Ocular injuries in survivors of improvised explosive devices (IED) in commuter trains

<p>Abstract</p> <p>Background</p> <p>Ocular injuries are common in survivors of terror incidents that involve the use of explosive materials. These explosives are commonly of a High Explosive type (HE) and may be fashioned into improvised explosive devices (IED) that incorporate additional materials to maximise trauma and injuries. Serial IED explosions have occurred in commuter trains in several cities including London and Madrid but data on ocular injuries is limited. We report the ocular injuries of the survivors of a series of IED explosions in crowded commuter trains.</p> <p>Methods</p> <p>28 patients (56 eyes, 28 male, ages ranging from 22 to 52 years (mean 35.27 years) were screened in the triage area or the Intensive Care Unit (ICU). Testing included bedside visual acuity testing, torchlight examination of the anterior segment and dilated (or if necessary, undilated) fundus examination. Selected patients underwent B-scan examination, magnetic resonance imaging of the brain, orbits and the optic nerves or visual evoked potential assessment. The injuries, investigations and procedures were entered into the patient's case sheet as well as into a standardised format suggested by the Indian eye injury registry (IER).</p> <p>Results</p> <p>16 of 28 patients (57.1%) had ocular injuries whereas 12 (42.8%) were found to be normal. Injuries were seen unilaterally in 10 patients and bilaterally in six yielding a total of 22 injured eyes. The common injuries were periorbital haemorrhages (09 eyes, 40%); first or second degree burns to the upper or lower lids (seen in 07 eyes, 31.8 %) and corneal injuries (seen in 08 eyes, 36.3%). Open globe injuries were seen in two eyes of two patients (09%). One patient (4.5%) had a traumatic optic neuropathy.</p> <p>Conclusion</p> <p>Ophthalmologists and traumatologists should be aware of these patterns of ocular injuries. Protocols need to include the screening of large numbers of patients in a short time, diagnostic tests (B scan, visual evoked potential (VEP) etc) and early surgery preferably at the initial triage itself as most of the serious injuries in our studies had been missed or not treated at an initial assessment.</p

Ocular features of hantavirus infection

Hantavirus infections are an emerging infectious disease that is beginning to be recognized both worldwide and in India as a cause of hemorrhagic fever that may present as a pulmonary syndrome or as a renal syndrome. Reports of ocular involvement are rare and include transient myopia, low intraocular pressure, conjunctival hemorrhages and changes of intraocular dimensions. Eleven patients (10 males, one female, mean age 37.6 years) were admitted to the intensive care unit for pyrexia of unknown origin or hemorrhagic fever following exposure to flood waters. Five male patients (mean age 31.6 years) were identified as suffering from hantavirus infection. In one patient, dot and blot intraretinal hemorrhages were seen in the macula of one eye and streak hemorrhages of the disc in the other. In the remaining four, no fundus abnormalities were seen. Ophthalmologists should be aware of these features

ASSOCIATION OF PSYCHOSOCIAL FACTORS WITH ANXIETY AND DEPRESSION IN PATIENTS FOLLOWING ACUTE MYOCARDIAL INFARCTION

Background: Anxiety and depression are proven independent predictors of mortality, disability, and reduced health related quality of life (HRQoL). Hence, this study was undertaken with aim to find the prevalence of anxiety and depression in patients following acute myocardial infarction (AMI) and to find out its association with various psychosocial factors. Methods: Stable patients admitted during 3 month period in Cardiology Intensive care unit of tertiary care Hospital with the diagnosis of acute myocardial infarction were included in this cross sectional study. Data was collected using a Semi- structured questionnaire. Anxiety and depression were assessed using Hospital Anxiety and Depression Scale (HADS) .Scores were analyzed using SPSS version 16. Results: A total of 75 patients (73.3% men and 26.7% women) with mean age 54.86 ± 9.91 years were included. Mean scores of anxiety and depression were 4.49 and 4.0 out of 21, respectively. Probable cases of anxiety and depression as per HADS were 29.33% and 21.33% respectively. There was a statistically significant association of Anxiety and depression with gender (P= 0.004(A), P= 0.002(D); education [P=0.018(A), P= 0.002 (D)]; and pre-existing known stressor [P=<0.001 (A) and P=0.002(D)]. The association of anxiety and depression with age, addiction, presence of co-morbidies and previous history of AMI / stroke was not statistically significant. Conclusion: Anxiety and depression are common after AMI. It was seen more in females, low literacy and those with pre-existing known cause of stress (stressor). Hence, psychological screening should be incorporated in routine assessment in patients with AMI during hospitalization to plan early intervention that could potentially improve recovery pattern

EFFECT OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION ON POST - OPERATIVE PAIN FOLLOWING A CARDIAC SURGERY- A PILOT STUDY

Background: Pain has been pointed out as one of the chief concerns of patients following a cardiac surgery. Adjunctive methods of postoperative pain control that may limit narcotic side effects are of considerable interest. The study aimed to evaluate the effectiveness of Transcutaneous electrical nerve stimulation (TENS) for treatment of post-operative pain in patients who underwent cardiac surgery using a median sternotomy. In addition, we sought to compare effectiveness of TENS and SHAM (placebo) TENS on 1. Pain at rest 2. Duration Of analgesia following the intervention. Methods: Twenty patients (8 females and 12 males) each during the 24-96hr post-operative period were a part of the study. They were randomly allocated to two groups: TENS & pharmacological analgesia (n=10) and SHAM & pharmacological analgesia (n=10). The Visual Analogue Scale (0-10) was used to assess the post-operative peri- incisional pain. Results: It was seen that both TENS and SHAM TENS (P value is 0.0917) were almost equally effective in reducing peri- incisional pain following a cardiac surgery through a median sternotomy. However, the duration of analgesia following treatment with TENS was significantly greater than that with SHAM TENS. Conclusion: Therefore both TENS and SHAM TENS can be used as a valuable strategy to alleviate post-operative suture site pain following a cardiac surgery, both clinically and statistically, but the duration of analgesia following TENS is significantly greater than that following SHAM