ali(Kamyar) saeidi mehrvarz’s Post

Cornea Update: Corneal Collagen Cross-linking for Keratoconus in Pediatric and Developmentally Delayed Patients: Purpose: Corneal cross-linking (CXL) is the standard of care in patients with keratoconus but presents unique challenges in children and developmentally delayed patients. We present our clinical decision-making algorithm, CXL surgical technique, and outcomes in these groups. Methods: A retrospective chart review was undertaken at a tertiary referral center of all patients who underwent CXL for keratoconus at University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh between October 1, 2017, and April 1, 2021. Demographic information along with preoperative, intraoperative, and postoperative ophthalmic examination findings were collected. The main outcome measures were indications of CXL, postoperative complications, and visual acuity (VA). Results: Forty-eight eyes of 34 patients [21 patients (30 eyes) with developmental delay (DD) and 13 patients (18 eyes) with no DD (NDD)] underwent epithelium-off, standard CXL. General anesthesia was used for CXL in all patients except for 3 with NDD. A temporary central tarsorrhaphy was performed in all patients with DD and 7 patients with NDD. The remaining got a bandage contact lens. There were no immediate postoperative complications. A trend toward improvement in VA was noted postoperatively. The mean logMAR VA (with habitual correction) was 0.67 preoperatively and 0.57 postoperatively (P = 0.3) in DD and 0.52 and 0.36, respectively (P = 0.13), in NDD. Conclusions: This retrospective review presents a technique for assessment and treatment of keratoconus in children and those with DD. Our technique ensures timely diagnosis and provides a safe method for CXL in these groups. Temporary central tarsorrhaphy is a well-tolerated option to reduce postoperative pain. http://dlvr.it/TBp39Y #Cornea #MostPopularArticles #Ophthalmology

The American Hospital Association (AHA) released its 2024 Q2 highlights for the ICD-10-CM/PCS and HCPCS coding systems. Key updates include:ICD-10-CM/PCS:Expanded Code Options: Significant additions and revisions were made, particularly in the respiratory and musculoskeletal systems, including new codes for thoracic vertebral body tethering (VBT) and spinal instrumentation. GUIDANCE ON SPECIFIC CONDITIONS: Updates were provided for coding chronic diseases and complications associated with mental health and chronic kidney disease, emphasizing the importance of accurate documentation. HCPCS:NEW AND REVISED CODES: The update includes 56 new, 21 deleted, and 12 revised HCPCS Level II codes, effective from April 1, 2024. Additionally, new CPT codes for influenza vaccines and PLA codes were introduced with effective dates in April and July 2024. CPT SURGERY SECTION UPDATES: The newsletter highlights changes in CPT codes related to spinal surgeries, respiratory procedures, and arthrodesis of the sacroiliac joint.

Ophthopedia Update:Outcomes of a Second Ahmed Glaucoma Implant with Mitomycin-C in Pediatric Glaucoma After Initial Valve Failure: Precis: After failure of a glaucoma drainage device in children, implantation of a second Ahmed glaucoma valve with mitomycin-C allows a significant reduction of intraocular pressure and number of medications with good medium- and long-term survival. Introduction: The effectiveness of glaucoma drainage devices (GDD) is limited in time. There is little literature regarding the optimal management strategy after failure of a GDD in pediatric glaucoma. Purpose: To report the outcomes of Ahmed glaucoma valve implantation (AGV) with mitomycin-C (MMC) after failure of a GDD in children. Methods: Retrospective chart review of patients with a history of at least one GDD receiving an AGV implantation with MMC between 2000 and 2019. We defined complete success as an IOP of 5 to 21 mmHg without glaucoma medication and qualified success as a final IOP of 5 to 21 mmHg with one or more glaucoma medication, without loss of vision. Results: Twenty-one patients (22 eyes) met the inclusion criteria. The intraocular pressure and number of medications were significantly reduced. The probability of complete success was 47% [95%CI: 29% – 75%] at 2 years and 34% [95%CI: 18% – 65%] at 4 years. The probability of qualified success was 74% [95%CI: 56% – 97%] at 2 years, and 54% [95%CI: 34% – 84%] at 5 years. Failure happened in 10 eyes after a mean time of 4.3 years ±3.6 [6 mo – 15 y], 5 of which (23%) for severe complication or loss of vision. Discussion: This study of implantation of a second valve with MMC reports a significant decrease of IOP and medications with medium- and long-term success rates close to those reported for a first valve implantation, although with a high risk of complications. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. #Glaucoma #Ophthalmology #Ophthotwitter

Surgical site occurrences (SSOs), particularly infections, are prevalent post-surgery complications, increasing morbidity and healthcare costs. The prophylactic use of advanced wound dressings such as Prevena™ and PICO™ are acclaimed for preventing SSOs. However, there is limited comparative data amongst devices regarding their effectiveness, especially in emergency surgeries which present a high risk for SSOs due to various patient-related factors. With this background in mind, we now publish a prospective randomized trial comparing Prevena™ and PICO™ in a Portuguese Hospital. Both worked well for this specific population and were better than conventional dressings. Unidade Local de Saúde do Tâmega e Sousa Faculdade de Medicina da Universidade do Porto https://lnkd.in/dgrU3vNY

Cornea Update: Corneal Collagen Cross-linking for Keratoconus in Pediatric and Developmentally Delayed Patients: Purpose: Corneal cross-linking (CXL) is the standard of care in patients with keratoconus but presents unique challenges in children and developmentally delayed patients. We present our clinical decision-making algorithm, CXL surgical technique, and outcomes in these groups. Methods: A retrospective chart review was undertaken at a tertiary referral center of all patients who underwent CXL for keratoconus at University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh between October 1, 2017, and April 1, 2021. Demographic information along with preoperative, intraoperative, and postoperative ophthalmic examination findings were collected. The main outcome measures were indications of CXL, postoperative complications, and visual acuity (VA). Results: Forty-eight eyes of 34 patients [21 patients (30 eyes) with developmental delay (DD) and 13 patients (18 eyes) with no DD (NDD)] underwent epithelium-off, standard CXL. General anesthesia was used for CXL in all patients except for 3 with NDD. A temporary central tarsorrhaphy was performed in all patients with DD and 7 patients with NDD. The remaining got a bandage contact lens. There were no immediate postoperative complications. A trend toward improvement in VA was noted postoperatively. The mean logMAR VA (with habitual correction) was 0.67 preoperatively and 0.57 postoperatively (P = 0.3) in DD and 0.52 and 0.36, respectively (P = 0.13), in NDD. Conclusions: This retrospective review presents a technique for assessment and treatment of keratoconus in children and those with DD. Our technique ensures timely diagnosis and provides a safe method for CXL in these groups. Temporary central tarsorrhaphy is a well-tolerated option to reduce postoperative pain. http://dlvr.it/TBKZ0V #Cornea #Ophthalmology #Ophthotwitter

📃Scientific paper: Double J stent combined with pyelostomy tube in pediatric laparoscopic pyeloplasty: a 5-year clinical experience in a single center Abstract: Objective To compare the outcome of using a double J (DJ) stent combined with pyelostomy tube with a DJ stent alone in laparoscopic pyeloplasty (LP) for pediatric ureteropelvic junction obstruction (UPJO). Methods A retrospective review of all patients with UPJO treated with LP between January 2017 and November 2021 was conducted in our center. According to different postoperative drainage methods patients were divided into a DJ stent group (52 cases) and a DJ stent combined with pyelostomy tube group (combination group, 41 cases). Operative time, bleeding volume, perirenal drainage stent removal time, postoperative hospital stay, postoperative complications, and renal function recovery were compared between the two groups. Renal ultrasound and diuretic renogram (DR) were used for preoperative and postoperative follow-up. Results A total of 52 patients were in the DJ stent group and 41 patients in the combination group. The mean hospital stay was 6.46 ± 2.66 days in the DJ stent group and 5.22 ± 1.63 days in the combination group (p < 0.05). Postoperative complications developed in 14 out of 52 patients in the DJ stent group (26.9%), while complications developed in 8 out of 41 patients in the combination group (19.5%) (p > 0.05). Non-catheter-related complications developed in 10/52 patients in the DJ stent group (19.2%) and only 1/41 patients in the combination group (2.4%) (p < 0.05). The renal function and renal cortex thickness in both groups were improved. C... Continued on ES/IODE ➡️ https://etcse.fr/ChE ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

ICYMI: Cornea Update: Corneal Collagen Cross-linking for Keratoconus in Pediatric and Developmentally Delayed Patients: Purpose: Corneal cross-linking (CXL) is the standard of care in patients with keratoconus but presents unique challenges in children and developmentally delayed patients. We present our clinical decision-making algorithm, CXL surgical technique, and outcomes in these groups. Methods: A retrospective chart review was undertaken at a tertiary referral center of all patients who underwent CXL for keratoconus at University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh between October 1, 2017, and April 1, 2021. Demographic information along with preoperative, intraoperative, and postoperative ophthalmic examination findings were collected. The main outcome measures were indications of CXL, postoperative complications, and visual acuity (VA). Results: Forty-eight eyes of 34 patients [21 patients (30 eyes) with developmental delay (DD) and 13 patients (18 eyes) with no DD (NDD)] underwent epithelium-off, standard CXL. General anesthesia was used for CXL in all patients except for 3 with NDD. A temporary central tarsorrhaphy was performed in all patients with DD and 7 patients with NDD. The remaining got a bandage contact lens. There were no immediate postoperative complications. A trend toward improvement in VA was noted postoperatively. The mean logMAR VA (with habitual correction) was 0.67 preoperatively and 0.57 postoperatively (P = 0.3) in DD and 0.52 and 0.36, respectively (P = 0.13), in NDD. Conclusions: This retrospective review presents a technique for assessment and treatment of keratoconus in children and those with DD. Our technique ensures timely diagnosis and provides a safe method for CXL in these groups. Temporary central tarsorrhaphy is a well-tolerated option to reduce postoperative pain. http://dlvr.it/TC1VCq #Cornea #MostPopularArticles #Ophthalmology

Updated Cochrane Review on Foot Orthoses for treating pediatric flat feet 🦶 ⠀ KEY FINDINGS "This review updates that from 2010, confirming that in the absence of pain, the use of high‐cost custom foot orthoses for healthy children with flexible flat feet has no supporting evidence, and draws very limited conclusions about foot orthoses for treating pediatric flat feet." ⠀ CLINICAL IMPLICATIONS 1️⃣ Most cases of pediatric flat feet reveal flexible feet that are pain-free and fall within the range of normal findings. Therefore, it is crucial to limit overmedicalization and unnecessary treatment of normal variation. ⠀ 2️⃣ Screening children for flat feet is unfounded, and both logically and economically refuted. Contrary to popular belief, there is no evidence to suggest that treating asymptomatic flat feet with foot orthoses will prevent future pain or injury. ⠀ 3️⃣ Attention should be re-directed to relevant pediatric foot conditions, which cause pain, limit function, or reduce quality of life. For example, children with foot pathology from discrete diagnoses (ex: juvenile idiopathic arthritis, cerebral palsy, Charcot Marie Tooth). ⠀ 📕 Link to review by Evans et al., 2022 👇 https://lnkd.in/epU8i6-Y

A 55-year-old male presented to the general outpatient department with a history of dysuria lasting one week and a tender mass in the penile region. The patient had no significant past medical history pertaining to urethral procedures or recurrent sexually transmitted diseases. He was diagnosed with a urinary tract infection and received antibiotic treatment. After the completion of this course, the patient returned to the urology department due to persistent symptoms. A physical examination revealed a midline perineal mass; upon palpation, urine was evacuated from the penis. The mass was multinodular with mobile contents, raising concerns regarding possible stones. Magnetic resonance imaging (MRI) of the urethra revealed a 2 cm × 1.5 cm × 2.5 cm urethral diverticulum connecting to the penile urethra, located on the right lateral side of the anterior aspect of the corpus spongiosum, accompanied by multiple small calculi. Additionally, it was noted that there was a small internal air bubble and faint rim enhancement, suggesting a possible infection or inflammatory process, with the possibility of gas-forming infection not being excluded. There was also a 3.0-cm lobulated calcification adjacent to the inferior aspect of the bulbar urethra, which connected to an elongated enhancing cystic tract extending to the left-sided perineum, containing two small calcifications, indicating another potential urethral diverticulum containing stones. This presentation was consistent with a stone-filled diverticulum. A cystoscopy conducted at that time yielded normal results. The patient was counselled regarding the condition and elected to undergo urethroplasty; however, he later declined the procedure. Two months thereafter, he presented to the emergency department with high-grade fever and dysuria, along with a tender and fluctuated mass in the perineal area. He was subsequently diagnosed with a peri-anal abscess and underwent incision and drainage by a general surgeon. Post-operatively, he reported continuous drainage of clear fluid from the wound, which was later confirmed to be urine based on creatinine analysis. A retrograde urethrogram and a voiding cystourethrogram indicated the presence of a 1.0-cm urethral diverticulum at the distal part of the penile urethra, which contained smaller lobulated calcifications and formed a urethro-cutaneous fistula. Furthermore, a larger lobulated calcification was noted adjacent to the proximal portion of the penile urethra. The patient was diagnosed with a ruptured multiple male urethral diverticulum, accompanied by calculi and a urethrocutaneous fistula. After thorough consultation, the patient elected to proceed with surgical intervention to address the urethral diverticulum and urethroplasty.

I am proud to announce our latest publication "Subdural Hematoma as a Complication of Endoscopic Third Ventriculostomy in a Pediatric Patient: a Case Report and Literature Review", now available in Child's Nervous System. Our report emphasizes the importance of considering subdural hematoma as a potential postoperative complication in pediatric patients undergoing ETV, despite its rarity. We discuss various pathophysiological theories that may lead to the development of subdural hematomas post-surgery. However, the scarcity of similar reported cases limits our understanding of these mechanisms. We hope that more cases will be documented in the future, enhancing our knowledge base and helping to establish more robust prevention strategies. Thanks to the entire team for their dedication. Read the full article here: https://lnkd.in/diWv8bvK #PediatricNeurosurgery #ETV #SDH