Unilateral Loss Research Articles

Frosted branch angiitis in a patient with systemic juvenile idiopathic arthritis: a case report

BackgroundFrosted branch angiitis is a retinal vascular condition that is associated with a viral infection or autoimmune disorders like Crohn’s disease, systemic lupus erythematosus, and Behcet’s disease. Frosted branch angiitis presents with vascular inflammation, retinal edema, and severe retinal vascular sheathing. We present a case of systemic juvenile idiopathic arthritis, an autoinflammatory disease, presenting with frosted branch angiitis.Report of CaseA 14-year-old female with systemic juvenile idiopathic arthritis and a history of bilateral anterior uveitis developed acute unilateral vision loss and was found to have frosted branch angiitis complicated by branch retinal vein occlusion. She underwent an extensive serology workup and aqueous viral PCR to rule out other possible autoimmune and viral etiologies for forested branch angiitis. She received systemic and intravitreal antiviral treatment due to positive CMV IgM initially. However, the clinical picture improved following the use of a higher dose of oral steroids and the switch of the immunosuppressive agent to a TNF-a inhibitor.ConclusionTo our knowledge, this would be the first case in the literature demonstrating a systemic juvenile idiopathic arthritis patient presenting with frosted branch angiitis. Infectious causes still must be ruled out, especially CMV, as it is the most common cause of secondary frosted branch angiitis.

Management of Open Globe Injury Followed by Cataract Traumatic and Corneal Laceration in a 37-year-old Man. A Case Report

Introduction : Ocular trauma is the most common cause of visual impairment and unilateral vision loss. According to the Birmingham Eye Trauma Terminology, ocular trauma consists of Open Globe Injury and Closed Globe Injury. Open globe injury is a full-thickness eyewall wound due to a laceration or occult rupture. Damage to the cornea and lens are among the most common types of ocular trauma.
 Case Illustration : This case report involves a 37 year-old-man who presented with complaints of pain and visual impairment in the left eye for the past month. The symptoms appeared after accidentally getting hit by a bamboo branch. Upon examination, the patient had a visual acuity of 1/300 in the left eye, ciliary injection (+), non-spherical pupil, and normal intraocular pressure on palpation. On slit lamp examination, a 7mm corneal laceration with a scar formation and a lens mass in the eye's anterior chamber.
 Discussion : In this case, the open globe injury resulted in visual impairment due to corneal laceration and traumatic cataracts. The trauma occurred one month before the examination, and the corneal laceration had already formed a leukoma. The patient underwent corneal repair and vitrectomy, extracapsular cataract extraction using the ECCE technique, and intraocular lens implantation.
 Conclusion : The prognosis of ocular trauma depends on the severity of the injury to the eye structures, the time between the injury and surgery, the preoperative visual acuity, the mode of injury, and the patient's age. The OTS scoring system can predict the final visual acuity outcome in such cases.

Orbital Tumor Misdiagnosed as Optic Neuritis in Rheumatoid Arthritis Patient: A Case Report

Abstract
 Introduction : Unilateral blurred vision and optic nerve swelling are the two most common signs of optic neuritis (ON). However, ON is rarely reported in patients with rheumatoid arthritis (RA), thus necessitating further diagnostic workup.
 Case Illustration : A 42-year-old woman visited our hospital with strabismus and progressive loss of vision in her left eye since three months ago. She had been treated with pulse dose steroid for suspected ON. She had been diagnosed with RA over five years and treated with immunomodulatory medication. Left eye examination revealed best corrected visual acuity of 20/50, proptosis, esotropia with painless limitation in temporal movement. Afferent pupillary defect (RAPD) and optic nerve swelling were present. OCT assessment revealed reduction in RNFL thickness. Further magnetic resonance imaging (MRI) investigation revealed a 2.35 x 2.6 x 1.8 cm mass in the left intraconal retrobulbar, in proximity to the medial optic nerve, which suggests a case of orbital Schwanoma. Excisional biopsy was performed and revealed a benign tumor.
 Discussion : Intraconal tumor may falsely be diagnosed as an optic neuritis in autoimmune patient. Neuro- ophthalmologic symptoms of systemic inflammatory in the optic nerve includes unilateral acute visual loss and pain in eye movement. Signs of ON includes RAPD, disc edema, and corresponding visual field defect. MRI of the optic nerve can assist diagnostic workup.
 Conclusion : The exact diagnosis of rheumatoid arthritis-associated ocular manifestations is challenging. Imaging using MRI might be needed to provide clarity in the diagnosis.

(246) Age Dependent Effect on Contralateral Testicular Compensation Following Testicular Loss

Abstract Introduction The human testicle is susceptible to loss from events like torsion, trauma, cancer, or cryptorchidism. Most paired organs are known to undergo compensatory hypertrophy following unilateral organ loss. The testicle is physiologically distinct in that it is thought to undergo a period of quiescence in childhood. Previous work has demonstrated testicular hypertrophy occurs if the loss of the contralateral testis occurs before puberty. However, it is unknown if compensatory physiology and growth differs by age of pre-pubertal loss. Objective This study aimed to investigate compensatory changes in testicular growth and the hormonal axis following unilateral orchiectomy in a neonatal, pre-pubertal and pubertal/adult murine model. Methods C57BL/6 mice were divided into experimental groups: neonatal (days of life 2-4), pre-pubescent (days of life 12-21), and post-pubescent (days of life 42-44) to undergo unilateral orchiectomy. A control group that did not undergo orchiectomy was utilized. Mice were sacrificed at maturity (over 80 days of life), blood samples were drawn, and the remaining testis was removed. Body and testis weight and testicular length in the long axis were measured in blinded fashion. Similarly, testosterone, luteinizing hormone (LH), and Follicle stimulating hormone (FSH) were assessed and expressed as a median and an interquartile range. Results Contralateral testes from neonatal and pre-pubertal mice who underwent orchiectomy weighed more (110.5, 12.2 and 103.0, 7.2 mg respectively. Figure 1.) (p < 0.05) than the control mice (91, 11.9 mg, respectively). There was no difference between post-pubertal group and control group. The degree of compensatory hypertrophy was greater in the neonatal group but not the pre-pubertal group when compared to the post-pubertal group. When examining the ratio of testicular weight to body weight, only the neonatal group was significantly higher than that of the control. Differences in FSH and testosterone were not statistically significant between experimental and control arms (p > 0.05). LH was significantly elevated in all experimental groups as compared to the control (p < 0.05). Conclusions This is the first study to assess testicular compensatory hypertrophy following contralateral testicular loss using a neonatal mouse survival surgery model. Testicular hypertrophy occurs when unilateral loss occurs prior to puberty, but not in adulthood in mice. Earlier testis loss may contribute to a greater degree of growth. Functionally, the unilateral testis can maintain eugonadal testosterone levels, but higher levels of LH are required following hemicastration to sustain eugonadal testosterone levels. Future studies are warranted to identify testicular transcriptomics in this model to evaluate for candidate genes potentially responsible for this phenotypic change. Disclosure No.

Complex breast reconstruction using bilateral profunda artery perforator-free-flaps in a resource-limited setting: a case report

Interestingly, the current shift in mastectomy patterns and advances in reconstruction techniques have contributed to an increasing number of patients requesting breast reconstruction postmastectomy every year. Depending on available expertise, patients can access breast reconstruction options (immediate or delayed), autologous, or implant-based. We present a case of a 36-year-old female patient 5 years into remission, having undergone mastectomy for invasive ductal carcinoma of the right breast and now preferred risk reduction surgery (prophylactic mastectomy) of her left unaffected breast with immediate reconstruction. The microsurgical technique utilized bilateral profunda artery perforator flaps from both thighs for (immediate and delayed) breast reconstruction. In our scenario, the authors had an unfavorable outcome on the side of delayed breast reconstruction (right) with a venous insufficiency diagnosis leading to unilateral complete flap loss, which was subsequently debrided and reconstructed with an obliquely-oriented pedicled Latissimus dorsi flap. In contrast, following risk reduction surgery and immediate reconstruction on the left side, the buried flap was a complete success, with the free nipple graft doing well postoperatively.

Effects of a Powered Ankle-Foot Prosthesis and Physical Therapy on Function for Individuals With Transfemoral Limb Loss: Rationale, Design, and Protocol for a Multisite Clinical Trial.

Powered ankle-foot prosthetic devices can generate net positive mechanical work during gait, which mimics the physiological ankle. However, gait deviations can persist in individuals with transfemoral limb loss because of habit or lack of rehabilitation. Prosthetic research efforts favor the design or evaluation of prosthetic componentry and rarely incorporate any type of rehabilitation, despite evidence suggesting that it is critical for minimizing gait imbalances. Given the accelerated rate of innovation in prosthetics, there is a fundamental knowledge gap concerning how individuals with transfemoral limb loss should learn to correctly use powered ankle-foot devices for maximum functional benefit. Because of the recent advances in prosthetic technology, there is also a critical unmet need to develop guidelines for the prescription of advanced prosthetic devices that incorporate both physical and psychological components to identify appropriate candidates for advanced technology. The primary goal of this investigation is to examine the roles of advanced prosthetic technology and a device-specific rehabilitative intervention on gait biomechanics, functional efficacy, and pain in individuals with transfemoral limb loss. The secondary goal is to develop preliminary rehabilitation guidelines for advanced lower limb prosthetic devices to minimize gait imbalances and maximize function and to establish preliminary guidelines for powered ankle-foot prosthetic prescription. This prospective, multisite study will enroll 30 individuals with unilateral transfemoral limb loss. At baseline, participants will undergo a full gait analysis and assessment of function, neurocognition, cognitive load, subjective preferences, and pain using their current passive prosthesis. The participants will then be fitted with a powered ankle-foot device and randomized into 2 equal groups: a powered device with a device-specific rehabilitation intervention (group A) or a powered device with the current standard of practice (group B). Group A will undergo 4 weeks of device-specific rehabilitation. Group B will receive the current standard of practice, which includes basic device education but no further device-specific rehabilitation. Data collection procedures will then be repeated after 4 weeks and 8 weeks of powered ankle use. This study was funded in September 2017. Enrollment began in September 2018. Data collection will conclude by March 2024. The initial dissemination of results is expected in August 2024. The projected trends indicate that the number of individuals with limb loss will dramatically increase in the United States. The absence of effective, evidence-based interventions may make individuals with transfemoral limb loss more susceptible to increased secondary physical conditions and degenerative changes. With this expected growth, considerable resources will be required for prosthetic and rehabilitation services. Identifying potential mechanisms for correcting gait asymmetries, either through advanced prosthetic technology or rehabilitative interventions, can provide a benchmark for understanding the optimal treatment strategies for individuals with transfemoral limb loss. ClinicalTrials.gov NCT03625921; https://clinicaltrials.gov/study/NCT03625921. DERR1-10.2196/53412.

Are Vestibuloocular Reflex Gain and Dynamic Visual Acuity Responsible of Oscillopsia After Complete Unilateral Vestibular Loss?

Acute and complete unilateral vestibular deafferentation induces a significant change in ipsilateral vestibuloocular reflex gain, making the patient unable to stabilize gaze during active or passive head movements. This inability creates the illusion that the visual environment is moving, resulting in persistent visual discomfort during rapid angular or linear acceleration of the head. This is known as oscillopsia. Our objective was to understand if the spontaneous sensation of oscillopsias after complete unilateral vestibular deafferentation by vestibular neurotomy at 5 days (D5) and at 3 months (M3) is correlated with the loss of vestibuloocular reflex gain and dynamic visual acuity. Retrospective cohort study was conducted in an otolaryngology tertiary care center (2019-2022) on patients with complete unilateral vestibular loss by vestibular neurotomy. They were divided into 2 groups according to the presence (group G1) or absence (group G2) of a spontaneous complaint of oscillopsia assessed at M3. Severity of oscillopsias evaluated by Oscillopsia Severity Questionnaire. Vestibuloocular reflex gain based on video head impulse test (vHIT) and the dynamic visual acuity were measured for each group at D5 and M3. Categorical variables were compared using χ2 test and quantitative variables using the nonparametric Wilcoxon-Mann-Whitney test. All patients have a complete vestibular deafferentation at D5 and M3. At D5 (G1 = 8 patients, G2 = 5 patients), there is no significant difference for ipsilateral and contralateral vestibuloocular reflex gains and dynamic visual acuity losses. The Oscillopsia Severity Questionnaire was 2.68 ± 1.03 in G1 and 1.23 ± 1.03 in G2 (P < .05). At M3 (G1 = 9 patients, G2 = 6 patients), there is no significant difference between groups for epidemiologic and clinical data and for vestibuloocular reflex and dynamic visual acuity losses. The Oscillopsia Severity Questionnaire was 2.10 ± 0.63 in G1 and 1.24 ± 0.28 in G2 (P < .05). The spontaneous disabling sensation of oscillopsia after complete unilateral vestibular loss is well assessed by the Oscillopsia Severity Questionnaire but cannot be explained by objective vestibular tests assessing vestibuloocular reflex gain (vHIT) or dynamic visual acuity loss at D5 or M3. Further studies are needed to measure the sensation of oscillopsia under real-life conditions and to identify the factors responsible for its persistence. Retrospectively registered.

Optic neuritis: a review of diagnostic imaging modalities and effective management approaches

Optic neuritis (ON) is a medical condition characterized by an acute inflammation of the optic nerve, usually caused by multiple sclerosis (MS). However, there are other causes such as infectious diseases, granulomatous disease, paraneoplastic disorders, and demyelination disorders. Usually, the commonest presentation is unilateral painful loss of vision. This study aimed to review the diagnostic imaging modalities and effective management approaches of ON. ON can be diagnosed through different modalities such as magnetic resonance imaging, which is the modality of choice to assess ON, providing crucial insights into the structural and functional changes within the optic nerve. In ON, the retrobulbar intra-orbital segment of the optic nerve often exhibits noticeable characteristics, including swelling and a high T2 signal. In addition, optical coherence tomography is a new, noninvasive tool for direct visualization of the head of the optic nerve that can detect thinner retinal nerve fiber layers diagnosing ON. In treating ON and MS, the main aim is to reduce the recurrence and severity of the attacks to minimize the subsequent disability. The utilization of disease-modifying drugs contributes to delaying the onset of subsequent episodes, reducing the occurrence of MS relapses, and minimizing the formation of demyelinating lesions.

MRI Findings in Leber’s Hereditary Optic Neuropathy: A case report

Background: Leber’s hereditary optic neuropathy (LHON) is a rare genetic condition which is mainly presented with painless, sub-acute central unilateral vision loss followed by contralateral vision loss after few weeks to months. Young adults are typically affected with men preponderance. Relatively, it is a common cause of blindness as a result of mutation in mitochondrial DNA (mtDNA). Case report: We reported the case of two brothers, who had recent history of vision loss. Fundoscopy examination revealed bilateral optic nerve atrophy along with vessel narrowing and absent macular reflex. We performed MRI bilateral orbits with contrast which revealed abnormal signals and atrophy of the optic nerves suggesting optic neuritis. Conclusion: Whenever young males develop bilateral sequential vision loss with a positive family history, the diagnosis of Leber’s hereditary optic neuropathy should be suspected. Ophthalmological examination may reveal signs suggestive of Leber’s hereditary optic neuropathy. MRI may demonstrate edema signals in both optic nerve along with thinning of nerve fibers suggesting nerve atrophy. MRI is considered an useful tool to show optic nerve abnormality and optic neuritis.

A 66-Year-Old Woman Presented with Sudden Onset Eye Pain and Loss of Vision: Do Not Miss MOGAD

A 66 -year- old woman presented to ED with sudden onset eye pain and unilateral loss of vision. She had considerable vascular risk factors including age, hypertension, diabetes mellitus and hypercholesterolemia. She was referred to neurology service with possible arteritic anterior ischemic optic neuropathy (AION). Given her age, painful visual loss and raised ESR, she was treated with steroids for possible giant cell arteritis (GCA). Because of her psychiatric history and poorly controlled diabetes mellitus, steroids were weaned quickly. 6 months later, she had a similar presentation affecting the other eye. MRI head showed disease progression with positive myelin oligodendrocyte glycoprotein (MOG) antibody in serum. MOG associated disorder (MOG-AD) is a steroid responsive inflammatory demyelinating disease but needs long term immunosuppression plan and monitoring of serum antibody.

Weak nystagmus in the dark persists for months after acute unilateral vestibular loss.

Weak nystagmus with fixation removed can be seen both in normal individuals and in recovery from a unilateral vestibular insult, thus its clinical significance is unclear in patients with dizziness. We thus sought to compare features of nystagmus at various stages following unilateral vestibular loss (UVL). We enrolled thirty consecutive patients after acute UVL with impaired vestibulo-ocular reflex (VOR) gain. The patients were allocated into three groups according to time from onset of symptoms: acute (1-7 days), subacute (8-30 days), and chronic (>30 days). Patients underwent video-oculography (with and without fixation) and video head impulse testing (vHIT) to determine VOR gain. We examined the relationships amongst SPV, VOR gain, and time from symptom onset across groups. There were 11, 10, and 9 patients in the acute, subacute, and chronic stages of UVL, respectively. With visual fixation, only 8 patients (26.7%) demonstrated nystagmus, all from the acute group. With fixation removed, 26 patients (86.7%) exhibited spontaneous nystagmus, including 90.9%, 90%, and 77.8% of the patients from the acute, subacute, and chronic groups, respectively. Horizontal nystagmus was paralytic (i.e., fast phase contralesional) in 25 (96.7%) cases. Horizontal SPV was negatively correlated with logarithm of time from onset to examination (r = -0.48, p = 0.007) and weakly negatively correlated with ipsilesional VOR gain (r = -0.325, p = 0.08). In the subacute or chronic stages of UVL, paralytic nystagmus with fixation removed persisted at a low intensity. Therefore, weak nystagmus in the dark may have diagnostic value in chronic dizziness.

Differences in Hearing Devices and Speech Therapy Utilization Between Children With Permanent Unilateral Versus Bilateral Hearing Loss.

In this study, we aimed to describe differences in diagnosis and both auditory and speech/language intervention utilization between children with permanent unilateral hearing loss as compared with bilateral hearing loss. A retrospective cohort study was performed of children evaluated in a multidisciplinary hearing loss clinic at a tertiary care pediatric hospital. Children aged 0 to 18 years with either permanent unilateral or bilateral hearing loss were included. One hundred fourteen children with unilateral hearing loss and 268 children with bilateral hearing loss were studied for a total of 382 children. There were no demographic differences between children with permanent unilateral versus bilateral hearing loss. Rates of newborn hearing screening and referred screening results were similar between those with unilateral and bilateral hearing loss. Despite similar rates of referred newborn hearing screening, those with bilateral hearing loss were diagnosed at a younger age (mean 3.6 years, SD 3.8 years) as compared with those with unilateral hearing loss (mean 5.0 years, SD 4.2 years). Children with unilateral hearing loss had similar severity of hearing loss in their poorer hearing ear as compared with children with bilateral hearing loss, yet they were significantly less likely to be fitted with hearing devices (53% versus 78%) or receive speech/language therapy (36% versus 54%) as compared with children with bilateral hearing loss. Multivariate analysis found that bilateral hearing loss and earlier age of hearing loss diagnosis were associated with hearing device use. Early diagnosis and intervention for childhood hearing loss have a significant impact on a child's educational success and social relationships. However, little is known about differences in diagnosis and resource utilization between children with permanent unilateral hearing loss versus bilateral hearing loss. Children with unilateral hearing loss were diagnosed at a later age and were less likely to utilize hearing devices or speech/language therapy compared with those with bilateral hearing loss, despite having similar severity of hearing loss in the poorer hearing ear. There is a strong body of evidence that children with unilateral hearing loss have improved hearing outcomes with hearing devices, which suggests there is room for improvement in identifying unilateral hearing loss and providing adequate services to optimize educational success. However, speech therapy is generally implemented in response to language delays. Therefore, children with unilateral loss may have lower rates of language delays as compared with those with bilateral hearing loss, thereby explaining differences in speech therapy utilization.

Exploring relationships among multi-disciplinary assessments for knee joint health in service members with traumatic unilateral lower limb loss: a two-year longitudinal investigation

Motivated by the complex and multifactorial etiologies of osteoarthritis, here we use a comprehensive approach evaluating knee joint health after unilateral lower limb loss. Thirty-eight male Service members with traumatic, unilateral lower limb loss (mean age = 38 yr) participated in a prospective, two-year longitudinal study comprehensively evaluating contralateral knee joint health (i.e., clinical imaging, gait biomechanics, physiological biomarkers, and patient-reported outcomes); seventeen subsequently returned for a two-year follow-up visit. For this subset with baseline and follow-up data, outcomes were compared between timepoints, and associations evaluated between values at baseline with two-year changes in tri-compartmental joint space. Upon follow-up, knee joint health worsened, particularly among seven Service members who presented at baseline with no joint degeneration (KL = 0) but returned with evidence of degeneration (KL ≥ 1). Joint space narrowing was associated with greater patellar tilt (r[12] = 0.71, p = 0.01), external knee adduction moment (r[13] = 0.64, p = 0.02), knee adduction moment impulse (r[13] = 0.61, p = 0.03), and CTX-1 concentration (r[11] = 0.83, p = 0.001), as well as lesser KOOSSport and VR-36General Health (r[16] = − 0.69, p = 0.01 and r[16] = − 0.69, p = 0.01, respectively). This longitudinal, multi-disciplinary investigation highlights the importance of a comprehensive approach to evaluate the fast-progressing onset of knee osteoarthritis, particularly among relatively young Service members with lower limb loss.

Acute Optic Neuritis: An Update on Approach and Management.

This review discusses the physical examination and diagnostic tests necessary to diagnose optic neuritis (ON) and provides an update on the approach and management of acute ON. A comprehensive search of the PubMed database was conducted, limited to English-language journals and recent publications. A total of 160 articles were initially screened by title, of which 73 articles were included in the narrative synthesis. ON is an inflammation of the optic nerve that can be caused by different systemic and neurological disorders. It is commonly presented as a subacute unilateral painful vision loss, and based on its clinical manifestation, it can be classified as typical or atypical. Atypical ON is bilateral with visual acuity of worse than 20/200 or has an atypical demographic presentation for demyelination, such as a non-Caucasian male with optic disc swelling, for which neuromyelitis optica spectrum disorder (NMOSD), myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), or other etiologies should be considered. Steroids and immunosuppressants are the main treatment options for ON, and timely treatment initiation is critical to preventing irreversible vision loss, especially in atypical cases.

Abstract 18126: A Rare Case of a Left Ventricular Papillary Fibroelastoma With an Initial Presentation of Unilateral Vision Loss

A 59-year-old female with hypertension presented with acute onset of decreased vision in the right eye. She reported waking up 3 days prior to admission with sudden onset of shadow in the right eye appearing like a falling curtain which eventually progressed to total visual loss. She also complained of headaches and palpitations. The patient denied pain, nausea, vomiting, photophobia, changes in speech, aphasia, facial weakness, arm or leg weakness or numbness. She states that this is her first experience of vision loss. At the time of admission, she was hypertensive to 170/100s and started on amlodipine 5mg and losartan 25mg. Neurology and ophthalmology were consulted for concerns of stroke and new vision loss. She was started on heparin drip, aspirin 81mg, atorvastatin 80mg, and methylprednisolone 1g. Ocular examination revealed right brachial retinal artery occlusion. MRI brain showed chronic microvascular changes, but no acute intracranial hemorrhage or infarction. CT angiogram of the neck showed mild soft plaque in right carotid bifurcation. Transthoracic echocardiogram revealed a 1.6cm x 1.6cm left ventricular mobile mass which appeared to be attached to the posteromedial papillary muscle and left ventricle ejection fraction of 60%. The patient underwent open heart surgery for removal of the mass. The mass was confirmed to be a papillary fibroelastoma attached to the left ventricular trabeculum. The mitral valve and subvalvular apparatus were not involved. New onset of stroke or acute vision loss is generally a result of thromboembolism. Most times it can be caused by a clot formed in a patient with atrial fibrillation. In other cases, it can be due to a ruptured cholesterol plaque. However, primary cardiac tumors are rare, especially ones on the papillary muscle. We presented a rare case of papillary fibroelastoma that possibly embolized causing acute unilateral vison loss. This case reinforces the importance of cardiac imaging in new stroke or acute vision loss.

Visual impairment and blindness caused by retinal diseases: A nationwide register-based study.

Retinal disorders cause substantial visual burden globally. Accurate estimates of the vision loss due to retinal diseases are pivotal to inform optimal eye health care planning and allocation of medical resources. The purpose of this study is to describe the proportion of visual impairment and blindness caused by major retinal diseases in China. A nationwide register-based study of vitreoretinal disease covering all 31 provinces (51 treating centres) of mainland China. A total of 28 320 adults diagnosed with retinal diseases were included. Participants underwent standardised ocular examinations, which included best-corrected visual acuity (BCVA), dilated-fundus assessments, and optical coherence tomography. Visual impairment and blindness are defined using BCVA according to the World Health Organization (WHO) (visual impairment: <20/63-≥20/400; blindness: <20/400) and the United States (visual impairment: <20/40-≥20/200; blindness: <20/200) definitions. The risk factors of vision loss were explored by logistic regression analyses. Based on the WHO definitions, the proportions for unilateral visual impairment and blindness were 46% and 18%, respectively, whereas those for bilateral visual impairment and blindness were 31% and 3.3%, respectively. Diabetic retinopathy (DR) accounts for the largest proportion of patients with visual impairment (unilateral visual impairment: 32%, bilateral visual impairment: 60%) and blindness (unilateral blindness: 35%; bilateral blindness: 64%). Other retinal diseases that contributed significantly to vision loss included age-related macular degeneration, myopic maculopathy, retinal vein occlusion, and rhegmatogenous retinal detachment and other macular diseases. Women (bilateral vision loss: P = 0.011), aged patients (unilateral vision loss: 45-64 years: P < 0.001, ≥65 years: P < 0.001; bilateral vision loss: 45-64 years: P = 0.003, ≥65 years: P < 0.001 (reference: 18-44 years)) and those from Midwest China (unilateral and bilateral vision loss: both P < 0.001) were more likely to suffer from vision loss. Retinal disorders cause substantial visual burden among patients with retinal diseases in China. DR, the predominant retinal disease, is accountable for the most prevalent visual disabilities. Better control of diabetes and scaled-up screenings are warranted to prevent DR. Specific attention should be paid to women, aged patients, and less developed regions.

Biomechanical effects of an articulating prosthetic toe joint during stair navigation for individuals with unilateral, below-knee limb loss

Stair navigation is an essential and demanding form of locomotion. During stair ascent and descent, persons with lower limb loss exhibit gait characteristics which may increase their risk of falls and joint degeneration of the intact limb. To reduce deviations from typically-able-bodied gait and overloading of the intact limb for this population, one potential intervention involves modifying passive prosthetic feet by incorporating a flexible toe joint that simulates the biological metatarsophalangeal joint. In this study, we aimed to assess the user preferences and biomechanical effects of a flexible prosthetic toe joint during stair ascent and descent for persons with unilateral lower-limb loss. Nine participants with unilateral lower-limb loss were recruited (Male; Medicare Functional Classification Level: eight K4, one K3; age: 41 ± 11 years; mass: 95 ± 13 kg; height: 1.84 ± 0.05 m; mean ± SD). No significant changes in lower-limb joint mechanics were identified. Five of nine participants preferred the unmodified prosthesis with a standard carbon fiber keel for both stair ascent and descent. Varied user preferences and inconsistent changes in lower-limb joint parameters between participants highlight the importance of subject-specific analyses and individualized device prescription.

Identification of vestibular loss in children with sensorineural hearing loss using the balance subset of the BOT-2 test

BackgroundVestibular loss in children with sensorineural hearing loss (SNHL) is quite high. Despite the high prevalence of vestibular loss and balance impairment in children with SNHL, they are rarely assessed by clinicians and therefore are commonly undiagnosed. The purpose of the study was to evaluate the balance subset of the Bruininks-Oseretsky Test (BOT-2) as a tool to identify vestibular loss in children with SNHL and to determine its predictive values for vestibular loss.MethodsThe study included 210 children allocated into 4 groups: group 1 (control healthy children), group II (children with SNHL but without vestibular loss), group III (children with SNHL and unilateral vestibular loss), and group IV (children with SNHL and bilateral vestibular loss). Caloric test, video head impulse test (vHIT), and cervical vestibular evoked myogenic potential (c-VEMP) test were used for vestibular assessment in children with SNHL and to allocate them accordingly into one of the aforementioned groups. Scores of the balance subset of the BOT-2 were compared among the three groups and compared to the control healthy children.Results21.4% of children with SNHL but without vestibular loss have balance deficit revealed by the balance subset of the BOT-2, reflecting its better sensitivity for detecting balance deficit than the physiologic vestibular tests. Children with unilateral or bilateral vestibular loss (groups III and IV) showed a more significant balance deficit than children without vestibular loss (group II). The worst balance score was found in children with bilateral vestibular loss. The positive predictive value of the BOT-2 for peripheral vestibular loss in children with SNHL was 88%.ConclusionThe balance subset of the BOT-2 has particularly good predictive values for vestibular loss in children with SNHL. The test is a simple, easy, fast office test which does not require any costly equipment.

Dyke-Davidoff-Masson Syndrome a Rare Cause of Cerebral Hemiatrophy: A Case Report

Cerebral hemiatrophy or Dyke-Davidoff-Masson syndrome (DDMS) is a rare clinical and radiological entity, characterized by seizures, facial asymmetry, contralateral hemiplegia or hemiparesis and mental retardation. These findings are due to a brain lesion that may occur early in life or in utero. Radiological features include unilateral loss of brain volume associated with compensatory bony alterations in the calvarium, such as thickening, hyperpneumatization of the paranasal sinuses and mastoid cells and elevation of the petrous crest. We report a case of a 13-year-old adolescent who presented with multiple episodes of generalized tonic-clonic seizures. In our case, the clinical history and CT imaging were sufficiently accurate to diagnose DDMS.

ENDOSCOPIC TRANSNASAL SPHENOTOMY AND RESECTION OF BULLOUS MIDDLE TURBINATE

Sphenoiditis is an inflammatory disease of the mucous membrane of the sphenoid sinus. As a rule, changes in the main sinus are combined with other rhinological pathology, while its isolated lesion accounts for only 1-2% of cases among all inflammatory pathologies of the paranasal sinuses. The anatomical and topographical features of the location of the sphenoid sinus, as well as the nonspecificity of symptoms, lead to late diagnosis of this disease. Among the complaints presented by patients, the most common is headache without clear localization (72%). In second place in terms of frequency of occurrence, visual disturbances are detected in the form of diplopia, progressive unilateral vision loss, and narrowing of the visual fields on the affected side. Visual symptoms account for 21% of patients with isolated sphenoiditis (IS). Rhinological manifestations of the disease include: mucus running down the back of the throat and nosebleeds. Thus, patients are under the supervision of doctors of related specialties for a long time: ophthalmologists, neurologists and other specialists.