Trypan blue staining of internal limiting membrane and epiretinal membrane during vitrectomy: visual results and histopathological findings

Aims: To report on the use of trypan blue (TB) 0.06% for staining the internal limiting membrane (ILM) and epiretinal membrane (ERM) during vitrectomy and report on their histology. Method: 14 consecutive patients with idiopathic macular hole or macular pucker (seven patients each) were prospectively recruited for ILM or ERM peel respectively. After pars plana vitrectomy and induction of posterior vitreous detachment, 0.5 ml TB 0.06% in phosphate buffered saline (VisonBlue) was injected over the posterior pole in an air filled eye and left for 2 minutes. The stained tissue was peeled with intraocular forceps. Specimens were evaluated using histochemical and immunohistochemical methods. Results: The average follow up was 4.4 months. Internal limiting membranes and epiretinal membranes were stained satisfactorily in all cases and removed successfully. Eight patients (57%) had improvement of 2 or more Snellen lines. All seven macular holes closed. In the ERM cases, no residual membranes were observed clinically, at the latest follow up. No complications relating to the use of the dye were encountered intraoperatively or postoperatively. Of the 14 procedures, nine (four macular hole and five macular pucker) yielded sufficient tissue for histopathological evaluation. Histological and immunohistological assessment revealed that the morphology of these specimens was similar to that observed in macular hole ILM and macular pucker ERM removed without the aid of dye. Conclusion: TB staining facilitated the identification and delineation of ILM and ERM removal during the surgical management of macular holes and macular pucker. The visual outcome of this series and the specimens removed suggest they are no different from those without TB staining. Its use in posterior segment appears to be safe but further studies are required to investigate its long term safety

Analysis of Neonatal Sepsis in Kumasi, Ghana Through Paper-Based Medical Records

Reducing infant mortality is Millennium Development Goal 4 in Ghana, though it has remained high and unchanged. Improving care and reducing health complications related to infections and respiratory distress has shown to decrease the prevalence of neonatal deaths and preterm births. The objective of this study is to present data originating from an electronic medical records (EMR) pilot project and communicate the results of an analysis of neonatal sepsis using health information from paper-based medical records to identify characteristics of the neonatal patients at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Medical records from the Mother Baby Ward (n=198) from 2009-2014 were processed using scanners connected to laptop computers. Health information was manually extracted and verified by two researchers for quality assurance purposes and included sepsis, respiratory distress, cough, difficulty feeding, lethargy, seizures, jaundice, birth history, birth maturity and birth location. Regression analysis revealed a significant association between sepsis and birth location (p=0.0180, 95% CI) as well as sepsis and jaundice (p=0.0446, 95% CI). A descriptive profile of the population revealed that 63.6% of infants comprised of 97 males and 101 females were differentially diagnosed as having sepsis. There were 21 (10%) twins observed. Of the 198 cases included in the analysis, there were 127 (64%) full-term births, 105 (53%) cases reporting respiratory distress and 93 (46%) reporting jaundice. The process of manually scanning and converting paper-based medical records to later use for manual data extraction provides a safe and secure way to evaluate health information related to infant and neonate health