AlM:To report an unusual case of neuroretinits with coexistent Bell's Palsy.METHODS:A case report.RESULTS: A 16-year-old boy presented with right eye blurring of vision for one week. It was associated with high fever and facial asymmetry. The visual acuity of the right eye was 6/60 and the left eye was 6/6. Funduscopy of the right eye showed swollen and hyperemic optic disc with presence of macular star. There was also left lower motor neuron nerve palsy. Humphrey visual field perimetry showed small paracentral scotoma with enlargement of blind spot. Complete blood count showed neutrophilia with increased erythrocyte sedimentation rate (ESR). Serology for syphilis, toxoplasmosis, Lyme disease and cat-scratch disease was negative. Herpes simplex virus, Herpes zoster virus, and human immunodeficiency virus investigations were negative. Rickettsia was also negative. MRI of the brain and orbit were normal without demyelinating lesion. He was started with high dose intravenous methylprednisolone 250mg four times per day for three days. He was then discharged home with oral prednisolone 1mg/kg for another 11 days. During the follow-up,the visual acuity was improved to 6/6 after six months with slightly pale disc.The Bell's palsy was also improved without obvious facial asymmetry.CONCLUSION:It is important for clinician to examine other cranial nerces in optic neuritis. Although neuroretinitis with coexistent facial nerve in optic neuritis.Although neuroretinitis with coexistent facial nerve palsy is a rare conditon,thorough examinations and investigations should be made to exclude the inportant infetice causes.Optic neuritis with coexistent facial nerce palsy responds well to the high dose steroids.

INTRODUCTION: A second-tier rapid response team (RRT) is activated for patients who do not respond to first-tier measures. The premise of a tiered response is that first-tier responses by a ward team may identify and correct early states of deterioration or establish goals of care, thereby reducing unnecessary escalation of care to the RRT. Currently, utilisation and outcomes of tiered RRTs remain poorly described. METHODS: A prospective observational study of adult patients (age ≥18 years) who required RRT activations was conducted from February 2018 to December 2019. RESULTS: There were 951 consecutive RRT activations from 869 patients and 76.0% patients had a National Early Warning Score (NEWS) ≥5 at the time of RRT activation. The majority (79.8%) of patients required RRT interventions that included endotracheal intubation (12.7%), point-of-care ultrasound (17.0%), discussing goals of care (14.7%) and intensive care unit (ICU) admission (24.2%). Approximately 1 in 3 (36.6%) patients died during hospitalisation or within 30 days of RRT activation. In multivariate analysis, age ≥65 years, NEWS ≥7, ICU admission, longer hospitalisation days at RRT activation, Eastern Cooperative Oncology Group performance scores ≥3 (OR [odds ratio] 2.24, 95% CI [confidence interval] 1.45-3.46), metastatic cancer (OR 2.64, 95% CI 1.71-4.08) and haematological cancer (OR 2.78, 95% CI 1.84-4.19) were independently associated with mortality. CONCLUSION Critical care interventions and escalation of care are common with second-tier RRTs. This supports the need for dedicated teams with specialised critical care services. Poor functional status, metastatic and haematological cancer are significantly associated with mortality, independent of age, NEWS and ICU admission. These factors should be considered during triage and goals of care discussion.
Adolescent ; Adult ; Aged ; Critical Care ; Hospital Mortality ; Hospital Rapid Response Team ; Humans ; Prospective Studies ; Tertiary Care Centers

INTRODUCTIONRefractive error remains one of the primary causes of visual impairment in children worldwide, and the prevalence of refractive error varies widely. The objective of this study was to determine the prevalence of refractive error and study the possible associated factors inducing refractive error among primary school children of Malay ethnicity in the suburban area of Kota Bharu, Kelantan, Malaysia.

MATERIALS AND METHODSA school-based cross-sectional study was performed from January to July 2006 by random selection on Standard 1 to Standard 6 students of 10 primary schools in the Kota Bharu district. Visual acuity assessment was measured using logMAR ETDRS chart. Positive predictive value of uncorrected visual acuity equal or worse than 20/40, was used as a cut-off point for further evaluation by automated refraction and retinoscopic refraction.

RESULTSA total of 840 students were enumerated but only 705 were examined. The prevalence of uncorrected visual impairment was seen in 54 (7.7%) children. The main cause of the uncorrected visual impairment was refractive error which contributed to 90.7% of the total, and with 7.0% prevalence for the studied population. Myopia is the most common type of refractive error among children aged 6 to 12 years with prevalence of 5.4%, followed by hyperopia at 1.0% and astigmatism at 0.6%. A significant positive correlation was noted between myopia development with increasing age (P <0.005), more hours spent on reading books (P <0.005) and background history of siblings with glasses (P <0.005) and whose parents are of higher educational level (P <0.005). Malays in suburban Kelantan (5.4%) have the lowest prevalence of myopia compared with Malays in the metropolitan cities of Kuala Lumpur (9.2%) and Singapore (22.1%).

CONCLUSIONThe ethnicity-specific prevalence rate of myopia was the lowest among Malays in Kota Bharu, followed by Kuala Lumpur, and is the highest among Singaporean Malays. Better socio-economic factors could have contributed to higher myopia rates in the cities, since the genetic background of these ethnic Malays are similar.

Child ; Cross-Sectional Studies ; Female ; Follow-Up Studies ; Humans ; Malaysia ; epidemiology ; Male ; Prevalence ; Refraction, Ocular ; Refractive Errors ; complications ; epidemiology ; physiopathology ; Retrospective Studies ; Schools ; Suburban Population ; statistics & numerical data ; Vision, Low ; epidemiology ; etiology ; physiopathology ; Visual Acuity

Anesthesia ; COVID-19/epidemiology* ; Critical Care ; Humans ; Pandemics ; SARS-CoV-2

Humans ; Hospital Rapid Response Team ; Attitude of Health Personnel ; Perception