bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiation protection and the safe use of X-ray equipment: Laws, regulations and responsibilities
Authors: Herbst Charles Petrus , Fick Gerhard H 
Published: May 2014

Lately, South Africa’s regulatory framework for electromagnetic medical devices has come under considerable pressure. In this article the legislative framework and regulatory infrastructure are scrutinized, by looking at how the legislature has given form to protective measures against ionizing radiation.
Although the Hazardous Substances Act provides for effective protection against radiation, poor administration led to insufficient staffing levels, uncertainty about Regulations and licensing conditions and therefore undermines a sound radiation protection infrastructure. The legal basis of enforcing licensing conditions through a website without proper consultation with interested and affected parties is questionable and ineffective in controlling radiation levels.
Effective and legal radiation control is possible by activating the National Advisory Committee on Electronic Products provided for in Regulation R326 published in 1979, but never implemented.
The possible impact of annual quality assurance tests currently enforced through licensing conditions on the radiation dose of the population is not cost effective as new training and accreditation structures had to be created. The fact that generally more than 80% of overexposures are caused by human error is a clear indication that training of the daily users of X-ray equipment should be emphasized and not the training and accreditation of the technicians responsible for a single quality assurance test per year.
Constructive engagement with the professional bodies involved in the medical use of X-rays through a National Advisory Committee on Electronic Products may be a cost effective solution for lowering radiation dose to the population.
Paired opposite Clear Corneal Incision: Time-Related Changes of its Effect and Factors on which those Changes Depend
Authors: Nemeth Gabor , Kolozsvari Bence , Berta Andras , Laszlo Modis 
Published: May 2014

Purpose To assess astigmatism induced by paired opposite clear corneal incision (OCCI) compared to single incisions and to investigate factors on which its effect depends. Methods The study comprised 326 eyes from 326 patients. In patients with <1.0 D corneal astigmatism, clear corneal incision was performed (CC group, n = 245), and in those with >1.0 D preoperative corneal astigmatism, a second, opposite clear corneal incision was made (OCCI group, n = 81). Both groups consisted of superior, temporal, and oblique subgroups according to the steepest meridian. Prior to the surgery, and after surgery, repeated keratometry was performed and surgically induced astigmatism (SIA) was calculated using vector analysis. Results Two weeks after the surgery, the SIA was 0.67 ± 0.44 D in the CC group and 1.15 ± 0.65 D in the OCCI group; 9 weeks after the operation, it was 0.61 ± 0.43 D in the CC group and 0.99 ± 0.57 D in the OCCI group (p<0.001). The SIA showed no significant postoperative change in our groups. Conclusions Opposite clear corneal incision reliably induces about 1.0 D of corneal astigmatism on the steep meridian in proportion to the rate of preoperative astigmatism. Its magnitude is independent of the location of the incisions and its effect remains unchanged during the postoperative period.
Sub-Tenon Block does not Provide Superior Postoperative Analgesia vs Intravenous Fentanyl in Pediatric Squint Surgery
Authors: Ramachandran Rashmi , Rewari Vimi , Chandralekha  , Sinha Renu , Trikha Anjan , Sharma Pradeep 
Published: May 2014

Purpose We evaluated the efficacy of sub-Tenon block in decreasing perioperative pain, incidence of intraoperative oculocardiac reflex (OCR), and postoperative nausea and vomiting (PONV) in pediatric squint surgery. Methods A total of 67 children age 2-12 years, American Society of Anesthesiologists Physical Status 1 and 2, were randomized to receive either sub-Tenon block (ST) in the operative eye or 2 mcg/kg of intravenous fentanyl (F) for squint surgery after induction of general anesthesia in this double-blind study. Postoperative pain was measured by either modified Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) or Visual Analogue Scale (VAS). Pain in the postoperative period (up to 2 hours) was measured as the primary endpoint. Other parameters measured in the groups were intraoperative hemodynamics, postoperative modified CHEOPS or VAS at shifting, 1, 2, 6, 12, and 24 hours after surgery, incidence of intraoperative OCR, and PONV at shifting, 30 minutes, 1, 2, 6, 12, and 24 hours after surgery. Results There was no statistical difference in the postoperative pain scores in the recovery room up to 2 hours after surgery. The VAS and CHEOPS scores were not different in the groups up to 24 hours after surgery. The incidence of OCR was significantly higher in group F than group ST. The incidence of PONV was significantly higher in group F than group ST at 30 minutes and 1 hour after the surgery (41%, 47% vs 19%, 9%, respectively, p<0.05). However, there was no statistically significant difference in intraoperative hemodynamics and PONV scores after 2 hours in the postanesthesia care unit. Conclusions Use of sub-Tenon block does not decrease the incidence of postoperative pain significantly in children undergoing squint surgery. However, it leads to a statistically significant decrease in the incidence of intraoperative OCR and PONV in the early recovery period in these patients.
Evaluation of the Efficacy and Safety of the Ophthalmic Insert Mydriasert in Patients Undergoing Retinal Angiography
Authors: Cagini Carlo , Caricato Anna , Tosi Gianluigi , Pascale Angelo , Cesari Claudia , Fiore Tito 
Published: May 2014

Purpose To verify the efficacy to obtain mydriasis and cardiovascular safety of Mydriasert (ophthalmic insert containing tropicamide and phenylephrine) in diabetic and nondiabetic patients undergoing retinal angiography by comparing it with usually administered eyedrops (tropicamide 1% and phenylephrine 10%). Methods This was a prospective randomized study. A total of 154 eyes of 77 patients were randomly divided into 2 groups: group 1 consisted of 78 eyes, group 2 consisted of 76 eyes, and the patients were monitored for pupillary dilation, blood pressure, heart rate, and possible adverse effects at 0, 20, 40, 60, and 90 minutes. Results No severe adverse effects were observed in either group. In the entire sample studied, the mean pupillary diameter was greater in the eyedrops group after 20 and 40 minutes, while mydriasis was similar in the 2 groups after 60 minutes. The diabetic patients treated with Mydriasert had less mydriasis than those treated with eyedrops after 20 and 40 minutes, and diabetic patients showed less mydriasis than the nondiabetic patients after 60 and 90 minutes. There was no significant between-group difference in mean heart rate or systolic and diastolic blood pressure at any of the time points. Conclusions Mydriasert assures an adequate degree of mydriasis for retinal angiography in both diabetic and nondiabetic patients. There are no differences in efficacy or safety between the insert and the usually administered eyedrops, but the low total drug dose administered with the insert reduces the risk of cardiovascular side effects.
Applications of Different Types of Gas-Permeable Contact Lenses in Keratoconus and Their Visual Results
Authors: Kazanci Burcu , Ozek Dilay , Anayol Alparslan , Balikçi Ayşe , Ileri Dilek , Yilmazbaş Pelin 
Published: May 2014

Purpose To show applications of different types of gas-permeable contact lenses in patients with keratoconus and to compare visual acuity (VA) results. Methods A total of 229 eyes of 133 patients who used different types of rigid gas-permeable contact lenses between April 2003 and April 2010 at the Cornea and Contact Lens Unit of Eye Clinic 2 of the Ministry of Health, Ulucanlar Eye Training and Research Hospital, were included. Visual acuity of patients was classified as uncorrected and corrected with eyeglasses and corrected with contact lenses. The patients were compared in terms of VA, daily contact lens wear time, and complications. Results A total of 70 out of 133 (52.6%) patients in our study were male, and 63 (47.4%) were female. The mean age was 25.9 ± 7.03 years (12-45). As for the classification of the 229 eyes included in the study, 136 of 229 (59.4%) eyes had moderate keratoconus, 88 (38.4%) had advanced keratoconus, and 5 (2.2%) had severe keratoconus. Following the contact lens application, the VA in all patients increased when compared to uncorrected and corrected with eyeglasses groups and the difference was statistically significant (p<0.005). When a comparison of different types of contact lenses was made, a statistically significant difference was not found (p>0.5) in terms of increase in VA. When patients were evaluated in terms of contact lens wear times, it was observed that Boston Equalens II was preferred by patients wearing lenses 4–8 hours/day. For patients wearing lenses more than 8 hours a day, Rose K lens was used the most. No serious complication was observed in any of the patients that would lead them to stop wearing contact lenses during the follow-up period. There was also no need for keratoplasty in any patient during the follow-up period. Conclusions We detected an increase in VA in patients with rigid contact lenses. In addition, some contact lenses were better tolerated by patients and were used for a longer time during the day.
Ocular Surface Evaluation in Allogenic Hematopoietic Stem Cell Transplantation Patients
Authors: Vanathi Murugesan , Kashyap Seema , Khan Rehan , Seth Tulika , Mishra Pravas , Mahapatra Manoranjan , Tandon Radhika 
Published: May 2014

Purpose To evaluate ocular surface of chronic graft versus host disease (GVHD) patients in allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods Cross-sectional study of allo-HSCT patients. Data recorded included Ocular Surface Disease Index (OSDI) score, fluorescein tear break-up time (FTBUT), Schirmer I test, ocular surface staining, dry eye severity, and conjunctival impression cytology (CIC). Results Of 40 allo-HSCT patients (mean age 25.7 ± 11.03 years) studied, dry eye disease was noted in 30%. The OSDI was mild in 16.67%, moderate in 45.83%, and severe in 20.83% ocular GVHD (oGVHD) eyes; mild in 94.64%, moderate in 5.36% non-oGVHD eyes (p<0.001). The FTBUT was ≤5 seconds in 45.83%, >5 seconds in 54.17% of eyes with chronic oGVHD. Schirmer I test score was ≤5 mm in 58.33% of eyes with oGVHD. Conjunctival staining score was <3 in 25%, ≥3 in 75% of oGVHD eyes. Corneal staining score of <3 in 79.17%, ≥3 in 20.83% was seen in oGVHD eyes. Chronic oGVHD was seen in 24 eyes, with dry eye severity of level 3 in 17.5%, level 2 in 2.5%, level 1 in 10%. The CIC was abnormal in 75% with altered morphology seen in 22 eyes with oGVHD (91.7%) and 38 eyes without oGVHD (67.9%) (p = 0.024). Conclusions Significant ocular surface changes occur due to chronic oGVHD in allo-HSCT patients. The OSDI score, corneal involvement, and Schirmer I test are indicative of ocular morbidity in post allo-HSCT eyes. Conjunctival impression cytology abnormality is also seen in eyes without oGVHD.
“Pushed” Stent Intubation for Treatment of Complex Congenital Nasolacrimal Duct Obstruction
Authors: Eshraghi Bahram , Aghajani Amirhossein , Kasaei Abulfazl , Tabatabaei Zia , Akbari Mohammadreza , Fard Masoud Aghsaei 
Published: May 2014

Purpose To assess the success rate of pushed stent intubation in children with complex congenital nasolacrimal duct obstruction (CNLDO). Methods This prospective study was performed in a single academic center. Forty-four eyes with complex CNLDO were treated with pushed stent intubation. Outcome measures included clinical signs plus a parental history of residual symptoms at 6 months after surgery. Relative risk with 95% confidence intervals (CI) for outcomes was reported. Results The mean follow-up after surgery was 9.0 months (range 6.5-13 months). Complete resolution was achieved in 26 of 44 eyes (59.1%; 95% CI 43.3%-73.3%) after pushed stent. Sex (odds ratio [OR] 2.9; 95% CI 0.4-18.9), age (OR 0.9; 95% CI 0.5-1.5), previous history of probing (OR 1.1; 95% CI 0.1-8.1), and presence of mucopurulent discharge (OR 1.1; 95% CI 0.1-7.8) did not have significant impact on the failure rate in all subjects. Conclusions In patients with complex CNLDO, treatment with a pushed stent intubation alleviated the clinical signs and symptoms of CNLDO. Pushed stent has the advantage of reduced operating time and easy placement.
Choroidal Thinning in Pseudoexfoliation Syndrome Detected by Enhanced Depth Imaging Optical Coherence Tomography
Authors: Goktas Sertan , Sakarya Yasar , Ozcimen Muammer , Sakarya Rabia , Bukus Abdulkadir , Ivacik Ismail Senol , Erdogan Erkan 
Published: May 2014

Purpose To measure choroidal thickness in patients with pseudoexfoliation (PEX) syndrome and to compare the values with control eyes using enhanced depth imaging optical coherence tomography (EDI-OCT). Methods Thirty-four patients with PEX syndrome and 30 age- and sex-matched healthy subjects were included in this study. Only one eye of each of the patients was included. Choroidal thickness was measured manually from the outer border of the retinal pigment epithelium to the inner scleral border at the subfovea, 3 mm temporal to the fovea, and 3 mm nasal to the fovea using EDI-OCT. Results A total of 34 eyes from 34 consecutive patients with PEX syndrome (19 women and 15 men; mean age 75.3 ± 6.6 years) were included in the analysis. The mean subfoveal, temporal, and nasal choroidal thickness was significantly thinner in the PEX syndrome group compared with the control group (p<0.05, at all points). The mean choroidal thickness in the PEX syndrome group was as follows: 259 ± 33 μm, 211 ± 29 μm, and 106 ± 24 μm, subfoveal, temporal, and nasal to the fovea, respectively. In comparison, the mean choroidal thickness in the control group was 274 ± 23 μm, 225 ± 17 μm, and 117 ± 17 μm, at the subfovea, 3 mm temporal to the fovea, and nasal to the fovea, respectively. Conclusions In PEX syndrome, there is choroidal thinning subfoveal, temporal, and nasal to the fovea on EDI-OCT. Decreased choroidal thickness, probably due to increased vascular resistance, and reduced blood flow, is seen in PEX syndrome.
Donor Descemet-off versus Descemet-on Deep Anterior Lamellar Keratoplasty: A Confocal Scan Study
Authors: Feizi Sepehr , Zare Mohammad , Hosseini Seyed Bagher , Kanavi Mozhgan Rezaee , Yazdani Shahin 
Published: May 2014

Purpose To compare confocal features of grafts following deep anterior lamellar keratoplasty (DALK) using a donor without Descemet membrane (DM) versus a full-thickness donor with intact DM and endothelium. Methods This retrospective comparative study examined 45 eyes from patients with keratoconus who underwent DALK using the big-bubble technique. The big-bubble technique yielded a bared DM in all keratoconic eyes. Twenty-seven eyes received tissue from a donor without DM (group 1), while 18 received tissue from a full-thickness donor with an intact DM and endothelium (group 2). A group of normal eyes (n = 28, group 3) served as controls. Confocal microscopy was used to determine keratocyte density, explore the donor-recipient interface including clarity and reflectivity, evaluate endothelial cell density and morphology, as well as measure interface depth and central corneal thickness. Results Mean follow-up duration was 20.2 ± 8.6 months and 29.6 ± 17.0 months in groups 1 and 2, respectively (p = 0.13). Confocal scan demonstrated that the keratocyte profiles and distribution were more similar to normal corneas in group 2. Significantly more severe interface haziness was observed when donor DM and endothelium was retained (mean interface reflectivity value of 102.7 ± 22.1 versus 161.7 ± 30.0 light reflectance units in groups 1 and 2, respectively, p<0.001). Conclusions Graft cellular profiles and healing response at the donor-recipient interface can be profoundly affected depending on whether donor DM and endothelium is removed or retained.
Timolol 0.1% Gel versus Timolol 0.5% Eyedrops in the Prophylaxis of Ocular Hypertension after Phacoemulsification Surgery
Authors: Cagini Carlo , Di Pasquale Giovanni , Lupidi Marco , Cerquaglia Alessio , Pascale Angelo , Boccolucci Alessandro , Fiore Tito 
Published: May 2014

Purpose To determine the efficacy of timolol 0.1% gel in preventing increased intraocular pressure (IOP) after uncomplicated cataract surgery. Methods In this prospective, double-blinded, randomized study were enrolled 70 patients who underwent uncomplicated cataract surgery with phacoemulsification and intraocular lens implantation. After cataract surgery, 25 patients received a single instillation of timolol 0.1% gel (group A); 20 a single instillation of timolol 0.5% eyedrops (group B); and 25 no treatment (group C). The IOP was measured before surgery (T0) and 5 minutes (T1), 2 hours ± 30 minutes (T2), 4 hours ± 30 minutes (T3), and 24 hours ± 180 minutes after surgery (T4). Results The patients in groups A and B had lower mean IOP values than those in group C at T2, T3, and T4; IOP was higher at T2 and T3 than at T1 in the control group. The IOP spikes in group C were higher than those observed in groups A and B: at T2, they were observed in 40% of the patients in group A, 30% in group B, and 76% in group C; and at T3, in respectively 20%, 10%, and 68%; and at T4, in respectively 4%, 0%, and 28%. Conclusions Timolol 0.1% gel is as effective as timolol 0.5% eyedrops in reducing IOP and in limiting the occurrence of IOP spikes for up to 24 hours after phacoemulsification.
Ocular Surface Alterations in Blepharospasm Patients Treated with Botulinum Toxin a Injection
Authors: Kocabeyoglu Sibel , Sekeroglu Hande Taylan , Mocan Mehmet C. , Muz Ersin , Irkec Murat , Sanac Ali Sefik 
Published: May 2014

Purpose To evaluate ocular surface changes secondary to periocular botulinum toxin A injection in patients with essential blepharospasm. Methods Thirteen eyes of 13 patients with essential blepharospasm who underwent periocular botulinum toxin A injection were included in this prospective study. Patients were evaluated prior to and at 2-week and 1-, 3-, and 6-month time points following injections. Ocular surface tests were carried out in the order of tear break-up time (TBUT), lissamine green (LG) staining, Schirmer I test with anesthesia, and ocular surface disease index (OSDI) questionnaire for all patients. The Friedman test with Conover post hoc method was used for statistical comparisons of values at different time points. Results The TBUT was found to be increased at 1 month after the injection (8.5 ± 2.1; p = 0.018) and decreased below baseline levels (6.4 ± 2.1) at the 6-month visit (5.7 ± 2.0; p = 0.018). None of the Schirmer test values at follow-up visits were significantly different as compared to baseline levels (11.3 ± 5.5), although the 2-week measurement (14.3 ± 5.6) was significantly higher as compared to that at the 6-month follow-up visit (9.6 ± 4.9; p = 0.034). There was also a significant decrease in LG staining scores at 2-week (0.6 ± 0.4; p = 0.012) and 1-month (0.6 ± 0.4; p = 0.012) time points compared to the baseline levels (1.1 ± 0.6). The OSDI scores improved at 2-week (5.4 ± 6.8; p<0.001), 1-month (3.2 ± 5.1; p<0.001), 3-month (2.5 ± 4.4; p<0.001), and 6-month (5.5 ± 5.4; p<0.001) time points as compared to baseline levels (11.6 ± 8.5). Conclusions Botulinum toxin A injection appears to have a positive but temporary effect on ocular surface parameters in patients with blepharospasm.
Evaluation of the Hemodynamic Effectiveness of Aortic Dissection Treatments via Virtual Stenting
Authors: Alimohammadi Mona , Bhattacharya-Ghosh Benjamin , Seshadhri Santhosh , Penrose Justin , Agu Obiekezie , Balabani Stavroula , Díaz-Zuccarini Vanessa 
Published: May 2014

Aortic dissection treatment varies for each patient and stenting is one of a number of approaches that are utilized to Stabilize the condition. Information regarding the hemodynamic forces in the aorta in dissected and virtually stented cases could support clinicians in their choices of treatment prior to medical intervention. Computational fluid dynamics coupled with lumped parameter models have shown promise in providing detailed information that could be used in the clinic; for this, it is necessary to develop personalized workflows in order to produce patient-specific simulations. In the present study, a case of pre- and post-stenting (virtual stent-graft) of an aortic dissection is investigated with a particular focus on the role of personalized boundary conditions. For each virtual case, velocity, pressure, energy loss, and wall shear stress values are evaluated and compared. The simulated single stent-graft only marginally reduced the pulse pressure and systemic energy loss. The double stent-graft results showed a larger reduction in pulse pressure and a 40% reduction in energy loss as well as a more physiological wall shear stress distribution. Regions of potential risk were highlighted. The methodology applied in the present study revealed detailed information about two possible surgical outcome cases and shows promise as both a diagnostic and an interventional tool.
Septic Shock Secondary to β-hemolytic Streptococcus-induced Necrotizing Fasciitis treated with a Novel Cytokine Adsorption Therapy
Authors: Hetz Hubert , Berger Reinhard , Recknagel Peter , Steltzer Heinz 
Published: May 2014

Introduction Numerous animal studies and preliminary data from a clinical trial in septic patients demonstrated that a decrease in blood cytokine levels using an extracorporeal cytokine filter (CytoSorb™) can effectively attenuate the inflammatory response during sepsis and possibly improve outcomes. Methods A 60-year-old female was admitted to hospital due to a forearm fracture. After surgical wound care by osteosynthesis the patient developed surgical wound infection which progressed to necrotizing fasciitis. All diagnostic criteria for SIRS were evident with additional proven infection from β-hemolytic streptococcus. On admission to the ICU, the patient presented a full picture of multiple organ dysfunction syndrome due to septic shock including kidney failure, lung failure as well as thrombocytopenia, metabolic acidosis, and arterial hypotension. Results After one day on mechanical ventilation and an IL-6 level of 70 000 pg/ml the patient was treated with CytoSorb therapy over a period of four days, resulting in a significant reduction of IL-6 to 66 pg/ml and an overall improvement of the patient's condition. Despite the necessity of enucleation, the patient was successfully stabilized until control of the surgical infectious source was achieved. Importantly, treatment was safe and well-tolerated, without any adverse events. Conclusions This is the first report of the clinical application of CytoSorb hemoadsorption in combination with a CRRT in a patient with septic shock. CytoSorb as described was able to significantly reduce IL-6 plasma levels and decrease vasopressor need while no adverse and device-related events occurred. CytoSorb seems to be an interesting and safe extracorporeal therapy to stabilize and bridge septic patients to surgery or recovery.