Children's visual acuity tests without professional supervision: a prospective repeated measures study.

BACKGROUND: Home visual acuity tests could ease pressure on ophthalmic services by facilitating remote review of patients. Home tests may have further utility in giving service users frequent updates of vision outcomes during therapy, identifying vision problems in an asymptomatic population, and engaging stakeholders in therapy. METHODS: Children attending outpatient clinics had visual acuity measured 3 times at the same appointment: Once by a registered orthoptist per clinical protocols, once by an orthoptist using a tablet-based visual acuity test (iSight Test Pro, Kay Pictures), and once by an unsupervised parent/carer using the tablet-based test. RESULTS: In total, 42 children were recruited to the study. The mean age was 5.6 years (range 3.3 to 9.3 years). Median and interquartile ranges (IQR) for clinical standard, orthoptic-led and parent/carer-led iSight Test Pro visual acuity measurements were 0.155 (0.18 IQR), 0.180 (0.26 IQR), and 0.300 (0.33 IQR) logMAR respectively. The iSight Test Pro in the hands of parents/carers was significantly different from the standard of care measurements (P = 0.008). In the hands of orthoptists. There was no significant difference between orthoptists using the iSight Test Pro and standard of care (P = 0.289), nor between orthoptist iSight Test Pro and parents/carer iSight Test Pro measurements (P = 0.108). CONCLUSION: This technique of unsupervised visual acuity measures for children is not comparable to clinical measures and is unlikely to be valuable to clinical decision making. Future work should focus on improving the accuracy of the test through better training, equipment/software or supervision/support.

Aetiologies of acquired pediatric sixth nerve palsies in a U.K. based population.

Due to the low incidence of sixth cranial nerve palsies in children, there has been limited evidence published on this subject, especially from a population based within the UK. The incidence of etiologies has been found to vary significantly within the literature, especially with regard to neoplasms. The main aim of this study is to present the etiologies of newly diagnosed pediatric sixth nerve palsies in a UK-based population. We also take into consideration if the palsies were isolated or associated with other neurological signs or symptoms. Retrospective data collection was carried out on the medical records of 50 pediatric patients with a new-onset sixth nerve palsy. They all presented to a large tertiary referral hospital in the South of the UK between 1 January 2007 and 31 December 2017. Data collected for each patient included age, gender, ethnicity, unilateral versus bilateral, other signs and symptoms, etiology, where the patient first presented, and whether the palsy was the first presenting feature. Thirty-three (66%) patients had a new-onset sixth nerve palsy in conjunction with other neurological signs or symptoms and were considered non-isolated. Seventeen cases (34%) were found to be isolated. Etiologies included high intracranial pressure (18%), neoplasm (14%), surgery for neoplasm (14%), viral (14%), infection (12%), trauma (8%), idiopathic (6%), benign space-occupying lesion (4%), congenital (2%), inflammation (2%), Alexander's disease (2%), Kawasaki syndrome (2%), and diabetes (2%). Our study found non-isolated sixth nerve palsies to be the most common presentation. These patients had a high number of potentially sinister etiologies, the most common being high intracranial pressure followed by post-surgery for neoplasm and neoplasm. Isolated sixth nerve palsies were more commonly due to viral or idiopathic etiology; however, two cases of benign space-occupying lesion and one of neoplasm were identified.

Praziquantel degradation in marine aquarium water.

Praziquantel (PZQ) is a drug commonly utilized to treat both human schistosomiasis and some parasitic infections and infestations in animals. In the aquarium industry, PZQ can be administered in a "bath" to treat the presence of ectoparasites on both the gills and skin of fish and elasmobranchs. In order to fully treat an infestation, the bath treatment has to maintain therapeutic levels of PZQ over a period of days or weeks. It has long been assumed that, once administered, PZQ is stable in a marine environment throughout the treatment interval and must be mechanically removed, but no controlled experiments have been conducted to validate that claim. This study aimed to determine if PZQ would break down naturally within a marine aquarium below its 2 ppm therapeutic level during a typical 30-day treatment: and if so, does the presence of fish or the elimination of all living biological material impact the degradation of PZQ? Three 650 L marine aquarium systems, each containing 12 fish (French grunts: Haemulon flavolineatum), and three 650 L marine aquariums each containing no fish were treated with PZQ (2 ppm) and concentrations were measured daily for 30 days. After one round of treatment, the PZQ was no longer detectable in any system after 8 (±1) days. The subsequent two PZQ treatments yielded even faster PZQ breakdown (non-detectable after 2 days and 2 ± 1 day, respectively) with slight variations between systems. Linear mixed effects models of the data indicate that day and trial most impact PZQ degradation, while the presence of fish was not a factor in the best-fit models. In a completely sterilized marine system (0.5 L) PZQ concentration remained unchanged over 15 days, suggesting that PZQ may be stable in a marine system during this time period. The degradation observed in non-sterile marine systems in this study may be microbial in nature. This work should be taken into consideration when providing PZQ bath treatments to marine animals to ensure maximum drug administration.

Large, mobile, transmitral metastastic osteosarcoma presenting as cardiac arrest.

UNLABELLED: The present case is an unusual one of a 21-year-old female with a primary osteosarcoma and left lung metastasis presenting following a witnessed pulseless electrical activity cardiac arrest. The electrocardiogram was unremarkable. A computed tomography pulmonary angiogram (CTPA) demonstrated a tumour within the left inferior pulmonary veins. Transthoracic echocardiography (TTE) revealed a severely hypokinetic left ventricle and a multi-lobulated, mobile mass arising from one of the left pulmonary veins which prolapsed to varying degrees on a beat-to-beat basis back and forth through the mitral valve into the left ventricle (during ventricular diastole) and retracted back into the left atrium (during ventricular systole). The present case demonstrates the importance of performing TTE in an emergency presentation, its influence on diagnosis and, in the present case, its usefulness in aiding the decision to withdraw life-sustaining treatments. It also highlights the importance of considering urgent intervention for a tumour seen to prolapse through the mitral valve because of the real risk of acute obstruction. LEARNING POINTS: The present case emphasises the importance of thorough clinical assessment in triggering TTE assessment in a critical care setting.TTE is a portable, radiation-free imaging modality that can aid rapid diagnosis in a deteriorating patient and guide an informed management plan.Many district general hospitals in the UK lack cardiology support and access to echocardiography 'out-of-hours'. TTE, in the hands of an experienced operator, is an invaluable tool in the emergency assessment and management of critically unwell patients and should be available 24 h a day, 7 days a week.Echosonographers and physicians seeing similar dynamic tumour pathology with variable transmission through the mitral valve should bear in mind acute obstruction as a potential consequence and thus consider urgent intervention.

A simple reagent-free spectrophotometric assay for monitoring metronidazole therapy in aquarium water.

A reagent-free spectrophotometric assay was developed to measure the concentration of metronidazole (a 5-nitroimidazole) in both freshwater and seawater matrices. This assay is simple, repeatable, sensitive, and precise and is ideal for use when a rapid, selective test to determine metronidazole concentration in aqueous matrices is necessary. The assay was practically tested on a South American fishes display during treatment with metronidazole for an outbreak of the flagellated parasite Spironucleus in a mixed cichlid (family Cichlidae) and tetra (family Characidae) community. The assay clearly illustrated the course of treatment for the system during a real clinical application. The assay is not without limitations, as interferences can occur from other drugs in the matrix with similar absorbance spectra. Nonetheless, this type of assay illustrates the potential for use of native absorbance assays in aqueous matrices for this and other therapeutic compounds.

Neonatal small left colon syndrome in the offspring of diabetic mothers-an analysis of 105 children.

BACKGROUND AND AIM: Neonatal small left colon syndrome (NSLCS) is considered a rare cause of neonatal intestinal obstruction, with few documented cases in the English literature. Maternal diabetes has been reported in 40% to 50% of the published cases of NSLCS. Currently, the incidence of maternal diabetes is increasing, but there has been no study to ascertain the incidence and significance of NSLCS in this population. This review aims to assess the current significance of NSLCS and its association with maternal diabetes. MATERIALS AND METHOD: This was a retrospective review of 105 offspring of diabetic mothers who were admitted during the period 2004 to 2008 to our neonatal unit with special emphasis on associated NSLCS. RESULTS: There were 6 cases of intestinal obstruction in this group of 105 children. Five children, including a pair of twins, had classic features of NSLCS as demonstrated in the contrast enema with an abrupt transition at the splenic flexure and a narrow left colon. Conservative treatment was successful in all, negating the need for further invasive investigation. The sixth child had rectosigmoid Hirschprung disease. During the study period, there were no other cases of NSLCS in the nondiabetic population. CONCLUSION: Neonatal small left colon syndrome is the most common cause of intestinal obstruction in offspring of diabetic mothers. Neonatal small left colon syndrome can be confidently diagnosed in this population based on the classic clinical and radiologic findings. The incidence of NSLCS can be expected to increase as the incidence of maternal diabetes increases.

The feasibility and usefulness of oximetry measurements in primary care.

AIM: To explore the feasibility and usefulness of oximetry measurements in primary care. METHODS: Data collection over six months in 17 volunteer general practices in Gateshead using the Nellcor NPB-40 pulse oximeter and a simple data recording form. RESULTS: 229 measurements of oxygen saturation were made with 65% in the 61-80 years age group. 30 patients (13%) were found to have readings of 90% or lower; ten were admitted and four referred for outpatient assessment. The readings reassured the doctor and the patient in more than 60% of cases. CONCLUSIONS: With minimal training, doctors and nurses made significant use of the oximeters, gaining valuable reassurance in the majority and identifying potentially important hypoxia in the minority. Greater use of pulse oximetry may be a way of making more targeted use of scarce hospital-based specialist services.