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Navid Hakim,1 Philippa Longmore,1 Victor H Hu1,2 1Eye Department, Mid Cheshire NHS Hospitals Foundation Trust, Crewe, UK; 2International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UKCorrespondence: Navid HakimEye Department, Mid Cheshire NHS Hospitals Foundation Trust, Crewe, CW1 4QJ, UKTel +44 7540492816Email navid.hakim@nhs.netIntroduction: An ophthalmic remote consultation clinic was implemented due to the COVID-19 pandemic for stable patients under the corneal service in a district general hospital in Cheshire, UK. Patients were reviewed either by video or telephone consultation. The purpose of this survey was to assess patient satisfaction with this service.Methods: Consecutive patients who were seen by remote consultation between September 2020 and November 2020 were identified. Approval for the survey was gained from the hospital Patient Experience and Survey department. A telephone survey was conducted between 4 and 8 weeks after the initial patient appointment. Data were obtained for patient demographic information, appointment details and patient satisfaction with their appointment, including preference for subsequent appointments and open feedback.Results: Eighty-four remote consultations were identified and 51 (60.7%) patients completed the survey: 48 (94.1%) reported satisfaction with their remote consultation; 36 (70.5%) reported satisfaction for a subsequent remote consultation; and 33 (64.7%) patients reported they preferred being seen remotely rather than face-to-face. Qualitative data on patients’ thoughts about the service could be categorised into 4 themes: satisfaction with the interaction and service, conveniency, lack of clinical examination and satisfaction with the service given the current pandemic circumstances.Conclusion: This survey has shown that patients were satisfied with their remote consultation and the majority thought it was an acceptable method of consultation. This also allowed patients to continue being seen during a period of COVID-19 lockdown and reduce patient footfall through the hospital. Overall feedback indicated very high levels of patient satisfaction with this service.Keywords: COVID-19, ophthalmology, telemedicine, cornea

Navid Hakim,1 Jamil Hakim2 1St. Pauls Eye Department, Royal Liverpool Hospital, Liverpool, UK; 2Ophthalmology Department, Queen Mary’s Hospital Sidcup, Sidcup, UKCorrespondence: Navid HakimSt. Pauls Eye Department Royal Liverpool Hospital Prescot St, Liverpool L7 8XP, UKTel +07540492816Email navid.hakim@nhs.netIntroduction: Central retinal artery occlusion is an ophthalmic emergency which typically causes acute, painless visual loss. Several conservative treatment options are practiced with little benefit. Thrombolysis as a therapeutic option has gathered interest as well as controversy. This paper aims at reviewing the relevant literature to assess the efficacy and safety of intra-arterial thrombolysis for acute central retinal artery occlusion.Methods: A review of the literature was conducted. Keywords included “intra-arterial thrombolysis” or “intra-arterial fibrinolysis” in combination with “central retinal artery occlusion” or “CRAO”. A Cochrane Database search was performed for randomised control trials, systematic reviews and meta-analyses using the same keywords.Results: Twenty-eight studies were identified which included case reports, case series, case-control studies and 1 randomised control trial: the European Assessment Group for Lysis in the Eye Study. Improvement in vision was measured using different methods and at different time points. The findings of these studies generally favour an effect towards intra-arterial thrombolysis however there are many limitations. Additionally, the European Assessment Group for Lysis in the Eye Study showed lack of effect in intra-arterial thrombolysis vs conservative measures.Conclusion: Current evidence is not sufficient to recommend intra-arterial thrombolysis due to the variability of visual improvement within retrospective studies, heterogeneity in treatment regimens between studies and adverse effects. Intra-arterial thrombolysis may have a role in patients presenting early, particularly if they have monocular vision, after discussion of the risks and benefits. Further high-quality trials assessing the clinical efficacy of intra-arterial thrombolysis may shed more light on this topic.Keywords: central retinal artery occlusion, intra-arterial, thrombolysis, fibrinolysis

Navid Hakim,1 Cristina Soare,2 Jamil Hakim2 1Department of Medicine, Princess Royal University Hospital, Orpington, 2Department of Ophthalmology, Queen Mary’s Hospital Sidcup, Sidcup, UK Abstract: Walker–Warburg syndrome (WWS) is a disorder characterized by ocular and brain malformations, and congenital muscular dystrophy. Retinal malformations are common in WWS; however, bilateral retinal detachment is a rare occurrence. We present a case of a newborn baby delivered at 36+3 weeks, who was the first living child of consanguineous parents of Turkish origin. On antenatal anomaly scans, the fetus had hydrocephalus that had increased throughout pregnancy, and a diagnosis of hydrancephaly was made at 36 weeks of gestation. Hypotonia, cleft lip and palate, poor suck and absent gag reflex were noted at birth. Ophthalmic examination at the age of 2 days revealed bilateral funnel retinal detachment. B-scan ultrasonography confirmed these findings, and magnetic resonance imaging (MRI) of the brain was performed at the age of 13 days to establish a diagnosis. The MRI showed lissencephaly, hydrocephalus and thin rim of brain parenchyma, with a cobblestone appearance of the cortex and pontine and cerebellar hypoplasia, consistent with the diagnosis of WWS. The infant deteriorated and died at 39 days of age from complications associated with the brain anomalies. In summary, bilateral retinal detachment is extremely rare and in association with hydrocephalus and posterior fossa anomalies strongly suggests the diagnosis of WWS. Keywords: bilateral retinal detachment, Walker–Warburg syndrome, hydrancephaly, facial anomalies

Total stations, global navigation satellite systems (GNSS) instruments, and laser scanners are common tools used in detailed surveys because of the precision they bring to measurements and data collection. While conventional land surveying methods using total stations and GNSS instruments are widely used for their accuracy, they require a team of at least three people and can be costly. In 2021, Apple introduced the iPhone 13 Pro with a built-in LiDAR sensor that can potentially be used for land surveying. However, it is unclear whether the LiDAR data obtained from the iPhone is accurate and reliable enough to replace the conventional surveying methods. Therefore, a comparison study between the conventional method and the iPhone LiDAR sensor needs to be conducted to evaluate the feasibility and potential benefits of using the iPhone LiDAR sensor in land surveying. The purpose of this study is to evaluate the differences between tacheometry method using total station and laser scanning method using iPhone 13 Pro Max in generating detail survey plan. This study was conducted UiTM Shah Alam Stadium, Shah Alam, Selangor. For scanning method, two device poses (distance of sensor to target) are used which are 5 and 10 cm. Based on results and analysis, the differen ce between the actual elevation value and the scanning data from the device at 5 cm and 10 cm is relatively small. The lowest values for the device's position at 5 cm and 10 cm are -0.025 m and -0.057 m, respectively, and the highest values are 0.023 m and 0.017 m, respectively. The average deviation at the device's position of 5 cm is 0.023 m, while the average deviation at the device's position of 10 cm is 0.017 m. In conclusion, the LiDAR sensor in the iPhone 13 Pro Max has the potential to be a valuable tool for assessing accuracy in detailed survey plans. Its possible applications in different fields are worth further exploration. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The duration of daycare surgery (DS) is relatively shorter compared to other types of surgeries. The main objective here is to provide comfort to the patients and family members without compromising safety and quality of medical care for the patients. In addition, there are many proven advantages of DS such as shorter waiting time, earlier return to work, reduced cross-infections, reduced cancellation rates due to emergency cases and cost-effective. Due to the constraints of inpatient operating time and availability of hospital beds, thyroid surgery is performed as DS in our centre. In this study, we analysed the cost-effectiveness and safety between the daycare and inpatient hemithyroidectomy. MATERIALS AND METHODS: This cost minimisation comparative study was conducted in Kuala Lumpur Hospital, Malaysia, from January 2019 to June 2021. The total cost for each hemithyroidectomy for providers and patients were calculated for both groups. Any complications in the surgery for the two groups were documented. RESULT: Seventy-one patients were recruited: forty-one (57.7%) daycare hemithyroidectomies and thirty (42.3%) inpatient hemithyroidectomies. The cost of daycare hemithyroidectomy were significantly lower than the inpatient hemithyroidectomy with a median percentile of RM1089.00 (IQR= RM 339.48) and RM 1477.10 (IQR = RM 434.02) respectively (p-value <0.001). None of the patients in either group developed any surgical complications. CONCLUSION: Daycare hemithyroidectomy minimises the cost for providers while still maintaining the safety of the procedure. Therefore, daycare hemithyroidectomy is cost-effective and should be advocated in all tertiary hospitals in Malaysia. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is a systemic disease that alters the metabolism of blood sugar. Poorly controlled diabetes or hyperglycaemia is associated with an array of micro-vascular, macro-vascular, and neuropathic complications. There is a widely held belief that infections are usually more frequent and severe in diabetic patients. Diabetes prevalence is increasing in the developed & developing countries, and the appropriate management of patients with diabetes has become increasingly important for the prevention of hospital-acquired infections. Postoperative wound infection continues to be a major source of morbidity and mortality in developing countries despite recent advances in aseptic techniques. There is little information regarding postoperative wound infection in controlled diabetic patients undergoing elective operation. Objectives: The aim of our study was to evaluate the postoperative wound infection in controlled diabetic and non-diabetic patients in elective operations. Materials & method: This cross sectional comparative study was conducted in Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, during the period of October 2011 to March 2012. A total seventy three patients with controlled diabetics and seventy three non-diabetics were selected. Inclusion criteria were patients undergoing clean and cleancontaminated elective operations. Un-controlled diabetes, patient undergoing contaminated and dirty operation, patient with tuberculosis, jaundice, uraemia, having cortico-steroids /chemoradiation and operated for malignancies were excluded. After preoperative preparation specific operation was done. All patients were followed up for 30 days of post operative period for development of any postoperative wound infection. All information recorded in data collection sheet. Data was processed and analysed with the help of computer program SPSS-16 and Microsoft excel. Quantitative data expressed as mean and standard deviation and qualitative data as frequency and percentage. Result: The patients of diabetic group [31 male, 42 female; mean age, 44.5 (SD 8.2) years] and non-diabetic group [40 male, 33 female; mean age, 43.1 (SD 9.4) years] were similar in age and sex (p>0.05 each). The rate of postoperative wound infection after elective abdominal surgery was 7.5% [in controlled diabetic group was 12.3% and that of non-diabetic group was 2.7% (p<0.05)] and the patients of diabetic group were 5.0 times more likely to develop wound infection as compared to that of non-diabetic group (OR=4.992; 95% of CI=1.040--23.971) in clean and clean contaminated elective abdominal surgery. The length of postoperative hospital stay was significantly more in diabetic group than that of non-diabetic group (8.2 (SD ± 2.9) vs 6.8 (SD ± 3.2) days; p<0.01). Conclusion: Postoperative wound infection was higher in controlled diabetic patients than that of non-diabetic. These results support the consideration of diabetes as an independent risk factor for SSIs after elective surgery. Continued efforts are needed to improve surgical outcomes for diabetic patients. [ABSTRACT FROM AUTHOR]

Decarbonizing industrial heating globally is a significant challenge, driving the integration of high-temperature heat pumps for heat recovery and electrification in the industrial sector. However, current high-temperature heat pumps with low global warming potential refrigerants face limitations in delivering high-temperature heat due to their restricted compressor discharge temperature or require several compressors/intercoolers. To address these issues, a novel high-temperature cascade heat pump system is proposed, utilizing water (R718) in the high stage, while selecting one among six low GWP refrigerants (R1234ze(Z), R1233zd(E), R1336mzz(Z), R600, R600a, R601) in the low stage, with single compressor at each stage. To manage high discharge temperatures of high stage, liquid water injection is applied during high stage compression, modeled for both wet and dry steam. The model is validated against available experimental data with maximum error less than 5 %. Further, the effectiveness of the internal heat exchanger in low stage cycle is assessed for all investigated low stage refrigerants. Results reveal that R718 + R600 offers the optimal refrigerant working pair, achieving a maximum COP × VHC of 2895.1 kJ m−3 for delivering high temperature heat at water condensation temperature of 190 °C and recovering heat from low temperature waste energy of 50 °C.