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A dosing protocol with regard to individualized radioiodine treatment of pet cats along with hyperthyroidism.
OBJECTIVE To systematically review the literature exploring the impact of isolation on hospitalised patients who are infectious psychological and non-psychological outcomes. DESIGN Systematic review with meta-analysis. DATA SOURCES Embase, Medline and PsycINFO were searched from inception until December 2018. Reference lists and Google Scholar were also handsearched. RESULTS Twenty-six papers published from database inception to December 2018 were reviewed. A wide range of psychological and non-psychological outcomes were reported. There was a marked trend for isolated patients to exhibit higher levels of depression, the pooled standardised mean difference being 1.28 (95% CI 0.47 to 2.09) and anxiety 1.45 (95% CI 0.56 to 2.34), although both had high levels of heterogeneity, and worse outcomes for a range of care-related factors but with significant variation. CONCLUSION The review indicates that isolation to contain the risk of infection has negative consequences for segregated patients. Although strength of the evidence is weak, comprising primarily single-centre convenience samples, consistency of the effects may strengthen this conclusion. More research needs to be undertaken to examine this relationship and develop and test interventions to reduce the negative effects of isolation. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.AIM To reassess the association between near work, outdoor exposure and myopia in children through an objective approach. METHODS Eighty-six children (10.13±0.48 years) were asked to wear Clouclip, a newly developed wearable device that is able to measure working distance and eye-level illuminance, for a complete week to obtain information on near work and outdoor exposure. The mean daily Clouclip wearing time was 11.72±1.14 hour. The spherical equivalent refraction was determined by cycloplegic autorefraction. RESULTS The myopic children were found to be exposed to light intensities >3000 lux (0.68±0.50 hour vs 1.02±0.53 hour, p=0.012) and >5000 lux (0.42±0.35 hour vs 0.63±0.31 hour, p=0.004) for shorter durations on average each day than the non-myopic children. Additionally, the myopic children spent more time on average each day on activities at a distance of 5000 lux (OR=1.12, 95% CI 1.03 to 1.77, p=0.046)) were the independent protective factors and risk factors, respectively. CONCLUSION The current study provides novel evidence, based on objective data, to support the association between the intensity of near work, light intensity and myopia. However, the causality and the dose-effect relationship need to be investigated further. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.BACKGROUND/AIMS This study assessed the feasibility of a novel contact lens device for intraocular pressure (IOP) and ocular pulse amplitude (OPA) continuous measurements over 24 hours. METHODS This prospective, open-label, single-centre, non-randomised study included glaucoma and healthy subjects. IOP and OPA values acquired by the pressure-measuring contact lens (PMCL) device in one patient's eye at the beginning of the measurement were compared with tonometry values (Goldman applanation tonometry (GAT) and dynamic contour tonometry (DCT)) in the same eye just before PMCL placement. Furthermore, IOP and OPA values measured with PMCL on the study eye during a water drinking test (WDT) were compared with DCT values in the fellow eye. Comparisons were performed using t-tests with 95% Confidence Intervals. RESULTS Twenty-four-hour IOP and OPA curves were obtained for eight subjects. The mean IOP difference between PMCL and tonometry on the same eye was within ±5 mm Hg in 75% (GAT) and 87.5% (DCT) of subjects. IOP variations due to WDT were detected by PMCL and DCT, showing an average increase of 2.43 and 1.85 mm Hg, respectively. Differences between PMCL and DCT for IOP variations in fellow eyes were within ±5 mm Hg for 97.2% of time points. The difference between OPA in fellow eyes was within ±5 mm Hg for 85.5% of the time points. CONCLUSIONS This first-in-human study is a proof-of-concept for 24-hour continuous measurements of IOP and OPA with the PMCL. This device is non-invasive and has good comparability with standard tonometry. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.BACKGROUND To assess the clinical and patient-centred effectiveness of a novel residential ocular care (ROC) model in Australian individuals residing in residential care. METHODS In this prospective, multicentred, randomised controlled trial conducted in 38 Australian aged-care facilities (2015-2017), 178 visually impaired individuals living in residential care facilities (mean age ±SD 83.9±8.6 years; 65.7% women) were cluster randomised to ROC (n=95) or usual care (n=83) pathways. The ROC arm comprised a tailored and comprehensive within-site eye examination and care rehabilitation pathway, while usual care participants were given a referral to an external eyecare provider. Outcomes included presenting distance and near visual acuity (PNVA); Rasch-transformed Reading, Emotional and Mobility scores from the Impact of Vision Impairment questionnaire; quality of vision (QoV comprising Rasch-transformed Frequency, Severity and Bother domains) scores; Euroqol-5-Dimensions (raw scores); Cornell Scale for Depression (raw scores) and 6-month falls frequency, assessed at baseline and 6 months post intervention. Within-group and between-group comparisons were conducted using linear mixed models, adjusted for baseline differences in characteristics between the two arms. RESULTS At 6 months, intention-to-treat analyses showed significant between-group improvements in ROC residents compared with usual care for PNVA, Emotional and QoV scores (all p less then 0.05) These significant findings were retained in per-protocol analyses. No other between-group changes were observed. CONCLUSION Our ROC model was effective in improving near vision, emotional well-being and perceived burden of vision-related symptoms in residential care dwellers in Australia with vision impairment. Future studies to evaluate the cost effectiveness and implementation of ROC in Australia are warranted. © Author(s) (or their employer(s)) 2020. No commercial re-use. SecinH3 See rights and permissions. Published by BMJ.The possibility of a retained foreign body should always be considered when a patient presents with a history of orbital trauma, especially when the patient is unresponsive or temporarily responsive to treatment. Not all cases of retained foreign body present with decreased vision or restricted mobility or fever. The entry wound is also not apparent on examination in all cases. In summary, meticulous history-taking, thorough examination, high index of suspicion along with a low threshold for imaging studies are essential to make a timely diagnosis of a retained intraorbital foreign body. The prompt removal with the appropriate approach may not only save the eye but also the life of the patient. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.Aneurysm of the pedal arteries is uncommon. Dorsalis pedis aneurysms are a clinically rare phenomenon. We present a case of traumatic fusiform aneurysm of the dorsalis pedis artery in an otherwise well 53-year-old Caucasian man. Initial history was suggestive of micro-embolic disease to the medial toes of the left foot and on examination pulses were palpable throughout the lower limbs with a strong, palpable dorasalis pedis pulse. Ankle brachial pressure indexes were normal but reduced toe pressures to the left toes. Colour flow duplex imaging revealed aneurysmal dilation, involving all layers of artery wall, with irregular intraluminal thrombus across a 16-mm segment. Subsequent CTA run-off revealed all vessels were patent in the left lower limb. Due to concerns over further embolisation, our patient underwent successful ligation of the his dorsalis pedis. He had an uneventful post-operative recovery. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.Post-Epstein-Barr virus (EBV) cerebellitis is very rare complication of infectious mononucleosis and only a few adult cases are reported in literature. We present a 23-year-old patient who was admitted to the neurology service with worsening ataxia, nystagmus and dysarthria, 1 week after infectious mononucleosis. Imaging and cerebrospinal fluid studies were normal, serum studies revealed acute transaminitis and positive EBV viral capsid IgM and IgG. The patient underwent a 5-day course of intravenous immunoglobulins with rapid resolution of all his symptoms and was safely discharged home. The pathophysiology of post-EBV cerebellitis involves autoreactive antibodies, rather than a direct viral insult. Antineuronal antibodies might be the result of a mimicry between EBV proteins and neuronal antigens or they can be secreted by the EBV-transformed lymphocytes themselves. Many reports stress the benign, self-limiting nature of this syndrome; however, immunotherapy might de facto decrease the severity and duration of illness. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVE Gestational diabetes mellitus (GDM) is a metabolic disorder of pregnancy that is increasingly prevalent among Chinese women. Few studies have examined whether the migration status of Chinese women contributes to the risks of developing GDM during pregnancy. RESEARCH DESIGN AND METHODS In this observational, cross-sectional and hospital-based study, we examined the prevalence of GDM and glycemic levels at oral glucose tolerance test (OGTT) among 491 Australian Chinese migrants (n=491) and native Chinese (n=1000). We defined GDM using the International Association of Diabetes and Pregnancy Study Groups guidelines. We collected data on maternal age, body mass index (BMI) and gestational age (GA) at booking and GA at delivery from medical records. We used multiple logistic and linear regression models to calculate the OR of having GDM and mean differences in glycemic levels in Australian Chinese migrants, relative to native Chinese. RESULTS Age-at-booking and BMI-at-booking adjusted GDM prevalence was significantly higher in Australian Chinese migrants than native Chinese (19.7% vs 14.6%; p=0.01). After adjusting for age, BMI at booking and GA at booking, fasting glucose levels were significantly lower (β -0.08 mmol/L; 95% CI -0.14 to 0.02), while 2-hour glucose levels were significantly higher (0.22 mmol/L; 0.02 to 0.43) in Australian Chinese immigrants than native Chinese. CONCLUSIONS Migration status may be a marker for abnormal glucose metabolism during pregnancy among Australian Chinese migrants, possibly due to socio-economic disadvantages and lifestyle changes associated with migration. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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