Search Results (54)

Background and Objectives: In Germany, access to medical care is often hindered by long wait times for specialist appointments and emergency department care. Inappropriate utilization of emergency services further exacerbates delays for truly urgent cases. To evaluate the utilization of the statutory ophthalmic emergency service in Freiburg and identify patient- and system-level factors contributing to inappropriate use. Materials and Methods: A paper-based, anonymous questionnaire was distributed to patients attending the ophthalmologic emergency practice (Notfallpraxis) of the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung), which is located within the premises of the Eye Center of the University Hospital Freiburg, Germany, at selected periods between July and September 2020, alongside a short physician assessment. Standardized instruments were used to assess symptom severity, urgency perception, and healthcare-seeking behavior. Statistical analyses were performed using R and Excel. Results: A total of 157 questionnaires were included (response rate: 63%). Most visits occurred on weekends (47%) and before 10 p.m. (83%). While 68% of patients believed their symptoms required same-day treatment, physicians assessed only 30% of cases as clinically urgent. A total of 60% of patients did not attempt to contact an outpatient ophthalmologist beforehand, and only 38% reported having a regular ophthalmologist. Patients’ perceived urgency was significantly associated with symptom severity and older age, whereas physician-assessed urgency was strongly linked to symptom duration. Conclusions: A substantial proportion of ophthalmic emergency visits in Freiburg are for non-urgent conditions. These findings underscore the need for improved coordination with outpatient care providers, better patient education, and structural reforms to reduce inappropriate utilization and ensure timely access for truly urgent cases. Full article

Objectives: Evisceration is a rarely performed surgical procedure, and literature information regarding the characteristics of patients undergoing this surgery is limited. This study aims to evaluate the demographic features and etiological factors of patients who underwent evisceration surgery in a tertiary clinic over 10 years. Methods: This descriptive study comprised the data of 134 patients who underwent evisceration surgery at the Department of Ophthalmology, Faculty of Medicine, Çukurova University, Adana, Türkiye, between 2011 and 2022. Demographic data of all patients, including age, sex, surgical indication, etiology, primary disease location, pathology results, and follow-up periods, were recorded and analyzed. Results: The mean age of the 134 patients included in the study was 56.18 ± 22.71 (min: 8–max: 91), with a male-to-female ratio of 65.2% to 34.8%. Evisceration etiologies included trauma (37%), endophthalmitis (37%), absolute blind eye (12.6%), and spontaneous perforation (11.9%). Endophthalmitis cases were more common in older ages and females, trauma patients in younger ages and males, and spontaneous perforation in older ages and males. Progression to panophthalmitis was observed in 6.6% of all cases, and all were found to originate from endophthalmitis. Culture growth was positive in 18.5% of the cases, with the most commonly grown microorganisms in culture being Pseudomonas aeruginosa, Streptococcus dysgalactiae and Aspergillus fumigatus. Escherichia coli and Staphylococcus epidermidis rates were significantly higher in cases progressing to panophthalmia. Acute inflammation was more prevalent in cases of endophthalmitis and spontaneous perforation, while chronic inflammation was in cases of trauma and absolute blind eyes. Conclusions: Trauma was the main etiology of evisceration in young males and endophthalmitis in older females. Considering trauma prevention measures is important for public health in terms of eyeball saving. Full article

Background/Objectives: Childhood obesity is a significant health concern also capable of impacting ocular health. This study evaluates the effects of childhood obesity on corneal morphology, anterior chamber parameters, intraocular pressure (IOP), and corneal endothelial cell morphology. Understanding these relationships may contribute to early diagnosis and management strategies. Methods: This prospective, cross-sectional study was conducted at the Harran University Faculty of Medicine between January and December, 2024. Ninety children aged 7–17 years were included, with only the right eyes being analyzed. The participants were categorized into three groups based on body mass index (BMI) percentiles: normal weight (≤85th percentile), overweight (86–94th percentiles), and obese (≥95th percentile). All participants underwent comprehensive ophthalmological examinations, including IOP measurement with a non-contact tonometer, corneal topography assessment using a Scheimpflug camera, and endothelial cell morphology evaluation via specular microscopy. Results: IOP was significantly higher in the overweight and obese groups (p < 0.001). Central corneal thickness (CCT) also increased significantly in these groups (p < 0.05). Positive correlations were determined between BMI and IOP (r = 0.493, p < 0.001) and CCT (r = 0.345, p < 0.001). Additionally, waist circumference exhibited a strong correlation with BMI (r = 0.905, p < 0.001) and a significant association with IOP (r = 0.463, p < 0.001). No significant differences were observed among the groups in terms of other anterior chamber or endothelial parameters. Conclusions: Childhood obesity is associated with increased IOP and CCT, suggesting potential alterations in corneal biomechanics and ocular physiology. These findings highlight the importance of routine ophthalmological evaluation in obese children to detect early ocular changes and prevent long-term complications. Full article

Indoor air quality is paramount for the health and well-being of individuals, especially in enclosed spaces like office buildings, schools, hospitals, and homes where people spend a significant amount of time. Ensuring good indoor air quality is not only essential for reducing symptoms such as headaches, eye and respiratory irritation, fatigue, and difficulty in concentration, but it is also a key component of sustainable building practices aimed at promoting long-term health and environmental balance. This study aims to explore the impact of the microclimate and fungal microbiota on the health and cognitive performance of occupants in a university classroom, which is part of a cultural heritage building. The research delves into various microclimatic parameters, including temperature, relative humidity, CO₂, volatile organic compounds, O₂, and particulate matters (PM_2.5 and PM₁₀), to understand their influence on the development of microbiota and the manifestation of symptoms associated with Sick Building Syndrome. Over the course of a year-long investigation, microbiological samples were collected, revealing the presence of 19 fungal species, with Cladosporium, Alternaria, and Aureobasidium being the most prevalent genera. These species were found to thrive in an environment characterized by inadequate ventilation, posing potential health risks to occupants, such as allergic reactions and respiratory infections. Microclimatic parameter values such as mean temperature of 22.9 °C and mean relative humidity of 38.5% indicated moderate conditions for fungal proliferation, but occasional high levels of PM_2.5 and CO₂ indicated periods of poor indoor air quality, negatively influencing the comfort and health of the occupants. The questionnaires completed by 190 students showed that 51.5% reported headaches, 44.2% frequent sneezing, and 43.7% severe fatigue, linking these symptoms to increased levels of CO₂ and PM_2.5. The novelty of the study lies in the integrated approach to indoor air quality assessment in a heritage educational building, highlighting the need for improved ventilation and air management to enhance health and cognitive performance, while emphasizing sustainable indoor environment management that balances occupant well-being with the preservation of cultural heritage. Full article

The development of the fluorescent lamp and the air-conditioning system resulted in buildings being lit inexpensively without having to rely on daylighting to save energy, as was the case during the incandescent lamp era. Consequently, architects were able to design buildings with deep floor plates for maximum occupancy, placing workstations far away from windows since daylighting was no longer a necessity. Floor-to-ceiling heights became lower to minimize the inhabitable volumes that needed to be cooled or heated. With the rising costs of land in some major American cities such as New York City and Chicago at the beginning of the twentieth century, developers sought to optimize their investments by erecting tall structures, giving rise to densely inhabited city centers with massive street canyons that limit sunlight access in the streets. Today, there is growing awareness in terms of the impact of the built environment on people’s health especially in terms of the health benefits of natural light. The fact that buildings, through their shapes and envelope, filter a large amount of daylight, which may impact building occupants’ health and well-being, should cause architects and building developers to take this issue seriously. The amount and quality of light we receive daily impacts many of our bodily functions and consequently several aspects of our health and well-being. The human circadian rhythm is entrained by intrinsically photosensitive retinal ganglion cells (ipRGCs) in our eyes that are responsible for non-visual responses due to the presence of a short-wavelength sensitive pigment called melanopsin. The entrainment of the circadian rhythm depends on several factors such as the intensity, wavelength, timing, and duration of light exposure. Recently, this field of research has gained popularity, and several researchers have tried to create metrics to quantify photopic light, which is the standard way of measuring visual light, into a measure of circadian effective lighting. This paper discusses the relationship between different parameters of daylighting and their non-visual effects on the human body. It also summarizes the existing metrics of daylighting, especially those focusing on its effects on the human circadian rhythm and its shortcomings. Finally, it discusses areas of future research that can address these shortcomings and potentially pave the way for a universally acceptable standardized metric. Full article

As the primary setting for students’ daily life and learning, university campuses are facing a growing concern about the impact of increased stress on students’ emotional well-being. The sound environment plays a critical role in affecting students’ mental health, learning efficiency, and overall well-being. However, research on the influence of campus soundscapes on students’ emotions is limited, and the mechanisms behind these effects remain to be explored. This study, using the Qishan Campus of Fuzhou University as a case, investigates the impact of campus soundscapes on students’ emotional perception and restorative effects. Four typical functional areas (academic zone (ACZ), residential zone (RDZ), recreational zone (RCZ), and administrative zone (ADZ)) were selected to analyze the effects of natural and artificial sounds on students’ emotions and physiological states. Based on EEG, eye tracking, sound level measurements, and questionnaire surveys, a one-way repeated measures ANOVA was used to assess students’ emotional arousal, valence, and physiological restoration under different soundscape conditions. The results showed that natural sounds, such as the sound of wind-blown leaves and flowing water, significantly improved students’ emotions and restorative effects, while artificial noises like construction sounds and traffic noise had negative impacts. Additionally, subjective perceptions of soundscape restoration were positively correlated with arousal, valence, and acoustic comfort, and negatively correlated with gaze frequency and pupil size. The findings provide a theoretical foundation for optimizing campus soundscape design and highlight the importance of natural sounds in enhancing students’ mental health and academic environment. Full article

As universities strive to create sustainable and comfortable learning environments, understanding the factors that influence student well-being is crucial for promoting good health and well-being (SDG 3) and fostering sustainable communities (SDG 11). This study, conducted at a female campus in the UAE, investigates the impact of various external factors on students’ psychological perceptions. Specifically, it examines how abaya color, landscape settings, and time of day affect body fatigue, eye fatigue, and thermal discomfort, providing valuable insights for campus planning and design. Using GrADS and an FLIR thermal camera, this research analyzed temperature, humidity, and surface temperatures. The Kruskal–Wallis test and Don Bonferroni pairwise comparisons were employed to assess the impact of conditions on psychological perceptions. The results indicate that abaya color insignificantly affected perceptions in summer, but light brown was preferred in spring. Landscape sites influenced eye fatigue and skin dryness in summer, favoring shaded areas. The time of day affected body heat, skin dryness, and thermal discomfort, with greater discomfort in summer afternoons. These findings offer valuable insights for campus planning, particularly in hot summer months, promoting students’ psychological well-being (SDG 3) and sustainable campus communities (SDG 11). Full article

Introduction: Dry eye disease (DED) is a very frequently encountered ocular disease, making it a growing public health burden. However, current treatments for DED present unmet medical needs owing to their side effects or ineffectiveness. Therefore, an effective and safe therapeutic agent to manage DED is needed. Method and Analysis: We planned a phase 2, dose-finding, double-blind, randomized placebo-controlled trial to evaluate the efficacy and safety of two different doses of USL (Useul), the extract of Achyranthis Radix, compared with placebo, for DED. USL has been found to protect against DED by inducing tear secretion and improving corneal irregularity via anti-inflammatory effects, which will provide new therapeutic options. One hundred and twenty participants will be enrolled, after assessing the inclusion/exclusion criteria, at Daejeon University Daejeon Korean Medicine Hospital. Enrolled participants will be allocated to standard-dose USL, high-dose USL, or placebo groups in a 1:1:1 ratio and will be required to administer the trial medication twice a day for 12 weeks and visit the clinic five times. For efficacy outcomes, objective endpoints of fluorescein corneal staining score, tear break-up time, Schirmer’s test, and meibomian test and subjective endpoints of Ocular Surface Disease Index, visual analog scale, Standard Patient Evaluation for Eye Dryness-II, and biomarkers will be assessed throughout the trial. Safety will be assessed based on adverse events, vital signs, laboratory tests, visual acuity, and intraocular pressure. Discussion: Our study results are expected to provide clinical evidence for the use of DED as an effective and safe agent for DED. Full article

Background: Eye care health promotion interventions aim to encourage the adoption of healthy behaviours that impact eye health and vision impairment, as well as increase the use of eye care services. Thus, this study aims to explore and describe the perceptions of eye care coordinators on the implementation of eye care health promotion interventions in rural Limpopo Province. Methods: This exploratory, descriptive qualitative study employed individual in-depth interviews to collect data from 10 district eye health coordinators. Participants were purposely sampled between June and July 2024. Data were analysed thematically using NVivo version 12. Results: The study revealed seven key themes: human resources in eye health, resource management, policy and governance, eye care services, innovation in eye health, community and patient engagement, and coordination and referral systems. Conclusions: In summary, our study offers important insights into the challenges and opportunities in implementing eye care health promotion interventions. A recommendation is made to address identified challenges such as workforce shortages, inadequate infrastructure, fragmented policies and outdated technologies. Policymakers and eye health professionals can work towards achieving the goals of universal health coverage (UHC) in eye health, ultimately improving eye health outcomes. Full article

Background/Objectives: Dry eye disease is a leading cause of ophthalmologic consultations worldwide and can significantly impact quality of life. While global prevalence rates vary widely, data specific to South America are limited. This systematic review aims to describe and analyze the prevalence and associated factors of dry eye disease-related symptoms in South American populations. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted using databases such as PubMed, Web of Science, Scopus, and LILACS. Primary studies in English and Spanish that examined the prevalence of dry eye disease-related symptoms in South American populations and its associated factors were included without date restrictions. Studies were screened and selected based on predefined inclusion and exclusion criteria, resulting in the final inclusion of 16 studies from six South American countries. Results: This review identified significant variability in the prevalence of dry eye disease-related symptoms in South American populations in the region, ranging from 4% to 77.5%, with a mean prevalence of 39.3%. Higher prevalence rates were observed among specific groups, such as university students (58.6%) and administrative workers (57.9%). Factors associated with dry eye disease-related symptoms in South American populations included female sex, older age, prolonged screen time, insufficient sleep, and medical conditions such as hypertension, connective tissue disorders, and the use of medications like antihypertensives and antidepressants. Conclusions: The prevalence of dry eye disease-related symptoms in South American populations is notably higher than global averages, highlighting regional challenges. This study emphasizes the need for standardized diagnostic tools and comprehensive epidemiological research across South America, particularly in underrepresented countries, to inform public health strategies tailored to the specific needs of these populations. Full article

Rapid localization of ROI (Region of Interest) for tomographic medical images (TMIs) is an important foundation for efficient image reading, computer-aided education, and well-informed rights of patients. However, due to the multimodality of clinical TMIs, the complexity of anatomy, and the deformation of organs caused by diseases, it is difficult to have a universal and low-cost method for ROI organ localization. This article focuses on actual concerns of TMIs from medical students, engineers, interdisciplinary researchers, and patients, exploring a universal registration method between the clinical CT/MRI dataset and CVH (Chinese Visible Human) to locate the organ ROI in a low-cost and lightweight way. The proposed method is called Two-step Progressive Registration (TSPR), where the first registration adopts “eye–nose triangle” features to determine the spatial orientation, and the second registration adopts the circular contour to determine the spatial scale, ultimately achieving CVH anatomical knowledge automated mapping. Through experimentation with representative clinical TMIs, the registration results are capable of labeling the ROI in the images well and can adapt to the deformation problem of ROI, as well as local extremum problems that are prone to occur in inter-subject registration. Unlike the ideal requirements for TMIs’ data quality in laboratory research, TSPR has good adaptability to incomplete and non-thin-layer quality in real clinical data in a low-cost and lightweight way. This helps medical students, engineers, and interdisciplinary researchers independently browse images, receive computer-aided education, and provide patients with better access to well-informed services, highlighting the potential of digital public health and medical education. Full article

Introduction: Teledermatology, defined as the use of remote imaging technologies to provide dermatologic healthcare services to individuals in a distant setting, has grown considerably in popularity since its widespread implementation during the COVID-19 pandemic. Teledermoscopy employs a smartphone dermatoscope attachment paired with a smartphone camera to visualize colors and microstructures within the epidermis and superficial dermis that cannot be seen with the naked eye ABCD criteria alone. Methods: Our retrospective observational cohort and case–control study evaluated the utility of loaning a smartphone dermatoscope attachment to patients for remote triage of self-selected lesions of concern for skin cancer. The primary outcome was the number (percentage) of in-person follow-up visits required for patients who submitted lesion images, either with or without accompanying dermoscopic images. A medical record review was conducted on all Oregon Health & Science University Department of Dermatology spot check image submissions utilizing the smartphone dermatoscopes between August 2020 and August 2022. De-identified dermoscopic images of lesions that included corresponding non-dermoscopic clinical images in their submission (n = 70) were independently reviewed by a blinded expert dermoscopist. The expert used standard clinical algorithms (ABCD criteria for clinical images; dermoscopy three-point checklist for dermoscopic images) to determine whether the imaged lesion should be converted to an in-person visit for further evaluation and consideration for biopsy. Results: Of the 70 lesions submitted with corresponding clinical and dermoscopy images, 60 met the criteria for in-person evaluation from clinical (non-dermoscopic) image review compared to 28 meeting the criteria for in-person evaluation from dermoscopic images of the same lesion. Thus, a 53% reduction in conversion to an in-person consultation with the addition of smartphone dermatoscope images in virtual lesion triage was observed (p < 0.001, McNemar’s Test). Conclusion: Implementing patient-led teledermoscopy may reduce the frequency of in-person visits for benign lesions and consequently improve access to in-person dermatology consultations for patients with concerning and possibly malignant lesions. Full article

Background: Global awareness of ambient air pollution has heightened due to its detrimental impact on health, particularly in regions with elevated PM_2.5 levels. Chiang Mai has emerged as an area experiencing the highest PM_2.5 levels in Thailand. Objectives: to examine the prevalence of respiratory allergies and assess the impact of air pollution on the health-related quality of life (QoL) among university students in Chiang Mai. Methods: Chiang Mai University (CMU) and Maejo University (MJU) students were recruited. The Global Asthma Network (GAN) questionnaire screened for respiratory allergies (RAs). The disease-specific QoL questionnaire (Rcq-36) was administered twice during low-PM_2.5 and high-PM_2.5 seasons to evaluate air pollution’s impact on health-related QoL. Those showing potential RAs underwent a skin prick test (SPT) to investigate allergic sensitization. Results: Out of 406 participants, 131 (32%) reported respiratory allergies. Among those undergoing SPT, a high rate (82.54%) had positive results. Across both universities, students reported significantly lower QoL in multiple domains, particularly respiratory, eye, sleep, and emotional well-being, during the high-PM_2.5 season. This aligned with their poorer self-reported health on a visual analog scale (VAS; p-value < 0.01). PM_2.5 levels significantly impacted social functioning for CMU students (p-value = 0.001) and role limitations for MJU students (p-value < 0.001). Notably, participants without respiratory allergies (non-RAs) were more significantly affected by PM_2.5 than RA participants in almost all parameters, despite experiencing fewer baseline symptoms. Conclusions: Respiratory allergies, particularly allergic rhinitis, are prevalent among university students in Chiang Mai. This study underscores the substantial negative impact of ambient air pollution on QoL for both allergic and non-allergic students. Full article

Background: The global epidemic status of diabetic retinopathy (DR) and its burden presents an ongoing challenge to health-care systems. It is of great interest to investigate potential prognostic biomarkers of DR. Such markers could aid in detecting early stages of DR, predicting DR progression and its response to therapeutics. Herein, we investigate the prognostic value of intravitreal concentrations of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) in a DR cohort. Materials and methods: Vitreous sample acquisition was conducted at King Abdullah University Hospital (KAUH) between December 2020 and June 2022. Samples were obtained from any patient scheduled to undergo a pars plana vitrectomy (PPV) for any indication. Included patients were categorized into a DR group or a corresponding non-diabetic (ND) control group. Demographics, clinicopathological variables, standardized laboratory tests results, and optical coherence tomography (OCT) data were obtained for each included individual. Intravitreal concentrations of VEGF and PDGF were assessed using commercial enzyme-linked immunosorbent assay (ELISA). Results: A total of 80 eyes from 80 patients (DR group: n = 42 and ND control group: n = 38) were included in the analysis. The vitreous VEGF levels were significantly higher in the DR group compared to the ND control group (DR group 5744.06 ± 761.5 pg/mL versus ND control group 817.94 ± 403.1 pg/mL, p = 0.0001). In addition, the vitreous PDGF levels were also significantly higher in the DR group than those in the ND control group (DR group 4031.51 ± 410.2 pg/mL versus ND control group 2691.46 ± 821.0 pg/mL, p = 0.001). Bassline differences between test groups and clinical factors impacting VEGF and PDGF concentrations were investigated as well. Multiple regression analysis indicated PDGF as the sole independent risk factor affecting best-corrected visual acuity (BCVA) at the last follow-up visit: the higher the PDGF vitreous levels, the worst the BCVA. Conclusions: Vitreous concentrations of VEGF and PDGF are correlated with DR severity and may exhibit a possible prognostic potential value in DR. Further clinical and experimental data are warranted to confirm the observed findings and to help incorporate them into daily practice. Full article

Background: Meckel’s cave is a challenging surgical target due to its deep location and proximity to vital neurovascular structures. Surgeons have developed various microsurgical transcranial approaches (MTAs) to access it, but there is no consensus on the best method. Newer endoscopic approaches have also emerged. This study seeks to quantitatively compare these surgical approaches to Meckel’s cave, offering insights into surgical volumes and exposure areas. Methods: Fifteen surgical approaches were performed bilaterally in six specimens, including the pterional approach (PTA), fronto-temporal-orbito-zygomatic approach (FTOZA), subtemporal approach (STA), Kawase approach (KWA), retrosigmoid approach (RSA), retrosigmoid approach with suprameatal extension (RSAS), endoscopic endonasal transpterygoid approach (EETPA), inferolateral transorbital approach (ILTEA) and superior eyelid approach (SEYA). All the MTAs were performed both with 10 mm and 15 mm of brain retraction, to consider different percentages of surface exposure. A dedicated navigation system was used to quantify the surgical working volumes and exposure of different areas of Meckel’s cave (ApproachViewer, part of GTx-Eyes II, University Health Network, Toronto, Canada). Microsurgical transcranial approaches were quantified with two different degrees of brain retraction (10 mm and 15 mm). Statistical analysis was performed using a mixed linear model with bootstrap resampling. Results: The RSAS with 15 mm of retraction offered the maximum exposure of the trigeminal stem (TS). If compared to the KWA, the RSA exposed more of the TS (69% vs. 46%; p = 0.01). The EETPA and ILTEA exposed the Gasserian ganglion (GG) mainly in the anteromedial portion, but with a significant 20% gain in exposure provided by the EETPA compared to ILTEA (42% vs. 22%; p = 0.06). The STA with 15 mm of retraction offered the maximum exposure of the GG, with a significant gain in exposure compared to the STA with 10 mm of retraction (50% vs. 35%; p = 0.03). The medial part of the three trigeminal branches was mainly exposed by the EETPA, particularly for the ophthalmic (66%) and maxillary (83%) nerves. The EETPA offered the maximum exposure of the medial part of the mandibular nerve, with a significant gain in exposure compared to the ILTEA (42% vs. 11%; p = 0.01) and the SEY (42% vs. 2%; p = 0.01). The FTOZA offered the maximum exposure of the lateral part of the ophthalmic nerve, with a significant gain of 67% (p = 0.03) and 48% (p = 0.04) in exposure compared to the PTA and STA, respectively. The STA with 15 mm of retraction offered the maximum exposure of the lateral part of the maxillary nerve, with a significant gain in exposure compared to the STA with 10 mm of retraction (58% vs. 45%; p = 0.04). The STA with 15 mm of retraction provided a significant exposure gain of 23% for the lateral part of the mandibular nerve compared to FTOZA with 15 mm of retraction (p = 0.03). Conclusions: The endoscopic approaches, through the endonasal and transorbital routes, can provide adequate exposure of Meckel’s cave, especially for its more medial portions, bypassing the impediment of major neurovascular structures and significant brain retraction. As far as the most lateral portion of Meckel’s cave, MTA approaches still seem to be the gold standard in obtaining optimal exposure and adequate surgical volumes. Full article