Lifetime corneal edema load model

Purpose: To highlight the potential benefits for long-term use of silicone hydrogels daily disposable (DD) contact lenses, particularly with patients who are noncompliant, sleeping or napping while wearing their lenses, or those who have higher oxygen demands and wear this modality for decades. Methods: Published data for corneal swelling with lenses and no lens wear were used to develop a nonlinear least squares model. The edema load experienced with a range of oxygen transmissibilities (Dk/t) and wear compliance (sleep and napping) was determined. A mixed-effects linear regression model was used to compare the edema load for high and average corneal swellers. Results: The edema load generated demonstrates that a high Dk/t silicone hydrogel lens results in edema levels close to that with no lens wear. In comparison, hydrogels with a Dk/t of 27 (×10−9 [cm mL{O2}][s mLmmHg]), worn on a daily wear schedule will result in 1.5 times more edema and up to two times more if the patient is noncompliant over each decade of wear. High swellers after four decades of wear will have an edema load 10 to 17 times greater than average swellers depending on Dk/t and their degree of noncompliance with the daily wear modality. Conclusions: Prescribing silicone hydrogelDDlenses, particularly with higher DK/t,may help to maintain the long-term ocular health of patients, when they wear their lenses fulltime for many decades. Translational Relevance: Illustrates the importance of Dk/t for any CL wear modality where patients nap or sleep in lenses or have high oxygen needs

Advances in myopia prevention strategies for school-aged children: a comprehensive review

Myopia has significantly risen in East and Southeast Asia, and the pathological outcomes of this condition, such as myopic maculopathy and optic neuropathy linked to high myopia, have emerged as leading causes of irreversible vision loss. Addressing this issue requires strategies to reduce myopia prevalence and prevent progression to high myopia. Encouraging outdoor activities for schoolchildren and reducing near-work and screen time can effectively prevent myopia development, offering a safe intervention that promotes healthier habits. Several clinical approaches can be employed to decelerate myopia progression, such as administering low-dose atropine eye drops (0.05%), utilizing orthokeratology lenses, implementing soft contact lenses equipped with myopia control features, and incorporating spectacle lenses with aspherical lenslets. When choosing an appropriate strategy, factors such as age, ethnicity, and the rate of myopia progression should be considered. However, some treatments may encounter obstacles such as adverse side effects, high costs, complex procedures, or limited effectiveness. Presently, low-dose atropine (0.05%), soft contact lenses with myopia control features, and orthokeratology lenses appear as promising options for managing myopia. The measures mentioned above are not necessarily mutually exclusive, and researchers are increasingly exploring their combined effects. By advocating for a personalized approach based on individual risk factors and the unique needs of each child, this review aims to contribute to the development of targeted and effective myopia prevention strategies, thereby minimizing the impact of myopia and its related complications among school-aged children in affected regions

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

On right-angled spherical Artin monoid of type Dn

Recently Berceanu and Iqbal proved that the growth rate of all the spherical Artin monoids is bounded above by 4. In this paper we compute the Hilbert series of the right-angled spherical Artin monoid M(Dn∞)$\begin{array}{} M({D}^{\infty}_{n}) \end{array}$ and graphically prove that growth rate is bounded by 4. We also discuss its recurrence relations and other main properties

Risk factors for dengue shock syndrome in children admitted in Federal Govt. Polyclinic Hospital.Islamabad

Objective:  To determine the risk factors for dengue shock syndrome in children admitted in Federal Govt. Polyclinic Hospital (FGPC) Islamabad.Methodology:  It is a descriptive cross sectional study was conducted in Pediatric ward and Intensive care unit of Pediatric department of Federal Govt. Polyclinic hospital, Islamabad from August 2019 to October 2019. Children from1month to 12 years of age with dengue fever (DF) were enrolled in the study by non-probability sampling technique. We took history, did examination and investigation in 102 children reported at Pediatric department, polyclinic hospital Islamabad between August’ 2019 to October ‘2019. Epidemiologic variables of interest included age and sex. Clinical variables of interest included fever, duration of fever, petechiae, spontaneous bleed, melena, hematuria, gum bleed, rash, pleural effusion, ascites, hepatomegaly and duration of stay. Pathological variable included complete Blood Count (CBC) and dengue NS1Antigen. Result: A total of 102 patients were enrolled in the study, there were 63 (61.8%) males and 39 (38.2%) females with mean age of 91.55±36.7 to 96.17±35.94 months. Out of 102 patients admitted with dengue fever (DF)/dengue hemorrhagic fever (DHF), 13 (12.7%) developed ascites, pleural effusion and capillary refill time of more than 3 seconds, were labelled as experiencing dengue shock syndrome (DSS). Patients with capillary refill time of more than 3 seconds were found to be 2.44 times more likely to develop dengue shock syndrome (OR=2.44, 95% CI 1.47 – 4.03, p<0.001). Similarly, patients with thrombocytopenia (platelet count less than 150x103 cells) and leukocytopenia (TLC less than 4000x103 cells) were found to be at increased risk of developing dengue shock syndrome as compared to others (OR=1.28, 95% CI 1.12 – 1.48, p=0.001 and OR=1.6, 95% CI 1.12 – 5.21, p=0.01 respectively). Out of 13(12.7%) patients with DSS 1 patient (7.7%) died but no mortality observed in DHF. Conclusion: The univariate analysis revealed increased capillary refill time, thrombocytopenia and leukocytopenia to be significant predictors of dengue shock syndrome (DSS)

Pictorial review: Imaging features of unusual patterns and complications of hydatid disease

Hydatid disease is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm. We demonstrate rare locations and unusual complications of this entity during past 6 years. Rare locations during our observation included lumbar spine, sacral spine, spleen, ovary, abdominal wall, diaphragm, pelvis and right kidney. Unusual complications included formation of bronchopulmonary fistula, complete collapse of left lung secondary to hilar location of Hydatid cyst and hydatiduria