Pilot study of a glue-less, suture-less amniotic membrane for pterygium excision.

PURPOSE: Pterygium is a non-cancerous, fibrovascular growth of the bulbar conjunctiva that can cause visual disturbance, ocular pain, and cosmetic concerns. Surgical management is required in certain cases, which consists of excising the pterygium and associated Tenon's, then overlaying the bare sclera with an autograft or amniotic membrane using glue or sutures. The purpose of this study is to assess outcomes of pterygium repair using a newly developed self-adhesive amniotic membrane that does not require glue or sutures for fixation. METHODS: Chart review of pterygium excision using a new self-adhesive amniotic membrane from a single surgical practice from 2012-2018. Descriptive statistics from 51 primary cases of pterygium excision were included. RESULTS: Pterygium recurrence occurred in 3 of the 51 self-adhesive amniotic membrane cases studied, resulting in a recurrence rate of 5.9%. Pterygium excision with the self-adhesive amniotic membrane had high rate of pyogenic granuloma formation of 27%. Self-adhesive amniotic membranes were found to perform comparably to more widely used techniques for pterygium excision, namely amniotic membranes and conjunctival autographs with glue or sutures. However, the self-adhesive grafts are associated with substantially more pyogenic granuloma formation. CONCLUSION: Self-adhesive amniotic membranes offer comparable efficacy for preventing pterygium recurrence in comparison to other amniotic membranes and the conjunctival autograft. The incidence of pyogenic granuloma formation is higher in self-adhesive grafts compared to other widely used options.

A Rare Presentation of Direct Traumatic Optic Neuropathy in a Patient Poked in the Eye by an Antenna.

Traumatic optic neuropathy (TON) is defined as a loss of vision due to a traumatic injury to the optic nerve. Numerous mechanisms may contribute to the development of TON; however, most cases involve injuries to the globe, orbit, or adnexa. This case report presents a 24-year-old male who was inadvertently poked in the eye with an antenna and developed a direct optic nerve injury in the absence of a significant injury to the surrounding orbital structures. A CT scan was used to confirm the diagnosis. No visual recovery was observed throughout his clinical course. The proposed pathophysiologic mechanisms, clinical presentation, complications, treatments, and prognosis of traumatic optic neuropathy are subsequently discussed.

Traumatic central retinal vein occlusion following a hawk attack to the posterior cranium.

PURPOSE: We describe a patient who developed a central retinal vein oculsion following a diving hawk attack to her posterior cranium. OBSERVATIONS: A 50-year-old female presented with decreased visual acuity and color perception in the left eye following a diving hawk attack to her right-posterior parietal cranium. Medical history was significant for well-controlled type 2 diabetes, hyperlipidemia, and obesity. Fundoscopy of the left eye revealed pre, intra and subretinal hemorrhages in all 4 quadrants consistent with the "blood and thunder" appearance. Additional findings included optic disk edema, venous dilation and tortuosity. Optical Coherence Tomography of the left eye demonstrated pronounced macular edema with intra and subretinal fluid accumulation. Pattern electroretinography of the left eye was flattened. CONCLUSIONS AND IMPORTANCE: There are few documented cases of central retinal vein occlusion following blunt trauma to the cranium in the literature. To the best of our knowledge, this is the first case of central retinal vein occlusion associated with posterior cranial trauma. Also unique to the case is the mechanism of injury whereby the patient was attacked by a hawk at a high-diving velocity.

Evidence for changing intimate partner violence safety planning needs as a result of COVID-19: results from phase I of a rapid intervention.

OBJECTIVES: The aim of the study was to examine the need for modified safety planning strategies in response to COVID-19-related increases in intimate partner violence (IPV) as the initial phase of adapting an IPV safety planning intervention in Toronto, Ontario. METHODS: A rapid, systematic review was conducted to elucidate existing safety planning strategies used during public health emergencies. These were supplemented with strategies from an expert panel. A survey of IPV survivors and service providers gauged the helpfulness of each strategy during COVID-19. RESULTS: Together, the systematic review and expert panel yielded 26 conceptually distinct strategies, which were evaluated by 111 IPV survivors and providers. Of these, 19 (69%) were 'highly recommended', 3 (12%) were 'somewhat recommended' and 6 (23%) were not recommended for use during the COVID-19 pandemic because they might make the violence worse. CONCLUSIONS: Safety planning needs have changed owing to the effect of COVID-19 on IPV incidence, service provision and risk factors, as well as policies restricting freedom of movement. These results will be used to modify an existing IPV safety planning mobile application for use during COVID-19 and future public health emergencies.

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design.

This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.

Judicial sentencing in Canadian intimate partner sexual assault cases.

This article examines judicial descriptions of and responses to intimate partner sexual assaults in the Canadian context. Drawing on data from sexual assault sentencing judgments, we investigated 186 cases across four categories of perpetrator-victim relationship. Offence and case-related characteristics, as well as sentencing outcomes were analyzed. The data indicated notable similarities between intimate partner and stranger sexual assaults in terms of the occurrence of penetration, force, and injury. At the same time, our analyses revealed that strangers received longer sentences than intimate perpetrators. Some significant differences were also found between intimate partner and authority figure relationship groups across the variables examined.

Psychological and physical sequelae of intimate partner violence among women with limitations in their activities of daily living.

OBJECTIVE: To compare the psychological and physical sequelae of physical/sexual intimate partner violence in women with and without activity limitations. METHODS: We analyzed data from the Canadian 1999 General Social Survey. We included women reporting intimate partner violence in the previous 5 years (n = 897). RESULTS: As a result of the violence, women with activity limitations were significantly more likely to feel ashamed/guilty (21.7 vs. 14.5%), depression/anxiety (31.5 vs. 19.8%), fearful (43.0 vs. 33.0%), lowered self-esteem (35.2 vs. 21.1%), increased caution/awareness (20.3 vs. 10.9%), and problems relating to men (16.4 vs. 5.4%). Significantly more women with activity limitations reported physical injury from violence (57.0 vs. 36.6%) and having to take time off from everyday activities (42.1 vs. 30.3%). Women with activity limitations had higher medication use for sleeping problems (OR = 3.17, 95% CI = 1.36, 5.73), anxiety (OR = 3.29, 95% CI = 1.75, 6.19) and depression (OR = 2.63, 95% CI = 1.41, 4.90). CONCLUSION: Results suggest an additive effect between intimate partner violence and activity limitations that adds disproportionately to the burden of health for women with activity limitations.

The doctor's dilemma: caregiving and medicolegal evidence collection.

This paper reports on findings from a population-based study of sexual assault physicians who are responsible for both the health care of sexually assaulted persons and for conducting forensic medical examinations on them for the purpose of collecting corroborative evidence to aid in legal proceedings. Self-administered questionnaires were distributed to the 100 physicians attached to sexual assault care and treatment centres across the province of Ontario, Canada. The questionnaires were focussed on exploring their relative commitment to two assessment priorities: the collection of forensic evidence for the courts and the provision of medical care. While most of the 31 physicians replying expressed satisfaction with their participation in the legal arena, a substantial proportion indicated that although they believed medical care to be the most important part of their work, evidence collection and court appearances were the most time-consuming. In addition, over four-fifths admitted to having deviated from the standard protocol used for evidence collection, based on the belief that a particular procedure or information item might either emotionally or legally harm the victim or her/his case. We suggest that the implications of these findings point to a possible ambivalence towards the evidentiary dimension of the dual role of the sexual assault physician.

Abuse: a risk factor for low birth weight? A systematic review and meta-analysis.

BACKGROUND: Abuse during pregnancy is considered to be a potentially modifiable risk factor for low birth weight (LBW). We conducted a systematic review and meta-analysis to determine the strength of association between physical, sexual or emotional abuse during pregnancy and LBW. METHODS: We selected papers for review from an electronic search of MEDLINE (1966-1999), CINAHL (1982-1997) and the Cochrane Library. We retrieved articles using the following MeSH headings and keywords: "infant low birth weight," "fetus," "perinatal care," "pregnancy," "prenatal care," "infant mortality," "violence," "battered women," "spouse abuse," "infant morbidity," "antenatal" and "neonatal." When necessary, we contacted authors to obtain data that were not included in the published material. We analyzed the methodological quality of each eligible study and selected those of the highest quality for meta-analysis. RESULTS: We reviewed 14 studies, of which 8 were selected for meta-analysis. Using a fixed-effects model, we found that women who reported physical, sexual or emotional abuse during pregnancy were more likely than nonabused women to give birth to a baby with LBW (odds ratio 1.4, 95% confidence interval 1.1-1.8). INTERPRETATION: Abuse may be part of a complex interaction of factors that contribute to LBW.

Sexual assault and legal resolution: querying the medical collection of forensic evidence.

Very little is known about the role of medical evidence in the legal resolution of sexual assault cases. A retrospective review of hospital and police records was conducted to determine whether medico-legal evidence was related to the police laying of charges. Data were obtained from 187 female sexual assault victims who presented to a large urban hospital-based sexual assault treatment center and the police in Ontario, Canada between January 1 and December 31, 1994. Using stepwise logistic regression medico-legal variables were tested while controlling for non-medical factors. Neither the collection of sperm, semen and/or saliva nor the documentation of clinically observed injuries was significant in predicting an arrest and charge. In contrast, non-medical variables such as the victim's age, use of alcohol, resistance and relationship to the assailant, and the corroborating evidence of a witness were related to charge-laying. We question the value of uncritically continuing to collect medical forensic evidence.

Comparison of sexual assaults by strangers and known assailants in an urban population of women.

OBJECTIVE: To examine the characteristics of sexual assaults by strangers and those by people known to the victims in an urban community-based population of women. DESIGN: Descriptive study. SETTING: Sexual Assault Care Centre, Women's College Hospital, Toronto. PARTICIPANTS: All 677 women who presented to the centre between June 1, 1991, and Sept. 30, 1993, and for whom the victim-assailant relationship was known. OUTCOME MEASURES: Assailant's relationship to victim, sex of assailant, number of assailants, number, type and location of assaults, use of weapons, type of coercion and extent of physical trauma or injury. RESULTS: Sexual assault by a person known to the victim accounted for 456 (67.4%) of the assaults reported. In 344 cases the person was known more than 24 hours; 99 (28.8%) were current or previous boyfriends or spouses. Assailants who were strangers were more likely to assault the victim more than once (t = -2.42, 355 degrees of freedom [df], p < 0.05), force the victim to perform fellatio (chi 2 = 8.63, 1 df, p < 0.005), use weapons (chi 2 = 12.01, 1 df, p < 0.001) and use physical coercion (chi 2 = 4.42, 1 df, p < 0.05), whereas assailants who were known to the victims were more likely to assault a woman who was sleeping or drugged (chi 2 = 10.38, 1 df, p < 0.005). Sexual assault by a known assailant was more likely to occur in the home of the victim (chi 2 = 36.27, 1 df, p < 0.001) or the assailant (chi 2 = 8.46, 1 df, p < 0.005), whereas sexual assault by a stranger was more likely to occur outdoors (chi 2 = 89.80, 1 df, p < 0.001) or in a vehicle (chi 2 = 32.81, 1 df, p < 0.001). Overall, the mean number of trauma sites was greater among victims assaulted by strangers than among those assaulted by people they knew (t = -4.29, 180 df, p < 0.001). CONCLUSION: Two thirds of the sexual assaults in this urban population were committed by people known to the victims, and over two thirds of these assaults were associated with physical trauma. Improved victim services and prevention strategies should be built on this knowledge.

[Hemodynamic effect of isosorbide-5-mononitrate in acute cardiac insufficiency secondary to myocardial infarct]. / Efecto hemodinámico del 5-mononitrato de isosorbide en la insuficiencia cardíaca aguda secundaria a infarto de miocardio.

The hemodynamic effects of IS-5-MN were studied in 18 patients with acute myocardial infarction (AMI) complicated with left ventricular failure. Before treatment, 13 patients were in Forrester's hemodynamic class II and 5 in class IV. Hemodynamic monitoring was performed for 3 days, and the following parameters were measured: heart rate (HR), blood pressures (BP), right atrial (RAP), pulmonary artery and pulmonary capillary (PCP) pressures, cardiac index (CI), systemic (SVR) and pulmonary (PVR) vascular resistances, and coronary perfusion pressure (CPP). Patients with clinical symptoms of acute pulmonary edema or systolic BP (BPs) less than 90 mmHg were not included. Twenty mg of 5-IS-MN per os were administered every 8 h. Hemodynamic measurements and IS-5-MN plasma levels were obtained in basal conditions and 1/2, 1, 2, 6 and 8 h after the first and seventh dose of IS-5-MN. A significant decrease of systolic and diastolic BPs, RAP, PCP, SVR and PVR was observed after 1/2 of IS-5-MN administration and was maintained through the study, while CI and CPP increased and HR remained unchanged. The hemodynamic effect was maintained after the seventh dose, with a further decrease of the following parameters: BP, RAC, PCP and PVR. However, 2 patients were withdrawn from the study due to severe symptoms of heart failure. One patient presented headache. IS-5-MN plasma levels were identified after 1/2 h, with a peak level after 1 h, and were similar after the seventh dose. A significant correlation was found between the IS-5-MN levels and the delta RAP and delta PCP after the seventh dose.(ABSTRACT TRUNCATED AT 250 WORDS)