Bowled over by cricket: impact of tape-ball injuries on the eyes

Abstract PURPOSE: The aim of this study was to describe the type and severity of tape-ball cricket-related eye injuries seen at a tertiary care hospital. DESIGN: A descriptive case series. METHODS: This study included all cases of tape-ball cricket-related eye injuries presenting to the Section of Ophthalmology, Aga Khan University Hospital, Karachi, from January 2014 to January 2015. RESULTS: A total of 20 patients with tape-ball cricket-related eye injuries were treated during this period. The right eye was involved in most (14/20) of the cases. The commonest presenting symptoms included reduced/blurred vision, ocular pain, redness, and floaters. Sixty percent (12/20) of the affected eyes had a best corrected visual acuity of less than 20/200 at presentation, with the retina being the most commonly involved ocular structure. All patients reported that they were not wearing protective eyewear at the time of trauma. Despite standard management, half of the eyes had severe or total vision loss at the last follow-up (minimum, 3 months), mainly due to retinal damage. CONCLUSIONS: Our study calls for the compulsory use of protective eyewear by cricket players and for countrywide surveillance data on the true burden of this unnoticed preventable cause of unilateral eye injuries and associated vision loss

Effect of compound Unani Drug in the management of cervical spondylosis (Wajaur Raqaba): A case study

Cervical spondylosis is also known as cervical osteoarthritis. It is a disorder characterised by alterations in the bones, discs, and joints of the neck. These changes are induced by the regular wear and tear of ageing, which leads to intervertebral disc degeneration and osteophyte production. The most common complaints are pain in the head, neck, and shoulders, as well as tenderness in these areas. There is also pain radiation and a reduction in cervical range of motion. Wajaur Raqaba (cervical spondylosis) is treated through Ilaj bit Tadbeer (Regional therapy), Ilaj bid Dawa (Pharmacotherapy), and Ilaj bil Yad (Surgery). The purpose of this case study was to assess the efficacy of Unani formulations Habbe Asgand and Habbe Gul-e-akh in the treatment of cervical spondylosis. A 24-year-old female patient with cervical spondylosis presented to the OPD of Ajmal Khan Tibbia College, Aligarh. Treatment was given to the patient for a period of one month. The Northwick Park Neck Pain Questionnaire (NPQ) is used for the assessment of cervical pain. As assessed by NPQ, Unani formulations were proven to be safe and effective in the management of cervical spondylosis. Keywords Cervical spondylosis, Wajaur Raqaba, Unani formulations, Habbe suranjan and Habbe gul-e-akh

Trends and disparities in inpatient costs for eye trauma in the United States (2001-2014)

Purpose: To determine the trends and disparities in inpatient costs for eye trauma in the United States from 2001 through 2014.Design: Retrospective population-based cross-sectional study.Methods: National Inpatient Sample, a representative sample of U.S. hospital discharges, was used to determine costs of eye trauma hospitalizations. Linear regression was used to estimate changes in mean inflation-adjusted cost per admission. Multivariable logistic regression was used to evaluate factors associated with a cost in the highest quartile (\u3e$13 000) including age, sex, race, income quartile, primary payer, hospital location, size, and type. The model was adjusted for year of admission, length of stay, type of trauma, comorbidities, and the type and number of procedures performed.Results: The inpatient costs for eye trauma from 2001 through 2014 totaled$1.72 billion. The mean cost (95% confidence interval [CI]) per stay remained relatively constant: $12 000 ($11 000-13 000) in 2001 to $11 000 ($10 000-12 000) in 2014 (P = .643). A cost in the highest quartile was more likely in African Americans compared to whites (adjusted odds ratio, 1.3; 95% CI, 1.2-1.5), patients in the highest income quartile compared to those in the lowest (1.3; 1.2-1.5), uninsured patients compared to publicly insured patients (1.2; 1.1-1.4), teaching hospitals compared to non-teaching ones (1.5; 1.2-1.8), and the West compared to the South (2.4; 2.0-2.8).Conclusions: Inpatient costs of eye trauma have remained steady and can be potentially reduced by addressing associated disparities. Further research including outpatient costs and eye trauma in vulnerable populations will be key to optimizing care and advancing healthcare equity

Changes in the incidence of eye trauma hospitalizations in the United States from 2001 through 2014

Importance: Eye trauma is a common cause of vision loss and a substantial public health problem.Objective: To determine the changes in the incidence of eye trauma hospitalizations in the United States and compare the demographics of affected patients and outcomes of eye trauma as a primary or secondary admitting diagnosis.Design, setting, and participants: This retrospective longitudinal cohort study used the National Inpatient Sample, a representative sample of all US community hospitals, to determine the incidence, characteristics, and causes of primary and secondary inpatient eye trauma admissions from 2001 through 2014. All inpatients with relevant diagnoses were included. Linear regression was used to estimate changes in incidence. Logistic regression was used to compare demographics and outcomes between primary and secondary diagnoses, including age, sex, race, income, primary payer, region, year of admission, length of stay, cost, and disposition at discharge.Exposures: Eye trauma.Main outcomes and measures: Incidence and characteristics of inpatient primary and secondary eye trauma.Results: From 2001 to 2014, there were an estimated 939 608 inpatient admissions (of whom 556 886 were male patients [59.3%]; overall mean [SD] age, 49.4 [25.2] years) in the United States because of eye trauma diagnoses, with 778 967 of these (82.9%) as a secondary diagnosis. The incidence of primary eye trauma decreased from 3.9 to 3.0 per 100 000 population (difference, 0.9 [95% CI, 0.2-1.6] per 100 000 population; P = .001). The incidence of eye trauma as a secondary admitting diagnosis increased from 14.5 to 19.0 per 100 000 population (difference, 4.5 [95% CI, 1.9-7.2] per 100 000 population; P = .004). This was largely attributed to an increasing number of falls in individuals older than 65 years. The most frequent diagnosis was orbital fracture (64 149 [39.9%]) for primary trauma and contusion of eye and adnexa (19 301 [37.8%]) for secondary trauma. Primary trauma was more common in children (adjusted odds ratio [aOR], 2.21 [95% CI, 2.09-2.32]) and adolescents (aOR, 1.25 [95% CI, 1.19-1.32]) than adults (reference), African American individuals (aOR, 1.89 [95% CI, 1.81-1.97]) and Hispanic individuals (aOR, 1.52 [95% CI, 1.45-1.59]) than white individuals, and uninsured patients (aOR, 1.14 [95% CI, 1.07-1.22]) and those receiving Medicaid (aOR, 1.12 [95% CI, 1.05-1.19]) than Medicare beneficiaries. Patients with a primary diagnosis were more likely to have a stay of less than 3 days (patients with a primary diagnosis: 101 796 [63.4%]; secondary diagnosis: 274 538 [35.2%]), more likely to have costs in the lowest quartile (patients with a primary diagnosis: 51 212 [31.9%]; secondary diagnosis: 166 260 [21.3%]), and less likely to die (patients with a primary diagnosis: 526 [0.3%]; secondary diagnosis: 20 929 [2.7%]).Conclusions and relevance: These findings suggest that the increasing number of falls in individuals older than 65 years and the high risk of primary eye trauma in populations such as children and adolescents warrant the development and implementation of effective preventive strategies. Many of these patients are seen in ophthalmology practices where proactive risk assessment and counseling can play a critical role

Reasons for non-vaccination in pediatric patients visiting tertiary care centers in a polio-prone country

BACKGROUND: The Expanded Program on Immunization (EPI) was initiated by World Health Organization (WHO) in 1974 in order to save children from life threatening, disabling vaccine-preventable diseases (VPDs). In Pakistan, this program was launched in 1978 with the main objectives of eradicating polio by 2012, eliminating measles and neonatal tetanus by 2015, and minimizing the incidence of other VPDs. However, despite the efforts of government and WHO, this program has not received the amount of success that was desired. Hence, the objectives of this study were to elucidate the main reasons behind not achieving the full immunization coverage in Pakistan, the awareness of children’s attendant about the importance of vaccination, their attitudes, thoughts and fears regarding childhood immunization, and the major hurdles faced in pursuit of getting their children vaccinated. METHODS: This was an observational, cross-sectional, questionnaire-based study conducted during a one year period from 4th January, 2012 to 6th January, 2013 at the pediatric outpatient clinics of Civil Hospital (CHK) and National Institute of Child Health (NICH). We attempted to interview all the parents who could be approached during the period of the study. Thus, convenience sampling was employed. The parents were approached in the clinics and interviewed after seeking informed, written consent. Those patients who were not accompanied by either of their parents were excluded from the study. The study instrument comprised of three sections. The first section consisted was concerned with the demographics of the patient and the parents. The second section dealt with the reasons for complete vaccination or under-vaccination. The last section aimed to assess the knowledge, attitudes and beliefs of the respondents. RESULTS: Out of 1044 patients, only 713(68.3%) were fully vaccinated, 239(22.9%) were partially vaccinated while 92(8.8%) had never been vaccinated. The vaccination status showed statistically significant association with ethnicity, income, residence, number of children and paternal occupation (p < 0.05 for all). The most common provocative factor for vaccination compliance was mass media (61.9%). The most common primary reason for non-vaccination was lack of knowledge (18.1%), whereas the most common secondary reason for non-vaccination was religious taboos (31.4%). Majority of the respondents demonstrated poor knowledge of EPI schedules or VPDs. However, most believed that there was a need for more active government/NGO involvement in this area. CONCLUSION: The most common primary reason for non-vaccination, i.e. lack of knowledge, and the most common secondary reason, i.e. religious taboos, imply that there is dire need to promote awareness among the masses in collaboration with NGOs, and major religious and social organizations