Use and validation of mirrorless digital single light reflex camera for recording of vitreoretinal surgeries in high definition

Purpose: The purpose of this study is to describe the use of commercial digital single light reflex (DSLR) for vitreoretinal surgery recording and compare it to standard 3-chip charged coupling device (CCD) camera. Methods: Simultaneous recording was done using Sony A7s2 camera and Sony high-definition 3-chip camera attached to each side of the microscope. The videos recorded from both the camera systems were edited and sequences of similar time frames were selected. Three sequences that selected for evaluation were (a) anterior segment surgery, (b) surgery under direct viewing system, and (c) surgery under indirect wide-angle viewing system. The videos of each sequence were evaluated and rated on a scale of 0-10 for color, contrast, and overall quality Results: Most results were rated either 8/10 or 9/10 for both the cameras. A noninferiority analysis by comparing mean scores of DSLR camera versus CCD camera was performed and P values were obtained. The mean scores of the two cameras were comparable for each other on all parameters assessed in the different videos except of color and contrast in posterior pole view and color on wide-angle view, which were rated significantly higher (better) in DSLR camera. Conclusion: Commercial DSLRs are an affordable low-cost alternative for vitreoretinal surgery recording and may be used for documentation and teaching.

Substance use among university students at the St Augustine Campus of The University of the West Indies / Uso de sustancias entre los estudiantes universitarios en el Campus de Saint Augustine de la Universidad de West Indies

OBJECTIVE: Substance use and abuse is a well known public health risk that peaks in persons between 18 and 25 years of age and is prevalent among university students. While this has been repeatedly documented in developed nations, there have been limited studies in the English-speaking Caribbean. This study therefore sought to assess the prevalence of alcohol, tobacco and marijuana use among university students in the English-speaking Caribbean and any associated risk factors. METHODS: The study was designed as a descriptive, cross-sectional study to assess substance use in full-time, undergraduate students of The University of the West Indies (UWI), Trinidad and Tobago, over a six-month period. Questionnaires were distributed and students asked to self-report on their use of alcohol, tobacco and marijuana during the preceding six months. RESULTS: The six-month prevalence rate for alcohol was 70% and 28% of students were identified as regular users. Binge drinking was estimated at 31%. Muslims were least likely to have used alcohol when compared to other religious groupings. The prevalence rate for tobacco and marijuana was 17% and 13%, respectively. Ten per cent used all three substances. The use ofall three substances was associated with multiple problems. CONCLUSION: We conclude that substance use is common among many students of the UWI but generally lower than reports from other regions of the world. Despite this, substance use is associated with a number ofproblems and immediate educational interventions may be necessary to assist students in making informed and responsible choices.

OBJETIVO: El uso y abuso de sustancias es un riesgo bien conocido de la salud pública, que alcanza sus niveles más altos en personas entre los 18 y 25 años de edad, y es prevaleciente entre estudiantes universitarios. Si bien este fenómeno ha sido documentado una y otra vez en países desarrollados, los estudios en el Caribe anglófono han sido limitados. Por lo tanto, este estudio se propuso evaluar la prevalencia del uso del alcohol, el tabaco, y la marihuana, entre los estudiantes universitarios del Caribe angloparlante, y cualquier factor de riesgo asociado. MÉTODOS: El estudio se diseñó como un estudio descriptivo transversal para evaluar el uso de sustancias en estudiantes de pregrado a tiempo completo en la Universidad de West Indies (UWI), Trinidad y Tobago, por un periodo de seis meses. Se distribuyeron encuestas y se les pidió a los estudiantes entregar auto-reportes sobre el uso que habían hecho del alcohol, el tabaco y la marihuana en los seis meses precedentes. RESULTADOS: La tasa de prevalencia de seis meses para el alcohol fue del 70% y 28% de los estudiantes fueron identificados como usuarios regulares. El consumo de alcohol en forma de borracheras deliberadas se estimó en un 31%. Los musulmanes fueron los menos propensos al consumo de alcohol, en comparación con los restantes grupos religiosos. La tasa de prevalência para el tabaco y la marihuana fue de 17% y 13% respectivamente. El diez por ciento hacía uso de las tres sustancias. El uso de las tres sustancias estaba asociado a múltiples problemas. CONCLUSIÓN: Concluimos que el uso de sustancias es común entre muchos estudiantes de UWI, pero de modo general se halla por debajo de lo que se reporta desde otras regiones del mundo. No obstante, el uso de sustancias se encuentra asociado con un número de problemas, y puede que se requieran intervenciones educacionales inmediatas para ayudar a los estudiantes, de modo que estos puedan tomar decisiones responsables e informadas.

Efficacy and safety of the first parenteral selective COX-2 inhibitor, parecoxib sodium, in adult patients with postoperative pain.

Parecoxib, a prodrug of valdecoxib, a selective COX-2 inhibitor, has been recently introduced for the treatment of moderate to severe postoperative pain. This prospective, open, multicentric study enrolled 260 patients undergoing orthopaedic, gynaecological, dental and general surgery. Postoperatively, patients were treated with parecoxib, 40 mg IM/IV. There was a statistically significant decrease in the mean pain intensity score (p<0.05). At the end of 24 hours, 89.6% of total cases had a very good to total relief of pain. The mean duration of analgesia was 19.26 hours and mean time of onset of analgesia was 16.25 minutes ranging from 11-20 minutes. The laboratory values were within normal limits. The drug was well tolerated. There was no report of any hypersensitivity reaction. This study suggests that parecoxib, in a dose of 40 mg IM/IV, is an effective and safe option for the management of postoperative pain.

Incarcerated diaphragmatic hernia secondary to plication for eventration of diaphragm.

Diaphragmatic plication is the procedure of choice for congenital diaphragmatic eventration. In the absence of complications, most newborns with eventration do well after plication and have normal long-term respiratory functions. However complications are rare. Recurrence, ipsilateral pneumothorax and rupture of the diaphragm have been reported in literature. We report a case of incarcerated diaphragmatic hernia in a two-year-old child who had undergone plication for eventration of the diaphragm at six months of age.

Neonatal Hirschsprung's disease.

Since the classic description of this disease by Harold Hirschsprung's. In 1886 just over a century ago, there has been a marked evolution in the diagnostic modalities, understanding of the pathophysiology, unraveling of genetic association and the treatment approach of this disease. Recent research on the molecular biology of the disease has bestowed us with a clearer understanding of the pathogenesis of the disease. Genetic deletions have been identified which explain the familial incidence of 3.6%-7.8%, and in some kindreds the inheritance rate approaches 50%. Improvement in the diagnostic approaches has evolved from full thickness rectal biopsy (under GA) to suction rectal biopsy. The development of the histochemical staining for acetylcholinesterase, allows rapid identification in the lamina propria of hypertrophied extrinsic nerve fibers which have proliferated in the absence of intrinsic ganglion cells. Frozen sections now permit screening for normal ganglia in the myenteric plexus from seromuscular biopsies during the definitive pull-through procedures or leveling colostomy. This service, however, requires significant infrastructure and an expert pathologist, not widely available. Hirschsprung's disease (HD) variants like intestinal neuronal dysplasia(IND), hypoganglionosis are better identified and treated with availability of histochemical staining. The three-stage procedure till date remains the gold standard; however, increasingly, the world over, two stage and even single stage procedures are being tried. In the era of minimally invasive surgery, perineal pull through procedure has been attempted with or without laparoscopic assistance.

Surgical aspects of chronic constipation in children.

Chronic constipation accounts for 3% of paediatric visits. These patients can be broadly classified into three groups: (a) medical group (60-70%), (b) surgical group (20-25%), (c) refractory constipation group (5-10%). The first two groups can be managed by dietary adjustments and surgery respectively. The recognition and management of refractory constipation is a slower process and needs close scrutiny and perseverance before a definite therapeutic option could be decided.

Neurogenic bladder: urodynamic and surgical aspects.

Children with spina bifida often have vesico-urethral dysfunction manifesting either as upper urinary tract deterioration or voiding dysfunction, chiefly incontinence. Surgery of the back and presence of or increase in hydrocephalus may contribute to neuro-urologic worsening; secondary cord tethering and syrinx or hydromyelia may be additional factors coming into play later in life. Urodynamic assessment using simple modalities like uroflowmetry, external sphincter EMG, residual urine volume and cystometry provide data useful to classify patients according to detrusor and sphincter activity. Besides diagnosis, urodynamic studies are useful in guiding therapy of children with vesico-urethral dysfunction, and for their follow-up to detect sub-clinical deterioration. They also help to prognosticate risk of upper tract deterioration and the possible success of measures to contain incontinence. Urodynamic data in thirty one patients with spinal dysraphism who presented to us with urologic symptoms were analysed. Twenty-three children had hyper-reflexic bladders while in the other 8 the bladder was areflexic. 13 children showed upper tract dilatation. The leak point volume was significantly lower in this group of patients compared to those who did not show upper tract dilatation. Our results are comparable to earlier similar studies.