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As the global coronavirus disease 2019 (COVID-19) pandemic continues to sweep across the globe, reports of kidney involvement in adult patients infected with COVID-19 have been documented, and recently, cases in the pediatric population have also been reported.This report highlights the case of an 11-year-old boy who developed acute kidney injury presenting as gross hematuria, proteinuria, and hypertension immediately after a COVID-19 infection. A renal biopsy allowed us to diagnose the patient with post-COVID-19 infectionassociated de novo crescentic immune-mediated glomerulonephritis. Oral prednisolone and cyclophosphamide treatments were initiated after methylprednisolone pulse therapy administration. Currently, the patient is receiving medical treatment for five weeks, and his renal function is gradually recovering. Previous studies have suggested that, although quite rare, a variety of kidney complications can occur after COVID-19 infection or vaccination, and it is recommended to monitor renal function through evaluation. Herein, we report a pediatric case of post-COVID-19 infection-associated de novo crescentic immune-mediated glomerulonephritis consistent with rapidly progressive glomerulonephritis.
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Purpose@#To evaluate the usefulness of a newly generated monofocal intraocular lens (IOL) in patients with various retinal diseases who underwent combined cataract and pars plana vitrectomy surgery. @*Methods@#This prospective observational study included 33 patients with various retinal diseases. Monocular best-corrected distance visual acuity (BCDVA), uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), and contrast sensitivity were measured and compared with 40 age-matched patients in the standard monofocal IOL. @*Results@#The Eyhance IOL group demonstrated significantly better UCIVA at 6 months follow-up compared to the standard monofocal IOL group. No significant differences were observed between the two groups in contrast sensitivity, BCDVA, UCDVA, or UCNVA. The regression analysis showed a significant association between preoperative corrected distance visual acuity and improved UCIVA in the Eyhance IOL group. @*Conclusions@#The Eyhance ICB00 IOL proved to be a valuable option for patients with retinal diseases undergoing combined cataract surgery and vitrectomy. It effectively improved intermediate vision without compromising contrast sensitivity or distance visual acuity.
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Background@#Self-leadership, an action strategy that can maximize individual capabilities, can affect the organizational commitment of dental hygienists and ultimately improve the quality of medical services. This study aims to demonstrate the need for self-leadership and organizational commitment for dental hygienists and develop measures to improve the quality of medical services. @*Methods@#An online survey of dental hygienists working at dental hospitals and clinics in Seoul and Gyeonggi province, Republic of Korea was conducted from March 28 to May 1, 2022. A total of 341 questionnaires were returned and analyzed. The measurement tools were modified and supplemented based on the theories and models developed by Manz for self-leadership, Mowday for organizational commitment, and Cronin and Taylor for medical services. Descriptive statistics, independent t-tests, ANOVA, simple regression, and multiple regression analyses were performed using SPSS 25.0. @*Results@#In leadership education, self-leadership is based on participation experience, the number of participants, and when and where it is received. Organizational commitment comes from participation experience, and the quality of medical services has been found to affect participation experience and location. Self-leadership had an effect on the quality of medical services (β=0.497, t=10.551, p＜0.001; β =0.599, t=13.783, p＜0.001; β=0.353, t=7.601, p＜0.001) and organizational commitment was found to have a mediating effect. @*Conclusion@#Dental hygienists’ self-leadership has a positive effect on the quality of medical services through the formation of appropriate interrelationships within the organization. Therefore, self-leadership programs should be developed, participated in, and promoted to improve the self-leadership of dental hygienists. Moreover, hospitals should improve their environment to provide and improve self-leadership education.
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Purpose@#Children with nephrotic syndrome may experience disease relapse or aggravation triggered by various viral infections. Limited studies on the clinical implications of the coronavirus disease 2019 (COVID-19) pandemic in children with nephrotic syndrome have been published worldwide. Therefore, this study aimed to investigate the effects of COVID-19 on the clinical course of nephrotic syndrome in children. @*Methods@#The medical records of 59 patients with idiopathic nephrotic syndrome who visited our hospital between February and June 2022 were retrospectively analyzed. @*Results@#Twenty of the total 59 patients with nephrotic syndrome were diagnosed with COVID-19 during the study period. The mean age at the time of the diagnosis of nephrotic syndrome and COVID-19 in all 20 patients was 4.6±3.5 and 8.9±3.9 years, respectively. Three patients (15%) were diagnosed with nephrotic syndrome relapse during COVID-19 and the relapse rate was similar to them without COVID-19 (20.5%, 8/39 patients). At the time of the COVID-19 diagnosis, fever (85%) and cough (40%) were the most common symptoms. After the diagnosis of COVID-19, all patients showed improvement with symptomatic treatment, including antipyretic analgesics and cold medicine. None of the critical patients required hospitalization or oral antiviral medications. @*Conclusions@#Despite the use of immunosuppressants, the clinical manifestations of COVID-19 in children with nephrotic syndrome were not severe and are expected to be similar to that in the general population. The relapse rate of nephrotic syndrome in children with COVID-19 was also not different from them without COVID-19.
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Kleefstra syndrome is a rare genetic disease characterized by mental retardation, hypotonia, and a characteristic facial appearance. Furthermore, in some cases, Kleefstra syndrome is associated with various anorectal and genitourinary complications, including imperforated anus, vesicoureteral reflux, hydronephrosis, and chronic kidney disease. Herein, we present a case of Kleefstra syndrome with recurrent urinary tract infections associated with vesicoureteral reflux and rectourethral fistula, which was treated by a multidisciplinary approach.
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Objectives@#This study aimed to evaluate the effects of a toothpaste containing sodium pyrophosphate and a high concentration (1,450 ppm) of fluoride on dental plaque, gingivitis index, and calculus index in a clinical trial. @*Methods@#This study used an eight-week, randomized, double-blinded, controlled, comparative, parallel design. The participants, who voluntarily signed a consent form, were screened through visit evaluation if they met the selection/exclusion criteria. After a one-week run-in period, the selected participants were randomly assigned to either an experimental or control group in the order of their enrollment. Subsequently, the participants were asked to brush their teeth with the study toothpaste using the rolling method for 3 min, thrice daily, for 8 weeks. Oral examinations were performed at baseline and after 3 weeks, 4 weeks, and 8 weeks. Evaluation of papillary marginal attachment index (PMA index), Talbott’s gingival index, patient hygiene performance index (PHP index), Turesky plaque index, and calculus index were performed during the oral examination. @*Results@#After 8 weeks, the PMA indices were 7.12 for the control group and 5.00 for experimental groups. In addition, the PHP index was 2.06 for the control group and 1.66 for the experimental group. Significant differences were observed between the control and experimental groups in all indice (P<0.05). @*Conclusions@#This study shows that using a toothpaste containing sodium fluoride, sodium pyrophosphate, tocopherol acetate, and dental-type silica improves dental plaque removal, reduces gingivitis, and inhibits calculus formation.
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There have been some cases where abnormal histopathologic findings could not be found in the kidney could even with proper specimen collection through percutaneous renal biopsy (PRB) in accordance with its indication. We analyzed the incidence and clinical outcomes of children who showed normal histopathological findings in their PRBs. Methods: The medical records of 552 pediatric subjects who underwent PRB between 2005 and 2016 were reviewed. Twenty-six subjects were excluded because allograft biopsy was performed in nine subjects, and the age at biopsy was greater than 18 years in 17 subjects. Finally, 526 subjects were enrolled in this study. Results: Of the 526 pediatric patients, 32 (6.1%) showed no histopathological abnormalities in their PRBs. The male-to-female ratio of the patients was 1.9:1, and the mean ages at the first visit and at biopsy were 10.6 ± 4.1 and 11.4 ± 3.8 years, respectively. In accordance with the biopsy indications, recurrent gross hematuria showed the highest incidence rate, but combined hematuria and proteinuria had the lowest incidence rate regarding normal renal histopathology among all the subjects. At a mean follow-up of 35.5 ± 23.6 months, urinary abnormalities had improved in more than 50% of the subjects with normal renal histopathology, and none of the patients showed progression to end-stage renal disease or required rebiopsy due to symptom worsening during the follow-up period. Conclusion: The clinical outcomes of children with normal PRB histopathologic findings are generally good. Further studies to evaluate their long-term outcomes are needed.
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Purpose@#: This study aimed to identify the factors affecting coronavirus disease 2019 (COVID-19) infection control practices of nurses in negative pressure isolation rooms. @*Methods@#: The participants were 150 nurses working in three hospitals with negative pressure isolation rooms. Data were collected using structured questionnaires and analyzed using an independent t-test, one-way ANOVA, Scheffé test, Pearson correlation coefficients, and multiple regression analysis using the SPSS/WIN 26.0 program. @*Results@#: Factors significantly influencing the subject's COVID-19 infection control practice include Being married (β=.18, p =.016), working in a ward with negative pressure isolation rooms (β=.44, p <.001), working in an ICU with negative pressure isolation rooms (β=.27, p =.010), COVID-19 infection control attitude (β=.28, p =.001), anxiety for COVID-19 (β=.30, p <.001). The explanatory power of these variables for COVID-19 infection control practice was 24.6% (F=8.67, p <.001). @*Conclusion@#: It is expected that strategies that utilize positive attitudes which believe that COVID-19 disease may be overcome by COVID-19 infection control practice will help improve emerging infectious diseases infection control practice.
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Background@#This is an observational study to analyze an emergency department (ED) utilization pattern of coronavirus disease 2019 (COVID-19) vaccinated in-hospital healthcare workers (HCWs). @*Methods@#We included 4,703 HCWs who were administered the first dose of the COVID-19 vaccine between March 4 and April 2, 2021, in a tertiary hospital in Korea where fast-track and post-vaccination cohort zone (PVCZ) were introduced in ED. We analyzed data of participants' age, sex, occupation, date and type of vaccination, and their clinical information using SPSS v25.0. @*Results@#The sample comprised HCWs, who received either the ChAdOx1 (n = 4,458) or the BNT162B2 (n = 245) vaccines; most participants were female (73.5%), and 81.1% were under 50 years old. Further, 153 (3.3%) visited the ED and reported experiencing fever (66.9%) and myalgia (56.1%). Additionally, 91(59.5%) of them were in their 20s, and 106 (67.5%) were assigned to the PVCZ. Lastly, 107 (68.2%) of the patients received parenteral management.No patient required hospitalization. @*Conclusion@#In conclusion, vaccinated HCWs who visited the ED with adverse events had a high incidence of fever and a low likelihood of developing serious illnesses. As the COVID-19 vaccination program for Korean citizens continues to expand, strategies to minimize unnecessary ED overcrowding should be put into effect.
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Background@#This is an observational study to analyze an emergency department (ED) utilization pattern of coronavirus disease 2019 (COVID-19) vaccinated in-hospital healthcare workers (HCWs). @*Methods@#We included 4,703 HCWs who were administered the first dose of the COVID-19 vaccine between March 4 and April 2, 2021, in a tertiary hospital in Korea where fast-track and post-vaccination cohort zone (PVCZ) were introduced in ED. We analyzed data of participants' age, sex, occupation, date and type of vaccination, and their clinical information using SPSS v25.0. @*Results@#The sample comprised HCWs, who received either the ChAdOx1 (n = 4,458) or the BNT162B2 (n = 245) vaccines; most participants were female (73.5%), and 81.1% were under 50 years old. Further, 153 (3.3%) visited the ED and reported experiencing fever (66.9%) and myalgia (56.1%). Additionally, 91(59.5%) of them were in their 20s, and 106 (67.5%) were assigned to the PVCZ. Lastly, 107 (68.2%) of the patients received parenteral management.No patient required hospitalization. @*Conclusion@#In conclusion, vaccinated HCWs who visited the ED with adverse events had a high incidence of fever and a low likelihood of developing serious illnesses. As the COVID-19 vaccination program for Korean citizens continues to expand, strategies to minimize unnecessary ED overcrowding should be put into effect.
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PURPOSE: Ureteral duplication is a relatively common congenital urinary tract abnormality that can be associated with various clinical problems such as vesicoureteral reflux (VUR), hydronephrosis, and ectopic ureters. The purpose of this study was to analyze the clinical characteristics of pediatric patients with recently diagnosed ureteral duplication and to identify any differences from those described in previous reports.METHODS: We retrospectively reviewed the clinical characteristics and course of pediatric patients who were diagnosed with ureteral duplication between January 2008 and June 2017.RESULTS: A total of 32 pediatric patients were diagnosed with ureteral duplication during the study period. The male to female ratio was 1:2.2. Twenty-seven patients (84.4%) were first diagnosed with ureteral duplication at less than 3 months of age, and 26 (81.3%) were first diagnosed by prenatal ultrasonography. Four of the 32 patients were diagnosed with bilateral ureteral duplication, for a total of 36 occurrences of ureteral duplication. In 17 occurrences of complete ureteral duplication (47.2%), other urinary tract anomalies were also found; namely, ureterocele (7), VUR (11), and ectopic ureter (5). However, none of the patients with incomplete ureteral duplication had ureterocele or VUR.CONCLUSION: With the advent of routine prenatal ultrasound, ureteral duplication is being diagnosed earlier than was previously possible, enabling timely treatment of the various accompanying urinary tract anomalies. Multicenter studies are needed to establish guidelines for standardized evaluation and treatment of ureteral duplication.
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Child , Female , Humans , Male , Hydronephrosis , Retrospective Studies , Ultrasonography , Ultrasonography, Prenatal , Ureter , Ureterocele , Urinary Tract , Vesico-Ureteral RefluxABSTRACT
PURPOSE: The purpose of this study was to investigate the significance of non-mass enhancement (NME) findings on preoperative breast magnetic resonance imaging (MRI) when invasive breast cancer patients with single lesions underwent breast-conserving surgery (BCS). METHODS: We reviewed the preoperative MRI findings of 252 patients who underwent BCS from January 2014 to September 2016. Based on the MRI findings, we divided the patients into two groups, those who did and did not have NME, and we retrospectively analyzed the clinical outcomes of the two groups. RESULTS: The NME group had 57 patients, and the no-NME group had 195 patients. The incidence of in situ lesions was higher in the NME group than in the no-NME group (p<0.001). Additionally, the positive resection margin rate on frozen biopsy was higher in the NME group than in the no-NME group (p=0.002). CONCLUSION: When preoperative MRI had NME findings, in situ lesions were more likely to accompany invasive breast cancer lesions, and the positive resection margin rate for frozen biopsy during BCS was high. Therefore, in these cases, the lesion should be excised more widely when BCS is performed, or frozen biopsy for resection margin during BCS should be performed if possible.
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Humans , Biopsy , Breast Neoplasms , Breast , Incidence , Magnetic Resonance Imaging , Mastectomy, Segmental , Retrospective StudiesABSTRACT
OBJECTIVE: To investigate whether serum levels of high-density lipoprotein (HDL) and apolipoprotein A-1 (ApoA1), after the return of spontaneous circulation, can predict the neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA). METHODS: This was a retrospective observational study conducted in a single tertiary hospital intensive care unit. All adult OHCA survivors with admission lipid profiles were enrolled from March 2013 to December 2015. Good neurologic outcome was defined as discharge cerebral performance categories 1 and 2. RESULTS: Among 59 patients enrolled, 13 (22.0%) had a good neurologic outcome. Serum levels of HDL (56.7 vs. 40 mg/dL) and ApoA1 (117 vs. 91.6 mg/dL) were significantly higher in patients with a good outcome. Areas under the HDL and ApoA1 receiver operating curves to predict good outcomes were 0.799 and 0.759, respectively. The proportion of good outcome was significantly higher in patients in higher tertiles of HDL and ApoA1 (test for trend, both P=0.003). HDL (P=0.018) was an independent predictor in the multivariate logistic regression model. CONCLUSION: Admission levels of HDL and ApoA1 are associated with neurologic outcome in patients with OHCA. Prognostic and potential therapeutic values of HDL and ApoA1 merit further evaluation in the post-cardiac arrest state, as in other systemic inflammatory conditions such as sepsis.
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Adult , Humans , Apolipoprotein A-I , Apolipoproteins , Cholesterol, HDL , Heart Arrest , Intensive Care Units , Lipoproteins , Logistic Models , Observational Study , Out-of-Hospital Cardiac Arrest , Prognosis , Retrospective Studies , Sepsis , Survivors , Tertiary Care CentersABSTRACT
BACKGROUND/AIMS: An incomplete virological response has been observed to tenofovir dipivoxil fumarate (TDF) in nucleos(t)ide analogue (NA)-experienced chronic hepatitis B (CHB) patients. This study investigated the efficacy of TDF in NA-naïve CHB patients 96 weeks after treatment. METHODS: CHB patients treated with TDF were enrolled retrospectively between November 2012 and January 2016. We assessed virological and biochemical parameters. RESULTS: The study enrolled 179 NA-naïve patients with a median follow-up duration of 59.6 weeks. The serum hepatitis B virus (HBV) DNA level decreased significantly during treatment. The complete virological response (CVR) rate was 83.21% at week 96. In univariate analyses, the predictors of a CVR at 96 weeks were the baseline HBV DNA level (CVR vs. no-CVR, HBV DNA log10 mean value 7.34 vs. 7.86, 95% confidential interval [CI]: -7.89 to -7.37; p < 0.001) and male sex (CVR vs. no-CVR, 49.1% vs. 81.3%, odds ratio [OR] 0.22, 95% CI: 0.06 to 0.87; p = 0.025). In the multivariate analysis, male sex predicted a CVR at week 96. The CVR was significantly lower in males than in females (OR 0.12, 95% CI: 0.02 to 0.96; p = 0.046). CONCLUSIONS: TDF was effective for treating CHB for more than 2 years in NA-naïve patients.
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Female , Humans , Male , DNA , Follow-Up Studies , Hepatitis B , Hepatitis B virus , Hepatitis B, Chronic , Hepatitis, Chronic , Multivariate Analysis , Odds Ratio , Retrospective Studies , TenofovirABSTRACT
Marfan syndrome (MFS) is an inherited connective tissue disorder with a mutation in the fibrillin-1 (FBN1) gene. Fibrillin is a major building block of microfibrils, which constitute the structural component of the connective tissues. A 10-year-old girl visited our hospital with the chief complaint of precocious puberty. According to her medical history, she had a pulmonary wedge resection for a pneumothorax at 9 years of age. There was no family history of MFS. Mid parental height was 161.5 cm. The patient's height was 162 cm (>97th percentile), and her weight was 40 kg (75th-90th percentile). At the time of initial presentation, her bone age was approximately 11 years. From the ophthalmologic examination, there were no abnormal findings except myopia. There was no wrist sign. At the age of 14 years, she revisited the hospital with the chief complaint of scoliosis. Her height and weight were 170 cm and 50 kg, respectively, and she had arachnodactyly and wrist sign. We performed an echocardiograph and a test for the FBN1 gene mutation with direct sequencing of 65 coding exons, suspecting MFS. There were no cardiac abnormalities including mitral valve prolapse. A cytosine residue deletion in exon 7 (c.660delC) was detected. This is a novel mutation causing a frameshift in protein synthesis and predicted to create a premature stop codon. We report the case of a patient with MFS with a novel FBN1 gene missense mutation and a history of pneumothorax at a young age without cardiac abnormalities during her teenage years.
Subject(s)
Child , Female , Humans , Arachnodactyly , Clinical Coding , Codon, Nonsense , Connective Tissue , Cytosine , Exons , Marfan Syndrome , Microfibrils , Mitral Valve Prolapse , Mutation, Missense , Myopia , Parents , Pneumothorax , Puberty, Precocious , Scoliosis , WristABSTRACT
BACKGROUND/AIMS: Pyogenic liver abscess (PLA) is a life-threatening condition, despite advances in diagnostic technology and strategies for treatment. A strong predictor of mortality in this condition is septic shock. This study describes clinical, biochemical, and radiologic features in patients with PLA with or without septic shock, with the intent of describing risk factors for septic shock. METHODS: Of 358 patients with PLA enrolled, 30 suffered septic shock and the remaining 328 did not. We reviewed the medical records including etiologies, underlying diseases, laboratory, radiologic and microbiologic findings, methods of treatment and treatment outcomes. RESULTS: The case fatality rate was 6.1%. In univariate analysis, the presence of general weakness, mental change, low platelet level, prolonged PT, high BUN level, high creatinine level, low albumin level, high AST level, high CRP level, abscess size >6 cm, the presence of gas-forming abscess, APACHE II score ≥20, and the presence of Klebsiella pneumoniae infection were significantly associated with septic shock. Multivariate analysis showed the presence of mental change (p=0.004), gas-forming abscess (p=0.012), and K. pneumoniae infection (p=0.027) were independent predictors for septic shock. CONCLUSIONS: The presence of mental change, gas-forming abscess, and K. pneumoniae infection were independent predictors for septic shock in patients with PLA.
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Humans , Abscess , APACHE , Blood Platelets , Creatinine , Klebsiella pneumoniae , Liver Abscess, Pyogenic , Medical Records , Mortality , Multivariate Analysis , Pneumonia , Risk Factors , Shock, SepticABSTRACT
PURPOSE: Acute epiglottitis is a potentially fatal condition that can result in airway obstruction. The aim of this study is to examine the clinical features of adult patients who visited the emergency department (ED) with acute epiglottitis. METHODS: This retrospective observational study was conducted at a single tertiary hospital ED from November 2005 to October 2015. We searched our electronic medical records (EMR) system for a diagnosis of "acute epiglottitis" and selected those patients who visited the ED. RESULTS: A total of 28 patients were included. There was no pediatric case with acute epiglottitis during the study period. The mean age of the patients was 58.0+/-14.8 years. The peak incidences were in the sixth (n=7, 25.0%) and eighth (n=8, 28.6%) decades. The male-to-female ratio was 2.1:1. The most common symptom was sore throat (n=23, 82.1%), followed by dyspnea (n=15, 53.6%), hoarseness (n=7, 25.0%), fever (n=6, 21%), and dysphagia (n=5, 17.9%). The diagnosis of acute epiglottitis was confirmed when edema and hyperemia of the epiglottis were visualized by laryngoscopy. Twenty-six patients were treated conservatively with antibiotics and steroids without definite airway management. Two patients were intubated, but no patients required tracheostomy. CONCLUSION: In adult patients with acute epiglottitis, sore throat and dyspnea were the most common symptoms but fever was infrequent. Most patients improved with conservative management only. Definite airway management was required in only two patients in whom endotracheal intubations were performed successfully in the ED by emergency physicians, and surgical airway management was not required.
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Adult , Humans , Airway Management , Airway Obstruction , Anti-Bacterial Agents , Deglutition Disorders , Diagnosis , Dyspnea , Edema , Electronic Health Records , Emergencies , Emergency Medical Services , Emergency Service, Hospital , Epiglottis , Epiglottitis , Fever , Hoarseness , Hyperemia , Incidence , Intubation, Intratracheal , Laryngoscopy , Observational Study , Pharyngitis , Retrospective Studies , Steroids , Tertiary Care Centers , TracheostomyABSTRACT
OBJECTIVE: This study looks into the risk factors that affect the recurrence of Kawasaki disease (KD). METHODS: Among 618 child patients that have been hospitalized for the KD from July 2002 to May 2015 at the Soonchunhyang University Bucheon Hospital, 13 patients who have been hospitalized more than twice for the KD were selected as the relapse group. A comparative analysis was retrospectively conducted between the relapse group and the control group RESULTS: Among 618 child patients with KD, 13 cases (2.1%) showed recurrence in the disease. At initial episode of the relapse group, the mean age was 29±14.2 months. One year or less and 1-2 years old took up 76.8%, and 11 patients (84.6%) suffered a recurrence within 2 years after the initial episode. The relapse group, when compared to the control group, showed lower neutrophils count, and red cell distribution width (RDW) and C-reactive protein (CRP) levels were higher at initial episode. These differences were statistically significant (P<0.001, P<0.001, and P=0.015, respectively). There were no differences in other findings between the two groups. By utilizing the Youden's index, the optimal cutoff value was found, and RDW was 12% and CRP was 5.955 mg/dL. CONCLUSION: The research suggests that it is possible to predict recurrence probabilities of KD by checking RDW and CRP values during blood tests at initial episode. Children less than 1 year old and 1-2 years old with Kawasaki disease should be carefully observed for recurrence during the 2 years after the initial episode.
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Child , Humans , C-Reactive Protein , Erythrocyte Indices , Hematologic Tests , Mucocutaneous Lymph Node Syndrome , Neutrophils , Recurrence , Retrospective Studies , Risk FactorsABSTRACT
PURPOSE: To compare the surgically induced posterior astigmatism of microcoaxial cataract surgery using a 2.2 mm incision and conventional cataract surgery using a 2.85 mm incision. METHODS: This study included 56 eyes that underwent phacoemulsification and intraocular lens insertion. Subjects were divided into 2 groups: 26 eyes receiving a microcoaxial cataract surgery using a 2.2 mm incision (MCCS group) and 30 eyes receiving a conventional cataract surgery using a 2.85 mm incision (CCS group). Anterior, posterior and total corneal astigmatism was measured. The surgically induced anterior astigmatism, surgically induced posterior astigmatism and surgically induced total astigmatism were compared between MCCS and CCS groups. Corneal astigmatism was measured using a Pentacam(R) device (Oculus, Wetzlar, Germany), uncorrected visual acuity, best corrected visual acuity and corneal aberrations of front and rear side was measured preoperatively and at 1 day, 1 month and 2 months postoperatively. RESULTS: There was no difference in surgically induced posterior astigmatism between CCS and MCCS groups, however, surgically induced anterior astigmatism and surgically induced total astigmatism were significantly lower in the MCCS group than in the CCS group (p = 0.005 and, p = 0.036, respectively). There was a significant positive linear correlation between surgically induced posterior astigmatism and surgically induced total astigmatism in the CCS group (p = 0.01, r = 0.563). There was also a significant positive linear correlation between surgically induced anterior astigmatism and surgically induced total astigmatism in both CCS and MCCS groups (CCS group: p = 0.00, r = 0.855; MCCS group: p = 0.039, r = 0.407). CONCLUSIONS: There was no significant difference in the surgically induced posterior astigmatism between the MCCS and CCS groups. However, surgically induced posterior astigmatism significantly affected surgically induced total astigmatism in the CCS group but not in the MCCS group. Considering both anterior and posterior astigmatism of the cornea, microcoaxial cataract surgery using a 2.2 mm incision affects surgically induced total astigmatism less than conventional cataract surgery.
Subject(s)
Astigmatism , Cataract , Cornea , Lenses, Intraocular , Phacoemulsification , Visual AcuityABSTRACT
Adrenocortical insufficiency is the clinical manifestation of deficient production or action of glucocorticoids. It is a life-threatening disorder that can result from primary adrenal failure or secondary adrenal failure due to impairment of the hypothalamic-pituitary axis. Primary adrenocortical insufficiency can be caused by autoimmune adrenalitis, infection (especially, tuberculosis), metastatic cancer, lymphoma, adrenal hemorrhage, infarction or drugs. Among these, adrenal hemorrhage may be caused by anticoagulant drug or heparin therapy, thromboembolic disease, hypercoagulable states such as antiphospholipid syndrome, physical trauma, postoperative state, sepsis and severe stress from any cause. However, even fewer reports exist of adrenocortical insufficiency due to spontaneous bilateral adrenal hemorrhage. We report a rare case of acute adrenocortical insufficiency due to spontaneous bilateral adrenal hemorrhage presenting as acute abdominal pain.