Spontaneous closure of the large idiopathic full-thickness macular hole

Dear Editor, Idiopathic full-thickness macular hole (FTMH) represents an interruption in all retina layers from the internal limiting membrane to the photoreceptors, is unrelated to any other ocular or systemic conditions, and usually affects older women. Disruption of the macula and fovea causes poor vision, metamorphopsia, and central scotoma. Optical coherence tomography (OCT) is used in the diagnosis, classification, management results, and follow-up. While spontaneous closure of traumatic MH in a few weeks following the trauma is a frequent event in the literature, the spontaneous closure of stage III and IV idiopathic MH is only sporadically reported. Standard procedures to close the MH and enhance visual function include sutureless, small incision vitrectomy, and internal limiting membrane peeling. Herein we report a case of a 76-year-old woman who presented with spontaneous closure of stage II idiopathic FTMH documented by OCT after the patient refused surgery and missed the advised regular follow-up due to the COVID-19 pandemic.The authors acknowledge the patient's written consent to report this peculiar case.Scopu

The predictors of perforated appendicitis in the pediatric emergency department: A retrospective observational cohort study

Objective Appendiceal perforation has significant effects on perioperative morbidity and postoperative outcome. The present study aimed to identify possible predictive factors associated with perforated appendicitis (PA) in children at admission in the emergency department (ED). Methods In this retrospective observational cohort study, consecutive medical records of children <18 years old with surgically and histopathologically confirmed acute appendicitis (AA) over three years (2013–2015) were analyzed. Patients were divided into two groups: PA and non-perforated appendicitis (NPA). The differences between the two groups and potential predictors of PA were explored using univariate and multivariate analyses. Results During the study period, 295 patients underwent an appendectomy and had confirmatory AA diagnoses. Ninety-two patients had a PA (31.2%). In the univariate analysis, male gender, vomiting, diarrhea, fever, elevated white blood cell count (WBC) levels, and high C-reactive protein (CRP) were identified as predictors of PA. In the multivariate analysis, male gender (odds ratio [OR]: 3.133; 95% confidence interval [CI]: 1.610–6.096); vomiting (OR: 2.346; 95% CI: 1.141–4.822); diarrhea (OR: 4.549; 95% CI: 1.850–11.181); fever (OR: 3.429; 95% CI: 1.765–6.663); elevated WBC (OR: 2.962; 95% CI: 1.491–5.884) and elevated CRP (OR: 3.061; 95% CI: 1.267–7.396) were variables that predicted the PA in children. Conclusion Our data indicate that several clinical and biochemical parameters can reliably distinguish between pediatric PA and NPA at admission in the emergency department.Qatar National Library funded the open access publication of this article

An infant with ankyloblepharon filiforme adnatum associated with a cleft lip and palate: A case report

Ankyloblepharon filiform adnatum (AFA) is a rare but potentially ambylogenic congenital anomaly characterized by a partial or complete fusion of the eyelid margins.1 Although AFA has been reported as an isolated finding, it also has been associated with several disorders or as a part of well-defined syndromes (e.g., Edwards, Hay–Wells, popliteal pterygium, and curly hair-ankyloblepharon-nail dysplasia syndromes).2 Rosenman et al3 classified AFA into four groups: The first group consists of isolated cases that occur sporadically with no associated defects and with no particular genetic pattern; the second group is associated with life-threatening cardiac and CNS defects; the third group that occurs with ectodermal syndromes and has an autosomal dominant pattern; and a fourth group associated with cleft lip and palate defects, which were recorded in the proband or the extended family. Bacal et al4 further proposed the fifth group that includes AFA associated with chromosomal abnormalities. Williams et al5 introduced the sixth group, covering the cases with a family history of AFA without systemic anomalies. Therefore, the discovery of AFA requires a thorough pediatric examination. An early diagnosis and management of AFA prevent a stimulus deprivation amblyopia, which can cause a devastating effect on the visual acuity of the neonate. Simple excision of the tissue band from the lid margins has been used to treat AFA

The Role of Demographic and Clinical Characteristics in Distinguishing Testicular Torsion from Torsion of the Appendix Testis: A Single-center Retrospective Study

The acute scrotum (AS) in the pediatric population is a medical emergency. AS is usually caused by testicular torsion (TT) and torsion of the appendix testis (TAT). The current study explored which demographic and clinical characteristics can help distinguish between TT and TAT. We analyzed all children ≤16 years who underwent surgical exploration for AS. The patients were divided into Group 1/TT and Group 2/TAT. Ninety patients were included in the study (24 with TT and 66 with TAT). The peak incidence of TT was significantly higher than in the TAT group (p<0.001). Scrotal pain was more prevalent in the TAT group (p=0.02), whereas systemic signs (nausea/vomiting and abdominal pain) affected more frequently the TT patients (p=0.003 and p<0.001, respectively). The duration of symptoms was significantly longer in the TAT group (p<0.001). The duration of symptoms in the TT cohort significantly impacted the testicular salvage (p=0.008). Color Doppler ultrasound (CDUS) findings of absent/decreased testicular blood flow in the affected testis strongly favored the diagnosis of TT (p<0.001). The older age, shorter duration of symptoms, systemic signs, and CDUS findings can help distinguish between the two most common acute scrotum causes

Comparison of demographic and clinical characteristics in distinguishing testicular torsion from torsion of the appendix testis: A single-center retrospective study

Testicular torsion (TT) is an emergency requiring a prompt diagnosis and surgery to avoid irreversible changes and a complete loss of testis. The present study aimed to identify potential factors that may predict a testicular salvage after TT in pediatric patients. Consecutive medical records of all children ≤16 years old with surgically confirmed TT over a period of five years (2011-2016) were collected. Patients were divided into 2 groups according to testicular viability and the type of treatment: Orchidectomy and orchidopexy. The differences between the two groups and potential predictors of testicular salvage were analyzed. In conclusion, distinguishing TT from other acute scrotal pathology, including TAT, is crucial for timely surgical intervention and preservation of testes affected by AS. Older age, nausea/vomiting, abdominal pain, shorter duration of symptoms, and CDUS findings of absent or decreased testicular blood flow in the affected testis can distinguish between TT and TAT

The Effects of Ranitidine Treatment on the Risk of Necrotizing Enterocolitis in Preterm Infants: A Case-Control Study.

Gastric acidity plays an important role in the protection of infants against various pathogens from the environment. The histamine-2 receptor blockers (H2-blockers) are off-labeled drugs that are frequently prescribed in preterm neonates to prevent stress ulcers. The impact of the H2-blockers on the development of the necrotizing enterocolitis (NEC) in preterm infants is still controversial, particularly in the developing world. One hundred twenty-two preterm infants were enrolled in the study. The multivariate logistic regression model was used to identify potential postnatal risk factors associated with NEC. Preterm infants (n = 51) with total NEC, medical NEC, and surgical NEC had the highest rate of receiving ranitidine compared with controls (n = 71) (39.2%, 19.6%, and 47.6%, p < 0.05). Logistic regression analysis revealed that ranitidine use and nosocomial infections were significantly associated with NEC development (odds ratios 1.55 and 3.3). We confirm that ranitidine administration was associated with an increased risk of NEC in preterm infants. H2-blockers use should be only administered in very strictly selected cases after careful consideration of the risk-benefit ratio

Duration of symptoms is the only predictor of testicular salvage following testicular torsion in children: A case-control study

ObjectiveTesticular torsion (TT) is an emergency requiring a prompt diagnosis and surgery to avoid irreversible changes and a complete loss of testis. The present study aimed to identify potential factors that may be predict a testicular salvage after TT in pediatric patients. MethodsConsecutive medical records of all children ≤16 years old with surgically confirmed TT over a period of five years (2011–2016) were collected. Patients were divided into 2 groups according to testicular viability and the type of treatment: Orchidectomy and orchidopexy. The differences between the two groups and potential predictors of testicular salvage were analyzed. ResultsThirty-one boys with TT met the inclusion criteria and were included in the study. The mean age was 13.6 years (range, 10 days - 15.8 years). Testicular salvage was possible in 18 (58.1%) patients. The duration of symptoms and a lesser degree of torsion indicated a testicular salvage in children and adolescents with testicular torsion, but in multivariate analysis only duration of symptoms (time to surgical detorsion) was significantly associated with the risk of non-salvage. At follow-up, testicular atrophy affected 73.3% of the patients treated with orchidopexy. ConclusionDuration of symptoms is the only predictor of successful testicular salvage following testicular torsion in children. It is associated with a substantial risk of testicular loss and atrophy

Isolated deep orbital hemangioma treated successfully with oral propranolol in a 2-month-old infant: Case report with literature review

Purpose Infantile hemangiomas (IH) are the most common benign vascular tumors of infancy. Ocular complications due to orbital IH include strabismal, deprivational, or anisometropic astigmatism, and visual loss secondary to amblyopia. Observations We report a case of a two-month-old female infant with a severe deep orbital IH. The diagnosis was established by clinical examination and magnetic resonance imaging (MRI). The patient was treated with oral propranolol for six months. Complete tumor regression was observed clinically and by MRI following the treatment. The patient showed no adverse effects or tumor recurrence at the 14-month follow-up. Conclusions and Importance: Despite its benign nature, periorbital IH requires a rapid diagnosis and prompt treatment to prevent vision loss, particularly in infants. Our case confirms that oral propranolol may be regarded as a safe drug for periorbital IH with an excellent outcome