Neonatal hypoglycemia is common and can cause neurologic impairment, but evidence supporting thresholds for intervention is limited.
We performed a prospective cohort study involving 528 neonates ...with a gestational age of at least 35 weeks who were considered to be at risk for hypoglycemia; all were treated to maintain a blood glucose concentration of at least 47 mg per deciliter (2.6 mmol per liter). We intermittently measured blood glucose for up to 7 days. We continuously monitored interstitial glucose concentrations, which were masked to clinical staff. Assessment at 2 years included Bayley Scales of Infant Development III and tests of executive and visual function.
Of 614 children, 528 were eligible, and 404 (77% of eligible children) were assessed; 216 children (53%) had neonatal hypoglycemia (blood glucose concentration, <47 mg per deciliter). Hypoglycemia, when treated to maintain a blood glucose concentration of at least 47 mg per deciliter, was not associated with an increased risk of the primary outcomes of neurosensory impairment (risk ratio, 0.95; 95% confidence interval CI, 0.75 to 1.20; P=0.67) and processing difficulty, defined as an executive-function score or motion coherence threshold that was more than 1.5 SD from the mean (risk ratio, 0.92; 95% CI, 0.56 to 1.51; P=0.74). Risks were not increased among children with unrecognized hypoglycemia (a low interstitial glucose concentration only). The lowest blood glucose concentration, number of hypoglycemic episodes and events, and negative interstitial increment (area above the interstitial glucose concentration curve and below 47 mg per deciliter) also did not predict the outcome.
In this cohort, neonatal hypoglycemia was not associated with an adverse neurologic outcome when treatment was provided to maintain a blood glucose concentration of at least 47 mg per deciliter. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others.).
Purpose
Pre-term infants are at risk of abnormal visual development that can range from subtle to severe. The aim of this study was to compare flash VEPs in clinically stable pre-term and full-term ...infants at 6 months of age.
Methods
Twenty-five pre-term and 25 full-term infants underwent flash VEP testing at the age of 6 months. Monocular VEPs were recorded using flash goggles on a RETIscan system under normal sleeping conditions. Amplitude and peak time responses of the P2 component in the two eyes were averaged and compared between the two groups. Multiple regression analyses were performed to assess the relationship of the P2 responses with birth weight (BW) and gestational age (GA).
Results
At 6 months corrected age, pre-term infants had significantly delayed P2 peak times than full-term infants (mean difference: 10.88 95% CI 4.00–17.76 ms,
p
= 0.005). Pre-term infants also showed significantly reduced P2 amplitudes as compared to full-term infants (mean difference: 2.36 0.83–3.89 µV,
p
= 0.003). Although the regression model with GA and BW as fixed factors explained 20% of the variance in the P2 peak time (
F
2,47
= 5.98,
p
= .0045), only GA showed a significant negative relationship (
β
= −2.66,
p
= .003). Neither GA (
β
= 0.21,
p
= .28) nor BW (
β
= 0.001,
p
= .32) showed any relationship with P2 amplitude.
Conclusions
Our results demonstrate that, compared with full-term infants, clinically stable pre-term infants exhibit abnormal flash VEPs, with a delay in P2 peak time and a reduction in P2 amplitude. These findings support a potential dysfunction of the visual pathway in clinically stable pre-term infants as compared to full-term infants.
Purpose. Evidence suggests that choroid is thinner in myopes as compared to nonmyopes. However, choroidal thickness varies with the refractive error, age, axial length, and ethnicity. The purpose of ...this study was to determine the subfoveal choroidal thickness (SFCT) in high myopic Nepalese subjects and to investigate its association with the mean spherical equivalent refractive error (MSE), axial length, and age. Methods. Ninety-two eyes of 92 high myopic subjects (MSE ≤ −6 diopters) and 83 eyes of 83 emmetropic subjects (MSE: 0.00 Diopters) were included in the study. SFCT was assessed using spectral domain optical coherence tomography, and the axial length was measured using partial coherence interferometry. SFCT was measured manually using the inbuilt tool within the imaging software. Results. SFCT in the high myopic subjects was significantly thinner (mean ± SD: 224.17 ± 68.91 μm) as compared to the emmetropic subjects (353.24 ± 65.63 μm) (mean difference, 127.76 ± 130.80 μm, and p<0.001). In high myopic subjects, there was a significant negative correlation of choroidal thickness with the axial length (rho = −0.75; p<0.001) and MSE (rho = −0.404; p<0.01). Regression analysis demonstrated a decrease of choroidal thickness by 40.32 μm (p<0.001) for every 1 millimeter increase in the axial length and by 11.65 μm (p<0.001) for every 1 diopter increase in the MSE. Conclusion. High myopic Nepalese subjects had significantly thinner choroid as compared to emmetropes. The MSE and axial length were inversely correlated with the SFCT. Age had no effect on SFCT in this study. These findings may have implications in interpreting choroidal thickness values in clinical and epidemiological studies in myopes, especially in the south Asian population.
Synchronous existence of hepatic, splenic, and skeletal hemangiomas has not been reported previously in the English literature to our knowledge. In this case report, we present a case of coexistence ...of hepatic, splenic, and skeletal hemangiomas in a 30-year-old woman with on and off bilateral lumbar region pain and no significant past medical history. Radiological investigations, including ultrasound and computed tomography and magnetic resonance imaging helped identify the synchronous existence of hepatic, splenic, and skeletal hemangiomas. The patient improved with conservative management and was kept on follow-ups. Although there have been reports of coexistence of splenic and hepatic hemangiomas in the literature, to our knowledge, this is the first report of synchronous existence of hepatic, splenic, and skeletal hemangiomas.
Visual impairment (VI) affects physical, psychological, and emotional well-being, and social life as well. The purpose of this exploratory study was to assess the psycho-social impact of VI on ...health-related quality of life (HRQoL) among nursing home residents.
This cross-sectional study involved 272 residents of 60 years or older residing in seven nursing homes of the Kathmandu Valley, Nepal. Comprehensive ocular examinations, including near and distance vision assessment and refractions were carried out. VI was defined as visual acuity (VA) less than 6/18 in the better eye. Residents were divided into two groups: one group did not have VI (in whom VA was greater than or equal to 6/18 in the better eye), and the other had VI (in whom VA was worse than 6/18 in the better eye).Face-to-face interviews were conducted filling out a 36-item The Medical Outcomes Study Short-Form (SF-36) questionnaire. The SF-36 questionnaire was scored according to the scoring algorithm SF-36 subscales.
The mean age of residents was 74.68 ± 8.19 years (range, 60-99 years) and the majority were female (78.68%). The mean composite score of SF-36 was 46.98 ± 13.08. VI detrimentally affected scores of both the physical and the mental components, but the impact of VI was slightly greater for the physical component than that for the mental component. There was a trend towards a lower composite score as well as each subscale score of the SF-36 in participants with VI than in those without VI.
VI has a negative effect on HRQoL. HRQoL is reduced among nursing home residents and the reduction in the HRQoL bears a positive association with VI.
Background: The ocular surface is separated by a thin layer of tear film from outdoor air pollutants making individuals exposed to outdoor air pollution prone to various ocular surface disorders. The ...aim of this study was to determine the magnitude of ocular surface disorders symptoms among traffic police officers of Kathmandu, Nepal.
Methods: Two hundred traffic police officers working at different traffic police office branches of Kathmandu, Nepal were invited to the police headquarters for eye and vision examination. Among them, 91 individuals (95% males) completed the ocular surface disease index (OSDI) questionnaire and underwent Schirmer's I tear test.
Results: Symptoms of ocular surface disorders were reported by over 80% of the individuals. Approximately two-fifths of the individuals (38%) reported severe symptoms. Only 17% of the individuals' tear secretion was found to be below normal using the Schirmer's tear test. No significant association was observed between the OSDI score and Schirmer's tear test scores (r = 0.008, p = 0.94). A weak but significant relationship was observed between the OSDI score and job duration (r=0.21,p = 0.04). Individual exposed to outdoor air pollution for more than 10 years had higher odds of reporting ocular surface complaints as compared to those who were exposed for less than 10 years (OR = 3.94, p = 0.02).
Conclusion: Ocular surface disorder symptoms are common among traffic police officers of Kathmandu, Nepal. The duration of exposure appears to significantly contribute to the increased symptoms in this exposed population.
Background:
Studies suggest that lutein and zeaxanthin may be important for cognitive development in children, but a comprehensive evidence synthesis is lacking. The purpose of this evidence ...synthesis was to analyse the available data regarding the role of lutein and zeaxanthin for cognition in children and propose a theoretical basis for future studies.
Methods:
The PubMed, Scopus, the ISRCTN registry and Cochrane Library databases were searched for studies that evaluated the relationship between lutein and zeaxanthin and cognitive function in children. Reference list and ancestry searches were performed on relevant articles. A total of 543 articles were identified, of which six cross-sectional studies were included.
R
esults:
The literature search revealed that the evidence concerning the effect of lutein and zeaxanthin on cognition in children is sparse. However, there is some preliminary evidence indicating a positive association between lutein and zeaxanthin and cognition in childhood.
Conclusions:
The cross-sectional nature of the few studies available and the lack of RCT data indicates a need for further investigation before any firm conclusions can be drawn.
Abstract Purpose To evaluate the quality of life and the impact of low vision services in patients with low vision. Methods This prospective study evaluated visual function and vision-related quality ...of life in 44 Nepalese patients with low vision and compared that with age-gender matched normal population ( N = 40). The main outcome measure was 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) administered before and four weeks after the first examination. We were able to administer the follow-up questionnaires in only 23 out of 44 consecutive patients. Low vision services which included low vision devices (optical/non-optical), counseling and training were provided to all the participants. Self assessment of the low vision services was also obtained through a structured questionnaire in the follow-up patients. Results The mean composite score (49.53 ± 14.10) and all of the subscale score in NEI VFQ-25 for the low vision population were significantly lower than age and gender matched normal Nepalese population (89.90 ± 7.8). The mean composite score increased by 5.74 ± 3.9 and the six out of twelve subscale scores also improved significantly after low vision services. The low vision services were associated with improvement in objective measure of visual functioning in 90.9% (40 out of 44) of the patients at the first visit and were rated useful or very useful by 73.9% (17 out of 23) follow-up patients. Conclusions Low vision patients have poor quality of life as measured with the NEI VFQ-25. Low vision service is associated with improved visual function, better quality of life and high rate of patient satisfaction.
Optometry education in Nepal began in 1998 in collaboration with the University of Auckland, New Zealand, with the primary objective of addressing the unmet needs of eye health and vision care. Over ...the last two decades, the development of optometry education has seen significant progress, including a shift from a three-year to a four-year curriculum, an increase in the uptake of students, and recent launches of two additional bachelor's degree and a master's degree programmes. Complementary to the educational progress, several professional advances have occurred in the intervening years. These include the formation of the Nepalese Association of Optometrists that oversees the professional development and the rights, welfare, security, and protection of Optometrists, memberships into the World Council of optometry and the Asia Pacific Council of optometry, integration of the profession into the governmental regulatory body Nepal Health Professional Council, and formulation of the code of ethics and minimum requirements for a Bachelor's level University degree in optometry. This article briefly presents the historical events leading to the establishment of optometry in Nepal and the evolution of the program in the intervening years.
This article reviews educational standard, clinical practice, research advances, and challenges associated with optometry in Nepal and provides critical considerations for contemporary and new ...optometry programs in countries with similar socioeconomic status and health care systems.Optometry education started in Nepal in 1998 with the primary objective of addressing the unmet needs of eye health and vision care in the country. Over the last two decades, this program has made significant contributions to facilitating and improving the delivery of quality eye care and establishing the nation's eye health system as an exemplary model in South Asia. Despite the positive impact in a short time, optometry education and the profession continue to face several challenges, including a shortage of training resources and facilities, poor quality control and regulation of practice standards, lack of professional recognition, limited pathways for entry to governmental jobs via the national public service commission, and limited clinical and academic opportunities in existing eye care programs. This article reviews current education and clinical practice standards, highlights research advances, and discusses present and future challenges in sustaining and improving the quality of education and advancing the scope of practice of optometry in Nepal. Given the limited access to primary eye care services in Nepal, appropriate professional recognition and integration into the national health system, and initiatives targeted at improving the delivery of optometry education in alignment with successful international models may provide a long-sought solution to making eye care services accessible to all and lowering the burden of visual impairment in the country.
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