The aim of this study was the comparison of recurrence rates of pterygia following different surgical methods. Twenty-one patients were operated by the bare sclera technique, with the application of ...mitomycin C (0.25 mg/ml for 2 min). Twenty-seven patients were operated by limbal stem cell transplantation. The third group contained 13 patients who were operated by amniotic membrane transplantation. Five recurrences of pterygia were noted in the mitomycin C group and 2 each in the limbal stem cell transplantation group and the amniotic membrane group. The mean time to recurrence was 5.4 +/- 4.12 months in the mitomycin C group versus 10.5 +/- 3.5 months in the group of patients with limbal transplantation. In the third group, both recurrences were evident 4 months after the operation.
Abstract
Background
Nursing home residents represent the frailest patients in our community and are often referred to the Emergency Department (ED) for acute care. These referrals may have limited ...benefit and are associated with an increased risk of complications. This programme initiated a new acute outreach service providing urgent geriatric care in residential care settings, with the aim of avoiding unnecessary referrals.
Methods
A framework to deliver specialist acute geriatric care to 4 Residential Care Facilities (RCFs) (423 beds) was developed. Direct access by phone to a daily team lead was developed and provided on a Monday–Friday 8 am -5 pm basis. Referrals were triaged and acute response service provided through ANP and consultant geriatrician. Protocols to support iv fluid and antibiotic administration were agreed. Framework RCFs also engaged in specific Quality Improvement (QI) initiatives that focussed on falls reduction, skin integrity assessment, appropriate use of ED and safe staffing. Outcome measures for hospital admissions and 90-day mortality over a 7 month period (April—Oct 2022) was collected from patient’s medical records, electronic data and RCF records.
Results
174 urgent referrals were seen. Of these reviews, 5 (2.9%) required subsequent admission to hospital. Treatment with antibiotics was initiated in 9.8%. 1.7% required iv fluids and palliative measures recommended in 20.7%. The 90-day mortality was 12.9%. A total of 132 patients were referred directly to ED from the same 4 nursing homes over the same time period (4% reduction from 2021). QI initiatives demonstrated improvements in compliance with falls and continence risk assessments.
Conclusion
Specialist acute liaison care to nursing homes complimented with appropriate QI focus could present an opportunity for optimised care in RCF residents and mitigate risk of avoidable transfers.
The purpose of this study was to evaluate a nonfiltering glaucoma technique viscocanalostomy alone or in combination with small incision phacoemulzification and intraocular lens (IOL) implantation. ...From January 1999 to February 2001 viscocanalostomy was performed in 18 patients with medically uncontrolled primary open angle glaucoma. In 10 patients with cataract and primary open angle glaucoma combined operation phacoemulsification and viscocanalostomy was performed. The mean IOP reduction remained statistically significant after 12 months in both groups (p < 0.01). There was also a significant decrease in the antiglaucoma medications in both groups postoperatively. Perforation of trabeculo-Descemet's membrane occurred in two eyes with POAG and the procedure was completed as trabeculectomy, and those patients were excluded from the study. Good hypotensive effect with very low complications rate was achieved. Such a low complication rate makes this operation particularly attractive to surgeons who perform an increasing number of operations in outpatient's bases.
Hemophilia A is characterized by deficiency in FVIII and approximately 30% of people with severe hemophilia A are affected by inhibitors.A 11-year-old boy was diagnosed with severe hemophilia A ...immediately after birth due to hematoma around right kidney and positive family history. He developed inhibitors on FVIII when he was 12 months of age and therapy was changed in activated prothrombin complex on demand. During next 9 years, recurrent bleeding in the both knees started to occur which was manifested with haemophilic arthropathy.After several attempt, immune tolerance induction (ITI) was approved by insurance company when he was 10 years old. We started with plasma-derived F VIII in dosage of 100 i.u. per kg BW daily. Titer of inhibitors was negative after 3 months of ITI, and half life of FVIII was normalised after 6 months.For ease of administering therapy, central venous catheter (CVC) was inserted in right subclavian vein. On the other hand, usage of CVC can be complicated by infections and thrombosis. One year after insertion of CVC, he became febrile and microbiology findings revealed that blood culture was contaminated with Staphylococcus aureus, Acinetobacter ursingii, Achromobacter xyloxidans and Fusarium proliferatum which was indication for emergency removal of CVC. Unfortunately, during that surgical intervention, breakage of a CVC occurred and the tip of the catheter was notably missing.Emergency MSCT of thorax showed tubular structure located in right ventricle with loop at the entrance of right atrium and descending into the inferior vena cava as well as confluence with hepatic veins. To avoid major surgery, the retained portion was successfully removed by the interventional cardiologist through a femoral vein. During procedure, patient received plasma-derived FVIII to maintain the value of FVIII above 80% and there was no bleeding. Prophylactic antibiotics (meropenem, teicoplanin, liposomal amphotericin B) were continued for 10 days. After three negative blood cultures, negative galactomannan (GM) and 1,3-β-d-glucan (BDG) tests, he was released home and regularly controlled in day hospital. He is now using plasma-derived F VIII 1500 IU every other day as a prophylaxis of hemophilia A and is doing well without bleeeding and development of inhibitors.
The aim of this study was to determine the incidence and antimicrobial resistance of ESBL-producing strains in the community-acquired urinary tract infections (CAUTIs), which is necessary for ...antimicrobial therapy selection. From January 2003 to September 2004, 4,112 consecutive, non-duplicate coliform isolates from CAUTIs were analyzed. Antimicrobial susceptibility testing to fifteen antimicrobials was performed by disc-diffusion method. Double-disk synergy test (DDST) with amoxicillin-clavulanat, cefotaxime, ceftazidime, ceftriaxone and aztreonam, and Etest strips with PM/PML (AB Biodisk) was performed according to CLSI recommendation in order to detect the ESBL producers. The overall incidence of ESBL producing strains was 2.6% (108/4112), it was significantly higher in males, 8.4% (79/936) than in females, 0.9% (29/3176). The highest prevalence of ESBL producers was noted in the oldest and youngest age group: 4.8% (52/106) and 2.6% (27/1045), respectively. An increase from 2.2% (52/2402) to 3.3% (56/1710), and a shift of ESBL producers toward the age group 0-6 years (1.6% and 3.8%, respectively) in this period was observed. The incidence of ESBL producing strains among isolated Klebsiella spp. were 7.8% (83/1060), E. coli 0.7% (18/2561), Citrobacter spp. 0.6% (1/156), Enterobacter spp. 7.7% (3/39) and Proteus spp. 1.0% ( 3/297). Among ESBL producing isolates Klebsiella spp. predominated, 76.9% (83/108), followed by E. coli 16.7% (18/108). ESBL producing strains showed significantly higher resistance rates to all tested antibiotics as compared to to non-ESBL-producers. The increase and shift toward the youngest age group of the ESBL producer incidences is of our concern. Further studies are required to detect ESBL types in terms of highly different geographical dissemination of these isolates.
Objective of this study was to evaluate the intraocular pressure-reducing effect of latanoprost as monotherapy after replacing current dual therapy in glaucoma patients. The 6-months study comprised ...189 patients with primary open angle glaucoma who were treated at least 6 months with two different kind of topical medications (beta-blockers, pilocarpine, dorzolamide and brimonidine). Due to local side effects, multiple dosing regime and inadequately controlled intraocular pressure (IOP), they where switched to latanoprost 0.005% monotherapy. After switched to latanoprost, mean (IOP) was measured at baseline, after 15 days, 2 and 6 months of treatment. After six-months 178 patients had completed the study. These analyses enrolled all patients (n = 189), thus, the Intention-To-Treat (ITT) results were shown instead of the results of the reduced population. IOP was clinically importantly reduced from baseline level. Five patients had uncontrolled IOP. The difference between IOP before (21.9 +/- 2.4) and after 15 days (17.4 +/- 1.7), 2 months (16.7 +/- 1.8) and 6 months (16.6 +/- 1.4) was statistically significant (p < 0.001). 90% patients has reached target IOP < or = 18 mm. A conjunctional hyperaemia in 18 (9%), stinging and itching in 7 (4%) patients was reported. Increased iris pigmentation was seen in 3 (2%) patients. The results of this study indicate that dual therapy in open-angle glaucoma can effectively be replaced by latanoprost monotherapy in many patients.
Real and complex earthquakes SARIC, Dragomir
Transactions of the American Mathematical Society,
01/2006, Letnik:
358, Številka:
1
Journal Article
Recenzirano
Odprti dostop
We consider (real) earthquakes and, by their extensions, complex earthquakes of the hyperbolic plane \mathbb{H} ^2 of \mathbb{H} ^2 of a bending with complex parameter of small imaginary part is a ...holomorphic motion of S^1
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic ...and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
Consider a hyperbolic surface
X of infinite area. The Liouville map
L
assigns to any quasiconformal deformation of
X a measure on the space
G(
X
̃
)
of geodesics of the universal covering
X̃ of
X. We ...show that the Liouville map
L
is a homeomorphism from the Teichmüller space
T(X)
onto its image, and that the image
L(
T(X))
is closed and unbounded. The set of asymptotic rays to
L(
T(X))
consists of all bounded measured laminations on
X. Hence, the set of projective bounded measured laminations is a natural boundary for
T(X)
. The action of the quasiconformal mapping class group on
T(X)
continuously extends to this boundary for
T(X)
.
We show that the homotopy class of a quasiconformal self-map of the universal hyperbolic solenoid H_\infty is the same as its isotopy class and that the uniform convergence of quasiconformal ...self-maps of H_\infty to the identity forces them to be homotopic to conformal maps. We identify a dense subset of \mathcal{T}(H_\infty ) such that the orbit under the base leaf preserving mapping class group MCG_{BLP}(H_\infty) of any point in this subset has accumulation points in the Teichmüller space \mathcal{T}(H_\infty ). Moreover, we show that finite subgroups of MCG_{BLP}(H_\infty ) are necessarily cyclic and that each point of \mathcal{T}(H_\infty) has an infinite isotropy subgroup in MCG_{BLP}(H_\infty ).
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