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BACKGROUND: Macular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs. METHODS: We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the classic inverted ILM flap technique to modified ILM flap techniques as initial surgical treatment of eyes with large MHs of more than 400 microns. We sought to evaluate the following outcomes: (1) MH closure. (2) Best-corrected visual acuity (BCVA). (3) Foveal closure type (4) Rate of ellipsoid zone (EZ) defects and external limiting membrane (ELM) defects. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcomes. RESULTS: Four RCTs that enrolled 220 participants were deemed eligible. The analysis revealed no statistically significant differences in MH closure between both groups (95% CI: 0.20, 7.96; P = 0.81). No statistically significant differences in mean BCVA were found at 1 and 3 months between both groups (SMD: 0.04; 95% CI: -0.16, 0.23; P = 0.70 and SMD: -0.167; 95%CI: -1.240, 0.906; P = 0.760, respectively). In addition, there were no significant differences between the two groups in the pattern of foveal closure, namely U-shape, V-shape, and flap open at 3, 6, and 12 months (RR: 0.87; 95% CI: 0.67, 1.12; P = 0.28, RR: 0.96; 95% CI: 0.58, 1.61; P = 0.89, and RR: 1.95, 95% CI: 0.26, 14.50; P = 0.51, respectively). Finally, the analysis showed no statistically significant difference in both groups' EZ and ELM defect rates at 3, 6, and 12 months (RR: 1; 95% CI: 0.85; 1.18: P = 1 and RR: 1.14; 95% CI: 0.90, 1.45; P = 0.27). CONCLUSION: Macular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs.
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Objectives Technology is rapidly evolving to improve patient safety and increase healthcare providers' efficiency. Automated dispensing cabinets (ADCs) are an example of a technology that has been used to facilitate patient safety. As with any other technology, there are benefits and drawbacks associated with the use of ADCs. In this study, we aim to identify the issues related to maintaining ADCs in National Guard Health Affairs (NGHA) hospitals from the pharmacy technicians' perspective and find some solutions to overcome the problems that complicate the usability of the ADCs. Methods A cross-sectional qualitative study was conducted using an open-ended questionnaire. It was completed by 30 pharmacy technicians who deal with ADCs in NGHA hospitals. Results Three themes were extracted from the questionnaire: "issues faced by pharmacy technicians before filling the ADCs," "issues faced by pharmacy technicians during filling the ADCs," and "issues faced by pharmacy technicians after filling the ADCs." Discussion and conclusion This study portrayed a better understanding of the issues faced by pharmacy technicians who deal with ADCs based on their experience. It will help stakeholders to make appropriate decisions and improve the workflow for a successful ADC implementation.
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The most common side effect for cancer patients using epidermal growth factor receptor inhibitors (EGFRI) is the development of an itchy papulopustular rash. In severe cases, the patients are forced to stop taking the medications, hence affecting treatment outcomes. We herein report a case of a 50-year-old patient who developed a papulopustular rash after starting erlotinib. He treated himself with Ziziphus spina-christi leaves which is a plant well known for its anti-inflammatory and antibacterial properties in the middle east. We hypothesize that the anti-inflammatory, soothing, and antibacterial activity of the Ziziphus tree might actually represent a possible better treatment of the rash than available treatments, particularly in patients on EGFR blockers, and hence improve treatment outcomes.