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Mathan JJ, Yao A, Thia B, Mitra B, Dameer A, Dong M, Chan E. Re: 'clinical outcomes of the Centre for Eye Health: an intra-professional optometry-led collaborative eye care clinic in Australia'. Clin Exp Optom 2021; 105:667-668. [PMID: 34751102 DOI: 10.1080/08164622.2021.1989974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Jeremy J Mathan
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Australia
| | - Anthony Yao
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Department of Ophthalmology, Western Hospital, Footscray, Australia
| | - Brandon Thia
- Department of Ophthalmology, Alfred Hospital, Melbourne, Australia
| | - Biswadev Mitra
- School of Public Health & Preventive Medicine, Monash University, Clayton, Australia.,Emergency & Trauma, The Alfred Hospital, Melbourne, Australia
| | | | - Michael Dong
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Elsie Chan
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
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Thia B, McGuinness MB, Ebeling PR, Khong JJ. Diagnostic accuracy of Immulite® TSI immunoassay for thyroid-associated orbitopathy in patients with recently diagnosed Graves' hyperthyroidism. Int Ophthalmol 2021; 42:863-870. [PMID: 34613563 DOI: 10.1007/s10792-021-02052-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE The Immulite® thyroid stimulating immunoglobulin (TSI) immunoassay is a relatively new commercial assay that has shown good diagnostic accuracy in Graves' hyperthyroidism (GH). However, its clinical utility in thyroid-associated orbitopathy (TAO) is less clear. The purpose of this study was to assess the diagnostic accuracy of the Immulite® TSI immunoassay for TAO and investigate the associations between TSI and other clinical measures. METHODS One hundred and forty patients that had been diagnosed with GH within the previous 12 months were recruited. Identification and grading of TAO were performed at enrolment and serum samples were analysed using the Immulite® TSI immunoassay. RESULTS Of the 140 participants recruited, 75 (53.6%) had TAO. Age, sex and time since GH diagnosis were similar between those with and without TAO (p ≥ 0.300). TSI level tended to decrease with increasing time from GH diagnosis (Spearman's ρ - 0.28, 95% CI - 0.43, - 0.12). TSI levels were higher among those with than those without TAO (median 4.0 vs. 2.7 IU/L, respectively, p = 0.037). There was no correlation between TSI level and inflammatory index score (ρ = 0.14, 95% CI - 0.03, 0.30) or clinical severity (p = 0.527) among those with TAO. TSI level showed poor diagnostic accuracy for TAO (area under the receiver operating characteristic curve 0.60, 95% CI 0.51, 0.70). CONCLUSIONS Although Immulite® TSI level was higher in the presence of TAO, it showed poor diagnostic accuracy and no correlation with clinical markers of TAO severity or activity.
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Affiliation(s)
- Brandon Thia
- Department of Ophthalmology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
| | - Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, 3002, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Peter R Ebeling
- Department of Medicine, Monash Medical Centre, School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
| | - Jwu Jin Khong
- Department of Ophthalmology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, 3002, Australia.,Orbital, Plastic and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, 3002, Australia.,Department of Surgery, University of Melbourne, Austin Health, Heidelberg, VIC, 3084, Australia
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Hogarty DT, Ben Artsi E, Thia B, Meusemann R, Gaskin B. Acute subperiosteal orbital haematoma following general anaesthesia in the setting of recent trauma. Orbit 2021; 41:485-487. [PMID: 33522377 DOI: 10.1080/01676830.2021.1880445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Subperiosteal orbital haematoma (SOH) is an uncommon condition that involves bleeding within the potential space between the periosteum and orbital bone. This typically occurs within the superior orbit. If the SOH is large enough it can compress orbital structures and be sight threatening. Therefore, it is important for the clinician to recognize the potential causes for this phenomenon which will help guide the diagnosis. Herein we describe a unique case of unilateral SOH in a 47-year-old male following otherwise uncomplicated general anaesthesia. This occurred 6 weeks after a motorbike accident in which there was no facial/ocular injury. This case report identifies for the first time the potential for a late-onset SOH in the setting of a stressor event. It also highlights the potential for this condition to occur following general anaesthesia in a supine patient having a non-cardiac procedure, previously recognized as a potential stressor.
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Affiliation(s)
| | - Elad Ben Artsi
- Department of Ophthalmology, The Alfred, Melbourne, Australia
| | - Brandon Thia
- Department of Ophthalmology, The Alfred, Melbourne, Australia
| | - Robin Meusemann
- Department of Ophthalmology, The Alfred, Melbourne, Australia
| | - Brent Gaskin
- Department of Ophthalmology, The Alfred, Melbourne, Australia
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Dong M, Hogarty D, Thia B, Meusemann R. Globe rupture and total traumatic aniridia following blunt facial trauma 30 years after cataract surgery. Arch Trauma Res 2021. [DOI: 10.4103/atr.atr_97_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Garcia SC, Toolis M, Ubels M, Mollah T, Paul E, Pandey A, Thia B, Wong T, Tiruvoipati R. Comparison of clinical characteristics and outcomes between alcohol-induced and gallstone-induced acute pancreatitis: An Australian retrospective observational study. SAGE Open Med 2021; 9:20503121211030837. [PMID: 34290866 PMCID: PMC8274077 DOI: 10.1177/20503121211030837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/18/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To compare the characteristics and outcomes of patients presenting to hospital with alcohol-induced and gallstone-induced acute pancreatitis. METHODS Retrospective study of all patients with alcohol-induced or gallstone-induced pancreatitis during the period 1 June 2012 to 31 May 2016. The primary outcome measure was hospital mortality. Secondary outcome measures included hospital length of stay, requirements for intensive care unit admission, intensive care unit mortality, mechanical ventilation, renal replacement therapy, requirement of inotropes and total parenteral nutrition. RESULTS A total of 642 consecutive patients (49% alcohol; 51% gallstone) were included. No statistically significant differences were found between alcohol-induced and gallstone-induced acute pancreatitis with respect to hospital mortality, requirement for intensive care unit admission, intensive care unit mortality and requirement for mechanical ventilation, renal replacement therapy, inotropes or total parenteral nutrition. There was significant difference in hospital length of stay (3.07 versus 4.84; p < 0.0001). On multivariable regression analysis, Bedside Index of Severity in Acute Pancreatitis score (estimate: 0.393; standard error: 0.058; p < 0.0001) and admission haematocrit (estimate: 0.025; standard error: 0.008; p = 0.002) were found to be independently associated with prolonged hospital length of stay. CONCLUSION Hospital mortality did not differ between patients with alcohol-induced and gallstone-induced acute pancreatitis. The duration of hospital stay was longer with gallstone-induced pancreatitis. Bedside Index of Severity in Acute Pancreatitis score and admission haematocrit were independently associated with hospital length of stay.
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Affiliation(s)
| | - Michael Toolis
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Max Ubels
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Taha Mollah
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Eldho Paul
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- ANZIC-RC, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ashish Pandey
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Brandon Thia
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Tricia Wong
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Ravindranath Tiruvoipati
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- ANZIC-RC, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Ravindranath Tiruvoipati, Department of Intensive Care Medicine, Frankston Hospital, 2 Hastings Road, Frankston, VIC 3199, Australia.
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Abstract
OBJECTIVE To describe the characteristics of patients presenting to an Emergency Department (ED) following overdoses; to identify risk factors for intensive care unit (ICU) admission among these patients; and to identify the rate of mortality and repeat overdose presentations over four years. METHODS Adult patients presenting to ED following drug overdose during 2014 were included. Data were collected from medical notes and hospital databases. RESULTS During the study period, 654 patients presented to ED 800 times following overdose. Seventy-eight (9.8%) resulted in ICU admission, and 59 (7.4%) required intubation; 57.2% had no history of overdose presentations, and 72.9% involved patients with known psychiatric illness. Overdose of atypical antipsychotics (AAP), age and history of prior overdose independently predicted ICU admission. A third of patients (n = 196, 30%) had subsequent presentations to ED following overdose, in the four years from their index presentation, with an all-cause four-year mortality of 3.4% (n = 22). CONCLUSION A history of overdose, use of AAP and older age were risk factors for ICU admission following ED presentations. Over a third of patients had repeat overdose presentation in the four-year follow-up with a mortality of 3.4%.
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Affiliation(s)
- Mark Savage
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia
| | - Ross Kung
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia
| | - Cameron Green
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia; and Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Brandon Thia
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia
| | - Dinushka Perera
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia
| | - Ravindranath Tiruvoipati
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia; and Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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Abstract
This article was migrated. The article was not marked as recommended. There is a growing body of literature suggesting a decline in undergraduate ophthalmic education. Anecdotally and in the literature, ophthalmology is a specialty that many students and doctors feel lacking in knowledge and skills, which may put patient-care at risk.The aim of this review was to investigate (with an emphasis on systematic review of literature, complimented by snapshot-survey of student representatives from U.K. medical schools) the current status of ophthalmology education provided at U.K. medical schools as well as students' perception of their preparedness for future practice, to guide the future of ophthalmic education. A comprehensive literature search was carried out using Embase, Health Management Information Consortium and Ovid MEDLINE. Simultaneously, a survey was sent out to all U.K. medical schools to ascertain the current status of undergraduate ophthalmology education and students' perception on preparedness for future practice.Results showed that though more schools are now providing an ophthalmic education, the length of teaching has eroded. Almost 10% of medical schools reported no formal ophthalmic education. Almost half of the total surveyed felt 'unprepared' or 'very unprepared' for future practice. We recommend the General Medical Council and Medical Schools Council to work together with the Royal College of Ophthalmologists to improve the current situation.
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