were patients with previous eyelid surgery, strabismus, levator function of ≤3, and associated procedures. Margin reflex distance (MRD) 1 and 2 and levator function were measured by the same observer before and at least 6 months after the ptosis repair.
Results:
Lower scleral show was observed in 56.8% and 80% of MP and AP, respectively. Margin reflex distance 2 was significantly (r = −0.37, p = 0.002) associated with MRD1 in the MP group (multiple regression analysis). Both groups showed a significant improvement of MRD2, postoperatively resulting in symmetric MRD2 in 91.4% of MP and 80% of AP group. It was not changed in 43% of MP and 25% of AP group. Multiple regression analysis showed that preoperative MRD2 was the only significant factor associated with postoperative improvement of scleral show in the MP group.
Conclusions:
Lower scleral show was significantly improved after ptosis repair in both MP and AP. The more severe MP was significantly associated with more severe preoperative scleral show. Preoperative MRD2 was the only factor predicting postoperative improvement of scleral show in the MP. No factor was significantly associated with MRD2 in the AP group.
Purpose:To evaluate the effect of spironolactone on chronic central serous chorioretinopathy (CSC).Methods:In this prospective interventional case series, patients with chronic CSC were treated with spironolactone (25 mg daily) for at least 6 weeks. If the subretinal fluid (SRF) had not completely resolved by this time, treatment was continued, and the dosage was increased to 25 mg twice daily. Primary outcome measure was the change in maximum SRF height at the final follow-up visit, as detected by optical coherence tomography. Secondary outcome measures were changes in best corrected visual acuity (BCVA) and central macular thickness (CMT).Results:Sixteen eyes of 14 patients with chronic CSC were enrolled. Mean follow-up time was 6.4 ± 4.3 months. Baseline BCVA was 0.54 ± 0.44 logarithm of the minimum angle of resolution (log MAR), which improved to 0.42 ± 0.43 log MAR at the final visit (P = 0.04). Mean CMT decreased from 282.69 ± 103.23 μm at baseline to 236.75 ± 90.10 μm at final visit (P = 0.11), and the mean of maximum SRF height decreased from 155.63 ± 95.27 μm at baseline to 77.19 ± 95.68 μm at the final visit (P = 0.04). SRF resolved completely in seven eyes (43.75%).Conclusion:In eyes with persistent SRF due to CSC, spironolactone therapy was associated with a statistically significant decrease in maximum SRF height, as well as an improvement in BCVA.
Background:Observational studies, rather than randomized trials, revealed that statins might be associated with other benefits.Objectives:The present study aimed at evaluating the preventive effects of lovastatin when used as a prophylactic agent for early and late infective complications after surgery.Patients and Methods:A total of 149 patients undergoing elective intracranial and spinal surgeries, were enrolled in a double- blind randomized clinical trial in the department of neurosurgery of a teaching hospital. An amount of 20 mg lovastatin and the same dose of placebo, one day before the operation and three days after the surgery, were used for cases and controls, respectively. The patients were evaluated for local and systemic infections during hospitalization and 10, 30, 60 and 90 days after discharge.Results:A total of 149 patients, 78 men and 71 women with a mean age of 40.3 ± 16.5, were assigned to prophylactic protocols. 46 and 103 patients were in the case and control groups, respectively. Eight episodes of infection were detected, including six bacterial meningitis and two episodes of hospital- acquired pneumonia. All of the patients with documented postoperative infections were part of the placebo group, however, there were no significant statistical differences between the groups (P = 0.059).Conclusions:In spite of the differences between the two groups, the results did not significantly support the preventive effect of statins in postoperative infections.
Background & Aim: Delirium is prevalent in the intensive care unit, especially among mechanically-ventilated patients. Delirium is associated with a significant increase in adverse outcomes but it usually remains undiagnosed, making it necessary to develop and validate diagnostic tools. This study determined the validity and reliability of the Persian version of the Confusion Assessment Method for Intensive Care Units in Iran.
Methods & Materials: This cross-sectional study was conducted in open-heart intensive care unit of three university hospitals of Tehran, Iran. After piloting the translated confusion assessment method for intensive care units on 10 patients and refining the translated scale accordingly, 40 ventilated patients were consecutively selected and screened for delirium by two independent evaluators, and one psychiatrist. Inter-rater reliability between the two evaluators was assessed by the Kappa coefficient. Validity indices (i.e., sensitivity and specificity) of the Persian-CAM-ICU and 95% confidence intervals were calculated, given the psychiatrists’ diagnosis as the reference standard. Data were analyzed in Stata software (v. 11).
Results: Of 40 selected patients, CAM-ICU detected delirium in 30%. The Persian-CAM-ICU had a sensitivity and specificity of 75% and 96%, and a positive and negative predictive value of 92% and 85%, respectively. Youden’s J statistic of the scale was 71%. Each of the four domains of the CAM-ICU showed a sensitivity and specificity of more than 69% and 90%, respectively, suggesting acceptable construct validity. There was good agreement between the two evaluators in terms of delirium diagnosis with the Persian-CAM-ICU (kappa coefficient = 0.74, P<0.0001).
Conclusion: The Persian version of the CAM_ICU is an effective, valid and reliable diagnostic tool in critically ill ICU patients. Application of the scale is recommended for the prompt diagnosis and prevent potential delirium in ventilated patients.
Lash ptosis was significantly worse in MP than in AP. Lower LF was correlated with more severe LP. Ptosis repair resulted in significant improvement of LP and its symmetry with the contralateral eyelid. Lash ptosis symmetry did not correlate with eyelid height symmetry postoperatively.
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