Introducing a new method of retinoscopy for refraction of infants and young children: The �Mirza� tele lens retinoscopy

Purpose: This study aimed to evaluate the refractive error of the uncooperative infants and children with the new method of retinoscopy called the tele-lens (�Mirza�) retinoscopy. Methods: In the �Mirza� tele-lens retinoscopy, the examiner placed the trial lenses in 1/3 distance between the tested eye person and peephole of the retinoscope (22.2 cm far from the spectacle plane). First, the optical calculations were done to find the correction factors for this new method of retinoscopy. Second, the dry standard and �Mirza� tele-lens retinoscopy were performed in 78 eyes from 39 children aged 7�12 years with good cooperation and next, the procedure was repeated using cyclopentolate drops and then the results of the two methods were compared, and at the end, the dry �Mirza� tele-lens retinoscopy was done in the 60 eyes of 31 uncooperative infants with a mean age of 21.85 ± 8.79 months for evaluating the feasibility of the �Mirza� tele-lens retinoscopy procedure. The intraclass correlation coefficient (ICC) and Bland�Altman plot for assessment of agreement between the findings of two retinoscopic methods in dry and cyclo conditions were used. Results: The comparison between the dry standard and �Mirza� tele-lens retinoscopic results with means of 1.39 ± 1.43 and1.36 ± 1.39, respectively were not statistically significant (p > 0.05). Besides, comparing the mean cycloplegic results of two methods (standard vs. �Mirza� tele-lens), the difference was not statistically significant (2.37 ± 1.44 vs. 2.41 ± 1.37) (p > 0.05). Moreover, Two-way repeated measures ANOVA revealed no significant retinoscopy method � use of drops interaction (P = 0.103) in comparing two methods of the standard and �Mirza� tele-lens retinoscopy. ICC results indicated high agreement between two methods in both dry (ICC = 0.993) and cyclo (ICC = 0.989) conditions. Conclusions: The �Mirza� tele-lens retinoscopy method can be performed with satisfactory results in infants and children who do not cooperate for the standard procedure of measuring the refractive errors. © 2020 Spanish General Council of Optometr

Spontaneous spinal subarachnoid hemorrhage associated with subdural hematoma at different spinal levels

We describe the clinical features and MR-imaging findings of spontaneous spinal subarachnoid hemorrhage located in the lumbar spine associated with subdural hematoma at a higher, thoracic level in a 66-year-old man without neurological deficit. The sequential MR-imaging changes of hemorrhage at various stages in its evolution are portrayed. The possible pathogenetic mechanism for these very unusual, combined hemorrhages in both spinal compartments is discussed

Evaluation of visual evoked potential binocular summation after corneal refractive surgery

Purpose: To explore whether visual evoked binocular summation is affected in eyes with refractive errors after refractive surgery. Methods: Twenty participants (6M, 14F) aged 20�35 years (mean 26.7 ± 4.4) were assessed through pattern-reversal visual evoked potential viewing with their every eye (first right eye and then left eye) and then with both eyes while wearing their best correction before undergoing surgery. Also, parameters of the P100 component of pattern-reversal visual evoked potential were evaluated after 3 months of refractive surgery in two different check sizes. Monocular and binocular amplitudes and latencies of P100 wave and binocular summation index were compared between before and after surgery. Results: Monocular visual evoked potentials elicited by two different high-contrast checkerboard-patterned stimuli were significantly reduced in P100 wave amplitude (P 0.05). Similar to monocular findings of P100 wave amplitude, on binocular viewing, the mean value of pattern-reversal visual evoked potential amplitude was significantly reduced (P < 0.05), and P100 wave latency was prolonged (P < 0.05) after refractive surgery in participants. Also, the mean postoperative binocular summation index value as compared to that in the preoperative was significantly lesser (P < 0.05) for the subject in this study. Conclusions: Refractive surgery can degrade binocular visual performance throughout the change in visual evoked potential binocular summation. However, monocular function deteriorates less than binocular function after refractive surgery. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature

Return of Olfaction after Gross Total Resection of an Olfactory Groove Meningioma: Case Report

Patients with olfactory, groove meningiomas may present with anostnia, Surgery in patients with intact olfaction can also lead to anosmia when the olfactory nerves are sacrified. Olfaction can be preserved by using the prerional approach and microsurgical technique. To our knowledge; however, the recovery of olfaction after resection of an olfactory groove meningroma has not been reported. We therefore describe a patient who presented with anosmia whose evaluation revealed a large olfactory groove meningioma. She underwent a bifrontal approach for microsurgical gross bilateral excision of the tumor. At her 6-month follow-up examination, her olfaction, as measured by formal testing, had recovered

Controversy in Operative Techniques for Cervical Spondylosis Discectomy: Autograft Versus Allograft Versus No Graft

The anterior approach to the cervical spine provides neurosurgeons with an excellent technique for managing spondylitic and discogenic pathologies. The need for vertebral column reconstruction and internal fixation is based on the severity of the pathology and intrinsic biomechanical instability. The senior author\u27s (V.K.H.S.) preferences for reconstruction and arthrodesis as well as the technique of anterior cervical discectomy are presented

The difference between induction and maintenance dosages of propofol for general anesthesia in patients with and without sleep quality disorder

This study was conducted to compare propofol dose requirements between patients with and without sleep quality disorder (SQD) in order to achieve the same depth of anesthesia. Methods: In this comparative study, adult patients who were candidates for elective cataract surgery under general anesthesia in American Society of Anesthesiologists (ASA) class I or II were included. Using a validated questionnaire, patients were divided into two groups with Pittsburgh Sleep Quality Index (PSQI) higher and lower than five. Pre-induction with midazolam 0.02 mg/kg and fentanyl 2 µg/kg was administered 3 min before induction. Induction and 1-hour maintenance doses of propofol to achieve and maintain bispectral index score (BIS) 40–60 were measured and compared in the two groups. Results: Seventy patients, 47 of which (67.1%) were female, with the mean age of 63.83 ± 10.67 years were enrolled; 35 in SQD group and 35 in normal group. Baseline and demographic characteristics were not significantly different between the two groups. BIS score after pre-induction was significantly lower in SQD group compared with normal group (p = 0.002). Propofol dose at the time of induction and also 1 hour after induction was significantly lower in SQD group compared to normal group (p < 0.001). Total dose of propofol required was significantly lower in SQD group (209.26 ± 81.02) compared to normal group (342.91 ± 100.59) (p < 0.001). Based on the unstandardized Beta of multivariable linear regression model, mean total propofol requirement in SQD group was 113.43 mg less than normal group (p < 0.001). Conclusion: In the current study, induction and maintenance doses of propofol for general anesthesia were significantly lower in patients with SQD, in comparison with normal patients

Overview and patient selection for carotid endarterectomy

This article reviews the risk factors, natural history, and treatment options for the management of atherosclerotic carotid artery disease. Preoperative considerations and indications for surgical intervention are also reviewed. Algorithms for the management of symptomatic and asymptomatic stenoses are presented