Early clinical experience with a new preloaded one-piece intraocular lens in paediatric cataract surgery.

PurposeTo report the clinical experience of using the Tecnis PCB00 (Abbott Medical Optics, Santa Ana, CA, USA) preloaded one-piece intraocular lens (IOL) in the setting of a tertiary referral centre for paediatric cataract.MethodsA retrospective case note review of all paediatric cataract surgeries using the Tecnis PCB00 IOL, at a single UK paediatric ophthalmology department.ResultsNine eyes in seven patients received the IOL between December 2014 and January 2016. All patients underwent lens aspiration and insertion of the IOL 'in the bag.' The indications for surgery included developmental cataract (8/9) and traumatic cataract (1/9). Mean age at the time of surgery was 7 years (range 2-14). The median improvement in logMAR best-corrected visual acuity was 0.475 (range 0.250-1.500). The mean follow-up duration was 5 months (range 1-13). No operative or post-operative complications occurred as a result of using the device.ConclusionThe Tecnis PCB00 preloaded IOL appears to be a safe and effective device in treating paediatric cataract.

Traumatic bicycle handlebar hernia.

High velocity impact by handlebar is a rare cause of abdominal wall hernia following blunt trauma. We report a case of bicycle handlebar induced traumatic hernia with jejunal perforation. This case demonstrates that presentation of a traumatic hernia can be delayed and that computed tomographic scanning is useful in confirming the diagnosis. Surgical exploration with primary repair of the defect is the definitive treatment in cases of traumatic hernia.

What is the best screening method to detect Serratia marcescens colonization during an outbreak in a neonatal intensive care nursery?

Serratia marcescens can cause outbreaks in neonatal intensive care units (NICUs), but the optimum method of screening for carriage has not been determined in this group of patients. During an outbreak of S. marcescens infections across two geographically distinct NICUs, babies were screened for both respiratory and gastrointestinal carriage. A total of 58 babies were colonized (N = 47) or infected (N = 11) with S. marcescens over a nine-month period. Forty-four colonized babies had paired respiratory and gastrointestinal tract specimens collected. Of these, 39% were positive from the gastrointestinal tract and 22% from respiratory tract specimens alone, and 39% had growth from both sites. Enrichment prior to inoculation on to solid media increased the detection of respiratory tract carriers. During an outbreak of S. marcescens, both respiratory and gastrointestinal samples should be collected in order to maximize the identification of colonized infants. Broth enrichment adds an additional day to obtaining results but increases the yield of positive results from respiratory specimens.

Predischarge screening of very low birthweight infants by click evoked otoacoustic emissions.

OBJECTIVE: To evaluate the role of transient evoked otoacoustic emission (TEOAE) in screening very low birthweight (VLBW) neonatal intensive care unit (NICU) graduates for hearing loss in comparison with visual reinforcement orientation audiology (VROA) at 10 months. METHODOLOGY: The study population was all VLBW neonatal survivors discharged from a single regional NICU at John Hunter Childrens Hospital (JHCH), Newcastle, New South Wales, Australia, between April 1994 and March 1996. A TEOAE screen was performed prior to discharge and repeated if necessary until a pass was obtained in at least one ear. Infants were further screened by VROA at their local Australian Hearing Services (AHS) office at 10 months corrected age. Repeated TEOAE failures were referred directly for an ENT opinion. RESULTS: A total of 193 infants were eligible for enrolment during the study period. One hundred and forty-four (75%) received TEOAE testing. The median age of first screen was 36 weeks gestational age. Ninety-five (66%) of infants tested passed on a single screen. Of the remaining 49 infants, 26 passed on retesting (overall pass rate 84%). Twenty-three (16%) were deemed to have failed the TEOAE screen. Of the 121 infants who passed TEOAE, only 67 (55%) completed VROA. Two of these infants have a high frequency sensorineural loss and one of them has been aided. In the 23 who failed TEOAE, nine have subsequently had normal VROA, another, though not tested is clinically normal. three have hearing loss with middle ear disease and eight have confirmed sensorineural deafness, all aided. One infant has died and an infant with Down's syndrome has been adopted out of the area. It is of interest to note that the eight aided infants are all of less than 28 weeks gestation. If we restrict analysis to infants with completed VROA testing, the TEOAE has a 97% negative predictive value for sensorineural deafness and a 38% positive predictive value. CONCLUSIONS: This study has highlighted both the prevalence of hearing impairment in the very premature survivors and difficulties in compliance with a VROA based hearing screen. We see an advantage in directing resources towards an early screening test, such as TEOAE, that can be applied while the target population is still captive.

Thai monks and lay nuns (mae chii) in urban health care.

In the process of defining their identity in relation to other social institutions, Thai monks and increasingly, lay nuns (mae chii), have been adopting social and community roles in rural areas. Studies conducted in the early 1980s and repeated more recently indicate that these can be adapted to suit urban situations such as paramedical roles in hospitals in which mae chii may prove more effective than monks as counsellors. But although the young scholar monks whose views were solicited were mostly open to such roles on the part of the mae chii, the majority were opposed to their full ordination as bhikkhuni.

Azathioprine and cyclosporin: different tissue matching criteria needed?

Of 275 renal transplants performed over seven years in a single unit, azathioprine was the main immunosuppressive agent in 128 and cyclosporin in 147. With azathioprine graft survival was, as expected, negatively related to the number of HLA mismatches; with cyclosporin the reverse held true.