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Purpose: The aim of this study was to evaluate the changes in astigmatism after unilateral recession of horizontal rectus muscles in pediatric patients. Methods: The authors retrospectively evaluated the medical history of 52 children with esotropia or exotropia, that underwent a unilateral recession strabismus surgery. The intervention group consisted of the 52 eyes that underwent strabismus surgery, and the control group consisted of the other 52 fellow unoperated eyes of the same participants. The intervention group was divided into medial and lateral rectus muscle subgroups, and four subgroups based on the astigmatism axis preoperatively (A: with-the-rule astigmatism, B: no astigmatism, C: intermediate meridians, D: against-the-rule astigmatism). All patients were examined one day preoperatively, and then, six weeks postoperatively. Paired tests were conducted, and the significant level was set to 0.05 or was adjusted for subgroups. Results: A mean difference 0.43 D of astigmatism (95% CI: 0.27, 0.59) was observed after the surgery between intervention and control group (P < 0.001). Astigmatism change (postoperative - preoperative) in subgroup A was 0.50 D (P < 0.001) and in subgroup B was 0.75 D (P < 0.001). Moreover, astigmatism changes of 0.50 D were found in both lateral (P < 0.001) and medial rectus muscle group (P = 0.002). Conclusion: Strabismus surgery appears to be associated with alterations in astigmatism, and in particular increase in cylindrical power in the eyes that had with-the-rule astigmatism or no astigmatism preoperatively. Those changes should be considered when planning the operation, to avoid transforming clinically non-significant astigmatism into clinically significant.

The purpose of this report is to present a case of orbital rhabdomyosarcoma (RMS) masquerading as a dermoid cyst. A six-year-old boy with an unremarkable medical history presented in the outpatient department with a palpable mass in the superonasal region of the right orbit, which had rapidly grown in the past month. The most likely diagnosis was dermoid cyst and the patient was scheduled for surgical excision. A high index of suspicion was raised intraoperatively based on the appearance of the lesion due to the presence of a feeder vessel. The histopathology examination identified alveolar RMS. The patient was referred to a pediatric oncology department and commenced intravenous chemotherapy. RMS may masquerade as various conditions, including dermoid cysts and chalazion. A high index of suspicion should be raised in cases with rapidly growing lesions.

The aim of this study was to evaluate the changes in astigmatism after unilateral recession of horizontal rectus muscles in pediatric patients. The authors retrospectively evaluated the medical history of 52 children with esotropia or exotropia, that underwent a unilateral recession strabismus surgery. The intervention group consisted of the 52 eyes that underwent strabismus surgery, and the control group consisted of the other 52 fellow unoperated eyes of the same participants. The intervention group was divided into medial and lateral rectus muscle subgroups, and four subgroups based on the astigmatism axis preoperatively (A: with-the-rule astigmatism, B: no astigmatism, C: intermediate meridians, D: against-the-rule astigmatism). All patients were examined one day preoperatively, and then, six weeks postoperatively. Paired tests were conducted, and the significant level was set to 0.05 or was adjusted for subgroups. A mean difference 0.43 D of astigmatism (95 CI: 0.27, 0.59) was observed after the surgery between intervention and control group (P < 0.001). Astigmatism change (postoperative - preoperative) in subgroup A was 0.50 D (P < 0.001) and in subgroup B was 0.75 D (P < 0.001). Moreover, astigmatism changes of 0.50 D were found in both lateral (P < 0.001) and medial rectus muscle group (P = 0.002). Strabismus surgery appears to be associated with alterations in astigmatism, and in particular increase in cylindrical power in the eyes that had with-the-rule astigmatism or no astigmatism preoperatively. Those changes should be considered when planning the operation, to avoid transforming clinically non-significant astigmatism into clinically significant.

The purpose of this article is to report a case of bilateral foveal hypoplasia in an eight-year-old girl who presented to the ophthalmology department due to poor vision in both eyes. Clinical examination revealed bilateral nystagmus, decreased vision, as well as iris transillumination. Dilated fundus examination indicated the absence of light reflex around the foveal area and optical coherence tomography (OCT) imaging exhibited the absence of the fovea centralis depression. These findings, in addition to the patient's light-colored hair and skin complexion, raised suspicion for albinism. The patient was referred for genetic testing and the results confirmed the diagnosis of tyrosinase-positive oculocutaneous albinism (OCA2).

AimThe aim of the study was to evaluate the long-term effect of large horizontal rectus muscle recession on macula thickness using spectral domain optical coherence tomography (SD-OCT).Material and methodsForty-two children were included in the study. The intervention groups were the medial rectus (MR) group (=20 eyes ) and the lateral rectus (LR) group (=22 eyes), including the eyes that underwent large medial and lateral rectus muscle recession, respectively. The control group included the fellow 42 unoperated eyes of the same children. Each eye was scanned using Topcon Maestro2 OCT-Angiography (OCTA; Topcon, Tokyo, Japan) preoperatively and then two months following surgery. A paired t-test was used to compare the mean difference in macular thickness between the intervention and control groups using the statistical program R (R Foundation for Statistical Computing, Vienna, Austria).ResultsThe mean change in central, parafoveal, and perifoveal macular thickness of the intervention group was not statistically significant.ConclusionThe long-term changes in macular thickness, as evaluated using SD-OCT both for the central and peripheral regions of the fovea, following large horizontal rectus muscle recession surgery, are not statistically significant.

IntroductionThe epidemiology of severe lower respiratory tract infections (LRTI) is constantly changing. We aimed to describe it using the BioFire® FilmArray® Pneumonia plus (PNplus) Panel.MethodsIn a sub-study of the PROGRESS trial, sputum samples of 90 patients with sepsis and LRTI were retrospectively studied. The primary endpoint was the comparative detection rate of pathogens between conventional microbiology and PNplus Panel; secondary endpoints were microbiology and the association with the inflammatory host response.ResultsFifty-six patients with community-acquired pneumonia without risk factors for multidrug-resistant (MDR) pathogens and another 34 patients with risk factors for MDR were studied; median pneumonia severity index (PSI) was 113 (88–135). PNplus detection rate was 72.2% compared to 10% by conventional microbiology (p < 0.001); Streptococcus pneumoniae was the most common pathogen. PSI and procalcitonin were greater among patients with bacterial pathogens than viral pathogens. Median procalcitonin was 0.49 ng/ml and 0.18 ng/ml among patients with ≥ 105 and < 105 copies/ml of detected bacteria, respectively (p = 0.004). Resistance reached 14.4%.ConclusionPNplus detects severe pneumonia pathogens at a greater rate than conventional microbiology. High levels of inflammation accompany bacterial detection.Trial RegistrationPROGRESS, ClinicalTrials.gov NCT03333304, 06/11/2017.

Difficult airway assessment is based on various anatomic parameters of upper airway, much of it being concentrated on oral cavity and the pharyngeal structures. The diagnostic value of tests based on neck anatomy in predicting difficult laryngoscopy was assessed in this prospective, open cohort study. We studied 341 adult patients scheduled to receive general anaesthesia. Thyromental distance (TMD), sternomental distance (STMD), ratio of height to thyromental distance (RHTMD) and neck circumference (NC) were measured pre-operatively. The laryngoscopic view was classified according to the Cormack-Lehane Grade (1-4). Difficult laryngoscopy was defined as Cormack-Lehane Grade 3 or 4. The optimal cut-off points for each variable were identified by using receiver operating characteristic analysis. Sensitivity, specificity and positive predictive value and negative predictive value (NPV) were calculated for each test. Multivariate analysis with logistic regression, including all variables, was used to create a predictive model. Comparisons between genders were also performed. Laryngoscopy was difficult in 12.6% of the patients. The cut-off values were: TMD ≤7 cm, STMD ≤15 cm, RHTMD >18.4 and NC >37.5 cm. The RHTMD had the highest sensitivity (88.4%) and NPV (95.2%), while TMD had the highest specificity (83.9%). The area under curve (AUC) for the TMD, STMD, RHTMD and NC was 0.63, 0.64, 0.62 and 0.54, respectively. The predictive model exhibited a higher and statistically significant diagnostic accuracy (AUC: 0.68, P < 0.001). Gender-specific cut-off points improved the predictive accuracy of NC in women (AUC: 0.65). The TMD, STMD, RHTMD and NC were found to be poor single predictors of difficult laryngoscopy, while a model including all four variables had a significant predictive accuracy. Among the studied tests, gender-specific cut-off points should be used for NC.