Pott's puffy tumor, a feature of osteomyelitis of the frontal bone, is a rare entity, especially in adults. Sir Percival Pott originally described this condition as a complication of trauma to the frontal bone. This is also a recognized complication of fronto-ethmoidal sinusitis. We present a rare case of Pott's puffy tumor caused by an insect bite presenting initially as a preseptal cellulitis and explore its pathogenesis and management.
Introduction Registering a child as visually impaired is a potentially traumatic, but necessary, milestone in paediatric ophthalmology. Registration enables the provision of services essential to maximise the child's potential. Purpose This study was carried out to investigate the changes over a 10-year period in the rates of registration of childhood blindness at a tertiary paediatric ophthalmology department. Particular attention was given to diagnosis, whether the disease was preventable, time to registration, age at registration, and the socioeconomic status of the patient's family. Methods A retrospective analysis of all children registered blind or partially sighted over a 10-year period until December 2006. Results A total of 256 children were registered blind or partially sighted over the 10 years. All cases were analysed. Of these, 58.2% were male and the average age at registration was 76 months; 52.0% were registered as severely sight-impaired. The most common primary diagnosis was cerebral visual impairment (CVI) in 27% cases, followed by optic atrophy in 16%, and the commonest anatomical site involved was the retina in 30.9%. An average of 25.6 (SD 8.0) registrations were carried out each year. The number of registrations per year is increasing. Seven cases (2.7%) were deemed avoidable and 61 cases (23.8%) were deemed potentially treatable. The mean index of multiple deprivation (IMD) score for the English cases (45.1) was significantly higher than of the surrounding area (Po0.0001) Conclusions The yearly rates of registration increased slowly over the 10 years. The most common underlying cause for registration remains CVI, with the yearly proportion of registrations because of CVI not altering. The average age of registration was 6.3 years. A significant proportion of the cases of visual
BackgroundDriving a car is the most common form of transport among the older population. Common medical conditions such as cataract, increase with age and impact on the ability to drive. To compensate for visual decline, some cataract patients may self-regulate their driving while waiting for cataract surgery. However, little is known about the self-regulation practices of older drivers throughout the cataract surgery process. The aim of this study is to assess the impact of first and second eye cataract surgery on driver self-regulation practices, and to determine which objective measures of vision are associated with driver self-regulation.MethodsFifty-five older drivers with bilateral cataract aged 55+ years were assessed using the self-reported Driving Habits Questionnaire, the Mini-Mental State Examination and three objective visual measures in the month before cataract surgery, at least one to three months after first eye cataract surgery and at least one month after second eye cataract surgery. Participants’ natural driving behaviour in four driving situations was also examined for one week using an in-vehicle monitoring device. Two separate Generalised Estimating Equation logistic models were undertaken to assess the impact of first and second eye cataract surgery on driver-self-regulation status and which changes in visual measures were associated with driver self-regulation status.ResultsThe odds of being a self-regulator in at least one driving situation significantly decreased by 70% after first eye cataract surgery (OR: 0.3, 95% CI: 0.1–0.7) and by 90% after second eye surgery (OR: 0.1, 95% CI: 0.1–0.4), compared to before first eye surgery. Improvement in contrast sensitivity after cataract surgery was significantly associated with decreased odds of self-regulation (OR: 0.02, 95% CI: 0.01–0.4).ConclusionsThe findings provide a strong rationale for providing timely first and second eye cataract surgery for older drivers with bilateral cataract, in order to improve their mobility and independence.
ObjectivesTo analyze the association between visual impairment and driver self-regulation among a cohort of older drivers waiting for first eye cataract surgery.MethodsNinety-six drivers with bilateral cataract aged 55+ years were assessed before first eye cataract surgery. Data collection consisted of a researcher-administered questionnaire, objective visual measures (visual acuity, contrast sensitivity and stereopsis), a visual attention test (the useful field of view test) and a cognitive test (the Mini-Mental State Examination). Driver self-regulation practices were collected using the Driving Habits Questionnaire and were also measured with an in-vehicle monitoring device. Characteristics of self-regulators and non-self-regulators were compared and a logistic regression model was used to examine the association between 3 objective visual measures and driver self-regulation status.ResultsAfter controlling for potential confounding factors, only binocular contrast sensitivity (p=0.01), age (p=0.03) and gender (p=0.03) were significantly associated with driver self-regulation status. The odds of participants with better contrast sensitivity scores (better vision) self-regulating their driving in at least 1 driving situation decreased (odds ratio [OR]: 0.01, 95% CI: 0.00–0.28) while those of increasing age reported an increased odds of self-regulating their driving (OR: 1.08, 95% CI: 1.01–1.15). The odds of males self-regulating their driving was decreased compared with females (OR: 0.28, 95% CI: 0.09–0.86).ConclusionsWorse binocular contrast sensitivity scores, increasing age and being female were significantly associated with driver self-regulation. The study highlighted that while self-regulation was common among cataract patients, a proportion of those with poor vision did not self-regulate. Further research should determine how cataract patients could benefit from self-regulation strategies while waiting for cataract surgery.
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