Bilateral Choroidal Detachment Induced by Unilateral Application of a Fixed Combination of Topical Timolol Maleate and Brinzolamide

We describe a 66-year-old man who developed bilateral choroidal detachment that was induced by unilateral topical administration of a fixed combination of 1% brinzolamide and 0.5% timolol maleate the day after an uneventful phacoemulsification surgery and intraocular lens implantation involving his right eye. We believe that the reaction was an idiosyncratic reaction, most likely against brinzolamide. The condition improved rapidly after the cessation of the fixed combination of brinzolamide and timolol maleate and treatment with 1% topical prednisolone acetate every hour and 1% cyclopentolate twice a day bilaterally. Although there are several similar cases involving choroidal detachment after oral acetazolamide and topical dorzolamide treatment mentioned in the literature, the present case is the first case report involving bilateral choroidal detachment after topical treatment with brinzolamide.Â

Bilateral Choroidal Detachment Induced by Unilateral Application of a Fixed Combination of Topical Timolol Maleate and Brinzolamide

We describe a 66-year-old man who developed bilateral choroidal detachment that was induced by unilateral topical administration of a fixed combination of 1% brinzolamide and 0.5% timolol maleate the day after an uneventful phacoemulsification surgery and intraocular lens implantation involving his right eye. We believe that the reaction was an idiosyncratic reaction, most likely against brinzolamide. The condition improved rapidly after the cessation of the fixed combination of brinzolamide and timolol maleate and treatment with 1% topical prednisolone acetate every hour and 1% cyclopentolate twice a day bilaterally. Although there are several similar cases involving choroidal detachment after oral acetazolamide and topical dorzolamide treatment mentioned in the literature, the present case is the first case report involving bilateral choroidal detachment after topical treatment with brinzolamide.

The combined S velocity achieved from tricuspid annulus and pulmonary annulus with tissue Doppler imaging could predict the proximal right coronary artery occlusion in patients with inferior myocardial infarction

Aim: To investigate if combined S velocity (CSV) calculated from tricuspid annulus and pulmonary annulus with tissue Doppler imaging in individuals with acute inferior myocardial infarction were linked to proximal RCA lesions. Methods: The study comprised 48 patient who had been diagnosed with acute inferior myocardial infarction and had culprit lesions in the right coronary artery. The RCA occlusion in Group A was proximal to the right ventricular branch, while the RCA occlusion in Group B was distant to the RV branch. The combined S velocity was tested, as well as other echocardiographic parameters. Results: In terms of metrics indicating right ventricular function, there were substantial disparities between the groups. A favorable association was established in the univariate correlation analysis between CSV and tissue Doppler imaging derived tricuspid annulus systolic velocity (St), pulmonary annulus motion velocity evaluated by TDI (PAMVUT), RV tricuspid annular plane systolic excursion (TAPSE), and fractional area change (FAC). CSV was identified as an independent predictor of proximal RCA occlusion in a multivariate logistic regression test. In the ROC analysis, CSV<18.3 cm/s and PAMVUT<8.6 cm/s indicated proximal RCA occlusion with 83 percent sensitivity and 71 percent specificity (AUC=0.83, p<0.001), and 85 percent sensitivity and 71 percent specificity (AUC=0.81, p<0.001), respectively. Conclusion: CSV measurements were revealed to be an important predictor of proximal RCA occlusions in this investigation

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

An improved quasi-zero stiffness vibration isolation system utilizing dry friction damping

Quasi-zero stiffness (QZS) isolators, a nonlinear vibration isolation technique, enhance the isolation performance, by lowering the natural frequencies of an isolation system while providing higher static load bearing capacity compared to similarly performing linear isolators. Despite its performance improvement, the challenge of implementing QZS isolation systems is due to their highly nonlinear stiffness characteristics as a result of cubic like behavior of stiffness elements used. Although increasing linear damping in the isolation alleviates the input dependency of the QZS isolation systems by reducing the resonance amplitudes, it results in increased transmissibility in the isolation region, which is an adverse effect. Therefore, in this study, in order to overcome this, dry friction damping is implemented on the QZS isolation system. Hysteresis loop for the new QZS dry friction element is obtained and a mathematical model is introduced. For the nonlinear isolation system, harmonic balance method is used to transform the nonlinear differential equations into a set of nonlinear algebraic equations. For single harmonic motion, analytical expressions of Fourier coefficients are obtained in terms of elliptic integrals. Numerical solution of the resulting set of nonlinear algebraic equations is obtained via Newton's method with arc-length continuation. Performance of the isolation system under periodic base excitation is studied for different base excitation levels and the stability of the periodic steady-state solutions is investigated

Splitting of a Dexamethasone Implant (Ozurdex) following the Injection

In this brief report, we share our observations on a splitted Dexamethasone implant (Ozurdex) which we discovered a week after the injection. It is likely that implant splitting neither changes the efficacy of the implant nor creates a mishap for the patient

Magnesium and diltiazem relaxes phenylephrine-precontracted rat aortic rings

Perioperative vasospasm during cardiovascular surgery is a challenging problem. Several vasodilator agents are frequently utilized for its prevention in surgical practice. Magnesium and diltiazem both have known potential vasorelaxant effects. We planned to compare the efficacy of diltiazem and magnesium in relieving phenylephrine-precontracted rat aortic rings. Ten young adult female Wistar albino rats weighing 230–260 g were used in this study. The aortic rings in the organ bath equilibrated and reached their baseline tension. Precontraction was induced by 0.001 mmol/l phenylephrine and cumulative concentration–relaxation curves were obtained by consecutively increasing the addition of either diltiazem (10(−6)-0.1 mmol/l) or magnesium (0.1–10 mmol/l). The mean maximal relaxation responses observed by diltiazem and magnesium on separate aortic rings were 90 ± 3 and 53 ± 2%, respectively. The calculated EC50 of diltiazem was 0.01035 mmol/l, whereas the EC50 of magnesium was 4.064 mmol/l (P < 0.05). Both magnesium and diltiazem produced vasorelaxation on phenylephrine-precontracted rat aortic rings in this study, but the potency of diltiazem regarding the EC50 value was significantly higher than that of magnesium. Magnesium could be a candidate together with diltiazem to inhibit vasospasm on arterial grafts during coronary bypass surgery

Black and Blue Gold: Effects on regional agriculture in Kenya

The Turkana region of Kenya is one of the poorest areas of the country. In September 2013 the identification oftwo huge aquifers in the Turkana region had been announced. This study, through a single-country comparative static CGE model (STAGE), analyses the economic effects of the new discoveries on Kenya. Preliminary results indicate that increases in the availabilities of potable and irrigation water individually have relatively muted effects on agricultural production