Factors predicting screen time related to physical and behavioural complaints in primary school children

BACKGROUND AND OBJECTIVE

Physical and behavioural problems from extended usage of electronic devices are issues among primary school children. This study is aimed to investigate the prevalence of physical and behavioural complaints arising from the electronic device usage and to identify the potential factors that predicted the complaints.

METHODS

This was a primary school-based cross-sectional study using multistage cluster sampling, conducted at Bau district in Sarawak, Malaysia in 40 primary schools. A questionnaire was used to collect information of usage pattern in insufficient lighting, timing and position. The physical and behavioural complaints were traced. Data analysis was performed using SPSS version 22. A p-value < 0.05 with 95% CI was considered as statistically significant.

RESULTS

About 52.8% of the 569 students used digital devices in a bright room, 69.8% in the day time and 54.4% in sitting position. The physical complaints were headache (32.9%), neck, shoulder and back pain (32.9%) followed by by eye strain (31.8%). Regarding behavioural problems, 25.7% of the students had loss of interest in study and outdoor activities (20.7%), skipped meals (19.0%) and arguments/disagreements with parents (17.9%). After logistic regression analysis, the lying position (OR=1.71, 95% CI: 1.096, 2.688) and darkroom lighting (OR=2.323 95% CI: 1.138, 4.744) appeared to be potential predictors of the complaint.

CONCLUSION

One-quarter of the students studied experienced physical complaints, and one-fifth had behavioural problems associated with the use of electronic devices. Lying position and darkroom lighting are the potential predictors of complaints. Therefore, we suggest that the children should use electronic devices in the sitting position with adequate room lighting.

Wavelength-tunable single longitudinal mode fiber optical parametric oscillator

We demonstrate a ring cavity single longitudinal mode fiber optical parametric oscillator using a passive sub-ring cavity and an unpumped erbium doped fiber configured with an external fiber mirror for single mode selection. The unpumped erbium doped fiber uses its saturable absorption characteristic to generate a self-induced narrowband filter when two counter-propagating waves interfere inside the fiber. A single longitudinal mode laser is obtained with a linewidth of 17.35 kHz at a pump power of 31.2 dBm. A 3.8 nm tuning range from 1536.5 nm to 1540.3 nm is achieved with a signal-to-noise ratio of about 60 dB. The power stability of the single longitudinal mode laser is 2.07 dB over a period of 30 minutes.

Extended nonlinear parametric process in anomalously pumped linear cavity oscillator

We demonstrate a linear cavity fiber optical parametric oscillator with extended pump-signal separation of 14.3 THz (116 nm). The signal laser is provided by a pair of 1675nm fiber Bragg gratings and a tunable idler from 1456.12 nm to 1462.48 nm is generated by detuning the pump wavelength in the anomalous dispersion regime of a highly nonlinear fiber. At such large pump-signal separation, we are still able to record a parametric conversion efficiency of more than -35 dB and idler optical signal-to-noise-ratio of 50 dB on average. The stability of the lasing signal and idler is examined and result shows both signal and idler peak power fluctuation is less than 1 dB over a period of 30 minutes.

Harvesting keratolimbal allografts from corneoscleral buttons: a novel application of cyanoacrylate adhesive

AIM

To describe an alternative and novel technique using cyanoacrylate glue to achieve successful limbal tissue dissection, from an organ culture media stored corneoscleral button, without an artificial anterior chamber.

METHODS

A donor corneoscleral button (leftover from penetrating keratoplasty) was divided into two equal semicircular halves. A thick layer of tissue adhesive (N-butyl-2-cyanoacrylate) was spread on a sterile rubber block (the under surface of the donor punch). One half of the donor corneoscleral rim was placed epithelial side up on the adhesive and allowed to attach firmly to the block. This composite provided stability to the donor rim allowing lamellar dissection of the limbal tissue to be performed without damaging the limbal epithelium.

RESULTS

Regular, partial-thickness limbal tissue was obtained. There was no histological evidence of glue or cellular toxicity of the harvested limbal stem cells. This harvested tissue had been grafted successfully in patients with limbal stem cell deficiency also undergoing keratoplasty.

CONCLUSIONS

Tissue adhesive can be a simple, effective and useful tool in the dissection and harvesting of corneal limbal stem cell allografts from corneoscleral buttons stored in organ culture media.

An eye on sexually transmitted diseases: sexually transmitted diseases and their ocular manifestations

Ocular examination should be a part of the routine assessment of the patients seen at sexually transmitted diseases (STD) clinics due to the importance of these organs in the general wellbeing of patients. It is essential to keep an open eye on ocular signs and symptoms of patients with a history of exposure to common STD pathogens, to ensure prompt investigation and management of ocular complications of the STDs, which, if left unnoticed, otherwise could subject the patients to a great deal of anxiety and distress.

What you can see in your patient's eyes? Review of ocular manifestations of HIV in HAART era

The early diagnosis and treatment of ocular disease to prevent morbidity and mortality of patients with human immunodeficiency virus (HIV) is of paramount importance. Since the advent of highly active antiretroviral therapy (HAART), the incidence of ocular complications of HIV has decreased and their manifestations and natural course are also modified. This has been observed in the face of emerging immune recovery, which per se has brought new difficulties in the process of diagnosing and management of the ocular disease. Conditions such as immune recovery uveitis could affect eyes with history of opportunistic disease with a potential to cause vision loss; with this regard, differentiation of the inflammatory process from infective causes is essential. The other sexually contracted diseases are also to be included in this complex picture because of their contribution to the clinical picture and also sharing common routes of transmission with HIV. There is very little doubt that visual deterioration would further deteriorate the already compromised quality of life of this group of patients. In this review, authors wish to provide evidence available in the medical literature around the visual health issues in HIV-infected patients and raise awareness towards the changing pattern of the ocular disease in the HAART era.

Therapeutic deep lamellar keratoplasty for corneal perforations

OBJECTIVES/AIMS

Corneal perforation can be potentially blinding unless the integrity of the globe is restored quickly. Although penetrating keratoplasty (PK) may achieve this, it carries a high risk of endothelial rejection in inflamed eyes. Deep lamellar keratoplasty (DLK) may be an alternative option to PK in such eyes owing to its potential for a lower incidence of rejection. We report the efficacy of DLK in patients with corneal perforations.

PATIENTS AND METHODS

Four patients underwent layer-by-layer DLK for noninfective corneal perforation, after measures such as the use of a bandage contact lens, tissue adhesive, and conjunctival pedicle flap had failed. The preoperative visual acuity was hand movements in one patient, 1/60 in two, and 6/60 in one. All four had iris incarcerated within the corneal perforations. SF6 gas (three patients) and air (one patient) were injected into the anterior chamber at the end of surgery.

RESULTS

The integrity of the globe was restored in all four patients with an improvement in visual acuity (6/60 in one and 6/36 or better in three). The mean follow-up time was 7 months. All four patients had clear corneas 3 months postoperatively, apart from the area of the original perforation. There was no recurrence of ulceration or perforation.

CONCLUSION

DLK is a safe and effective therapeutic measure in the management of patients with corneal perforations acting to preserve the integrity of the globe and restore vision.

Management and outcome of sight-threatening diabetic retinopathy in pregnancy

AIMS

To report the management and outcomes of sight-threatening diabetic retinopathy in pregnancy.

METHODS

A retrospective review of 8 diabetic females who developed pregnancy related sight-threatening diabetic retinopathy requiring treatment over a 12-year period.

RESULTS

In total, 16 eyes of eight patients were included in this series. The mean age of the patients at presentation was 30.75 years +/-3.8 SD and the mean duration of diabetes was 21.0 years +/-5.1 SD. The mean follow-up period was 46.75 months +/-47.2 SD. A total of 87.5% of patients showed progression of diabetic retinopathy during pregnancy, 71% of which were in the sight-threatening proliferative category. In the postpartum period, 81% of patients continued to progress to proliferative diabetic retinopathy, requiring panretinal photocoagulation and multiple other surgical procedures. In all, 69% of eyes retained visual acuity equal to or better than 0.3 logMAR units (6/12).

CONCLUSION

Sight-threatening diabetic retinopathy in pregnancy is a rare disease, but it can have devastating consequences for mother and child. Laser photocoagulation should be considered for pregnant women with severe preproliferative diabetic retinopathy. Proliferative diabetic retinopathy may not regress postpartum. Close followup should be extended in the postpartum period in this group of patients until the retinopathy is stabilised. The presence of combined rhegmatogenous and tractional retinal detachment and neovascular glaucoma were associated with the worst outcome.

Microencapsulation of oils using sodium alginate

The feasibility of encapsulating wheatgerm oil and evening primrose oil using sodium alginate by the emulsification method was explored in this study. It is based on the chemical reaction between the water-soluble sodium alginate and polyvalent cation, calcium, to form the water-insoluble alginate. The factors investigated were the physical appearance of the microspheres, the amount of oil that could be encapsulated, the flow property, size distribution and mean size of the microspheres produced. Encapsulation efficiency and oil content of wheatgerm oil increased with an increase in oil load. The mean size of the microspheres increased sharply at a high oil load of 250% w/w. Photographs of microspheres taken showed that the microspheres were larger, spherical and had more vesicles within, as oil load increased. Encapsulation efficiency of evening primrose oil microspheres was similar to wheatgerm oil microspheres at the respective oil loads of 50, 250 and 350% w/w. The emulsification method developed was successfully applied to wheatgerm oil, a fixed oil, with a maximum encapsulation efficiency of approximately 88%. It was satisfactory for evening primrose oil, which also belongs to the family of fixed oils.

Quantification of the surface morphologies of lactose carriers and their effect on the in vitro deposition of salbutamol sulphate

Application of the scanning probe microscopy technique for quantitative measurement of the surface roughness of lactose carriers was evaluated. The roughness values of four different lactose carriers were related to the in vitro deposition results of the drug, salbutamol sulphate. The rugosity values of the lactose carriers were represented by Ra values which were in the order of DCL-40>DCL-11>lactose 325M>lactose 200 M. In vitro deposition results using a twin impinger showed that rougher carrier surfaces generally allowed more drug particles to be emitted from the capsules and inhaler but the availability of the drug to stage 2 was reduced, as detachment of drug particles from the carrier surfaces was more hindered. There was an optimum Ra value for greater delivery of the drug particles to stage 2 of the twin impinger. A balance between adherence and detachment of the drug from the carrier surface was needed in order to optimize the delivery of a drug to the desired target sites using a dry powder inhaler.

The necessity of mandatory exploration of penetrating zone II neck injuries

To reevaluate the validity of our policy of mandatory surgical exploration of penetrating zone II neck injuries, the charts of 110 patients who underwent surgical exploration for such injuries were reviewed. Fifty-three percent of the patients had normal findings at exploration, whereas 33% had injuries involving vascular structures of the neck and 14% had nonvascular injuries. Injuries were not suspected on clinical grounds preoperatively in 23% of the patients in whom surgical exploration revealed injury. The injuries most likely to escape preoperative diagnosis were isolated venous injuries and isolated pharyngoesophageal injuries. Arteriography yielded false-negative results in two arterial injuries. No deaths and only a 5% incidence of minor complications occurred in the group with no injuries detected at exploration. We conclude that surgical exploration of penetrating zone II neck injuries is safe and appropriate.

Results of venous reconstruction after civilian vascular trauma

The treatment of venous injuries remains controversial. In an attempt to evaluate the results of current management of venous injuries, we retrospectively reviewed our experience between 1979 and 1984. During this period 142 patients had sustained injuries to 158 veins in the neck (31 patients), abdomen (45 patients), upper extremity (20 patients), and lower extremity (62 patients). Overall, 90 venous injuries (61%) were repaired, including 83% of caval and iliac vein injuries and 90% of injuries to the common femoral, superficial femoral, and popliteal veins. There was no morbidity after repair of 73 major veins. Morbidity occurred in four of 11 patients after ligation of major veins (edema in two patients and above-knee amputation in two others). Both ligation (N = 51) and repair (N = 17) of lesser veins (jugular, brachial, profunda femoral, tibial, and minor abdominal veins) resulted in no morbidity. Overall mortality was 6% with all deaths occurring in patients with abdominal venous trauma. These data indicate that repair of venous injuries can be performed without morbidity and that minor veins can be ligated without adverse sequelae. However, in view of the morbidity associated with ligation of major veins, efforts to restore flow to these injured vessels appear appropriate unless contraindicated by life-threatening injury.

Improved results in the treatment of civilian vascular injuries associated with fractures and dislocations

Patients with vascular injuries associated with fractures or dislocations of the extremities were managed according to a standard protocol, which included the liberal use of preoperative arteriography, early fasciotomy when indicated, individualization of timing and type of orthopedic procedures, arterial reconstruction primarily with interposition reversed saphenous vein grafts, repair of major venous injuries, routine completion arteriography, and regular postoperative monitoring of Doppler-derived ankle/brachial indices. Adherence to these principles led to a limb salvage rate of 97% in 38 patients with such injuries.

Optimal limb salvage in penetrating civilian vascular trauma

To evaluate current treatment of peripheral vascular trauma, we reviewed our recent experience with noniatrogenic penetrating vascular injuries of the extremities. Between 1979 and 1984, 139 patients sustained 204 vascular injuries inflicted by single gunshots (64%), stabbings (24%), and shotguns (12%). Eighty-four percent of patients underwent preoperative arteriography, which revealed occult arterial injury in 13 patients (9%). Compartmental hypertension necessitated fasciotomy in 19% of patients and was required more often after combined arterial and venous injuries (29%) than after isolated arterial injury (14%). Arterial continuity was restored by interposition grafting with reversed saphenous vein (62%), end-to-end anastomosis (19%), vein patch angioplasty (8%), or primary repair (4%). After arterial repair, completion angiography detected the need for revision in 8% of patients. Arterial ligation was performed in 7% of injuries and was only used in the treatment of tibial and distal profunda femoris injuries. Forty-five percent of patients sustained concomitant venous injury; 64% of all venous injuries and 90% of femoropopliteal venous injuries were repaired. No deaths occurred, and a single patient required amputation. We conclude that a protocol of preoperative arteriography, liberal. use of fasciotomy, frequent use of autologous interposition grafts, repair of major venous injuries, and routine use of completion arteriography can result in limb salvage rates that approach 100% after penetrating vascular trauma to the extremities.

Peripheral vascular trauma from close-range shotgun injuries

This report summarizes an eight-year experience (1976 to 1983) with 49 close-range shotgun blasts with associated major vascular injuries seen in a large urban hospital. Injuries to the upper extremity (40%), lower extremity (56%), and neck (4%) were seen. A high frequency of associated deep venous injury (82%), nerve injury (37%), fracture (33%), massive soft-tissue loss (43%), and compartmental hypertension (39%) was observed. There were no deaths in this series, and the limb salvage rate was 96%. Neither patient with multiple carotid artery injuries suffered a neurologic deficit. We attribute our success in the management of these complex injuries to rapid fracture immobilization, early and aggressive use of fasciotomy, adequate débridement of devitalized tissue, repair of deep venous injuries, arterial repair with autogenous tissue, and extra-anatomic bypass grafting in selected cases.

The treatment of cerebral ischemia by external carotid artery revascularization

Thirteen patients with internal carotid artery occlusion and symptomatic external carotid artery stenosis underwent external carotid artery revascularization by means of endarterectomy (n = 10) or subclavian artery--external carotid artery bypass (n = 3). All patients but one were followed up, for five to 46 months (mean, 20 months). There were no operative deaths or complications and no late strokes. One patient (7.7%) required early extracranial-intracranial (EC-IC) bypass for failure of the external carotid artery endarterectomy to relieve the initial symptoms. All remaining patients were completely (n = 9) or partially (n = 2) relieved of symptoms, and EC-IC bypass was not required. There were no criteria identified by either oculopneumoplethysmography or angiography that could reliably predict the need for subsequent EC-IC bypass. Ninety-two percent of the patients were adequately treated with external carotid artery revascularization alone, suggesting that subsequent EC-IC bypass is seldom required in patients with ipsilateral internal carotid artery occlusion and external carotid artery stenosis.

The effect of carotid siphon stenosis on stroke rate, death, and relief of symptoms following elective carotid endarterectomy

It has been suggested that carotid endarterectomy for carotid bifurcation disease may be contraindicated in the presence of carotid siphon lesions. This study was undertaken to assess any difference in stroke rate, mortality, or relief of symptoms in patients with and without such "tandem" lesions following elective carotid endarterectomy. Ninety-one bifurcation endarterectomies were performed in 79 patients. The patients were divided into two groups. Group I (44 patients, 47 endarterectomies) had carotid bifurcation stenosis only; group I (35 patients, 44 endarterectomies) had siphon stenosis plus bifurcation stenosis. All patients in both groups who were symptomatic before operation were relieved of their symptoms. In group I there were no intraoperative or perioperative strokes, four late strokes (8.7%), one operate death (2.1%), and no late deaths. Group II patients had two intraoperative strokes (4.5%), three perioperative strokes (6.8%), two late strokes (5.1%), four operative deaths (9.1%), and three late deaths (7.5%). Eighteen of the 35 patients in group II had a greater degree of carotid siphon stenosis than bifurcation stenosis. In this subgroup, there was one operative stroke (5.6%), only perioperative stroke (5.6%), one late stroke (5.9%), one postoperative death (5.6%), and one late death (5.6%). None of these differences were statistically significant. Relief of symptoms was the same in patients with and without tandem carotid lesions, and there was no significantly increased risk of stroke or death following bifurcation endarterectomy in patients with tandem carotid lesions.

Intraoperative assessment of limb revascularization by Doppler-derived segmental blood pressure measurements

Prompt recognition and correction of technical errors in vascular procedures in the lower extremities decreases patient morbidity and improves the chances for successful revascularization. A simple, versatile technique for intraoperative hemodynamic assessment of lower extremity revascularization procedures is described. Salient features include ability to detect and correct technical errors without reoperation and its associated morbidity, use of commonly available, inexpensive equipment, and ease of performance without involvement of either specifically trained or inexperienced personnel.

Elimination of iatrogenic impotence and improvement of sexual function after aortoiliac revascularization

One hundred ten men who underwent revascularization for aortoiliac occlusive disease by either aortic reconstruction (n = 66), crossover femorofemoral bypass (n = 38), or axillofemoral bypass (n = 6) were examined with regard to preoperative and postoperative sexual function. Aortic reconstructions were performed using a nerve-sparing technique, and special emphasis was placed on preservation or improvement of pelvic blood supply. Thirty patients (27%) were impotent preoperatively and postoperatively, 67 patients (61%) had normal sexual function preoperatively and postoperatively, and 13 patients (12%) who were impotent preoperatively regained sexual function as a result of revascularization, indicating that 30% (13/43) of all patients with preoperative impotence regained sexual function. No patient with normal preoperative sexual function was impotent postoperatively. Nerve-sparing aortic dissections, attention to preservation or improvement of pelvic blood flow, and, when appropriate, extra-anatomic bypass are essential in the preservation or improvement of sexual function after aortoiliac revascularization.

Anatomic and hemodynamic evaluation of percutaneous transluminal angioplasty

Of 34 balloon angioplasties of the lower extremity performed during a two year period, 29 were observed for three to 21 months. Hemodynamic measurements were performed preangioplasty, immediately postangioplasty and at three month intervals thereafter. Immediately, postangioplasty arteriograms were performed upon all patients. Late follow-up arteriograms were obtained for selected patients. Immediate anatomic success was achieved in 93 per cent of procedures, but early hemodynamic improvement occurred in only 62 per cent of the angioplasty procedures. At a mean follow-up time of nine months, continued success was noted in only 48 per cent of the procedures. Late failure with iliac artery procedures was demonstrated in only 18 per cent of the patients, while, in femoropopliteal angioplasty, late failure occurred in 50 per cent of the procedures. The results of this study and of others indicate that femoropopliteal balloon angioplasty in not a durable procedure. The durability of iliac artery angioplasty requires further evaluation.

Popliteal artery trauma. 31 consecutive cases without amputation

Injury to the popliteal artery is the most common cause of amputation in injured extremities. A six-year experience (1974-1979) at Cook County Hospital, Chicago, involved 31 popliteal artery injuries without amputation. Penetrating trauma was the most frequent cause of injury; however, a considerable number of blunt trauma injuries with fractures and dislocations were also present. Prolonged ischemic time was not a deterrent to successful vascular reconstruction. The recognition of compartmental hypertension and performance of fasciotomy before vascular repair were credited as major factors in our success. The use of interposition saphenous vein graft in the arterial reconstruction, repair of concomitant popliteal vein injuries, initial bone fixation of fractures with external fixators, and the performance of intraoperative arteriography were all important steps taken to ensure a 100% limb salvage.

Jejunoaortic fistula from ingested seamstress needle

A 27-year-old man was evaluated for sudden onset of massive hematemesis and hematochezia. A bleeding site was not seen on esophagogastroduodenoscopy. There was little blood in the stomach, which suggested that the bleeding site was below the ligament of Treitz. Angiography demonstrated the presence of an intra-aortic metallic foreign body that resembled a sewing needle. At operation, a chronic jejunoaortic fistula that contained the sewing needle was found and repaired. The patient had no recollection of having swallowed the needle, and it is presumed that he ingested it in infancy. He had an uneventful recovery.

The therapy of peripheral vascular ulcers--surgical management

Venous ulcers are a common malady of the civilized world. The etiology and its pathogenesis has been presented for a better understanding of its appropriate therapy. A conservative and surgical approach is necessary for effective treatment, of which the final goal is to reduce ambulatory venous hypertension and the prevention of venous ulcer formation. An effective regime of elastic support, periodic leg elevation and surgery for incompetent perforators is highly rewarding. The good results in the use of dextranomer for highly exudative ulcers have also been presented as another adjunct in the local care of venous ulcers.

Penetrating trauma of the neck

Two hundred forty-six patients admitted to the Trauma Unit of Cook County Hospital with penetrating neck wounds have been reviewed. A policy of mandatory neck exploration combined with a systematic approach to resuscitation and a diagnostic evaluation including neck and chest X-rays, endoscopy, and arteriography has been employed. The study has revealed a high incidence of negative neck explorations (63%) but minimal morbidity (less than 1%), no mortality, and a brief duration of hospitalization in the negative exploration group. Patients with positive explorations had an 8% morbidity and a 9% mortality rate. In addition, 13 of the patients with positive explorations had clinically negative wounds which might have been overlooked if selective management had been utilized in this series. We conclude that a policy of mandatory neck exploration is justified and advisable for patients sustaining penetrating neck injuries.