ABSTRACT
Purpose: The aim of this study is to identify common causes, associated ophthalmological abnormalities, and systemic comorbidities in children in Andhra Pradesh, India, with cerebral visual impairment (CVI). Methods: A retrospective review of case records of all children aged <16 years with diagnosis of CVI seen between January 2016 and December 2016 was carried out. Data were collected for their age, gender, cause of CVI, refraction, accommodation, anterior and posterior segment examination findings, and systemic problems. Results: A total of 124 patients were identified and studied (80 boys and 44 girls, mean age 5.23 years, 44.8% aged <2 years). The most common causes of CVI were hypoxic杋schemic encephalopathy (HIE) (34.4%), undetermined etiology (32.8%), neonatal seizures, and infantile spasms (16% each). The most common presenting complaints were poor vision (76%) and squint (11.2%). Profound visual impairment was seen in 88.8%, and 11.2% had high functioning CVI. Fifty-eight (46.4%) patients had significant refractive errors, 40 (32.25%) had strabismus, 4 (3.2%) had visually significant cataract, and 40 (32%) had optic atrophy. Motor delay was observed in 39.5%, speech delay was evident in 22.4%, and cognitive delay in 16%. Conclusion: HIE is the most common cause (one-third) of CVI in our population, and the majority of them presented at age <2 years (44.8%) with profound visual impairment (88.8%). A significant number of them have treatable ophthalmic conditions such as refractive errors (46.4%), accommodative insufficiency (12.1%), and cataract (3.2%), and more than one-third of them also have delay in other areas of development.
ABSTRACT
Background: To compare the effectiveness of Total contact casts (TCCs), Removable cast walkers (RCWs) and half-shoes to heal diabetic foot lesions. Methods: This proposed study was carried out as a prospective, randomized clinical trial in 100 patients diagnosed diabetic foot with superficial non-infected, non-ischemic diabetic plantar foot ulcers. Out of 100 pts, 10 pts did not use any prosthesis and in 90 pts, one of the three offloading modalities was used: Total contact cast (TCC), Removable cast walker (RCW) and half shoes (HS). Outcomes were assessed at wound healing or at 12 weeks, whichever came first. Primary outcome measures included duration of healing of diabetic wounds and also regarding the percent of wounds healed completely after 12 weeks. Results: The proportions of healing for patients treated with TCC, RCW, and HS were 85.7, 68.7, and 56.2%, respectively. A significantly higher proportion of patients were healed by 12 weeks in the TCC group when compared with the two other modalities. There was also a significant difference in survival distribution (time to healing) between patients treated with a TCC and both an RCW and half-shoe. The mean number of days to complete wound healing is 30 days for TCC, 52 days for RCW and 60 days for HS. Conclusion: The TCC seems to heal a higher proportion of wounds in a shorter amount of time than two other widely used off-loading modalities, the RCW and the half-shoe.