Nomophobia among university students in five Arab countries in the Middle East: prevalence and risk factors.

BACKGROUND: Excessive use of mobile phones leading to development of symptoms suggestive of dependence syndrome with teenagers are far more likely to become dependent on mobile phones as compared to adults. COVID-19 pandemic has had an impact on the mental health of several groups in society, especially university students. This study aimed to explore the prevalence of mobile phone dependence among university students and its associated factors. METHODS: Between September 2021 and January 2022, a cross-sectional study was conducted at universities in Jordan, Lebanon, Egypt, Bahrain, and Saudi Arabia utilizing an online and paper-based self-administered questionnaire. We employed a previously developed questionnaire by Aggarwal et al. RESULTS: A total of 5,720 university students were involved in this study (Egypt = 2813, Saudi Arabia = 1509, Jordan = 766, Lebanon = 432, and Bahrain = 200). The mean estimated daily time spent on using mobile phone was 186.4 (94.4) minutes. The highest mobile dependence score was observed for the university students from Egypt and the lowest mobile dependence score was observed for the university students from Lebanon. The most common dependence criteria across the study sample was impaired control (55.6%) and the least common one was harmful use (25.1%). Females and those reported having anxiety problem or using a treatment for anxiety were at higher risk of developing mobile phone dependence by 15% and 75%, respectively. CONCLUSION: Mobile phone dependence is common among university students in Arab countries in the Middle East region. Future studies exploring useful interventions to decrease mobile phone dependence are warranted.

Visual health and prevalence of dry eye syndrome among university students in Iraq and Jordan.

Dry eye syndrome (DES), is a multifactorial disease that affects the ocular surface and contributes to the ocular symptoms. The COVID-19 pandemic influenced the general population and university students' health in different ways. The pandemic forced many people including university students around the world to use virtual platforms on their digital devices, such as computers and smartphones, to work from a distance. This study aimed to explore the visual health and prevalence of dry eye syndrome among university students in Iraq and Jordan. This was a cross-sectional study that was conducted in Iraq and Jordan using online questionnaire tool for the duration between November 2021 and January 2022. University students in Jordan and Iraq were invited to participate in this study and formed the study population. No restrictions on study level or field of study were applied. A previously developed and validated questionnaire tools were used in this study (National Eye Institute Visual Functioning Questionnaire - 25 (VFQ-25) and the Women's Health Study Questionnaire (WHS), which was developed by Schaumberg et al.). A total of 1,431 university students were involved in this study (1,018 students from Iraq, 71.1%). Around one third the study participants (29.0%) reported that have been diagnosed by a clinician as having dry eye syndrome. Around15.3% of the total study participants reported that they feel their eyes are dry (not wet enough) and 17.3% reported that they feel their eyes are irritated. Based on Women's Health Study Questionnaire (WHS) criteria, a total of 479 participants (33.4%) are symptomatically diagnosed with DES. Students aged 27-29 years, those at their fifth year of study, and those who wear contact lenses are at higher risk of developing DYS compared to others. Dry eye syndrome is common health problem among university students. Further studies are required to identify other risk factors associated with DES. Future research should focus on identifying strategies that could help reduce the risk of developing DES as a result of the inevitability of long-term use of digital devices among many categories of society, including university students.

Is wearing a face mask associated with symptomatic dry eye disease among medical students during the COVID-19 era? An online survey.

BACKGROUND: Coronavirus disease 2019 has necessitate the routine use of masks worldwide. This study assessed the relationship between wearing a facemask and dry eye disease (DED) among a sample of medical students in Jordan. METHODS: This cross-sectional online survey enrolled medical students from all medical schools in Jordan. The questionnaire, which was shared via social media platforms, assessed sociodemographic information, ocular and medical history, facemask-wearing habits, the use of ocular devices, and the relationship with ocular discomfort. The ocular surface disease index (OSDI) questionnaire was also administered to quantify DED symptoms. RESULTS: A total of 1,219 students participated in this study. In total, 58.3% participants were females, and 52% were in the clinical science years. Symptomatic DED was found in 71.7% of participants. Female sex, basic science years, allergy reporting, and spending more than 6 h looking at screens were significantly associated with symptomatic DED. CONCLUSION: Wearing a facemask was not significantly associated with symptomatic DED. Further studies are needed to investigate the effect of wearing a facemask on the ocular surface.

The effect of pharmaceutical companies' marketing mix strategies on physicians prescribing practices in Jordan: a cross-sectional study.

BACKGROUND: Exploring the effect of different marketing mix strategies on physicians' prescribing practices is important due to its positive effect on the management of patients' diseases and improving the health status of individuals by promoting the use of the most cost-effective and safe treatment for patients. AIM: This study aimed to assess the perceived influence of the four pharmaceutical marketing mix strategies (product, price, place, and promotion) on physicians' prescribing practices in Jordan. METHOD: A quantitative survey study was conducted from May to November 2021 on practising physicians in Jordan. This research utilised a previously validated questionnaire developed by Hailu et al. The convenience sampling technique was used to recruit the study participants. The population of the study was practising physicians from the public and private sectors in Jordan. Any physician who was licensed to practice medicine in Jordan and actively engaged in patient care was considered eligible. The minimum sample size required was 379 participants, which was calculated based on a population size of 35,000 physicians in Jordan. Student t-test/One-way independent-measures ANOVA was used to compare the mean scores (indicating being affected by marketing mix elements between different demographic groups) after performing log transformation to restore the normality of the data. For the binary regression analyses, the dependent variable was the median score for each of the marketing mix elements. For each sub-scale and the overall scale, the median score was used to define the dummy variable used in the binary regression analysis. The study protocol was approved by the Scientific Research Ethics Committee at Isra University (SREC/21/06/005). RESULTS: A total of 315 physicians participated in the study. Overall, participating physicians showed moderate to high influence from marketing mix elements, with a median score of 141.0 (IQR: 118.0-156.0) out of 185, representing 76.2%. The lowest median score was found for the promotional tools used by pharmaceutical companies, with a median score of 48.5 (IQR: 40.0-56.0) out of 70, representing 69.3%. The highest median score found was for the pricing strategy implemented by pharmaceutical companies, with a median score of 25.0 (IQR: 18.8-28.0) out of 30, representing 83.3%. Working in private sector settings was an important predictor that increased the probability of physicians' prescribing practices being influenced by marketing mix elements (OR: 1.57; (95%CI: 1.00-2.47)), (p ≤ 0.05). CONCLUSION: Physicians in our study were highly affected by marketing mix strategies, specifically price strategy. Policymakers should guarantee a balanced relationship with pharmaceutical companies and physicians. We should make sure that promotion strategies have a positive impact on patients' health. The government is advised to decrease the taxes on medications to decrease the overall cost for patients.

Post-concussion Syndrome Light Sensitivity: A Case Report and Review of the Literature.

Photophobia is considered the second most common symptom of both concussion and post-concussion syndrome. Soldiers on duty experience photophobia after blast-related concussions or mild traumatic brain injury in 60-75% of instances. In addition, soldiers report other symptoms, such as asthenopia, squinting, dry eyes and headaches, for which they are considered to be at high risk. According to the International Brain Injury Association, some concussed patients report indirect symptoms such as multi-tasking difficulties, dizziness, vertigo, and fatigue. Moreover, some concussed individuals experience photophobia for approximately 6 months or indefinitely. We present the case of a 23-year-old soldier who presented with severe photophobia after a mild traumatic head injury. His photophobia was alleviated after the administration of topical anaesthetic drops in the eyes in the absence of any ocular surface pathology. He was diagnosed with post-concussion syndrome light sensitivity and was managed successfully with rose-coloured special photophobia glasses tinted with FL-41. Photophobia is a common neurological symptom in military personnel that needs more attention as it affects body and mind. We have reported an uncommon pathway of photophobia, which may unveil an unrecognised mechanism that may play a role in post-concussion photophobia.

Knowledge and awareness of the general population and healthcare providers about retinoblastoma: It is time to know the glow.

Retinoblastoma is the most frequent primary intraocular tumour in childhood. Early detection of retinoblastoma is the key to successful management with a higher chance of survival. This study aims to assess the knowledge of the general population and healthcare providers about retinoblastoma in term of presentation, risk factors, timing for diagnosis, and complications. A cross-sectional study using an online survey was conducted in three Arab countries (Jordan, Saudi Arabia, and Iraq) between 28 August and 16 September 2020. The questionnaire tool was constructed based on an extensive literature review to explore the study's aim and objectives. Logistic regression was used to identify predictors of better knowledge about retinoblastoma. A total of 3676 participants were involved in the study (Jordan = 2654, Saudi Arabia = 604, and Iraq = 418). The average retinoblastoma knowledge score for the whole study population was 6.25 (SD = 4.12) out of 21, representing 29.8% (out of the maximum possible total score). Participants aged above 50 years old, married individuals, those with a secondary education level, those who work as professionals in industry, those who have more than four children, and those who reported that they were not in direct contact with a large number of children were less likely to be knowledgeable about retinoblastoma presentation, risk factors, the timing for diagnosis, and complications (P < .05). Early detection is the cornerstone for decreasing morbidity and mortality among children with retinoblastoma. However, the awareness and knowledge about retinoblastoma are very limited in our study population. Efforts should be directed at increasing awareness of both the general population and healthcare providers regarding retinoblastoma. Policymakers are responsible for improving knowledge and awareness about retinoblastoma to facilitate early detection of the disease by conducting awareness campaigns in addition to improve screening skills of healthcare providers and providing them with proper screening and diagnostic tools.

Occupational burnout and job satisfaction among physicians in times of COVID-19 crisis: a convergent parallel mixed-method study.

BACKGROUND: Healthcare professionals including physicians were subjected to an increased workload during the COVID-19 crisis, leaving them exposed to significant physical and psychological distress. Therefore, our present study aimed to (i) assess the prevalence of burnout and levels of job satisfaction among physicians in Jordan, and (ii) explore physicians' opinions, experiences, and perceptions during the pandemic crisis. METHODS: This was a mixed-method study that utilized a structured web-based questionnaire and semi-structured individual interviews. The 10-Item Burnout Measure-Short version (BMS), and the 5-Item Short Index of Job Satisfaction (SIJS) were adopted to assess occupational burnout and job satisfaction, respectively. Semi-structured interviews were conducted, based on a conceptual framework that was developed from Herzberg's Two-Factor Theory of Motivation and Job Demands-Resources Model. Descriptive statistics and regression models, as well as inductive thematic analysis, were used to analyze quantitative and qualitative data, respectively. RESULTS: A total of 973 survey responses and 11 interviews were included in our analysis. The prevalence of burnout among physicians was (57.7%). Several significant factors were positively associated with burnout, including female gender, working at highly loaded hospitals, working for long hours, doing night shifts, lack of sufficient access to personal protective equipment, and being positively tested for SARS-CoV-2. Regarding job satisfaction, regression analysis revealed that age was positively associated with higher levels of job satisfaction. On contrary, being a general practitioner or specialist, working at highly loaded hospitals, low salaries, and suffering from burnout have predicted lower levels of job satisfaction. Besides, four themes have emerged from the thematic analysis: (i) Work-induced psychological distress during the pandemic, (ii) Decision-driven satisfactory and dissatisfactory experiences, (iii) Impact of the pandemic on doctor-patient communication and professional skills, and (iv) Economic impacts of the pandemic crisis and lockdown. CONCLUSION: A significant physical and psychological burden was associated with the COVID-19 pandemic. Reliable efforts should be implemented aiming at protecting physicians' physical and mental wellbeing, enhancing their working conditions, and raising awareness about burnout. Evidence-based decisions and proper utilization of financial and human resources at institutional and national levels are believed to be crucial for the sustainability of the health workforce, especially in crises.

Clinical and Sonographic Evaluation of Postmenopausal Bleeding (PMB) Followed by Diagnostic and/or Therapeutic Hysteroscopy and Guided Biopsy in Jordanian Hospitals.

Background and Objectives: The goal of this study was to evaluate the clinical sonographic evaluation of postmenopausal bleeding (PMB) followed by diagnostic and/or therapeutic hysteroscopy and guided biopsy in Jordanian hospitals. Materials and Methods: A retrospective multi-centric study was performed in hospitals in Al-Karak and Amman from 2014-2016. The study recruited 189 cases to evaluate the aetiology of postmenopausal bleeding. Atrophic endometrium was observed as a major cause of postmenopausal bleeding according to histopathology. The cases were also distributed according to parity in which nulliparous patients were observed. Results: Hysteroscopy was observed to be effective for the diagnosis of postmenopausal bleeding. Conclusion: There is a need to assess more approaches for the diagnosis of postmenopausal bleeding among women.

An unusual coexistence of iris mammillations and optic disc pit with keratoconus: A case report and literature review.

Iris mammillations are distinctive uniform nipple-like elevations that cover the anterior surface of the iris partially or totally. It is a rare finding and may coexist with other ocular and extraocular manifestations. Optic nerve pit (ONP), also known as optic disc pit (ODP) or optic hole, is a congenital defect resulting from the failure of fetal fissure closure during the embryonic development. It belongs to the congenital cavitary anomalies spectrum. This case presents a 19-year-old female patient who complained of a gradual decrease in visual acuity in both eyes for 4 years. Slit-lamp and fundus examinations revealed iris mammillations and ODP in the left eye. Corneal topography revealed bilateral keratoconus, which was managed with cross-linking. Iris mammillations and ODP are poorly understood ocular anomalies that are not reported frequently and have never been reported previously both combined with keratoconus. Thus, ophthalmologists should be aware of these conditions, their differential diagnosis, and their possible association with other disorders. This is the first reported case of the combined coexistence of iris mammillations and ODP with keratoconus.

Hospital admissions due to vasomotor and allergic rhinitis in England and Wales between 1999 and 2019: an ecological study.

BACKGROUND: Allergic rhinitis is among the most prevalent chronic disorders in high-income countries. Its estimated cost is €30-€50 billion annually in the European Union and in the UK, it is approximately €1.8 billion per year. AIM: To study hospital admissions for vasomotor and allergic rhinitis in England and Wales during the past 20 years. METHOD: This was an ecological study using publicly available data extracted from the Hospital Episode Statistics (HES) database in England and the Patient Episode Database for Wales (PEDW). The trend in hospital admissions was assessed using a Poisson model. RESULTS: Admission rate increased by 2.14-fold [from 2.59 (95% CI 2.46-2.73) in 1999 to 8.16 (95% CI 7.93-8.39) in 2020 per 100,000 persons, trend test, p < 001]. The most prevalent hospital admission reasons were allergic rhinitis due to pollen, other allergic rhinitis, and unspecified allergic rhinitis, which accounted for 56.4%, 22.3%, and 15.7%, respectively. The age group 15-59 years accounted for 69.5% of the total number of admissions. Admission rate between males increased by 2.25-fold. Admission rate between females increased by 2.02-fold. CONCLUSION: Vasomotor and allergic rhinitis are common cause of hospital admissions in England and Wales that showed a clear increase in the rate of their admissions in the past 20 years. Allergic rhinitis due to pollen was the most dominant cause of admission, which warrants further investigation to identify its preventable risk factors and decrease the probability of the exacerbation of patients' cases and the need for hospitalization.

Prevalence of Dry Eye Disease Among Medical Students and Its Association with Sleep Habits, Use of Electronic Devices and Caffeine Consumption: A Cross-Sectional Questionnaire.

Introduction: Dry eye disease (DED) is a common and multifactorial disease of the ocular surface which causes visual disturbance and feelings of discomfort among patients. The prevalence rate among medical students is an important issue to consider. This study investigates the relationship between caffeine consumption, sleeping habits, use of electronic devices, and DED among a convenient sample of medical students in Jordan. Methods: This cross-sectional online survey enrolled medical students from all six medical schools in Jordan. The questionnaire, which was shared via social media platforms, assessed socio-demographics, caffeine consumption amounts and patterns, sleep quality, and the use of electronic devices and their relation to ocular discomfort, DED, and related symptoms. The ocular surface disease index (OSDI) questionnaire was also administered to quantify the symptoms of DED. Results: A total of 1223 students participated in this study (RR=24.46%); 64% were females, and 43% were in their clinical placement years. Of the participants, 317 (25.92%) had normal eyes, and 906 (74.08%) had symptomatic DED. Of the students, 1206 (98.6%) used electronic devices directly before bed, and only 399 (32.62%) used blue-light-protective glasses. Lower DED risk was linked to male gender (OR=0.535, 95% CI 0.392-0.73, p <0.01), clinical years of medical school (OR=0.564, 95% CI 0.424-0.75, p<0.01). Poor sleep quality corresponded to more incidence of DED, regardless of sleeping for 5-6 hours (OR=3.046, 95% CI 1.299-7.139, p=0.01) or for less than 5 hours (OR=3.942, 95% CI 1.824-8.519, p<0.01). Also, caffeine consumption only marginally affected its incidence, but the results were statistically insignificant. Conclusion: Female gender, basic science years, and spending more than 6 hours looking at screens were significantly associated with symptomatic DED. Caffeine consumption did not pose any significant risk to the incidence of DED.

The Effect of Lockdown Due to the COVID-19 Pandemic on Digital Eye Strain Symptoms Among the General Population: A Cross-Sectional Survey.

Repetitive prolonged use of digital devices without regular breaks has detrimental effects on ocular health and quality of vision. Individuals with chronic eye problems and refractive errors are at higher risk of developing digital eye strain (DES). Correction of refractive errors, adopting healthy practices will reduce its risk. The survey examined the effect of prolonged lockdown on the development and increased severity of digital eye strain (DES) symptoms among the general population. An online survey was conducted in March 2020 on social media platforms in Jordan. Data from 1,460 responders were analyzed. About half of the respondents were between 30-49 years, 28.4% were retired, 21% had chronic systemic illness, and 23% reported chronic eye problems. A rise in the use of digital devices during lockdown was reported by 957 participants, with 33% of them used digital devices more than 4 h a day. The most common symptoms before and during lockdown were headache and neck / shoulder pain have the highest associations (X2 = 280.0, 271.3, df = 4, p < 0.001 respectively). Female gender, existence of chronic eye problems and systemic diseases, and duration of using digital devices were found to be statistically significant factors associated with increasing severity of eye symptoms during lockdown. Not taking enough regular breaks from digital devices showed significant association with blurred vision at distance and near (X2 = 13.03, 10.74, df = 4, P = 0.011, 0.03, respectively). People with chronic eye problems and increased time using devices during lockdown developed new eye complaints three times more than before the lockdown and males were two times more likely than females to have more severe eye symptoms.

Bilateral Surgically Induced Necrotizing Scleritis After Pterygium Excision with Conjunctival Autograft: A Case Report.

Surgically induced necrotizing scleritis (SINS) is an immune-mediated condition that rarely occurs after ocular surgeries with a latency period of days to years. We present a case of a 49-year-old man who developed bilateral SINS two weeks after uneventful bilateral pterygium excision with conjunctival autografts. He was managed with a course of oral prednisolone, topical antibiotic ointment, topical non-steroidal anti-inflammatory drugs and lubricants, and close follow-up and rheumatological consultation.

The first reported case of CDH3-related hypotrichosis with juvenile macular dystrophy from Jordan: a case report.

BACKGROUND: Pathogenic variants in the Cadherin 3 (CDH3) gene are responsible for the occurrence of Hypotrichosis with Juvenile Macular Dystrophy (HJMD) and Ectodermal Dysplasia, Ectrodactyly and Macular Dystrophy Syndrome (EEMS), both of which are rare autosomal recessive disorders characterized by hypotrichosis and progressive macular dystrophy. The CDH3 gene encodes for P-cadherin, a calcium-binding protein that is essential for cell-cell adhesion, which is expressed in the retinal pigment epithelial cells and hair follicles. MATERIALS AND METHODS: Fundus examination of both eyes was done in addition to clinical investigation. Genomic DNA was extracted from a whole-blood sample and whole-exome sequencing (WES) was performed to identify the underlying etiology.All identified variants were evaluated for their pathogenicity and causality. RESULTS: We present the first case of HJMD in a 23-year-old female patient from Jordan. The patient presented to our ophthalmology clinic with poor vision in both eyes. Gross examination revealed sparse scalp hair along with macular dystrophy on fundus exam in both eyes. HJMD was suspected and whole-exome sequencing (WES) confirmed the diagnosis with the identification of a homozygous frameshift deletion (p.Gly277AlafsTer20) localised in exon 7 of the CDH3 gene. CONCLUSION: Blindness due to progressive macular degeneration is a common manifestation in numerous syndromic recessive disorders such as HJMD. Ophthalmologists should consider the importance of systemic manifestations and genetic testing for the confirmation of diagnosis.

Cluster headache associated with oculomotor nerve palsy: A case report and review of literature.

Cluster headaches are a series of short, excruciating, and unilateral pain that happens for a short period at a time over days, weeks, or months and may awake people from sleep. It is situated behind, in, or around one eye only with possible radiation to the forehead at the same side. Cluster headache is characterized by many ocular features. However, extraocular muscle involvement is unusual in this type of headache. We present a case of chronic cluster headache associated with diplopia due to oculomotor nerve palsy in a 24-year-old man, which responded successfully to oral steroid. This presentation is rare. Therefore, ophthalmologists and neurologists should consider it in their list of a differential diagnosis. A short course of oral prednisolone has a role in the management of patients in such cases.

Visual Outcome for Children with Optic Pathway Gliomas Treated with Systemic Chemotherapy.

Purpose: This study aims to report visual acuity outcomes for patients with optic pathway gliomas (OPG) treated with systemic chemotherapy and analyze the associated factors. Patients and Methods: A retrospective study of 29 children with OPG treated with chemotherapy at King Hussein Cancer Center (KHCC), Amman, Jordan, between May/2005 and August/2020. Details on patient demographics, tumor location, systemic chemotherapy, and progression of disease were extracted from medical records. Results: Fifty-four eyes of twenty-nine patients were included in this study with a follow-up range from 2 to 17 years. Sixteen patients (55%) had a history of neurofibromatosis-1 (NF1). Most of the eyes (31, 57%) had visual acuity ranges in the moderate or better group. The age group ≥5 years at diagnosis, those with hydrocephalus, and patients with non-NF1 presented the worst visual acuity ranges from severe or worse; the p-value was 0.043, 0.0320, and 0.0054, respectively. Following treatment with systemic chemotherapy, visual acuity improved in 5 (17%) patients, remained the same in 23 (79%) patients, and only one patient (3%) had vision deterioration. Of the five patients who showed vision improvement, only one had radiological regression of the tumor. Parallel to this, three (10%) patients showed tumor progression in the final magnetic resonance image (MRI) findings without affecting the final vision. Conclusion: Children older than 5 years at diagnosis, in sporadic OPG, and those with hydrocephalus had the worst vision at presentation. Treatment with systemic chemotherapy prevented further deterioration of vision, and following treatment with systemic chemotherapy, most of the patients had the same vision; this stability indicates that vision at diagnosis is an important predictor for the final visual outcome.

Trends in Hospital Admissions Due to Neoplasms in England and Wales between 1999 and 2019: An Ecological Study.

Objectives: This study aimed to investigate the trends in neoplasm-related hospital admissions (NRHA) in England and Wales between 1999 and 2019. Methods: This is an ecological study using publicly available data taken from the two main medical databases in England and Wales; the Hospital Episode Statistics database in England and the Patient Episode Database in Wales. Hospital admissions data were collected for the period between April 1999 and March 2019. Results: A total of 35,704,781 NRHA were reported during the study period. Females contributed to 50.8% of NRHA. The NRHA rate among males increased by 50.0% [from 26.62 (95% CI 26.55−26.68) in 1999 to 39.93 (95% CI 39.86−40.00) in 2019 per 1000 persons, trend test, p < 0.001]. The NRHA rate among females increased by 44.1% [from 27.25 (95% CI 27.18−27.31) in 1999 to 39.25 (95% CI 39.18−39.32) in 2019 per 1000 persons, trend test, p < 0.001]. Overall, the rate of NRHA rose by 46.2% [from 26.93 (95% CI 26.89−26.98) in 1999 to 39.39 (95% CI 39.34−39.44) in 2019 per 1000 persons, trend test, p < 0.001]. Conclusion: Hospital admission rates due to neoplasms increased between 1999 and 2019. Our study demonstrates a variation in NRHA influenced by age and gender. Further observational studies are needed to identify other factors associated with increased hospital admissions among patients with different types of neoplasms.

Trends in Hospital Admission Due to Diseases of the Eye and Adnexa in the Past Two Decades in England and Wales: An Ecological Study.

PURPOSE: To investigate the trends of hospital admissions concerning diseases of the eye and adnexa in the United Kingdom in the past 20 years. MATERIALS AND METHODS: An ecological study was conducted using hospital admission data taken from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admissions data for diseases of the eye and adnexa were extracted for the period between April 1999 and March 2019. The trend in hospital admissions was assessed using a Poisson model. RESULTS: Hospital admission rate for diseases of the eye and adnexa increased by 73.8% [from 7.48 (95% CI 7.45-7.50) in 1999 to 13.00 (95% CI 12.97-13.02) in 2019 per 1000 persons, trend test, p < 0.001]. The most common cause of hospitalisation for diseases of the eye and adnexa was disorders of the lens (62.3%), followed by disorders of the choroid and retina (14.2%), followed by disorders of the eyelid, lacrimal system and orbit (11.5%). Hospital admission rate among males increased by 91.2% [from 6.19 (95% CI 6.16-6.22) in 1999 to 11.83 (95% CI 11.80-11.87) in 2019 per 1000 persons]. Hospital admission rate among females increased less sharply by 63.2% [from 8.71 (95% CI 8.68-8.75) in 1999 to 14.22 (95% CI 14.18-14.26) in 2019 per 1000 persons]. CONCLUSION: There are clear gender and age trends in the epidemiology of hospital admissions related to eye and adnexa disorders. Further observational studies are warranted to identify other risk factors for these important causes of hospitalisation and understanding of differential trends.

Drugs utilization profile in England and Wales in the past 15 years: a secular trend analysis.

BACKGROUND: Medication use assessment has a critical role in promoting the effective and rational use of pharmaceutical medications. There are no studies that have explored the utilization of all medications in England and Wales in the past 15 years without restrictions in the age group being studied or class of medications. AIM: To explore the medication utilization pattern of dispensed medications in England and Wales in the past 15 years. METHOD: A secular trend analysis study using publically available dispensing data on the population level in England and Wales for the duration between 2004 and 2019. Medication dispensing data was extracted from the Prescription Cost Analysis database. RESULTS: Medication prescriptions rate increased by 42.6% [from 1,345,095.75 (95% CI 1,345,004.25 - 1,345,187.26) in 2004 to 1,918,138.48 (95% CI 1,918,038.38 - 1,918,238.57) in 2019 per 100,000 persons, trend test, p < 0.001]. During the study period, the most common medication prescriptions were for the cardiovascular system, central nervous system, and endocrine system, which accounted for 30.2%, 18.8%, and 9.4%, respectively. The rate of medication prescriptions for skin, immunological products and vaccines, infections, and musculoskeletal and joint diseases decreased by 18.4%, 15.8%, 9.8%, and 5.7%, respectively. CONCLUSION: The last two decades have witnessed a remarkable rise in the quantity of medications dispensed in community settings. Utilization of chronic disease medications has increased in the past 15 years, specifically, dispensed medications for the cardiovascular system, central nervous system, and endocrine system. It is necessary to conduct additional cohort studies to investigate the clinical outcomes and prescribing safety of these medications.

Role of bevacizumab intraocular injection in the management of neovascular glaucoma.

AIM: To assess the long-term effects of intraocular bevacizumab (Avastin) injections as an adjunctive drug to manage patients with neovascular glaucoma (NVG). METHODS: A retrospective study was conducted consisting of 34 eyes with secondary NVG caused by proliferative diabetic retinopathy (n=25), ischemic central retinal vein occlusion (n=8), and retinal ischemia resulting from persistent detachment (n=1) were managed by intraocular injections of bevacizumab (1.25 mg/0.05 mL), in addition to other treatments. The main outcome measure was the change in the degree of iris neovascularization. Secondary outcomes included intraocular pressure and the number of additional interventions or antiglaucoma medications administered after injection. RESULTS: All patients were followed-up for at least 12mo. At the last follow-up, complete regression of rubeosis irides was detectable in 13 (38.2%) eyes and incomplete regression in 21 eyes (61.8%). The mean intraocular pressure was 45.32±7.185 mm Hg at baseline and significantly decreased to 26.15±5.679 mm Hg at the last follow-up visit (P=0.000005). Patients received an average of 4.97 injections. As additional treatments, 12 eyes (35%) received laser photocoagulation and 6 eyes (18%) underwent retinocryopexy. No further treatment was needed in 16 eyes (47.1%). CONCLUSION: Intravitreal bevacizumab injection can have a favorable effect in controlling intraocular pressure and pain control in patients with NVG because it decreases the angiogenesis and helps to augment the results of conventional procedures. The primary cause of retinal ischemia should be always targeted.