Management, risk factors and treatment outcomes of rhegmatogenous retinal detachment associated with giant retinal tears: scoping review

BACKGROUND

Rhegmatogenous retinal detachment (RRD) is a serious condition that occurs when the retina detaches from its underlying retinal pigment epithelium. RRDs associated with giant retinal tears (GRTs) are caused by retinal tears at least 90° or one-quarter of the circumferential extent. This scoping review systematically identifies and summarizes clinical studies evaluating surgical techniques for the management of GRT-related RRDs, discusses functional and visual outcomes and the risk factors affecting treatment outcomes.

METHODS

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Google Scholar, and Springer Link databases were searched for relevant papers (from January 2001 to March 2023). Studies that were published in the English language and reported the risk factors, management, and treatment outcomes of GRT-related RRDs were included in the review. The outcome measures included anatomic success rates, changes in BCVA (logMAR) from baseline to the final follow-up, and adverse events.

RESULTS

A total of 11,982 articles were identified. After the title and abstract review, 71 studies were deemed eligible for full-text review. Thirty-six studies that met the eligibility criteria were included in the final review. Four surgical techniques were identified: pars plana vitrectomy (PPV), combined PPV and scleral buckling, scleral buckling alone, and pneumatic retinopexy. Various types of tamponades, including gas, silicone oil, and air, have been used. PPV was the most commonly used surgical technique in 33.1-100% of patients. Among the 20 studies that used PPV alone, 17 were associated with preoperative PVR. In addition, scleral buckling alone or in combination with PPV was reported as a treatment option in 10 studies, with 2-100% of patients experiencing scleral buckling alone and 13.6-100% experiencing combined PPV and complementary scleral buckling. Primary anatomic success (PAS) was achieved with retinal reattachment via a single operation with no residual tamponade, whereas final anatomic success (FAS) was achieved via more than one operation with no residual tamponade. Reported single surgery anatomic success (SSAS) rates range from 65.51 to 100%. The preoperative best-corrected visual acuity (BCVA) ranged from 0.067 to 2.47 logMAR, whereas the postoperative BCVA ranged from 0.08 to 2.3 logMAR. An improvement in visual acuity was observed in 29 studies. Cataracts (3.9-28.3%) were the most common postoperative complication, followed by high IOP (0.01-51.2%) and PVR (0.8-31.57%).

CONCLUSION

PPV is the most common surgical technique, and currently microincision vitrectomy surgery (MIVS) systems are commonly employed. Silicone oil is the most frequently used tamponade in RRD repair. Risk factors for GRT-related RRD include age, sex, lens status, high myopia status, proliferative vitreoretinopathy (PVR), presenting visual acuity, the extent of the GRT and retinal detachment, and macular involvement. Future research areas include guidelines to reduce variability in the reporting of surgical methodology, choice of tamponades, and reporting of functional and visual outcomes to inform the best therapeutic interventions in GRT-related RRD.

Over-the-counter use of short-acting beta-2 agonists: a systematic review

BACKGROUND

The widespread use of short-acting beta-2 agonists (SABA) as an as-needed treatment for asthma is well-established. However, excessive use of SABA has been linked to undesirable outcomes such as increased risk of asthma attacks, exacerbations, and even death. The availability of SABA as an over-the-counter (OTC) medication has contributed to their overuse, leading to undertreated asthma and reduced access to asthma education.

OBJECTIVE

This systematic review aimed to summarize the prevalence, characteristic features of, and factors contributing to over-the-counter SABA purchase or overuse.

METHODS

The databases searched included PubMed, Scopus, Springer Link, Google Scholar, CINAHL, and APA PsycArticles. Original research articles reporting the prevalence, characteristics features, and factors regarding over-the-counter SABA use, available as full text, published in English language between the year 2000 and April 2023 were included in this review. Commentaries, letters to editor, review articles, qualitative studies, clinical trials, and conference proceedings were excluded. Data extraction was followed by a review of the quality of studies included and data were then synthesized for meaningful findings. This systematic review had been registered in the PROSPERO with registration number CRD42023421007.

RESULTS

A total of 18 articles were included. The prevalence range of OTC SABA users in populations were 1.4% to 39.6% and SABA over-users among OTC users were 14% to 66.4%. Factors mostly associated with this behavior were moderate-severe asthma, and less use of preventers. On top of that, not understanding the risk of SABA overuse was clear in many studies that explored this factor.

CONCLUSION

Over-the-counter purchase and overuse of SABA medication is a common problem, leading to adverse consequences such as uncontrolled asthma and increased healthcare utilization. Addressing these issues requires improved patient education about their conditions and adequate information regarding the potential long-term effects of SABA use by the healthcare providers. Management and education of asthma patients, including regular monitoring and follow-up, can help reduce overuse of SABA medication and prevent negative consequences.

Perceptions, attitudes, and behaviors of asthma patients towards the use of short-acting β2-agonists: A systematic review

BACKGROUND

Short-acting β2-agonists (SABA), the most potent and rapid-acting relievers are commonly used to provide quick relief of asthma symptoms. However, there is an increasing concern regarding the misuse of SABA medicines.

OBJECTIVE

This qualitative systematic review aims to determine, evaluate, and summarize the perceptions, attitudes, and behaviors towards the use of SABA from the patients' perspectives.

METHODS

The databases searched included PubMed, Scopus, PsycINFO, CINAHL, and Cochrane database. Original research articles reporting the perceptions, attitudes, or behaviors of asthma patients towards the use of SABA, which was available as full text, published in the English language between the year 2000 and February 2023 were included in the review. Commentaries, letters to editor, review articles, and conference proceedings were excluded.

RESULTS

A total of five articles were included. Six overarching themes were obtained: (1) perceptions on health status; (2) perceptions and attitudes towards the impact of asthma; (3) perceptions towards asthma control; (4) perceptions towards asthma knowledge; (5) risk perceptions; (6) perceptions, attitudes, and behaviors towards the use of SABA.

CONCLUSION

Despite the fact that SABA could rapidly alleviate asthma symptoms, SABA over-users were less likely to describe their health status and asthma control as 'excellent'. Most SABA over-users did not know that frequent SABA usage would worsen their asthma control, and they exhibited psychological linkage towards the use of SABA. Collaborative efforts between policymakers, healthcare professionals and patients are warranted to reconstruct SABA prescribing practice and usage.

Remedial Aspect of Zinc Oxide Nanoparticles Against Serratia Marcescens and Enterococcus Faecalis

Zinc oxide nanoparticles (ZnO NPs) have been widely used in biomedical applications due to their high biocompatibility and low toxicity to humans. The present work aimed to investigate the antibacterial effects of different concentrations of ZnO NPs on two opportunistic pathogens, Serratia marcescens and Enterococcus faecalis. The surface interaction between nanoparticles and bacterial cell wall, and the subsequent morphological alterations on the bacterial surface, were examined through Fourier transform infrared spectroscopy and scanning electron microscope. The energy dispersive X-ray analysis was used to confirm the elemental composition of ZnO NPs and the cellular accumulation of ZnO NPs in bacteria. The growth-inhibitory test demonstrated a dose-dependent growth inhibitory effect of ZnO NPs against both the test bacteria, as the higher concentration of nanoparticles caused the higher bacterial growth inhibition. The results showed that ZnO NPs caused a higher growth inhibition (63.50 ± 2.50%) on the Gram-positive bacterium E. faecalis compared to the Gram-negative bacterium S. marcescens (51.27 ± 4.56%). Fourier transform infrared spectrum revealed the possible involvement of hydroxyl, carboxyl, amides, methylene, and phosphate groups from the biomolecules of bacterial cell wall such as proteins, carbohydrates, lipids, and phospholipids in the interaction of ZnO NPs on bacterial cell surface. Energy dispersive X-ray analysis showed the higher accumulation of ZnO NPs in E. faecalis than S. marcescens analogous to the bacterial growth inhibition. Scanning electron microscopy images confirmed the antibacterial properties of ZnO NPs, showing the loss of integrity of cell membrane and distortion of bacterial cells. Hence, the potential of ZnO NP as an antibacterial agent against S. marcescens and E. faecalis has been confirmed.

Treatment of lumbar intervertebral disc protrusions by manipulation

From 1975 through 1983, a total of 517 patients with protruded lumbar discs were admitted for manipulative treatment. Of these, 76.8% had satisfactory results. There were 73 recurrences (14.1%) at intervals ranging from two months to 12 years. Forty-seven cases did not respond to manipulation. These results indicate that manipulation of the spine can be effective treatment for lumbar disc protrusions. In general, the manipulation consists of eight maneuvers in three positions. The selection of the appropriate maneuvers depends on the patient's symptoms and signs and on the judgment and expertise of the operator. Practice is necessary to become proficient in spinal manipulation techniques. Several mechanisms of regression lumbar disc protrusions are possible.