Blog Archive

Αλέξανδρος Γ. Σφακιανάκης

Tuesday, June 4, 2019

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,


Circulating Histones Are Major Mediators of Multiple Organ Dysfunction Syndrome in Acute Critical Illnesses...
Circulating Histones Are Major Mediators of Multiple Organ Dysfunction Syndrome in Acute Critical IllnessesObjectives: Multiple organ dysfunction syndrome is characterized by simultaneous multiple organ failure, which is the leading cause of death in acute critically ill patients. However, what mediates multiple organ dysfunction syndrome is not fully understood. The discovery of toxic effects by extracellular histones on different individual organs strongly suggests their involvement in multiple...
Αλέξανδρος Γ. Σφακιανάκης
now
Impact of Telemonitoring of Critically Ill Emergency Department Patients Awaiting Intensive Care Unit...
Impact of Telemonitoring of Critically Ill Emergency Department Patients Awaiting Intensive Care Unit TransferObjectives: Because of overcrowding and limited critical care resources, critically ill patients in the emergency department may spend hours to days awaiting transfer to the ICU. In these patients, often termed "ICU boarders," delayed ICU transfer is associated with poor outcomes. We implemented an emergency department–based, electronic ICU monitoring system for ICU boarders. Our aim was...
Αλέξανδρος Γ. Σφακιανάκης
now
Fluid Overload Associates With Major Adverse Kidney Events in Critically Ill Patients With Acute Kidney...
Fluid Overload Associates With Major Adverse Kidney Events in Critically Ill Patients With Acute Kidney Injury Requiring Continuous Renal Replacement TherapyObjectives: We examined the association between fluid overload and major adverse kidney events in critically ill patients requiring continuous renal replacement therapy for acute kidney injury. Design: Retrospective cohort study. Setting: ICU in a tertiary medical center. Patients: Four-hundred eighty-one critically ill adults requiring continuous...
Αλέξανδρος Γ. Σφακιανάκης
now
Intracranial Hypertension and Cerebral Perfusion Pressure Insults in Adult Hypertensive Intraventricular...
Intracranial Hypertension and Cerebral Perfusion Pressure Insults in Adult Hypertensive Intraventricular Hemorrhage: Occurrence and Associations With OutcomeObjectives: Elevated intracranial pressure and inadequate cerebral perfusion pressure may contribute to poor outcomes in hypertensive intraventricular hemorrhage. We characterized the occurrence of elevated intracranial pressure and low cerebral perfusion pressure in obstructive intraventricular hemorrhage requiring extraventricular drainage....
Αλέξανδρος Γ. Σφακιανάκης
1m
Critical Care Medicine
Outcome Prediction in Postanoxic Coma With Deep LearningObjectives: Visual assessment of the electroencephalogram by experienced clinical neurophysiologists allows reliable outcome prediction of approximately half of all comatose patients after cardiac arrest. Deep neural networks hold promise to achieve similar or even better performance, being more objective and consistent. Design: Prospective cohort study. Setting: Medical ICU of five teaching hospitals in the Netherlands. Patients: Eight-hundred...
Αλέξανδρος Γ. Σφακιανάκης
1m
Outcome Prediction in Postanoxic Coma With Deep LearningObjectives: Visual assessment of the electroencephalogram...
Outcome Prediction in Postanoxic Coma With Deep LearningObjectives: Visual assessment of the electroencephalogram by experienced clinical neurophysiologists allows reliable outcome prediction of approximately half of all comatose patients after cardiac arrest. Deep neural networks hold promise to achieve similar or even better performance, being more objective and consistent. Design: Prospective cohort study. Setting: Medical ICU of five teaching hospitals in the Netherlands. Patients: Eight-hundred...
Αλέξανδρος Γ. Σφακιανάκης
1m
Outcome Prediction in Postanoxic Coma With Deep LearningObjectives: Visual assessment of the electroencephalogram...
Outcome Prediction in Postanoxic Coma With Deep LearningObjectives: Visual assessment of the electroencephalogram by experienced clinical neurophysiologists allows reliable outcome prediction of approximately half of all comatose patients after cardiac arrest. Deep neural networks hold promise to achieve similar or even better performance, being more objective and consistent. Design: Prospective cohort study. Setting: Medical ICU of five teaching hospitals in the Netherlands. Patients: Eight-hundred...
Αλέξανδρος Γ. Σφακιανάκης
1m
Sphenoid sinus pneumatization, septation, and the internal carotid artery: A computed tomography study...
Sphenoid sinus pneumatization, septation, and the internal carotid artery: A computed tomography studyOlusola C Famurewa, Bolanle O Ibitoye, Sanyaolu A Ameye, Christianah M Asaleye, Oluwagbemiga O Ayoola, Olaoluwa S OnigbindeNigerian Medical Journal 2018 59(1):7-13Background: The air spaces of the nasal cavity and the sphenoid sinus (SS) constitute a convenient corridor to access lesions of the skull base using the endoscopic endonasal transsphenoidal approach (EETA). Safe EETA depends on the SS...
Αλέξανδρος Γ. Σφακιανάκης
2m
Postpartum sequelae of the hypertensive diseases of pregnancy: A pilot studyOchuwa Adiketu Babah, Olalekan...
Postpartum sequelae of the hypertensive diseases of pregnancy: A pilot studyOchuwa Adiketu Babah, Olalekan Olaleye, Bosede B AfolabiNigerian Medical Journal 2018 59(1):1-6Background: Hypertensive disorders are one of the most common medical conditions that may complicate pregnancy. Postpartum blood pressure (BP) pattern is, however, less clear in affected women and decision to discharge them is usually decided arbitrarily. Materials and Methods: A cohort study conducted at Lagos University Teaching...
Αλέξανδρος Γ. Σφακιανάκης
3m
Το να μάθεις να τρέφεις την ψυχή σου είναι ένα από τα πιο..
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Αλέξανδρος Γ. Σφακιανάκης
13m
Contrast-Associated Acute Kidney Injury Roxana Mehran, M.D., George D. Dangas, M.D., Ph.D., and Steven...
Contrast-Associated Acute Kidney InjuryRoxana Mehran, M.D., George D. Dangas, M.D., Ph.D., and Steven D. Weisbord, M.D.ArticleFigures/MediaMetrics72 ReferencesFigure 1.Classification of Available Contrast Agents.Contrast-associated acute kidney injury is characterized by a decrease in kidney function that occurs within days after the intravascular administration of iodinated contrast material. In the 1950s, initial cases were reported in patients with preexisting kidney disease who were undergoing...
Αλέξανδρος Γ. Σφακιανάκης
15m
Muco-Obstructive Lung Diseases Richard C. Boucher, M.D. Article Figures/Media Metrics 75 References...
Muco-Obstructive Lung DiseasesRichard C. Boucher, M.D.ArticleFigures/MediaMetrics75 ReferencesA spectrum of lung diseases that affect the airways, including chronic obstructive pulmonary disease (COPD), cystic fibrosis, primary ciliary dyskinesia, and non–cystic fibrosis bronchiectasis, can be characterized as muco-obstructive diseases.1-4 These diseases have the clinical features of cough, sputum production, and episodic exacerbations that are often associated with a diagnosis of chronic bronchitis.5...
Αλέξανδρος Γ. Σφακιανάκης
20m
Controlled Trial of Budesonide–Formoterol as Needed for Mild Asthma Richard Beasley, D.Sc., Mark Holliday,...
Controlled Trial of Budesonide–Formoterol as Needed for Mild AsthmaRichard Beasley, D.Sc., Mark Holliday, B.Sc., Helen K. Reddel, Ph.D., Irene Braithwaite, Ph.D., Stefan Ebmeier, B.M., B.Ch., Robert J. Hancox, M.D., Tim Harrison, M.D., Claire Houghton, B.M., B.S., Karen Oldfield, M.B., Ch.B., Alberto Papi, M.D., Ian D. Pavord, F.Med.Sci., Mathew Williams, Dip.Ex.Sci., et al., for the Novel START Study Team*AbstractBACKGROUNDIn double-blind, placebo-controlled trials, budesonide–formoterol used on...
Αλέξανδρος Γ. Σφακιανάκης
21m
Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke Henry Ma, Ph.D., Bruce...
Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of StrokeHenry Ma, Ph.D., Bruce C.V. Campbell, Ph.D., Mark W. Parsons, Ph.D., Leonid Churilov, Ph.D., Christopher R. Levi, M.B., B.S., Chung Hsu, Ph.D., Timothy J. Kleinig, Ph.D., Tissa Wijeratne, M.D., Sami Curtze, Ph.D., Helen M. Dewey, Ph.D., Ferdinand Miteff, M.B., B.S., Chon-Haw Tsai, Ph.D., et al., for the EXTEND Investigators*AbstractBACKGROUNDThe time to initiate intravenous thrombolysis for acute ischemic stroke is generally...
Αλέξανδρος Γ. Σφακιανάκης
22m
How to Perform an Elliptical Excision of the Skin Tomas J. Saun, M.D., Jessica Truong, M.D., Shelly...
How to Perform an Elliptical Excision of the SkinTomas J. Saun, M.D., Jessica Truong, M.D., Shelly P. Dev, M.D., and Kyle Wanzel, M.D.https://www.nejm.org/doi/full/10.1056/NEJMvcm1404883?query=primarycare-hospitalistThis video demonstrates elliptical excision of the skin, a procedure that can be used in the diagnosis and management of skin and subcutaneous lesions, may be performed with minimal risk in most patients, and may avert the need for other, more invasive procedures.Watch this video and...
Αλέξανδρος Γ. Σφακιανάκης
23m
Coronary Arteritis in IgG4-Related Disease Jaime de la Fuente, M.D., and Jared Bird, M.D. A 47-year-old...
Coronary Arteritis in IgG4-Related DiseaseJaime de la Fuente, M.D., and Jared Bird, M.D.A 47-year-old man presented to the cardiology clinic for evaluation of coronary-artery dilatations that had been detected on computed tomography (CT) of the chest performed as a follow-up examination of pulmonary nodules. The patient was asymptomatic but had a history of biopsy-proven IgG4-related disease involving the pancreas and the lacrimal and parotid glands. At the current presentation, he had no swelling...
Αλέξανδρος Γ. Σφακιανάκης
24m
Mometasone or Tiotropium in Mild Asthma with a Low Sputum Eosinophil Level Stephen C. Lazarus, M.D.,...
Mometasone or Tiotropium in Mild Asthma with a Low Sputum Eosinophil LevelStephen C. Lazarus, M.D., Jerry A. Krishnan, M.D., Ph.D., Tonya S. King, Ph.D., Jason E. Lang, M.D., Kathryn V. Blake, Pharm.D., Ronina Covar, M.D., Njira Lugogo, M.D., Sally Wenzel, M.D., Vernon M. Chinchilli, Ph.D., David T. Mauger, Ph.D., Anne-Marie Dyer, M.S., Homer A. Boushey, M.D., et al., for the National Heart, Lung, and Blood Institute AsthmaNet*AbstractBACKGROUNDIn many patients with mild, persistent asthma, the percentage...
Αλέξανδρος Γ. Σφακιανάκης
26m
Early detection of diabetic polyneuropathy (DPN)
Early detection of diabetic polyneuropathy using paired stimulation studies of the sensory nervesObjective This study seeks to use the RRP, a sensitive parameter for detecting early change in peripheral polyneuropathies, as a tool for early detection of diabetic polyneuropathy (DPN). Design The RRP of the median and sural sensory nerves were measured in 57 diabetic patients (male 31, female 26) and 23 healthy controls (male 16, female 7). The shortest inter-stimulus interval, where the latency of...
Αλέξανδρος Γ. Σφακιανάκης
29m
The Validity of the Montreal Cognitive Assessment for Moderate to Severe Traumatic Brain Injury Patients:...
The Validity of the Montreal Cognitive Assessment for Moderate to Severe Traumatic Brain Injury Patients: A Pilot StudyObjective To pilot the use of Montreal Cognitive Assessment (MOCA) as a quick clinical screen for cognitive assessment in traumatic brain injury (TBI) patients. Design The study recruited 61 participants with moderate to severe TBI presenting to a tertiary rehabilitation center under the Brain Injury Program. A MOCA questionnaire and neuropsychological battery (Repeatable Battery...
Αλέξανδρος Γ. Σφακιανάκης
31m
Differences in the mitochondrial and lipid droplet morphology in female office workers with trapezius...
Differences in the mitochondrial and lipid droplet morphology in female office workers with trapezius myalgia, compared to healthy controls. A muscle biopsy studyObjective Trapezius myalgia, or more specific, myofascial dysfunction of the upper trapezius mainly affects women performing jobs requiring prolonged low level activation of the muscle. This continuous low muscle load can be accompanied by a shift to a more anaerobic energy metabolism, causing pain. To investigate whether morphological signs...
Αλέξανδρος Γ. Σφακιανάκης
31m
EMG Evaluation of Bodyweight Exercise Progression in a Validated ACL Injury Rehabilitation Program:...
EMG Evaluation of Bodyweight Exercise Progression in a Validated ACL Injury Rehabilitation Program: Cross-sectional StudyObjectives Regaining muscle strength is essential for successful outcome after anterior cruciate ligament (ACL) injury, why progression of exercise intensity in ACL injury rehabilitation is important. Thus, this study evaluated hamstring and quadriceps muscle activity progression during bodyweight exercises used in a validated ACL injury rehabilitation program. Design The study...
Αλέξανδρος Γ. Σφακιανάκης
31m
A NEW THRESHOLD FOR APPENDICULAR LEAN MASS DISCRIMINATES MUSCLE WEAKNESS IN WOMEN WITH HIP FRACTURE:...
A NEW THRESHOLD FOR APPENDICULAR LEAN MASS DISCRIMINATES MUSCLE WEAKNESS IN WOMEN WITH HIP FRACTURE: A CROSS-SECTIONAL STUDY.Objective To investigate the relationship between measures of muscle mass and grip strength in women with subacute hip fracture. Firstly, we aimed to assess the capability of the current thresholds for appendicular lean mass (aLM), aLM-to-body-mass-index ratio and aLM/height2 to separate weak and non-weak women. Secondly, we aimed to explore alternative thresholds for the 3...
Αλέξανδρος Γ. Σφακιανάκης
32m
Use of Platelet Rich Plasma for the Treatment of Acetabular Labral Tear of the Hip: A Pilot Study Objective...
Use of Platelet Rich Plasma for the Treatment of Acetabular Labral Tear of the Hip: A Pilot StudyObjective This study aims to assess whether ultrasound guided injection of platelet rich plasma (PRP) can safely and effectively treat symptoms associated with acetabular hip labral tears. Design Institutional Review Board (IRB) approval was gained for a prospective study of eight patients (N=8), who have previously failed conservative management, to receive ultrasound-guided injection of PRP at the site...
Αλέξανδρος Γ. Σφακιανάκης
32m
Painful Foot Disorders in the Geriatric Population: A Narrative Review Painful foot disorders are highly...
Painful Foot Disorders in the Geriatric Population: A Narrative ReviewPainful foot disorders are highly prevalent among older adults causing a significant impact on mobility, function, and risk of falls. Despite its significance, foot pain is often interpreted as a normal part of aging and relatively ignored by health care providers as well as by the elderly themselves. Accurate diagnosis of the cause of foot pain is possible for most cases via clinical evaluation without a costly workup. Clinicians...
Αλέξανδρος Γ. Σφακιανάκης
32m
Dalspinin isolated from Spermacoce hispida (Linn.) protects H9c2 cardiomyocytes from hypoxic injury...
Dalspinin isolated from Spermacoce hispida (Linn.) protects H9c2 cardiomyocytes from hypoxic injury by modulating oxidative stress and apoptosisPublication date: 15 September 2019Source: Journal of Ethnopharmacology, Volume 241Author(s): R. Lakshmi Sundaram, Hannah R. VasanthiAbstractEthnopharmacological relevanceSpermacoce hispida (S.hispida), a potential medicinal plant has been traditionally used as an antibacterial, antieczemic, antihypertensive, antidiabetic and antihyperlipidemic agent. Although,...
Αλέξανδρος Γ. Σφακιανάκης
32m
Alkaloids of dendrobium nobile lindl. Altered hepatic lipid homeostasis via regulation of bile acids...
Alkaloids of dendrobium nobile lindl. Altered hepatic lipid homeostasis via regulation of bile acidsPublication date: 15 September 2019Source: Journal of Ethnopharmacology, Volume 241Author(s): Si Huang, Qing Wu, Hao Liu, Hua Ling, Yuqi He, Changhong Wang, Zhengtao Wang, Yanliu Lu, Yuanfu LuAbstractEthnopharmacological relevanceAccumulation of hepatic lipid promotes systemic metabolic dysfunction and results in fatty liver. Our previous studies have shown that the alkaloids of Dendrobium nobile Lindl....
Αλέξανδρος Γ. Σφακιανάκης
33m
Bioactivities of serotonin transporter mediate antidepressant effects of Acorus tatarinowii Schott...
Bioactivities of serotonin transporter mediate antidepressant effects of Acorus tatarinowii SchottPublication date: 15 September 2019Source: Journal of Ethnopharmacology, Volume 241Author(s): Feng-Hong Zhang, Zhi-Mei Wang, Yan-Ting Liu, Ji-Sheng Huang, Shuang Liang, Hong-Hua Wu, Yan-Tong XuAbstractEthnopharmacological relevanceAcrorus tatarinowii Schott has been widely used in the treatments of neuropsychiatric and digestive disorders in clinical practices of traditional Chinese medicine for thousands...
Αλέξανδρος Γ. Σφακιανάκης
33m
Eleutherococcus senticosus (Rupr. & Maxim.) Maxim. leaves against ischemic stroke in rats
Mass spectrometry-based urinary metabolomics for the investigation on the mechanism of action of Eleutherococcus senticosus (Rupr. & Maxim.) Maxim. leaves against ischemic stroke in ratsPublication date: 15 September 2019Source: Journal of Ethnopharmacology, Volume 241Author(s): Rongjin Wang, Liqiang Shi, Shu Liu, Zhiqiang Liu, Fengrui Song, Zhiheng Sun, Zhongying LiuAbstractEthnopharmacological relevanceAs a traditional Chinese medicine, Eleutherococcus senticosus (Rupr. & Maxim.) Maxim....
Αλέξανδρος Γ. Σφακιανάκης
35m
Carica papaya seed extract slows human sperm Publication date: 15 September 2019 Source: Journal of...
Carica papaya seed extract slows human spermPublication date: 15 September 2019Source: Journal of Ethnopharmacology, Volume 241Author(s): V. Ghaffarilaleh, D. Fisher, R. HenkelAbstractEthnopharmacological relevanceTraditional healers use Carica papaya seeds as a remedy for diseases and as a contraceptive for men and abortion in women.Material and methodsSemen samples from 35 healthy men were allowed to liquefy and subsequently incubated for 60 min in Human Tubular Fluid medium containing 1% bovine...
Αλέξανδρος Γ. Σφακιανάκης
36m
A community-based cross-sectional study about knowledge, attitude, and practices of food safety measures...
A community-based cross-sectional study about knowledge, attitude, and practices of food safety measures among urban householdsShilpa Reddy Ganta, Deepti M KadeangadiIndian Journal of Health Sciences and Biomedical Research (KLEU) 2019 12(2):154-159OBJECTIVE: The objective of this study was to assess knowledge, attitude, and practices of food safety measures among urban households of Belagavi using the World Health Organization (WHO) "Five keys for food safety." MATERIALS AND METHODOLOGY: A community-based...
Αλέξανδρος Γ. Σφακιανάκης
37m
Prevalence of Vitamin D deficiency in patients with acute exacerbations of bronchial asthma: A one-year...
Prevalence of Vitamin D deficiency in patients with acute exacerbations of bronchial asthma: A one-year hospital-based cross-sectional studySrinija Kummaraganti, Gajanan S GaudeIndian Journal of Health Sciences and Biomedical Research (KLEU) 2019 12(2):132-138BACKGROUND AND OBJECTIVES: Bronchial asthma is one of the most common chronic diseases. In India, bronchial asthma has 66% frequency of reported exacerbations. Vitamin D has action on pro-inflammatory mediators and smooth muscle function and...
Αλέξανδρος Γ. Σφακιανάκης
38m
Quantification of mast cells in reactive oral lesions – A clue to the morphologic diversity Saurabh...
Quantification of mast cells in reactive oral lesions – A clue to the morphologic diversitySaurabh Shekar, Punnya V AngadiIndian Journal of Health Sciences and Biomedical Research (KLEU) 2019 12(2):123-126OBJECTIVE: Inflammatory fibrous hyperplasia (IFH), pyogenic granuloma (PG), peripheral ossifying fibroma (POF), and peripheral giant cell granuloma (PGCG) are common oral soft-tissue reactive lesions that correspond to excessive connective tissue proliferation as a reaction to trauma or irritational...
Αλέξανδρος Γ. Σφακιανάκης
38m
Impact of refractive error correction on mental and visual development in children with global developmental...
Impact of refractive error correction on mental and visual development in children with global developmental delayKS Smitha, VD Patil, Mahesh D Kamate, Madhav Prabhu, Umesh Harakuni, OP RakshithaIndian Journal of Health Sciences and Biomedical Research (KLEU) 2019 12(2):117-122PURPOSE: The purpose of the present study is to evaluate visual acuity and refractive status in children with global developmental delay (GDD) and to study the effect of early correction of refractive errors on vision and developmental...
Αλέξανδρος Γ. Σφακιανάκης
38m
Cytotoxic activity of endophytes isolated from Allamanda blanchetii A. DC Harsha D Pednekar, Harsha...
Cytotoxic activity of endophytes isolated from Allamanda blanchetii A. DCHarsha D Pednekar, Harsha V Hegde, Pramod J Hurakadale, Jyoti D Wagawade, Kishore G Bhat, Chetana BogarIndian Journal of Health Sciences and Biomedical Research (KLEU) 2019 12(2):112-116AIM: To evaluate the cytotoxic potential of endophytic fungi isolated from A. blanchetii. MATERIALS AND METHODS: Endophytic fungi were isolated from A. blanchetii using surface sterilization methods, grown in different types of media to ascertain...
Αλέξανδρος Γ. Σφακιανάκης
39m
Evaluation of interface reflectivity and corneal aberrations following Descemet's stripping automated...
Evaluation of interface reflectivity and corneal aberrations following Descemet's stripping automated endothelial keratoplastyHamid Khakshour, Malihe Nikandish, Maryam Salehi, Haleh Ghooshkhanehei, Amirhosein VejdaniOman Journal of Ophthalmology 2019 12(2):108-113PURPOSE: This study aims to evaluate visual outcome after Descemet's membrane stripping automated endothelial keratoplasty (DSAEK) and relate to interface and corneal higher-order aberrations (HOAs). MATERIALS AND METHODS: We enrolled 16...
Αλέξανδρος Γ. Σφακιανάκης
39m
Outcomes of lacrimal gland injection of botulinum toxin in functional versus nonfunctional epiphora...
Outcomes of lacrimal gland injection of botulinum toxin in functional versus nonfunctional epiphoraSwati Singh, Akshay Gopinathan Nair, Md Shahid Alam, Bipasha MukherjeeOman Journal of Ophthalmology 2019 12(2):104-107PURPOSE: The purpose of this study is to assess the outcomes of lacrimal gland injections of botulinum toxin A (BoNTA) for epiphora secondary to lacrimal drainage disorders and functional epiphora. METHODS: This was a retrospective interventional case series where cases were divided...
Αλέξανδρος Γ. Σφακιανάκης
39m
Twenty-four-month real-world visual outcomes of intravitreal aflibercept as monotherapy for the treatment...
Twenty-four-month real-world visual outcomes of intravitreal aflibercept as monotherapy for the treatment of neovascular age-related macular degenerationThomas Siempis, Mariam El Abiary, Radhika Patel, Manish GuptaOman Journal of Ophthalmology 2019 12(2):99-103BACKGROUND: Aflibercept is widely used as a treatment for neovascular age-related macular degeneration (nAMD). Nevertheless, there is no consensus in the optimal injection frequency in the 2nd year of treatment along with little real-world...
Αλέξανδρος Γ. Σφακιανάκης
39m
Risk factors for endothelial cell damage in diabetics after phacoemulsification Niruban Ganesan, Renuka...
Risk factors for endothelial cell damage in diabetics after phacoemulsificationNiruban Ganesan, Renuka Srinivasan, K Ramesh Babu, Muthukrishnan VallinayagamOman Journal of Ophthalmology 2019 12(2):94-98Background: To assess the corneal endothelium, central corneal thickness and the factors associated with endothelial cell damage after phacoemulsification in diabetics in comparison with non-diabetics Methods: It was a case control study with 80 eyes each in the diabetic group and the control group....
Αλέξανδρος Γ. Σφακιανάκης
40m
The feasibility and efficacy of intraoperative laser retinopexy in scleral buckling surgery Roshija...
The feasibility and efficacy of intraoperative laser retinopexy in scleral buckling surgeryRoshija Khanal Rijal, Deepesh MouryaOman Journal of Ophthalmology 2019 12(2):84-87BACKGROUND: This study was performed to assess the feasibility and efficacy of intraoperative laser retinopexy in scleral buckling (SB) surgery. MATERIALS AND METHODS: This was a retrospective, noncomparative, and interventional study. Records of 25 patients who had undergone intraoperative laser retinopexy during SB were retrospectively...
Αλέξανδρος Γ. Σφακιανάκης
40m
Ophthalmology
Vitrectomy versus Phaco-vitrectomyAhmed Sulaiman Al-HinaiOman Journal of Ophthalmology 2019 12(2):71-72Android mobile applications in eye careSiddharth Karuppasamy Karthikeyan, Rajesh Thangarajan, Nagarajan Theruvedhi, Krithica SrinivasanOman Journal of Ophthalmology 2019 12(2):73-77Google Play Store was used to search for eye care-related applications the android simulator using various general terms related to eye care to review and categorize various interactive eye care-related applications in...
Αλέξανδρος Γ. Σφακιανάκης
43m
Physical Medicine & Rehabilitation
Painful Foot Disorders in the Geriatric Population: A Narrative ReviewPainful foot disorders are highly prevalent among older adults causing a significant impact on mobility, function, and risk of falls. Despite its significance, foot pain is often interpreted as a normal part of aging and relatively ignored by health care providers as well as by the elderly themselves. Accurate diagnosis of the cause of foot pain is possible for most cases via clinical evaluation without a costly workup. Clinicians...
Αλέξανδρος Γ. Σφακιανάκης
44m
Ethnopharmacology
Protective effect of Shaoyao Decoction against colorectal cancer via the Keap1–Nrf2–ARE signaling pathwayPublication date: 15 September 2019Source: Journal of Ethnopharmacology, Volume 241Author(s): Xiaoyan Wang, Shakir M. Saud, Xiwen Zhang, Weidong Li, Baojin HuaAbstractEthnopharmacological relevanceUlcerative colitis is one of the three high risk factors for colorectal cancer. Studies have found that about 20% of cancers are caused by repeated chronic inflammatory stimuli over a long period of...
Αλέξανδρος Γ. Σφακιανάκης
44m
Health Sciences and Biomedical Research
Pediatric renal transplantsRB Nerli, Shridhar C GhaganeIndian Journal of Health Sciences and Biomedical Research (KLEU) 2019 12(2):99-100Burnout among healthcare professionals: Is it a cause for concern?Punnya V AngadiIndian Journal of Health Sciences and Biomedical Research (KLEU) 2019 12(2):101-102Maternal mental health and its influence on infant growth and development: A systematic review of observational studies in South and East AsiaShubhashree Venkatesh, J Vindhya, Anita NathIndian Journal...
Αλέξανδρος Γ. Σφακιανάκης
45m
Therapeutic potential of intravesical injections of platelet-rich plasma in the treatment of lower urinary...
Therapeutic potential of intravesical injections of platelet-rich plasma in the treatment of lower urinary tract disorders due to regenerative deficiencyQian-Sheng Ke, Jia-Fong Jhang, Teng-Yi Lin, Han-Chen Ho, Yuan-Hong Jiang, Yuan-Hsiang Hsu, Hann-Chorng KuoTzu Chi Medical Journal 2019 31(3):135-143The bladder urothelium plays an important role of barrier function to prevent influx of urinary toxic substance and bacteria. When there is insult to the urinary bladder, the urothelium will start to...
Αλέξανδρος Γ. Σφακιανάκης
47m
Ischemic stroke following neck dissection in the elderly Chuan-Yi Kuo, Yi-Ting Chen, Cheuk-Kwan Sun,...
Ischemic stroke following neck dissection in the elderlyChuan-Yi Kuo, Yi-Ting Chen, Cheuk-Kwan Sun, Kuo-Chuan HungTzu Chi Medical Journal 2019 31(3):177-181Objective: Despite the known association of perioperative stroke with perioperative mortality, the prevalence of stroke following neck dissection in elderly patients remains unclear. This study compared the incidence of neck dissection-associated perioperative stroke in elderly and younger patients. Materials and Methods: Totally, 1057 patients...
Αλέξανδρος Γ. Σφακιανάκης
48m
tea and coffee in the development of gastroesophageal reflux diseaseTao-Yang Wei, Pang-Hsin Hsueh,...
tea and coffee in the development of gastroesophageal reflux diseaseTao-Yang Wei, Pang-Hsin Hsueh, Shu-Hui Wen, Chien-Lin Chen, Chia-Chi WangTzu Chi Medical Journal 2019 31(3):169-176Objective: The incidence of gastroesophageal reflux disease (GERD) is increasing, and the disease has a close association with dietary habits. This study aims to investigate the role of tea and coffee drinking in the development of GERD. Materials and Methods: This study prospectively enrolled individuals who underwent...
Αλέξανδρος Γ. Σφακιανάκης
48m
Optimal imaging time for Tc-99m phytate lymphoscintigraphy for sentinel lymph node mapping in patients...
Optimal imaging time for Tc-99m phytate lymphoscintigraphy for sentinel lymph node mapping in patients with breast cancerChing-Chun Ho, Yu-Hung Chen, Shu-Hsin Liu, Hwa-Tsung Chen, Ming-Che LeeTzu Chi Medical Journal 2019 31(3):163-168Objectives: Sentinel lymph node (SLN) sampling has become a standard practice in managing early-stage breast cancer. Lymphoscintigraphy is one of the major methods used. The radioactive tracer used in Taiwan is Tc-99m phytate. However, this agent is not commonly used...
Αλέξανδρος Γ. Σφακιανάκης
48m
Comparison of intramuscular methylergometrine, rectal misoprostol, and low-dose intravenous oxytocin...
Comparison of intramuscular methylergometrine, rectal misoprostol, and low-dose intravenous oxytocin in active management of the third stage of laborRuchi Jain, Sudesh Agrawal, Kamala Verma, Aastha Jain, Mayank BaidTzu Chi Medical Journal 2019 31(3):158-162Objective: Active management of the third stage of labor (AMTSL) is a critical intervention for the prevention of postpartum hemorrhage (PPH), which is still the most common cause of maternal morbidity and mortality worldwide. The objective of...
Αλέξανδρος Γ. Σφακιανάκης
48m
Tzu Chi Medical Journal, a publication of Buddhist Compassion Relief Tzu Chi Foundation
Therapeutic potential of intravesical injections of platelet-rich plasma in the treatment of lower urinary tract disorders due to regenerative deficiencyQian-Sheng Ke, Jia-Fong Jhang, Teng-Yi Lin, Han-Chen Ho, Yuan-Hong Jiang, Yuan-Hsiang Hsu, Hann-Chorng KuoTzu Chi Medical Journal 2019 31(3):135-143The bladder urothelium plays an important role of barrier function to prevent influx of urinary toxic substance and bacteria. When there is insult to the urinary bladder, the urothelium will start to...
Αλέξανδρος Γ. Σφακιανάκης
49m
Anticoagulants for cancer-associated ischemic stroke Jin-Yi Hsu, An-Bang Liu Tzu Chi Medical Journal...
Anticoagulants for cancer-associated ischemic strokeJin-Yi Hsu, An-Bang LiuTzu Chi Medical Journal 2019 31(3):144-148Patients with cancer-associated ischemic stroke pose similar clinical manifestations and image characteristics, mainly embolic infarction, as patients with atrial fibrillation do. D-dimer, a degraded product of fibrin polymer, is a useful indicator of hypercoagulability, which frequently increases in cancer-associated stroke, but not in stroke resulted from atrial fibrillation. The...
Αλέξανδρος Γ. Σφακιανάκης
49m
Robotic-assisted minimally invasive oesophagectomy for cancer: An initial experience Chinnusamy Palanivelu,...
Robotic-assisted minimally invasive oesophagectomy for cancer: An initial experienceChinnusamy Palanivelu, Sumanta Dey, Sandeep Sabnis, Raghavendra Gupta, Bharath Cumar, Saravana Kumar, Ramesh Natarajan, Parthasarathi RamakrishnanJournal of Minimal Access Surgery 2019 15(3):234-241Background: The morbidity related to radical oesophagectomy can be reduced by adopting minimally invasive techniques. Over 250 thoraco-laparoscopic oesophagectomy (TLE) was done in our centre over the last 15 years, before...
Αλέξανδρος Γ. Σφακιανάκης
52m
Minimal Access Surgery
The unwanted third wheel in the Calot's triangle: Incidence and surgical significance of caterpillar hump of right hepatic artery with a systematic review of the literatureLuigi Marano, Alberto Bartoli, Karol Polom, Raffaele Bellochi, Alessandro Spaziani, Giampaolo CastagnoliJournal of Minimal Access Surgery 2019 15(3):185-191Background: Caterpillar hump of the right hepatic artery is a rare variation increasing the risk of vascular and biliary injuries during hepatobiliary surgery. The aim of this...
Αλέξανδρος Γ. Σφακιανάκης
52m
A prospective study of gastro-oesophageal reflux disease symptoms and quality of life 1-year post-laparoscopic...
A prospective study of gastro-oesophageal reflux disease symptoms and quality of life 1-year post-laparoscopic sleeve gastrectomyAndrew G.N. Robertson, Andrew J Cameron, Brian Joyce, Phil Le Page, Bruce Tulloh, Andrew C de Beaux, Peter J LambJournal of Minimal Access Surgery 2019 15(3):229-233Introduction: There are concerns that laparoscopic sleeve gastrectomy (LSG) can cause severe gastro-oesophageal reflux disease (GORD). The aim of this study was to assess GORD symptoms and quality of life following...
Αλέξανδρος Γ. Σφακιανάκης
52m
Priapism in a pediatric chronic myeloid leukaemia patient: Unusual presentation of a rare disease...
Priapism in a pediatric chronic myeloid leukaemia patient: Unusual presentation of a rare disease in childrenPurnima Thakur, Vishal Verma, Vikas Fotedar, Kalindi SinghClinical Cancer Investigation Journal 2019 8(2):76-78A rare case of chronic myeloid leukemia (CML) presenting with priapism is reported in a pediatric patient. CML accounts for around 15% of hematological malignancies. It is still rarer in the pediatric age group. Investigations revealed hyperleukocytosis due to CML. When conservative...
Αλέξανδρος Γ. Σφακιανάκης
54m
Superficial extraskeletal ewing's sarcoma of forefoot with inguinal lymph node metastasis and lung...
Superficial extraskeletal ewing's sarcoma of forefoot with inguinal lymph node metastasis and lung metastasis: A rare casePoorva Vias, Shabnum Thakur, Rajeev K Seam, Vikas Fotedar, Ashish SaklaniClinical Cancer Investigation Journal 2019 8(2):73-75Ewing's sarcoma is the 2nd most common paediatric bone tumour but can also be seen in extraskeletal sites. Superficial extraskeletal ES is a rare entity and is rarely seen in foot. Majority of these patients are females in second decade of life, presenting...
Αλέξανδρος Γ. Σφακιανάκης
54m
Metaplastic chondroid breast carcinoma: A diagnostic challenge Milind Anil Bhatkule Clinical Cancer...
Metaplastic chondroid breast carcinoma: A diagnostic challengeMilind Anil BhatkuleClinical Cancer Investigation Journal 2019 8(2):70-72Metaplastic carcinoma of the breast is a rare entity. Extensive chondroid differentiation is even rarer in metaplastic breast carcinoma (MBC). Here, we report a case of metaplastic chondroid carcinoma of the breast with very few areas showing usual ductal carcinoma and pseudosarcomatous areas. The tumor was characterized by an abundant chondromyxoid matrix. The definitive...
Αλέξανδρος Γ. Σφακιανάκης
54m
clinicopathologic features of thyroid cancer
A study of clinicopathologic features of thyroid cancer in Western Iran: A 9-year experienceBabak Izadi, Somayeh Jalilian, Mazaher Ramezani, Masoud Sadeghi, Sedigheh KhazaeiClinical Cancer Investigation Journal 2019 8(2):64-69Introduction: Thyroid cancer is reported as the most rapidly increasing and third-most common cancer among females. This study aimed to evaluate the data related to thyroid cancer in Kermanshah, Iran, for the first time. Materials and Methods: The data of thyroid cancers were...
Αλέξανδρος Γ. Σφακιανάκης
55m
An evaluation of special AT-rich sequence-binding protein 2 expression in primary epithelial tumors...
An evaluation of special AT-rich sequence-binding protein 2 expression in primary epithelial tumors and metastatic tumors of the ovaryEsra Oz, Zehra Bozdag, Neslihan Bayramoglu Tepe, Zeynep Bayramoglu, Omer Faruk Dizibuyuk, Metin KarakokClinical Cancer Investigation Journal 2019 8(2):57-63Background: Ovarian cancer is the second most common gynecologic cancer in women. Differential diagnosis between primary and metastatic neoplasms can be problematic in some cases. The special AT-rich sequence-binding...
Αλέξανδρος Γ. Σφακιανάκης
55m
Response assessment of gefitinib therapy in the epidermal growth factor receptor- mutant advanced adenocarcinoma...
Response assessment of gefitinib therapy in the epidermal growth factor receptor- mutant advanced adenocarcinoma lung at a tertiary care center in North IndiaAnubhuti Singh, Anand Srivastava, Abhishek Verma, Rajiv GargClinical Cancer Investigation Journal 2019 8(2):41-46Context: Oral tyrosine kinase inhibitors (TKIs) have been proven to improve response rates (RRs) and progression-free survival in a chemo-naïve setting in the epidermal growth factor receptor (EGFR)-mutant advanced lung adenocarcinoma...
Αλέξανδρος Γ. Σφακιανάκης
55m
Clinical Cancer Investigation
Response assessment of gefitinib therapy in the epidermal growth factor receptor- mutant advanced adenocarcinoma lung at a tertiary care center in North IndiaAnubhuti Singh, Anand Srivastava, Abhishek Verma, Rajiv GargClinical Cancer Investigation Journal 2019 8(2):41-46Context: Oral tyrosine kinase inhibitors (TKIs) have been proven to improve response rates (RRs) and progression-free survival in a chemo-naïve setting in the epidermal growth factor receptor (EGFR)-mutant advanced lung adenocarcinoma...
Αλέξανδρος Γ. Σφακιανάκης
55m
Surgical margins and nodal metastasis are prognostic factors in oral squamous cell carcinoma: A meta-analysis...
Surgical margins and nodal metastasis are prognostic factors in oral squamous cell carcinoma: A meta-analysisMohammad Akheel, Rinku K George, Amit Jain, Qutubuddin Chahwala, Ashmi WadhwaniaClinical Cancer Investigation Journal 2019 8(2):47-51Background: To find out whether surgical margins and nodal metastasis are prognostic factors in oral squamous cell carcinoma (OSCC). Materials and Methods: PubMed search was done to look for studies done on surgical margins and nodal metastasis of OSCC from 2008...
Αλέξανδρος Γ. Σφακιανάκης
56m

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Critical Care Medicine

Outcome Prediction in Postanoxic Coma With Deep Learning
Objectives: Visual assessment of the electroencephalogram by experienced clinical neurophysiologists allows reliable outcome prediction of approximately half of all comatose patients after cardiac arrest. Deep neural networks hold promise to achieve similar or even better performance, being more objective and consistent. Design: Prospective cohort study. Setting: Medical ICU of five teaching hospitals in the Netherlands. Patients: Eight-hundred ninety-five consecutive comatose patients after cardiac arrest. Interventions: None. Measurements and Main Results: Continuous electroencephalogram was recorded during the first 3 days after cardiac arrest. Functional outcome at 6 months was classified as good (Cerebral Performance Category 1–2) or poor (Cerebral Performance Category 3–5). We trained a convolutional neural network, with a VGG architecture (introduced by the Oxford Visual Geometry Group), to predict neurologic outcome at 12 and 24 hours after cardiac arrest using electroencephalogram epochs and outcome labels as inputs. Output of the network was the probability of good outcome. Data from two hospitals were used for training and internal validation (n = 661). Eighty percent of these data was used for training and cross-validation, the remaining 20% for independent internal validation. Data from the other three hospitals were used for external validation (n = 234). Prediction of poor outcome was most accurate at 12 hours, with a sensitivity in the external validation set of 58% (95% CI, 51–65%) at false positive rate of 0% (CI, 0–7%). Good outcome could be predicted at 12 hours with a sensitivity of 48% (CI, 45–51%) at a false positive rate of 5% (CI, 0–15%) in the external validation set. Conclusions: Deep learning of electroencephalogram signals outperforms any previously reported outcome predictor of coma after cardiac arrest, including visual electroencephalogram assessment by trained electroencephalogram experts. Our approach offers the potential for objective and real time, bedside insight in the neurologic prognosis of comatose patients after cardiac arrest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http:/journals.lww.com/ccmjournal). Dr. van Putten is co-founder of Clinical Science Systems, a supplier of electroencephalogram systems for Medisch Spectrum Twente. The remaining authors have disclosed that they do not have any conflicts of interest. This work was performed in Medisch Spectrum Twente, Rijnstate Hospital, St. Antonius Hospital, University Medical Center Groningen and VieCuri Medical Center, The Netherlands. For information regarding this article, E-mail: m.tjepkema-cloostermans@mst.nl Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

XueBiJing Injection Versus Placebo for Critically Ill Patients With Severe Community-Acquired Pneumonia: A Randomized Controlled Trial
Objectives: To investigate whether XueBiJing injection improves clinical outcomes in critically ill patients with severe community-acquired pneumonia. Design: Prospective, randomized, controlled study. Setting: Thirty-three hospitals in China. Patients: A total of 710 adults 18–75 years old with severe community-acquired pneumonia. Interventions: Participants in the XueBiJing group received XueBiJing, 100 mL, q12 hours, and the control group received a visually indistinguishable placebo. Measurements and Main Results: The primary outcome was 8-day improvement in the pneumonia severity index risk rating. Secondary outcomes were 28-day mortality rate, duration of mechanical ventilation and total duration of ICU stay. Improvement in the pneumonia severity index risk rating, from a previously defined endpoint, occurred in 203 (60.78%) participants receiving XueBiJing and in 158 (46.33%) participants receiving placebo (between-group difference [95% CI], 14.4% [6.9–21.8%]; p < 0.001). Fifty-three (15.87%) XueBiJing recipients and 84 (24.63%) placebo recipients (8.8% [2.4–15.2%]; p = 0.006) died within 28 days. XueBiJing administration also decreased the mechanical ventilation time and the total ICU stay duration. The median mechanical ventilation time was 11.0 versus 16.5 days for the XueBiJing and placebo groups, respectively (p = 0.012). The total duration of ICU stay was 12 days for XueBiJing recipients versus 16 days for placebo recipients (p = 0.004). A total of 256 patients experienced adverse events (119 [35.63%] vs 137 [40.18%] in the XueBiJing and placebo groups, respectively [p = 0.235]). Conclusions: In critically ill patients with severe community-acquired pneumonia, XueBiJing injection led to a statistically significant improvement in the primary endpoint of the pneumonia severity index as well a significant improvement in the secondary clinical outcomes of mortality, duration of mechanical ventilation and duration of ICU stay. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). Supported, in part, by a Tianjin Science and Technology committee grant (14ZXLJSY00230) and National Natural Science Foundation of China (81630001,81490533). Drs. X. Yu and Zhi Liu disclosed work for hire. Dr. B. Zhang disclosed government work. The remaining authors have disclosed that they do not have any potential conflicts of interest. Clinical Trial Registration: http://www.chictr.org.cn/index.aspx. Unique identifier: ChiCTR-TRC-13003534. For information regarding this article, E-mail: bai.chunxue@zs-hospital.sh.cn; shanghongcai@126.com Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Intracranial Hypertension and Cerebral Perfusion Pressure Insults in Adult Hypertensive Intraventricular Hemorrhage: Occurrence and Associations With Outcome
Objectives: Elevated intracranial pressure and inadequate cerebral perfusion pressure may contribute to poor outcomes in hypertensive intraventricular hemorrhage. We characterized the occurrence of elevated intracranial pressure and low cerebral perfusion pressure in obstructive intraventricular hemorrhage requiring extraventricular drainage. Design: Prospective observational cohort. Setting: ICUs of 73 academic hospitals. Patients: Four hundred ninety-nine patients enrolled in the CLEAR III trial, a multicenter, randomized study to determine if extraventricular drainage plus intraventricular alteplase improved outcome versus extraventricular drainage plus saline. Interventions: Intracranial pressure and cerebral perfusion pressure were recorded every 4 hours, analyzed over a range of thresholds, as single readings or spans (≥ 2) of readings after adjustment for intracerebral hemorrhage severity. Impact on 30- and 180-days modified Rankin Scale scores was assessed, and receiver operating curves were analyzed to identify optimal thresholds. Measurements and Main Results: Of 21,954 intracranial pressure readings, median interquartile range 12 mm Hg (8–16), 9.7% were greater than 20 mm Hg and 1.8% were greater than 30 mm Hg. Proportion of intracranial pressure readings from greater than 18 to greater than 30 mm Hg and combined intracranial pressure greater than 20 plus cerebral perfusion pressure less than 70 mm Hg were associated with day-30 mortality and partially mitigated by intraventricular alteplase. Proportion of cerebral perfusion pressure readings from less than 65 to less than 90 mm Hg and intracranial pressure greater than 20 mm Hg in spans were associated with both 30-day mortality and 180-day mortality. Proportion of cerebral perfusion pressure readings from less than 65 to less than 90 mm Hg and combined intracranial pressure greater than 20 plus cerebral perfusion pressure less than 60 mm Hg were associated with poor day-30 modified Rankin Scale, whereas cerebral perfusion pressure less than 65 and less than 75 mm Hg were associated with poor day-180 modified Rankin Scale. Conclusions: Elevated intracranial pressure and inadequate cerebral perfusion pressure are not infrequent during extraventricular drainage for severe intraventricular hemorrhage, and level and duration predict higher short-term mortality and long-term mortality. Burden of low cerebral perfusion pressure was also associated with poor short- and long-term outcomes and may be more significant than intracranial pressure. Adverse consequences of intracranial pressure-time burden and cerebral perfusion pressure-time burden should be tested prospectively as potential thresholds for therapeutic intervention. A full list of the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR III). Investigators are available in Appendix 1 (Supplemental Digital Content 9, http://links.lww.com/CCM/E727). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). Supported, in part, by the National Institutes of Health grants 5U01NS062851 for Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR III). Genentech assisted by donating the study drug. Dr. Ziai received funding from C. R. Bard, Headsense, and NINDS. Drs. Ziai, Thompson, and Mayo, Ms. McBee, Dr. Ullman, Ms. Lane, and Drs. Awad and Hanley received support for article research from National Institutes of Health (NIH). Drs. Thompson's and Award's institutions received funding from the NIH. Ms. McBee's, Ms. Lane's, and Dr. Hanley's institutions received funding from NIH/NINDS 5U01NS062851, NIH/NINDS 1U01NS08082, and Genentech (drug donation). Ms. McBee, Dr. Ullman, Ms. Lane, and Drs. Awad and Hanley disclosed off-label product use of alteplase. Dr. Ullman's institution received funding from NIH/NINDS. Dr. Awad received funding from expert reviews and medicolegal opinions. Dr. Hanley received funding from BrainScope, Neurotrope, Portola Pharmaceuticals, Op2Lysis, HeadSense, and Medtronic. Dr. Ziai, Ms. McBee, Ms. Lane, and Drs. Awad and Hanley are supported by grant 5U01NS062851. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: weziai@jhmi.edu Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Limiting Treatment in Intensive Care: Contributions and Limits of Ethics Consultation
No abstract available

Impact of Critical Care Point-of-Care Ultrasound Short-Courses on Trainee Competence
Objectives: Competence in point-of-care ultrasound is recommended/mandated by several critical care specialties. Although doctors commonly attend point-of-care ultrasound short-courses for introductory training, there is little follow-up data on whether they eventually attain competence. This study was done to determine the impact of point-of-care ultrasound short-courses on point-of-care ultrasound competence. Design: Web-based survey. Setting: Follow-up after point-of-care ultrasound short-courses in the Asia-Pacific region. Subjects: Doctors who attended a point-of-care ultrasound short-course between December 2015 and February 2018. Interventions: Each subject was emailed a questionnaire on or after 6 months following their short-course. They were asked if they had performed at least 30 structured point-of-care ultrasound scans and/or reached point-of-care ultrasound competence and their perceived reasons/challenges/barriers. They were also asked if they used point-of-care ultrasound as a clinical diagnostic aid. Measurements and Main Results: The response rate was 74.9% (182/243). Among the 182 respondents, only 12 (6.6%) had attained competence in their chosen point-of-care ultrasound modality, attributing their success to self-motivation and time management. For the remaining doctors who did not attain competence (170/182, 93.4%), the common reasons were lack of time, change of priorities, and less commonly, difficulties in accessing an ultrasound machine/supervisor. Common suggestions to improve short-courses included requests for scanning practice on acutely ill ICU patients and prior information on the challenges regarding point-of-care ultrasound competence. Suggestions to improve competence pathways included regular supervision and protected learning time. All 12 credentialled doctors regularly used point-of-care ultrasound as a clinical diagnostic aid. Of the 170 noncredentialled doctors, 123 (72.4%) reported performing unsupervised point-of-care ultrasound for clinical management, either sporadically (42/170, 24.7%) or regularly (81/170, 47.7%). Conclusions: In this survey of doctors attending point-of-care ultrasound short-courses in Australasia, the majority of doctors did not attain competence. However, the practice of unsupervised point-of-care ultrasound use by noncredentialled doctors was common. Further research into effective strategies to improve point-of-care ultrasound competence is required. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: rrarvind@hotmail.com Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Why Understanding Sepsis Endotypes Is Important for Steroid Trials in Septic Shock?
No abstract available

Fluid Overload Associates With Major Adverse Kidney Events in Critically Ill Patients With Acute Kidney Injury Requiring Continuous Renal Replacement Therapy
Objectives: We examined the association between fluid overload and major adverse kidney events in critically ill patients requiring continuous renal replacement therapy for acute kidney injury. Design: Retrospective cohort study. Setting: ICU in a tertiary medical center. Patients: Four-hundred eighty-one critically ill adults requiring continuous renal replacement therapy for acute kidney injury. Interventions: None. Measurements and Main Results: Fluid overload was assessed as fluid balance from admission to continuous renal replacement therapy initiation, adjusted for body weight. Major adverse kidney events were defined as a composite of mortality, renal replacement therapy-dependence or inability to recover 50% of baseline estimated glomerular filtration rate (if not on renal replacement therapy) evaluated up to 90 days after discharge. Patients with fluid overload less than or equal to 10% were less likely to experience major adverse kidney events than those with fluid overload greater than 10% (71.6% vs 79.4%; p = 0.047). Multivariable logistic regression showed that fluid overload greater than 10% was associated with a 58% increased odds of major adverse kidney events (p = 0.046), even after adjusting for timing of continuous renal replacement therapy initiation. There was also a 2.7% increased odds of major adverse kidney events for every 1 day increase from ICU admission to continuous renal replacement therapy initiation (p = 0.024). Fluid overload greater than 10% was also found to be independently associated with an 82% increased odds of hospital mortality (p = 0.004) and 2.5 fewer ventilator-free days (p = 0.044), compared with fluid overload less than or equal to 10%. Conclusions: In critically ill patients with acute kidney injury requiring continuous renal replacement therapy, greater than 10% fluid overload was associated with higher risk of 90-day major adverse kidney events, including mortality and decreased renal recovery. Increased time between ICU admission and continuous renal replacement therapy initiation was also associated with decreased renal recovery. Fluid overload represents a potentially modifiable risk factor, independent of timing of continuous renal replacement therapy initiation, that should be further examined in interventional studies. Dr. Woodward designed the project, managed the database, gathered the data, prepared the figures, and wrote and submitted the article. Dr. Lambert and Ms. Li managed the database, analyzed the statistical data, and prepared the figures. Drs. Ortiz-Soriano, Bissell, Adams, Yessayan, and Morris designed the project and edited the article. Dr. Ruiz-Conejo gathered data and wrote the article. Mr. Kelly designed the project, managed the database, and extracted data. Dr. Neyra designed and supervised the project, and wrote and submitted the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). Dr. Lambert received support for article research from the National Institutes of Health. Dr. Neyra is currently supported by an Early Career Pilot Grant from the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR001998. The remaining authors have disclosed that they do not have any potential conflicts of interest. This work was performed at the University of Kentucky, Lexington, KY. For information regarding this article, E-mail: javier.neyra@uky.edu Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

A Progressive Early Mobilization Program Is Significantly Associated With Clinical and Economic Improvement: A Single-Center Quality Comparison Study
Objectives: To determine whether a progressive early mobilization protocol improves patient outcomes, including in-hospital mortality and total hospital costs. Design: Retrospective preintervention and postintervention quality comparison study. Settings: Single tertiary community hospital with a 12-bed closed-mixed ICU. Patients: All consecutive patients 18 years old or older were eligible. Patients who met exclusion criteria or were discharged from the ICU within 48 hours were excluded. Patients from January 2014 to May 2015 were defined as the preintervention group (group A) and from June 2015 to December 2016 was the postintervention group (group B). Intervention: Maebashi early mobilization protocol. Measurements and Main Results: Group A included 204 patients and group B included 187 patients. Baseline characteristics evaluated include age, severity, mechanical ventilation, and extracorporeal membrane oxygenation, and in group B additional comorbidities and use of steroids. Hospital mortality was reduced in group B (adjusted hazard ratio, 0.25; 95% CI, 0.13–0.49; p < 0.01). This early mobilization protocol is significantly associated with decreased mortality, even after adjusting for baseline characteristics such as sedation. Total hospital costs decreased from $29,220 to $22,706. The decrease occurred soon after initiating the intervention and this effect was sustained. The estimated effect was $–5,167 per patient, a 27% reduction. Reductions in ICU and hospital lengths of stay, time on mechanical ventilation, and improvement in physical function at hospital discharge were also seen. The change in Sequential Organ Failure Assessment score and Sequential Organ Failure Assessment score at ICU discharge were significantly reduced after the intervention, despite a similar Sequential Organ Failure Assessment score at admission and at maximum. Conclusions: In-hospital mortality and total hospital costs are reduced after the introduction of a progressive early mobilization program, which is significantly associated with decreased mortality. Cost savings were realized early after the intervention and sustained. Further prospective studies to investigate causality are warranted. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). Dr. Oosaki disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest. This study was conducted in the ICU of the Japan Red Cross Maebashi Hospital. For information regarding this article, E-mail: keiliu0406@gmail.com Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Impact of Telemonitoring of Critically Ill Emergency Department Patients Awaiting Intensive Care Unit Transfer
Objectives: Because of overcrowding and limited critical care resources, critically ill patients in the emergency department may spend hours to days awaiting transfer to the ICU. In these patients, often termed "ICU boarders," delayed ICU transfer is associated with poor outcomes. We implemented an emergency department–based, electronic ICU monitoring system for ICU boarders. Our aim was to investigate the effect of this initiative on morbidity, mortality, and ICU usage. Design: Single-center, retrospective cohort study. Setting: Nonprofit, tertiary care, teaching hospital with greater than 100,000 emergency department visits per year. Patients: Emergency department patients with admission orders for the medical ICU, who spent more than 2 hours boarding in the emergency department after being accepted for admission to the medical ICU, were included in the study. Interventions: None. Measurements and Main Results: During the study period, a total of 314 patients were admitted to the medical ICU from the emergency department, 214 of whom were considered ICU boarders with a delay in medical ICU transfer over 2 hours. Of ICU boarders, 115 (53.7%) were enrolled in electronic ICU telemonitoring (electronic ICU care), and the rest received usual emergency department care (emergency department care). Age, mean illness severity (Acute Physiology and Chronic Health Evaluation IVa scores), and admitting diagnoses did not differ significantly between ICU boarders receiving electronic ICU care and emergency department care. Forty-one electronic ICU care patients (36%) were ultimately transitioned to a less intensive level of care in lieu of ICU admission while still in the emergency department, compared with zero patients in the emergency department care group. Among all ICU boarders transferred to the ICU, in-hospital mortality was lower in the electronic ICU care cohort when compared with the emergency department care cohort (5.4% vs 20.0%; adjusted odds ratio, 0.08). Conclusions: In critically ill patients awaiting transfer from the emergency department to the medical ICU, electronic ICU care was associated with decreased mortality and lower ICU resource utilization. Current address for Dr. Kadar: 222 East Pearson St, Apt 1601, Chicago, IL 60611. Dr. Kadar, Ms. Hesse, and Dr. Bonder's institutions received funding from Be the Change Grant award from the Emergency Medicine Residents' Association. Mr. Amici was supported by National Institutes of Health T32GM008152. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: rachel.burt.kadar@gmail.com Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Circulating Histones Are Major Mediators of Multiple Organ Dysfunction Syndrome in Acute Critical Illnesses
Objectives: Multiple organ dysfunction syndrome is characterized by simultaneous multiple organ failure, which is the leading cause of death in acute critically ill patients. However, what mediates multiple organ dysfunction syndrome is not fully understood. The discovery of toxic effects by extracellular histones on different individual organs strongly suggests their involvement in multiple organ dysfunction syndrome. In this study, we investigate whether circulating histones are major mediators of multiple organ dysfunction syndrome in acute critical illnesses. Design: Combination of retrospective clinical studies and animal models with intervention. Setting: ICU in a tertiary hospital and research laboratories. Patients: Four hundred and twenty ICU patients, including sepsis (140), severe trauma (63), severe pancreatitis (89), and other admission diagnoses (128). Laboratory Investigation: Cells from major organs are treated with calf thymus histones or histone-containing sera. Animal models for sepsis, trauma, and acute pancreatitis are treated with antihistone reagents. Intervention: Antihistone reagents in in vitro, ex vivo, and animal models. Measurement and Main Results: Retrospective analysis of a prospectively recruited ICU cohort demonstrated a strong correlation between circulating histones and organ injury markers and Sequential Organ Failure Assessment scores. Ex vivo experiments showed that patient sera containing high histone levels were toxic to cultured cells from different origins, suggesting their universal toxicity to multiple organs. Animal models of sepsis, trauma, and pancreatitis further demonstrated a temporal correlation between histone levels and disease severity and multiple organ injury. Importantly, antihistone reagents, that is, antihistone single-chain variable fragment and nonanticoagulant heparin, could dramatically reduce multiple organ injury, particularly of the heart and lungs, and improve survival in mouse models. Conclusions: High levels of circulating histones are major mediators of multiple organ dysfunction syndrome. Our results indicate that monitoring upon ICU admission could inform on disease severity and developing antihistone therapy holds great potential of reducing multiple organ dysfunction syndrome and improving survival of critically ill patients. Dr. Cheng performed animal experiments and sample analysis. Dr. Cheng, Dr. Abrams, and Mr. Toh performed the cell viability assay. Dr. Abrams analyzed the clinical data and performed statistical analysis as well as figure and article editing. Dr. Alhamdi collected part of the clinical data. Drs. Yu, Wang, and Toh supervised the work and wrote, edited, and reviewed the article and figures. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). This work was supported by the Medical Research Council (G0501641), British Heart Foundation (PG/14/19/30751 and PG/16/65/32313), and National Institute of Health Research (II-FS-0110-14061)and received scholarships from China Scholarship Council (CSC:20160609156) and Southeast University (YBJJ1740) to Dr. Cheng. Dr. Cheng, Dr. Abrams, Mr. Toh, Dr. Yu, Dr. Wang, and Dr. Toh's institutions received funding from Medical Research Council (G0501641), British Heart Foundation (PG/14/19/30751 and PG/16/65/32313), and National Institute of Health Research (II-FS-0110-14061). Drs. Cheng, Abrams, Yu, Wang, and Toh received support for article research from Research Councils UK (RCUK). Drs. Cheng, Yu, and Wang disclosed government work. Dr. Alhamdi has disclosed that he does not have any potential conflicts of interest. For information regarding this article, correspondence via E-mail to: wpylg@hotmail.com; wangg@liverpool.ac.uk; toh@liverpool.ac.uk Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Early detection of diabetic polyneuropathy (DPN)




Early detection of diabetic polyneuropathy using paired stimulation studies of the sensory nerves
Objective This study seeks to use the RRP, a sensitive parameter for detecting early change in peripheral polyneuropathies, as a tool for early detection of diabetic polyneuropathy (DPN). Design The RRP of the median and sural sensory nerves were measured in 57 diabetic patients (male 31, female 26) and 23 healthy controls (male 16, female 7). The shortest inter-stimulus interval, where the latency of the response to the second stimulus recovers to normal, was defined as the RRP. Results The RRP of the median and sural nerves were significantly longer in diabetic patients (3.6 msec, p<0.001 and 3.8 msec, p<0.001, respectively) than in the control group (3.0 msec in both nerves). RRP values of both nerves were also significantly prolonged compared with the control group, even in diabetic patients without DPN based on conventional conduction studies (3.3 msec, p=0.002 for median nerve; 3.5 msec, p<0.001 for sural nerve) or without any clinical symptoms and signs (3.3 msec, p=0.007 for median nerve; 3.5 msec, p=0.001 for sural nerve). Conclusion The RRP was prolonged in diabetic patients even before other electrophysiologic abnormalities or clinical findings appeared. These results suggest that the RRP can be a possible early indicator of DPN. Corresponding author: Hee-Kyu Kwon, M.D., Ph.D Address: Department of Physical Medicine and Rehabilitation, Department of Medicine, Graduate School, Korea University, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea. E-mail: hkkwon@korea.ac.kr Disclosure statements: There is no conflicts of interest and no funding was provided for the study. The abstract of the study was presented at the 46th Annual Meeting of the Korean Academy of Rehabilitation Medicine on Oct. 27th, 2018, in Seoul, Korea. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.


Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Ophthalmology

Vitrectomy versus Phaco-vitrectomy
Ahmed Sulaiman Al-Hinai

Oman Journal of Ophthalmology 2019 12(2):71-72



Android mobile applications in eye care
Siddharth Karuppasamy Karthikeyan, Rajesh Thangarajan, Nagarajan Theruvedhi, Krithica Srinivasan

Oman Journal of Ophthalmology 2019 12(2):73-77

Google Play Store was used to search for eye care-related applications the android simulator using various general terms related to eye care to review and categorize various interactive eye care-related applications in android platform from the details available in the application website. Data collected from application description and application developer&#39;s webpage include target audience, category of apps, estimated number of downloads, average user rating, involvement of eye care professionals in developing the application, and cost of the app. All these data were collected only from the details provided in the application website considering on online user perspective and the developers were not contacted to collect any other details. In total, 475 applications were identified and grouped into 13 categories depending on the type of service the application provide. Out of which, only 107 (22.53&#37;) applications had mentioned about the eye care professional involvement in their design or development of the application. The applications were also stratified according to the target audience, and many had no user rating with very few downloads. The lack of evidence-based principles and standardization of application development should be taken into consideration to avoid its negative impact on the community, especially in eye care. 


The epidemiology of ocular trauma in Northern India: A teaching hospital study
Rajendra P Maurya, Tanmay Srivastav, Virendra Pratap Singh, CP Mishra, Abdullah Al-Mujaini

Oman Journal of Ophthalmology 2019 12(2):78-83

AIM: The aim was to determine the epidemiology of ocular trauma in a large teaching hospital in northern India over 4 years from 2010 to 2014. MATERIALS AND METHODS: This prospective, hospital-based, observational study was conducted at the Ophthalmology and Emergency Outpatient Departments of S. S. Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from March 2012 to February 2016. Detailed history was taken with special consideration to time, place and session of trauma, mode of injury, and type and nature of traumatic agent. All patients were thoroughly examined as per the standard clinical procedures to identify the type, extent, and severity of injury and impact on ocular structure and vision. Follow-up period was 6 months. Statistical analysis was based on age, sex, residence, marital status, occupation, per capita income, type of trauma and nature of damage, etc. RESULTS: Out of 402 patients, 293 (72.9&#37;) were male and 109 (27.1&#37;) were female. Overall male-to-female sex ratio was 2.7:1. Patients were aged between 2 and 70 years (mean: 26.48 &#177; 15.88, median: 23 years). The most vulnerable age group was 6&#8211;15 years (24.38&#37;) followed by 16&#8211;25 years (23.88&#37;). Maximum patients belonged to rural background (61.94&#37;). The extent of ocular trauma was 3.93&#37; (95&#37; confidence interval: 3.23&#8211;4.63). Majority of participants were single (78.11&#37;) and rest were married. About 112 (27.9&#37;) participants were illiterate and 24.4&#37; had primary education only. One hundred and eighty-eight (46.8&#37;) participants belonged to lower and lower middle socioeconomic status. The cases were clustered in Rs. 1000&#8211;5000 per capita income. Most of the injuries occurred in summer season (46.18&#37;) and in afternoon between 12.00 and 17.59 h (48.8&#37;). Majority of trauma occurred away from home (66.20&#37;) mainly on street (28.6&#37;) and playground (9.2&#37;). The most common injury was nonoccupational (82.3&#37;) including sports related (23.9&#37;) and road traffic accident (23.6&#37;). Mechanical injuries were accounted for 89.3&#37; of all eye injuries, and most common source was wooden object (24.9&#37;) followed by metallic objects (20.9&#37;). Traumatic agents were blunt and sharp in 56&#37; and 17&#37; of cases, respectively. Majority of traumatic agents were solid (82.1&#37;). Seven percent of victims were drowsy during trauma and 98.4&#37; of participants were not using any protective device at the time of injury. In 60.7&#37; of cases, time elapsed between injury and treatment was between 1 and 24 h. Around 44.5&#37; had isolated ocular trauma and rest 55.5&#37; were polytrauma cases. Three hundred and sixty-eight (91.5&#37;) participants had unilateral involvement and 8.5&#37; had bilateral involvement. Almost 52.8&#37; had injuries of adnexa and 32.8&#37; had globe injuries. More than half of the study participants had &#8805;3 ocular structure involvement. After 6 months, 14.8&#37; of the right eyes and 25.5&#37; of the left eyes showed poor outcome. CONCLUSION: This study highlights epidemiology of ocular trauma in northern India. Mass health education and awareness about risk of ocular trauma, morbidity caused by delayed presentation, and need to adopt safety or preventive strategies should be focused, especially during travel, playground, and at workplace. 


The feasibility and efficacy of intraoperative laser retinopexy in scleral buckling surgery
Roshija Khanal Rijal, Deepesh Mourya

Oman Journal of Ophthalmology 2019 12(2):84-87

BACKGROUND: This study was performed to assess the feasibility and efficacy of intraoperative laser retinopexy in scleral buckling (SB) surgery. MATERIALS AND METHODS: This was a retrospective, noncomparative, and interventional study. Records of 25 patients who had undergone intraoperative laser retinopexy during SB were retrospectively analyzed. RESULTS: All patients were phakic and macula was off in all cases. Adequate intraoperative laser retinopexy was achieved in 22 (88&#37;) patients, and 3 (12&#37;) patients required additional postoperative laser. Retina was attached in all patients at 6-month follow-up. CONCLUSION: Intraoperative laser retinopexy can give comparable results to cryoretinopexy with lesser postoperative complications in SB surgery. Although further comparative studies are needed, this study establishes the feasibility of intraoperative laser retinopexy in SB which has never been described before in the literature as per our knowledge. 


Sensitivity and specificity of teachers for vision screening among primary school children in South India
R Muralidhar, P Vijayalakshmi

Oman Journal of Ophthalmology 2019 12(2):88-93

AIMS: This study aims to determine the sensitivity and specificity of vision screening by school teachers among primary school children. SETTINGS AND DESIGN: Prospective nonrandomized clinical trial. SUBJECTS AND METHODS: The study was carried in primary school children of Madurai, Tamil Nadu from April 2007 to October 2007. Sixty-five primary school teachers from 57 schools around Madurai, Tamil Nadu, India, underwent a half-day training programme at the hospital. Each teacher on return to the school screened around a hundred children using the tumbling E. All screened children were subsequently screened by a team from the hospital. The optometrists used tumbling E (Snellen&#39;s 20/30 and Early Treatment of Diabetic Retinopathy Study (ETDRS) 20/32) to check the vision of all children. Any child complaining of defective vision or noted to have defective vision on screening underwent a comprehensive ophthalmic evaluation. The sensitivity and specificity of teacher screening was assessed based on the data obtained. RESULTS: Screening was completed for 5150 children. The prevalence of vision &#60;20/30 was 2.82&#37;. Teacher screening was noted to have a sensitivity of 24.8&#37; and a specificity of 98.65&#37;. Tumbling E ETDRS screening by the optometrist had the highest sensitivity of 94.48&#37; and specificity of 97.09&#37;. CONCLUSIONS: Our study shows that vision screening by trained optometrists is a very useful tool to identify visual impairment in primary school children. Measures need to be taken to improve the sensitivity of teacher screening before recommending its generalized use. 


Risk factors for endothelial cell damage in diabetics after phacoemulsification
Niruban Ganesan, Renuka Srinivasan, K Ramesh Babu, Muthukrishnan Vallinayagam

Oman Journal of Ophthalmology 2019 12(2):94-98

Background: To assess the corneal endothelium, central corneal thickness and the factors associated with endothelial cell damage after phacoemulsification in diabetics in comparison with non-diabetics Methods: It was a case control study with 80 eyes each in the diabetic group and the control group. Intraoperative mydriasis, effective phaco time (EPT) and postoperative inflammation were measured. Preoperative, 1st week, 6th week and 3rd month postoperative endothelial cell density (ECD), coefficient of variation (CV), hexagonality and central corneal thickness (CCT) were also measured using Konan noncon robo specular microscope (Model - NSP 9900). Results: In the control group, patients in the age group of 60-69 years were 3.8 times more at risk of ECL compared to patients in the age group of 50-59 years. Patients in whom EPT was &#8805;0.50 min, were 8.8 times more at risk of ECL when compared to patients in whom EPT &#60;0.25 min. In the diabetic group, patients who had an inflammatory score of 1&#43; in the first postoperative week; also had 5.7 times more risk of ECL when compared to patients in whom the inflammatory score was 0.5&#43; in the first postoperative week. There was a significant increase in CV (p-0.03) and CCT (p-0.03), significant decrease in the hexagonality (p-0.01) and no statistically significant difference in the endothelial cell loss (ECL) (p-0.34) in diabetics after phacoemulsification when compared to controls. Conclusion: The present study reveals postoperative inflammation as a risk factor for ECL in diabetics and not intraoperative mydriasis and EPT. 


Twenty-four-month real-world visual outcomes of intravitreal aflibercept as monotherapy for the treatment of neovascular age-related macular degeneration
Thomas Siempis, Mariam El Abiary, Radhika Patel, Manish Gupta

Oman Journal of Ophthalmology 2019 12(2):99-103

BACKGROUND: Aflibercept is widely used as a treatment for neovascular age-related macular degeneration (nAMD). Nevertheless, there is no consensus in the optimal injection frequency in the 2nd year of treatment along with little real-world data on visual outcomes. On that basis, the primary aim of this study was to assess the visual acuity (VA) and the total number of injections needed on average for these patients during the 24-month follow-up. MATERIALS AND METHODS: This is a retrospective observational study from an electronic medical record of consecutive patients treated with intravitreal aflibercept (both na&#239;ve and nonna&#239;ve eyes) who had completed the 24-month follow-up since the commencement of treatment. Patients followed the VIEW protocol in year 1 whereas in year 2, an as required approach/Pro Re Nata (PRN) was used. RESULTS: Eighty-seven eyes of 78 patients were analyzed. 43.7&#37; were nonnaive eyes. Baseline VA for all eyes (logMAR) was 52.6 letters, improving to 56.2 letters at 12 months and 55 at 24 months. Almost 83.9&#37; of the treated eyes (81.3&#37; of the patients) did not experience any significant visual loss receiving on average of 9.9 injections in the 24 months of follow-up and attending the hospital eye service 20.3 times in total. CONCLUSIONS: Aflibercept as monotherapy for the treatment of nAMD is associated with good 2nd year outcomes in a real-world setting using the PRN approach in year 2 and fewer injections comparing to the clinical studies, but a higher proportion of follow-up visits compared to the treat and extend regimen. 


Outcomes of lacrimal gland injection of botulinum toxin in functional versus nonfunctional epiphora
Swati Singh, Akshay Gopinathan Nair, Md Shahid Alam, Bipasha Mukherjee

Oman Journal of Ophthalmology 2019 12(2):104-107

PURPOSE: The purpose of this study is to assess the outcomes of lacrimal gland injections of botulinum toxin A (BoNTA) for epiphora secondary to lacrimal drainage disorders and functional epiphora. METHODS: This was a retrospective interventional case series where cases were divided into functional and nonfunctional epiphora. RESULTS: A total of 37 eyes of 31 patients were identified: 13 males and 18 females. The mean age was 52 years (median &#61; 53, range 29&#8211;86). The functional epiphora group had seven patients (8 eyes), subcategorized into hypersecretion (5), crocodile tears (1), and post seventh nerve palsy (1). Obstructive group (nonfunctional) had 24 patients (29 eyes), subcategorized into proximal canalicular block (12), common canalicular block (6), punctal stenosis (3), posttraumatic nasolacrimal duct obstruction (1), and partial nasolacrimal duct obstruction (1). Median preinjection Munk scores were similar in both groups (Grade 4). At 1 month, the median Munk score improved to 1 and 2 in functional and nonfunctional groups, respectively, after receiving a median dose of 4 units of BoNTA. Median reduction in Munk score was 75&#37; in functional group versus 50&#37; in nonfunctional group (P &#61; 0.07). No difference in terms of complications was noted (transient ptosis). CONCLUSIONS: Reduction in epiphora after lacrimal gland injection of botulinum toxin is seen in cases with functional epiphora as well as those with a physical obstruction in the lacrimal drainage pathway. While the symptomatic improvement was more in functional epiphora, the difference between the two groups was not statistically significant. 


Evaluation of interface reflectivity and corneal aberrations following Descemet's stripping automated endothelial keratoplasty
Hamid Khakshour, Malihe Nikandish, Maryam Salehi, Haleh Ghooshkhanehei, Amirhosein Vejdani

Oman Journal of Ophthalmology 2019 12(2):108-113

PURPOSE: This study aims to evaluate visual outcome after Descemet&#39;s membrane stripping automated endothelial keratoplasty (DSAEK) and relate to interface and corneal higher-order aberrations (HOAs). MATERIALS AND METHODS: We enrolled 16 eyes of 16 patients (eight males and eight females) in this interventional case series and followed DSAEK operation for about two to 20 months. OCULUS Pentacam, as well as other ophthalmic evaluations in follow-up visits, examined interface reflectivity and HOAs. Statistical relations were analyzed. RESULTS: There was statistically significant correlation between interface reflectivity and best corrected visual acuity (BCVA) (r &#61; 0.56, P &#61; 0.021). Pachymetry (central corneal thickness) and BCVA had a moderate correlation (r &#61; 0.6, P &#61; 0.013). There was no statistically significant correlation between pachymetry and follow-up time (r &#61; &#8722;0.36, P &#61; 0.16). Negative correlation between follow-up and interface reflectivity was also not statistically significant (r &#61; &#8722;0.24, P &#61; 0.35). Coma had a significant correlation with BCVA in cornea and cornea front maps (r &#61; 0.74, P &#61; 0.009 and r &#61; 0.71, P &#61; 0.013, respectively). CONCLUSION: Significant correlation between interface reflectivity and BSCVA was found, and anterior corneal HOAs are significantly higher than posterior HOAs. 


Refractive error of Saudi children enrolled in primary school and kindergarten measured with a spot screener
Ziaul Haq Yasir, Nada Almadhi, Salma Tarabzouni, Abdulrahman Alhommadi, Rajiv Khandekar

Oman Journal of Ophthalmology 2019 12(2):114-118

AIMS: To evaluate the refractive status of young Saudi schoolchildren with a &#8220;Spot Screener.&#8221; SUBJECTS AND METHODS: This cross-sectional study was conducted from January to July 2016 in Riyadh, Saudi Arabia. Children of kindergarten (3&#8211;5 years) and grades 1 and 2 (6&#8211;7 years) were screened for refractive error (RE) using the handheld Spot Screener (Welch Allyn, Skaneateles Falls, NY, USA). Data were collected on age, gender, and spectacle use. The pass/fail notation from the Spot Screener and the RE were documented. Children with a &#8220;fail&#8221; were re-tested with an autorefractor (AR). The rate of agreement was evaluated for the spherical equivalent (SE) from the Spot Screener and AR. RESULTS: We examined 300 schoolchildren and 114 preschool children. The prevalence of RE was 22&#37; in schoolchildren and 25&#37; in preschoolers. There were 183 (61&#37;) hyperopes, 110 (36.7&#37;) myopes, 6 (2&#37;) emmetropes, and 29 (9.7&#37;) astigmats (&#62;2 D cylinder) in grade 1 and 2. There were 85 (74.6&#37;) hyperopes, 22 (19.3&#37;) myopes, 7 (6.1&#37;) emmetropes, and 10 (8.8&#37;) astigmats among preschoolers. The SE differed between the AR and the Spot Screener in 17 (28&#37;) children of 61 failed Spot Screener tests. Accommodation (9, 53&#37;) and high astigmatism (8, 47&#37;) were the main underlying causes of the difference. The Spot Screener could identify RE for the first time in 51 (17&#37;) schoolchildren and 26 (22&#37;) preschoolers. End-users suggested that Spot Screener was child-friendly and quick to test RE. CONCLUSIONS: The Spot Screener could be a good initial screening tool for RE in young schoolchildren. 


Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Physical Medicine & Rehabilitation

Painful Foot Disorders in the Geriatric Population: A Narrative Review
Painful foot disorders are highly prevalent among older adults causing a significant impact on mobility, function, and risk of falls. Despite its significance, foot pain is often interpreted as a normal part of aging and relatively ignored by health care providers as well as by the elderly themselves. Accurate diagnosis of the cause of foot pain is possible for most cases via clinical evaluation without a costly workup. Clinicians should consider, not only musculoskeletal pathologies, but also vascular and neurological disorders in older patients with foot pain. Fortunately, a majority of patients improve with physiatric, non-operative interventions involving biomechanical analysis, function oriented rehabilitation programs and therapeutic exercise, the use of proper footwear and orthoses, and selected percutaneous interventions, as indicated. In this review, we discuss the physiologic changes of the aging foot relevant to foot pain, the impact of painful foot disorders on function and other key outcomes, and principles of diagnosis and intervention. We also briefly describe painful foot disorders of the elderly commonly encountered in a physiatric practice. Previous presentation of the data: not applicable Financial support: none Corresponding author: Mooyeon Oh-Park, M.D. Address: Burke Rehabilitation Hospital, 785 Mamaroneck Av, White Plains, NY, 10605, U.S.A. Email: mohpark@burke.org Painful Foot Disorders in the Geriatric Population: A Narrative Review Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Use of Platelet Rich Plasma for the Treatment of Acetabular Labral Tear of the Hip: A Pilot Study
Objective This study aims to assess whether ultrasound guided injection of platelet rich plasma (PRP) can safely and effectively treat symptoms associated with acetabular hip labral tears. Design Institutional Review Board (IRB) approval was gained for a prospective study of eight patients (N=8), who have previously failed conservative management, to receive ultrasound-guided injection of PRP at the site of hip labrum tear. We assessed pain reduction and functional ability at baseline, and then 2, 6, and 8 weeks after injection, using the Visual Analogue Scale (VAS) and Harris Hip Score (HHS), respectively. Results Statistically significant differences in HHS were seen two (86.5 +/- 10.8, p<0.01), six (88.0 +/- 10.7) p<0.01), and eight weeks (92.1 +/- 11.6, p<0.01) after injection as compared to baseline (76.0 +/- 13.4). Corresponding improvements were seen in VAS two (1.0, p<0.01 at rest, 2.5, p<0.01 with activity), six (0.9, p<0.01 at rest, 2.3, p<0.01 with activity), and eight weeks (0.5, p<0.01 at rest, 1.3, p<0.01 with activity) compared to baseline (3.8 at rest, 5.4 with activity). Conclusions Ultrasound-guided injection of PRP holds promise as an emerging, minimally-invasive technique toward symptom relief, reducing pain, and improving function in patients with hip labral tears. Correspondence: Arthur Jason De Luigi, DO, MHSA, 10825 N. 140th Way, Scottsdale, AZ 85259301793-2136. ajweege@yahoo.com Author Disclosures: Arthur Jason De Luigi, DO, MHSA Daniel Blatz, MD Christopher Karam, MD Zachary Gustin, MD Andrew H. Gordon, MD Competing Interests-None for any author Funding or grants or equipment provided for the project from any source-None for any author Financial benefits to the authors-None to any author Details of any previous presentation of the research, manuscript, or abstract in any form: Please note that we have presented this research at both national and local conferences. This research was selected as a Scientific Paper Presentation at the 2015 Association for Academic Physiatrists conference held in San Antonio, Texas. Gordon, A.H., C. Karam, D. Blatz, Z. Gustin, A.J. De Luigi. Administration of Platelet Rich Plasma to Hip Labral Tears Reduces Pain and Improves Function.Scientific Paper (Podium) Presentation, Annual Meeting of the Association of Academic Physiatrists. 2015. Gordon, A.H., C. Karam, D. Blatz, Z. Gustin, A.J. De Luigi. Improved Hip Function and Pain Alleviation after Single Administration of Platelet Rich Plasma for Hip Labral Tears: A Prospective Cohort Study.Oral Poster Presentation, Annual Meeting of the American Medical Society for Sports Medicine. 2015. Gordon, A.H., C. Karam, D. Blatz, Z. Gustin, A.J. De Luigi. Functional Improvement and Pain Reduction after Single Injection of Platelet Rich Plasma for Hip Labral Tears: A Prospective Cohort Study.Poster Presentation, MedStar Health Research Institute Research Symposium. 2015. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

A NEW THRESHOLD FOR APPENDICULAR LEAN MASS DISCRIMINATES MUSCLE WEAKNESS IN WOMEN WITH HIP FRACTURE: A CROSS-SECTIONAL STUDY.
Objective To investigate the relationship between measures of muscle mass and grip strength in women with subacute hip fracture. Firstly, we aimed to assess the capability of the current thresholds for appendicular lean mass (aLM), aLM-to-body-mass-index ratio and aLM/height2 to separate weak and non-weak women. Secondly, we aimed to explore alternative thresholds for the 3 measures of muscle mass to discriminate weakness. Design Cross-sectional study of 160 women with hip fracture admitted to a rehabilitation hospital. We assessed aLM by dual-energy x-ray absorptiometry and grip strength by a Jamar hand dynamometer. Weakness was defined as grip strength <16 kg. Results Weakness was not significantly associated with aLM <15.02 kg, aLM-to-body-mass-index ratio <0.512 or aLM/height2 <5.67 kg/m2. For aLM (but not for the other 2 measures of muscle mass) an alternative threshold (11.87 kg instead of 15.02 kg) significantly discriminated weakness: χ2 (1, n=160)=10.77 (p=0.001). The association between aLM <11.87 kg and grip strength <16 kg persisted after adjustment for age and body mass index: odds ratio =2.50 (95% CI 1.17-5.34; p=0.018). Conclusions Data suggests that the current thresholds for measures of muscle mass do not discriminate weakness in women with subacute hip fracture. For aLM an alternative cutoff-point actually separated weak and non-weak women. CORRESPONDING AUTHOR: Dr. Marco Di Monaco, Osteoporosis Research Center, Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo, Strada Santa Margherita 136, 10131, Torino, Italy. Tel. 0039 011 8199411; Fax 0039 011 8193012; Email Marco.di.monaco@alice.it,m.di-monaco@h-sancamillo.to.it DISCLOSURES: All the authors have no conflicts of interest. The study was not funded. The authors had no financial benefits for the study. The results have not been previously presented. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Letter to the Editor Regarding the Article "Dynamic Ultrasound Imaging for the Diagnosis of Superior Labrum Anterior to Posterior (SLAP) lesion"
No abstract available

Authors' Response to the Letter to the Editor on "Dynamic Ultrasound Imaging for the Diagnosis of Superior Labrum Anterior to Posterior (SLAP) Lesion"
No abstract available

EMG Evaluation of Bodyweight Exercise Progression in a Validated ACL Injury Rehabilitation Program: Cross-sectional Study
Objectives Regaining muscle strength is essential for successful outcome after anterior cruciate ligament (ACL) injury, why progression of exercise intensity in ACL injury rehabilitation is important. Thus, this study evaluated hamstring and quadriceps muscle activity progression during bodyweight exercises used in a validated ACL injury rehabilitation program. Design The study design involved single-occasion repeated measures in a randomized manner. Twenty healthy athletes (nine females) performed nine bodyweight exercises (three exercises per rehabilitation phase). Surface electromyography signals were recorded for hamstring (semitendinosus, biceps femoris) and quadriceps (vastus medialis, vastus lateralis) muscles, and normalized to isometric peak EMG (nEMG). Results Hamstring muscle activity did not increase from one rehabilitation phase to the next, ranging between 8-45% nEMG for semitendinosus and 11-54% nEMG for biceps femoris. Only one exercise (Cook hip lift) exhibited hamstring muscle activities above 60% nEMG. By contrast, quadriceps muscle activity increased, and late phase exercises displayed high nEMG (vastus lateralis >60% and vastus medialis >90% nEMG). Conclusion The examined bodyweight exercises did not progress for hamstring muscle activity but successfully progressed for quadriceps muscles activity. This study highlights the need for consensus on exercise selection when targeting the hamstring muscles in the rehabilitation after ACL injury. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Conflicts of interest None declared. Funding None declared. Corresponding author: Mette Kreutzfeldt Zebis E-mail corresponding author: mzeb@kp.dk Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Differences in the mitochondrial and lipid droplet morphology in female office workers with trapezius myalgia, compared to healthy controls. A muscle biopsy study
Objective Trapezius myalgia, or more specific, myofascial dysfunction of the upper trapezius mainly affects women performing jobs requiring prolonged low level activation of the muscle. This continuous low muscle load can be accompanied by a shift to a more anaerobic energy metabolism, causing pain. To investigate whether morphological signs of an impaired aerobic metabolism are present in female office workers with trapezius myalgia. Design Muscle biopsy analysis, using electron and light microscopy, was performed to compare mitochondrial and fat droplet morphology, and irregular muscle fibers, between female office workers with (n=17) and without (n= 15) work-related trapezius myalgia. Results The patient group showed a significantly higher mean area (P=0.023) and proportion (P=0.029) for the subsarcolemmal and intermyofibrillar mitochondria respectively, compared to the control group. A significantly lower mean area of subsarcolemmal lipid droplets was found in the patient group (P=0.015), which also displayed a significantly higher proportion of lipid droplets touching the mitochondria (P=0.035). A significantly higher amount of muscle fibers with COX deficient areas were found in the patient group (P=0.030). Conclusion The results of the present study may be indicatve for an impaired oxidative metabolism in work-related trapezius myalgia. However, additional research is necessary to confirm this hypothesis. Corresponding author: Kayleigh De Meulemeester Corneel Heymanslaan 10, 9000 Ghent (Belgium) Kayleigh.demeulemeester@ugent.be No conflicts of interest were present in writing this article. Kayleigh De Meulemeester is funded by BOF- UGent 01N04215. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Rehabilitation Research Experience for Medical Students (RREMS): A 10-year review
The purpose of this project was to evaluate the 10-year outcomes from the Rehabilitation Research Experience for Medical Students (RREMS). A target benchmark was 1 high quality output per student. Students were required to devise a research project and work full time with a mentor at an approved sponsor site for 8 weeks. Longitudinal surveys were used to collect data about research outputs, match results, and decisions about whether to pursue academic careers. From 2008 to 2017, 73 out of 153 (48%) applicants were awarded summer externships. Residency match results included: PM&R (45%), Internal Medicine (17%), Emergency Medicine (8%), Orthopedic Surgery (6%), Neurology (6%), Psychiatry (6%), OBGYN (6%), Pediatrics (4%), and Anesthesia (2%). The RREMS was successful in exceeding the target benchmark for quality scholarly output which included 73 oral presentations at the AAP meeting, 63 published and 20 in-review manuscripts directly related to summer research, 5 book chapters, and 51 published and 20 in-review manuscripts that were indirectly related to summer research. A total of 77% reported that the RREMS positively influenced their decision to pursue research in their future career, and 70% endorsed interest in becoming a clinician-scientist. Correspondence should be directed to: Brad E. Dicianno, MD, Human Engineering Research Laboratories, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206, 412-822-3700, (dicianno@pitt.edu) Disclosures: This manuscript has not been published and is not under consideration for publication elsewhere. Data from this manuscript was accepted as part of an abstract to be presented at the 2019 Association for Academic Physiatrists Annual Meeting in Puerto Rico. This project was funded by the Association of Academic Physiatrists, the Foundation for PM&R and the Craig H. Neilsen Foundation. Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Validity of the Montreal Cognitive Assessment for Moderate to Severe Traumatic Brain Injury Patients: A Pilot Study
Objective To pilot the use of Montreal Cognitive Assessment (MOCA) as a quick clinical screen for cognitive assessment in traumatic brain injury (TBI) patients. Design The study recruited 61 participants with moderate to severe TBI presenting to a tertiary rehabilitation center under the Brain Injury Program. A MOCA questionnaire and neuropsychological battery (Repeatable Battery for the Assessment of Neuropsychological Status [RBANS] and Color Trails Test[CTT]) were administered to participants who had completed inpatient rehabilitation. Results Receiver Operating Characteristic (ROC) analysis for the MOCA revealed an optimal balance of sensitivity and specificity at 24/25 to discriminate participants who were classified as less than 5th centile on the Total Scale Index on the RBANS. This achieved a sensitivity, specificity, PPV and NPV of 73.9%, 86.5%, 77.3% and 84.2% respectively. ROC analysis for the trail making subtest of the MOCA achieved a sensitivity, specificity, PPV and NPV of 79.4%, 74.1%, 79.4% and 74.1% in identifying patients classified as less than 5th centile on CTT Part 2. Conclusion The use of MOCA displayed good validity in identifying patients with clinically significant impairment on a standard neuropsychological assessment battery in the study population. However, it may lack sensitivity for estimating mild levels of impairment. All correspondence and requests for reprints should be addressed to: Matthew Rong Jie Tay, Tan Tock Seng Hospital Rehabilitation Center, c/o TTSH Rehabilitation Center @ Ang Mo Kio-Thye Hua Kwan (AMK-THK), 17, Ang Mo Kio Ave 9, Singapore 569766, Republic of Singapore. The authors confirmed that with regard to this submitted article, we have none of the following disclosures: competing interests, funding or grants or equipment from any source, and financial benefits to the authors, nor have we previously published any part or whole of this original work. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Early detection of diabetic polyneuropathy using paired stimulation studies of the sensory nerves
Objective This study seeks to use the RRP, a sensitive parameter for detecting early change in peripheral polyneuropathies, as a tool for early detection of diabetic polyneuropathy (DPN). Design The RRP of the median and sural sensory nerves were measured in 57 diabetic patients (male 31, female 26) and 23 healthy controls (male 16, female 7). The shortest inter-stimulus interval, where the latency of the response to the second stimulus recovers to normal, was defined as the RRP. Results The RRP of the median and sural nerves were significantly longer in diabetic patients (3.6 msec, p<0.001 and 3.8 msec, p<0.001, respectively) than in the control group (3.0 msec in both nerves). RRP values of both nerves were also significantly prolonged compared with the control group, even in diabetic patients without DPN based on conventional conduction studies (3.3 msec, p=0.002 for median nerve; 3.5 msec, p<0.001 for sural nerve) or without any clinical symptoms and signs (3.3 msec, p=0.007 for median nerve; 3.5 msec, p=0.001 for sural nerve). Conclusion The RRP was prolonged in diabetic patients even before other electrophysiologic abnormalities or clinical findings appeared. These results suggest that the RRP can be a possible early indicator of DPN. Corresponding author: Hee-Kyu Kwon, M.D., Ph.D Address: Department of Physical Medicine and Rehabilitation, Department of Medicine, Graduate School, Korea University, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea. E-mail: hkkwon@korea.ac.kr Disclosure statements: There is no conflicts of interest and no funding was provided for the study. The abstract of the study was presented at the 46th Annual Meeting of the Korean Academy of Rehabilitation Medicine on Oct. 27th, 2018, in Seoul, Korea. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Alexandros Sfakianakis
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