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ObjectiveTo evaluate the role of prophylactic propranolol in the prevention of retinopathy of prematurity (ROP) in infants ≤32 weeks of gestational age and their visual outcome at 1 year of corrected gestational age.DesignRandomised double blind placebo controlled trial, parallel group nrolment with allocation ratio of 1:1.SettingsTwo level III neonatal intensive care units.Participants109 preterm neonates of ≤32 weeks of gestation with postnatal age ≤8 days old.Intervention Study group: Infants with gestational age between 26 and 32 weeks were started on propranolol prophylaxis (0.5 mg/kg/dose every 12 hours) on seventh completed day of life, till a corrected gestational age of 37 weeks or complete vascularisation of retina whichever was later. Control group infants received a placebo.Outcome measures Primary: ROP of all grades; Secondary: evaluation of complications due to propranolol, ROP needing treatment with laser and/or antivascular endothelial growth factor (anti-VEGF) and visual outcome at 12 months corrected age.ResultsProphylactic propranolol in the prescribed dose of 1 mg/kg/day showed a decreasing trend in the incidence of ROP (56.8% vs 68.6%; p=0.39), need for laser therapy (21.56% vs 31.37%; p=0.37), treatment with anti-VEGF (3.92% vs 15.68%; p=0.09) or visual outcomes at 1 year in the study and control groups, respectively, though these reductions were not statistically significant. Decreasing trends favouring propranolol in all other ROP-related outcomes were also noted in the study group.ConclusionsProphylactic propranolol in the prescribed dose of 1 mg/kg/day showed a decreasing trend in all outcomes of ROP though statistically not significant.Trial registration numberCTRI/2013/11/004131.

Purpose Acute angle-closure glaucoma is a common ophthalmic emergency and individuals with shallow anterior chambers and suspected narrow angles are increasingly referred to the hospital eye service for assessment. There appears to be variation in subsequent management, with no national consensus or college guidelines. This study ascertains the current use of prophylactic YAG iridotomy in patients with no known history of an acute angle-closure glaucoma attack, and also the methods used in patient selection. Materials and methods Questionnaire-based survey mailed to 650 UK consultant ophthalmologists with a covering letter in 2003. Results A total of 546 questionnaires were returned. In all, 408 respondents (74.7%) confirmed they perform prophylactic YAG iridotomy and of these 347 (85.0%) use patient symptoms and 268 (65.6%) presenting IOP in patient selection, 394 (96.6%) perform gonioscopy and 97 (23.8%) use some form of provocative test first. A total of 135 (25.3%) stated they do not perform this procedure. Conclusion This study reveals current national practice among UK ophthalmologists, with variations in the assessment of patients with narrow angles but a high uptake of prophylactic YAG iridotomy.

Newer surgical tools, which have been widely accepted as important adjuncts in otological surgery, include the laser, otoendoscopy and facial nerve monitoring. A confidential postal questionnaire survey was carried out to evaluate the usage of these newer techniques among the Consultant members of the British Association of Otorhinolaryngology-Head and Neck Surgery. Our study revealed that the usage of otoendoscopy, laser and/or facial nerve monitoring is not as widespread as might be thought among otological surgeons in the United Kingdom.

To the Editor: With respect to the letter by Strandness and associates (Nov. 16 issue), 1 I wish to comment on several of the issues raised concerning the use of laser-assisted angioplasty. First, I agree that patients and physicians are often unaware of and perhaps misinformed about the indications, safety, and efficacy of new invasive interventions. However, inhibiting the development of new forms of technology and limiting their applications may not be in the best interests of patient care; informed consent and education about the exact merits of the procedures are. Second, the establishment of \"institutes\" and \"centers,\" with all the . . .

Improvements in acute burn care have enabled patients to survive massive burns that would have once been fatal. Now up to 70% of patients develop hypertrophic scars after burns. The functional and psychosocial sequelae remain a major rehabilitative challenge, decreasing quality of life and delaying reintegration into society. Approaches to optimise healing potential of burn wounds use targeted wound care and surgery to minimise the development of hypertrophic scarring. Such approaches often fail, and modulation of the established scar is continued although the optimal indication, timing, and combination of therapies have yet to be established. The need for novel treatments is paramount, and future efforts to improve outcomes and quality of life should include optimisation of wound healing to attenuate or prevent hypertrophic scarring, well-designed trials to confirm treatment efficacy, and further elucidation of molecular mechanisms to allow development of new preventive and therapeutic strategies.

Background. Integration of rapid diagnostic testing via matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) with antimicrobial stewardship team (AST) intervention has the potential for early organism identification, customization of antibiotic therapy, and improvement in patient outcomes. The objective of this study was to assess the impact of this combined approach on clinical and antimicrobial therapy–related outcomes in patients with bloodstream infections. Methods. A pre–post quasi-experimental study was conducted to analyze the impact of MALDI-TOF with AST intervention in patients with bloodstream infections. The AST provided evidence-based antibiotic recommendations after receiving real-time notification following blood culture Gram stain, organism identification, and antimicrobial susceptibilities. Outcomes were compared to a historic control group. Results. A total of 501 patients with bacteremia or candidemia were included in the final analysis: 245 patients in the intervention group and 256 patients in the preintervention group. MALDI-TOF with AST intervention decreased time to organism identification (84.0 vs 55.9 hours, P < .001), and improved time to effective antibiotic therapy (30.1 vs 20.4 hours, P = .021) and optimal antibiotic therapy (90.3 vs 47.3 hours, P < .001). Mortality (20.3% vs 14.5%), length of intensive care unit stay (14.9 vs 8.3 days) and recurrent bacteremia (5.9% vs 2.0%) were lower in the intervention group on univariate analysis, and acceptance of an AST intervention was associated with a trend toward reduced mortality on multivariable analysis (odds ratio, 0.55, P = .075). Conclusion. MALDI-TOF with AST intervention decreased time to organism identification and time to effective and optimal antibiotic therapy.

This study compares the surgical and functional outcomes of photoselective vaporization of the prostate (PVP), anatomical PVP (aPVP), and Greenlight laser enucleation of the prostate (GreenLEP) in the treatment of benign prostatic hyperplasia (BPH). A comprehensive search was conducted in February 2024 across PubMed, the Cochrane Library, and EMBASE databases, following PRISMA guidelines and registered with PROSPERO (CRD42024518321). Thirteen studies were included, with 11 analyzed in the meta-analysis. Compared to PVP, aPVP had longer operation times (MD: -11.42 min, 95% CI: -15.70 to -7.14, p  < 0.00001), higher energy utilization (MD: -56.83 kJ, 95% CI: -61.16 to -52.50, p  < 0.00001), and greater energy density (MD: -0.57 kJ/mL, 95% CI: -0.75 to -0.39, p  < 0.00001). GreenLEP showed superior energy efficiency (MD: 212.95 kJ, 95% CI: 40.41 to 385.50, p  = 0.02) and functional outcomes, particularly in Qmax, PVR, and PSA levels at final follow-up. GreenLEP also had the lowest re-operation rate (OR: 27.30, 95% CI: 8.52 to 87.51, p  < 0.00001) and was most effective for larger prostates. No significant differences in early, late, or major complications were observed across techniques. This meta-analysis highlights that aPVP and GreenLEP offer superior functional and efficiency benefits compared to PVP while maintaining comparable safety. GreenLEP is particularly advantageous for larger prostates, providing an effective and safe alternative.