Efficacy and Safety of Sutureless Trabeculectomy with Using Porous Collagen (Ologen) in Management of Glaucoma Patients

Purpose@#This study aims to investigate the safety, efficacy and feasibility of sutureless trabeculectomy using a porous collagen matrix that contains a connected porous structure (Ologen) in the control of intraocular pressure (IOP) in glaucoma patients . @*Methods@#The study includes 25 eyes from 24 patients that met the inclusion criteria. All eyes underwent trabeculectomy with the Ologen implant that provides a space with a dynamic and physiological aqueous reservoir system. The operation was considered successful if IOP is <15 mmHg without need of IOP-lowering drops at 18 months of follow-up. @*Results@#The target IOP was achieved in 21 out of the 25 eyes (84%), the remaining four eyes all had an IOP of 16 mmHg at 18 months. Short-term complications consisted of seven cases of bleb leakage treated with bandage contact lens and one case of mild choroidal effusion which resolved after observation alone. @*Conclusions@#We can conclude that this technique can provide safety, effectiveness and short learning curve for ophthalmology trainees with lower incidence of perioperative and postoperative complications. Further studies may be required to prove stability and long-term efficacy in management of glaucoma patients.

Efficacy and Safety of Sutureless Trabeculectomy with Using Porous Collagen (Ologen) in Management of Glaucoma Patients

Purpose@#This study aims to investigate the safety, efficacy and feasibility of sutureless trabeculectomy using a porous collagen matrix that contains a connected porous structure (Ologen) in the control of intraocular pressure (IOP) in glaucoma patients . @*Methods@#The study includes 25 eyes from 24 patients that met the inclusion criteria. All eyes underwent trabeculectomy with the Ologen implant that provides a space with a dynamic and physiological aqueous reservoir system. The operation was considered successful if IOP is <15 mmHg without need of IOP-lowering drops at 18 months of follow-up. @*Results@#The target IOP was achieved in 21 out of the 25 eyes (84%), the remaining four eyes all had an IOP of 16 mmHg at 18 months. Short-term complications consisted of seven cases of bleb leakage treated with bandage contact lens and one case of mild choroidal effusion which resolved after observation alone. @*Conclusions@#We can conclude that this technique can provide safety, effectiveness and short learning curve for ophthalmology trainees with lower incidence of perioperative and postoperative complications. Further studies may be required to prove stability and long-term efficacy in management of glaucoma patients.

All types of component malrotation affect the early patient-reported outcome measures after total knee arthroplasty

PURPOSE@#Outcomes following total knee arthroplasty (TKA), whether clinical, radiological or survival analysis, have been well-studied. Still, there are some concerns about patient satisfaction with the outcome of the surgery and factors that might contribute to a suboptimal result. This study aims to determine if there is correlation between primary TKA malalignment and early patient-reported outcome measures (PROMs).@*MATERIALS AND METHODS@#Sixty patients, who had primary TKA and a minimum of 2 years of follow up, were recruited for a detailed clinical and radiological examination. Knee alignment was measured in the coronal, sagittal and axial planes. Normal and the outlier measurements of the patients' knees were defined and the clinical results (PROMs) compared to see if there was a statistically significant difference.@*RESULTS@#Correlation between postoperative limb malalignment in the coronal and the sagittal planes and PROMs was not significant. Conversely, there was significant negative correlation between all types of malrotation and PROMs.@*CONCLUSIONS@#Although malalignment has been linked to inferior outcome and implant survival, our results showed that coronal and sagittal limb malalignment has no significant effect on early PROMs. However, all types of component rotational malalignment significantly worsen early PROMs.

Prediction of preterm birth in women with short cervix

Background: Second trimester short cervical length identifies women at increased risk for an early spontaneous Preterm birth [sPTB], hence raising a compelling needed for Cervical Assessment for prediction and possible Preventing Preterm Delivery

Objective of the study: to assess the implications associated with a short cervical length as well as the use of ultrasonographic-derived cervical length measurement in predicting preterm birth. Methods: the present review includes relevant randomized controlled trials [RCTs] that investigated the in Medline [via PubMed], Cochrane Library and Embase. Retrospective and Prospective Cohort studies, Case-control and Randomised controlled trials. There were no restrictions by outcomes examined, language or publication status

Results: The critical search results yielded 6 articles [randomized trials=2, cohort studies=3, case-control study=l] representing 653 patients . Five of the 6 presented similar pregnancy outcomes [spontaneous preterm birth or pregnancy Joss < 24 weeks' gestation] between the ultrasound-indicated and the history-indicated cerclage groups. 45-69% of the patients followed with cervical ultrasound were able to avoid cerclage

Conclusion: Evidence from randomized trials supports that transvaginal ultrasound is predictive of preterm birth in women with prior preterm birth and a short cervix. The thresholds proposed vary from 15 mm to 28 mm and cerclage is thus recommended

Knowledge and attitudes of students of college of medicine towards evidence-based medicine and barriers to its use in clinical practice in Erbil city, Iraq

Background and objective: Evidence-based medicine, by guiding medical care towards meaningful outcomes to patients, has a significant worldwide impact on medical care and education. It is important that medical students, whom are the future physicians, keep themselves updated with recent advancement in medical knowledge and health care. The aim of this cross-sectional study was to determine the attitude, knowledge and barriers among students towards evidence-based medicine and making them familiar with the concept and advantage of evidence based medicine

Methods: A cross-sectional study was conducted on 163 sixth year students of the College of Medicine at Hawler Medical University during the period from October 2012 to May 2013. The response rate was 86.5%. Knowledge towards evidence-based medicine, accessing and interpreting evidence and perceived barriers to practice evidence-based medicine among participants were the main outcome measures

Results: Of 141 of participants that filled the questionnaire, only 69.5% had heard about evidence-based medicine. Around 82% stated that they had knew evidence-based medicine and only 23.5% had knew steps of evidence-based medicine. Around 65% of respondents welcomed the promotion of evidence-based medicine and 74.4% agreed with that finding from the current study in which it would be helpful in daily management of patients. Furthermore, 31.6% of students reported that standard textbook as a frequent source used for medical knowledge. Around 91% of students did not know the strongest evidence in the hierarchy of evidence and only small proportion of students reported that they understand the common epidemiological concepts that are used in evidence-based medicine

Conclusion: Evidence-based medicine is relatively a new concept among students at the College of Medicine in Erbil. Although the students appeared interested in learning and implementing evidence-based medicine in clinical practice, they need more guidance and training to ensure the correct use of evidence-based medicine ideals

Voluntary fasting to control post-Ramadan weight gain among overweight and obese women

This study aimed to examine the effectiveness of an Islamic voluntary fasting intervention to control post-Ramadan weight gain. This study was conducted between July and November 2011. Two weight loss intervention programmes were developed and implemented among groups of overweight or obese Malay women living in the Malaysian cities of Putrajaya and Seremban: a standard programme promoting control of food intake according to national dietary guidelines [group B] and a faith-based programme promoting voluntary fasting in addition to the standard programme [group A]. Participants' dietary practices [i.e., voluntary fasting practices, frequency of fruit/vegetable consumption per week and quantity of carbohydrates/protein consumed per day], body mass index [BMI], blood pressure, fasting blood high-density lipoprotein cholesterol [HDL-C] and total cholesterol [TC]:HDL-C ratio were assessed before Ramadan and three months post-Ramadan. Voluntary fasting practices increased only in group A [P <0.01]. Additionally, the quantity of protein/carbohydrates consumed per day, mean diastolic pressure and TC:HDL-C ratio decreased only in group A [P <0.01, 0.05, 0.02 and <0.01, respectively]. Frequency of fruit/vegetable consumption per week, as well as HDL-C levels, increased only in group A [P = 0.03 and <0.01, respectively]. Although changes in BMI between the groups was not significant [P =0.08], BMI decrease among participants in group A was significant [P <0.01]. Control of post-Ramadan weight gain was more evident in the faith-based intervention group. Healthcare providers should consider faith-based interventions to encourage weight loss during Ramadan and to prevent post-Ramadan weight gain among patients

Analysis of induced sputum in patients with bronchial asthma

This study aimed to analyze induced sputum in asthmatic patients Bronchial asthma; under different forms of treatment and study factors that may affect sputum cellularity in asthmatic patients. Eighty asthmatic patients were included. Patients with contra-indication Sputum cell count for sputum induction were excluded. Spirometer, sputum induction, sputum processing, sputum total cell count, viability, centrifugation, staining and count were done. Eighty patients were included in the study to investigate induced sputum in asthmatic patients under different forms of treatment. Patient's sex 43 [53.8%] male and 37 [46.2%] female patients were included. Their mean age +/- SD was 32.05 +/- 10.87 years. Sputum cell indices of asthmatic patients were 35.22% neutrophilic inflammation, 17.81% eosinophilic inflammation and the lymphocytic inflammation was 26.48%. Study concluded that the use of sputum induction as noninvasive measurements of airway inflammation in the diagnosis and management of asthma is very important for every patient diagnosed with bronchial asthma before starting asthma management and for asthmatic patients who were not controlled by full asthma management to understand the type of airway inflammation

Platelet associated CD154 in immune thrombocytopenic purpura in children

CD40-ligand [CD 154] is expressed on activated CD4+T lymphocytes and is essential for the T cell-dependent activation of B lymphocytes. CD154 is also expressed at the activated platelet surface. The study aim to investigate the role of CD154 in ITP pediatric patients and correlate their levels with the course and progression of the disease. This study included 25 patients with acute ITP [13 females and 12 males] with age ranged between 2-6 years [group 1] and 25 patients with chronic ITP [14 females and II males] with an age ranging between 8-12 years [group II], also 25 apparently healthy children [10 females and 15 males] with an age ranging between 3-12 years as control [group III]. Studied groups were subjected to the following investigations; complete blood count, bone marrow examination and flowcytometric analysis of CD154 B lymphocyte counts. We found that there was a highly significant increase in CD 154 in patients with acute ITP compared with chronic ITP and control group [p=0.001 and 0.9001 respectively]. Also there was a negative correlation between CDI54 and platelet count in acute and chronic groups [r=-0.6, p=0.004 and r=-0.5, p=0.005 respectively]. There was a positive correlation between CD 154 and lymphocytic count in acute and chronic groups [r=0.422, p=0.007 and r=0.77, p=0.001 respectively]. In conclusion, the increased number of CD 154 might be one of the mechanisms that cause immune regulation dysfunction in ITP. Furthermore, the count is related to the severity of the disease as it was highly increased in acute phase than chronic and therefore CD154 expression is increased in ITP and is able to drive the activation of auto reactive B lymphocytes in this disease

Demographic transition and potential for development: the case of Iraqi Kurdistan

The effect of population growth and demographic transition on economic development has been well documented. The population growth in Iraqi Kurdistan is passing through a critical stage of demographic transition. It is, in fact, extremely likely that the region will fail to efficiently move through the demographic transition and will experience a long period in the demographic trap, i.e. the population will grow steadily and rapidly owing to the high fertility and low mortality rates. With correct government policies in terms of promoting family planning programmes, should the political context allow, demographic transition can pass smoothly through this critical stage. Furthermore, if demographic transition in Kurdistan moves to the next stage, it will provide an important window of opportunity for economic development. Proper exploitation of this demographic window through investment in education, on-the-job training and health services, in addition to proper and appropriate exploitation of economic resources and suitable and productive use of the labour force, will result in significant economic development over the next few decades

Robotic laparoscopic radical cystectomy inhalational versus total intravenous anesthesia: a pilot study

Robotic assistance may refine laparoscopic radical cystectomy. Steep Trendelenburg tilt [TT] and pneumoperitoneum [PP] are challenging anesthesia maneuvers. In view of those maneuvers, would inhalational anesthesia or total intravenous anesthesia [TIVA] be the more appropriate anesthetic management for this kind of surgery?. This issue is under consideration in this clinical trial. 15 patients scheduled for robotic laparoscopic radical cystectomy [RLRC] were randomly allocated into two groups to be anesthetized by either isoflurane anesthesia [ISO n = 8] or ketamine-midazolam-fentanyl total intravenous anesthesia [TIVA n = 7]. The hemo-respiratory dynamics, oxygenation and biochemical variables were monitored taking into consideration the system organ function as primary outcomes, and operative conditions and recovery profile as secondary outcomes. PP and TT increased the mean arterial and airway pressures and decreased lung compliance, and were associated with respiratory acidemia, while changes in heart rate remained within normal range. The duration of PP was shorter in TIVA patients but mean arterial pressure was higher than ISO group. ISO was associated with increased plasma concentrations of prothrombin, fibrinogen and aspartate aminotransferase. Though the number of patients is small in this study [n = 15], it nevertheless brings to light the advantages of TIVA during the robotic laparoscopic radical cystectomy [RLRC], by shortening the duration of PP without an increase in prothrombin and fibrinogen concentrations. A larger number of clinical trial are needed to further clarify this issue

[Medical school's experience with Arabization 1993-2003: Gezira University]

This paper examines the importance of teaching in the mother tongue and looks at the political decisions taken in this respect. The preparations for Arabization in the Faculty of Medicine, Gezira University [in 1993] are reviewed and the experience of implementation from 1994 to 2002 is analysed by questioning the students and professors. The successes, failures, problems and obstacles are discussed in detail. The paper concludes with discussion and recommendations on how to boost success in Arabization based on previous experience

Bone mineral density and bone scintigraphy in adult Saudi female patients with osteomalacia

This prospective study was conducted to demonstrate the role of bone mineral density [BMD] and bone scan in the management of adult Saudi female patients with established diagnosis of osteomalacia. Bone scan using Tc99m methylene diphosphonate [MDP] and BMD of the lumbar spine and femoral neck using dual x-ray absorptiometry [DXA] were performed at the time of diagnosis 6 months and one year after therapy in 96 Saudi female patients attending the metabolic bone disease clinic at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, between January 1997 through to June 1999, aged between 20 and 73-years [mean 42 years]. Alkaline phosphatase, calcium and inorganic phosphorus were measured for all patients before and after treatment. 25 Hydroxy Vitamin D was only measured with the first BMD measurements. The bone profile showed typical biochemical abnormalities of osteomalacia. The bone scan showed feature of "superscan" in all patients and "pseudofractures" in 43 patients. Bone mineral density measurements were compared with that of normal Saudi subjects matched for age and sex. The BMD was significantly low at diagnosis and showed significant improvement after therapy. The improvement of bone density in response to therapy was more evident in lumbar spine than in femoral neck bone. Our results showed that BMD in adult Saudi female patients with osteomalacia was markedly affected probably due to specific constitutional and environmental factors [inadequate exercise, lack of sun exposure and lack of intake of milk and dairy products]. In addition, lumbar BMD and serum calcium appeared to be better markers to monitor therapy. Bone scan helped in demonstrating disease activity, the presence of pseudofractures

Ultrastructural characteristics of synovial effusion cells in some arthropathies

OBJECTIVE: To evaluate the range of activation changes of polymorphonuclear leukocytes (PMN) and the ratio of apoptosis and necrosis in synovial effusions of patients with various arthropathies, and to reveal possible correlations with clinical variants of joint inflammation. METHODS: Synovial effusions were aspirated from the knee joints of patients with rheumatoid arthritis (RA, 28 cases), and seronegative spondyloarthritides (SSA): Reiter's disease (RD, 9 cases), peripheral form of the ankylosing spondyloarthritis (6 cases) and psoriatic arthritis (6 cases); and primary osteoarthritis (OA, 9 cases). Cytospin preparations were processed for transmission electron microscopy and assessed for the incidence of apoptosis, necrosis, and cytophagocytic cells (CPC) in the synovial fluid (SF). The range of activation changes of the neutrophil granulocytes, the dominating cell population in the arthritic SF, was evaluated. RESULTS: In all arthropathies under investigation most of the synovial effusion cells had intact ultrastructure with a certain amount of apoptotic cells dominating over the cells with signs of necrosis, and a few CPC. The highest rate of apoptosis was discovered in the synovial effusions of patients with RA, the lowest in those with OA, while the rate of CPC among the inflammatory joint diseases was the lowest in RA. In RA the current disease activity correlated with the incidence of apoptotic cells and CPC, while the clinical stage was related only to the CPC rate. These data suggest that in RA, despite exposure to the anti-apoptotic signals, apoptosis of the synovial effusion PMN is maintained at a significantly higher level than in non-rheumatoid arthropathies, both inflammatory (SSA) and degenerative (OA), providing elimination of the neutrophils accumulating in the joint cavity and thus stimulating resolution of the joint inflammation.

Role of surface coil magnetic resonance imaging in diagnosing vitreo-retinal disorders

This study included a total of 26 patients [16 females and 10 males with ages ranging from 5 months to 65 years]. In nine patients, the lesions were bilateral; thus, the total number of the examined eye globes was 35. All patients were subjected to history taking and MRI examination. Sixteen patients underwent US examination, while CT examination was performed to five patients. In the 26 patients evaluated with MRI, the final diagnosis included unilateral retinoblastoma [n = 3], bilateral retinoblastoma [n = 5], choroidal melanoma [n = 3], ciliary body capillary hemangioma [n = 1], choroidal metastasis [n = 2], choroidal hemangioma [n = 2], retinopathy of prematurity [bilateral] [n = 1], persistent hyperplastic primary vitreous [bilateral] [n = 1], bilateral coloboma [n = 2], endophthalmitis [n = 2], post-traumatic intraocular lesions [n = 1], retinal detachment [n = 2] and vitreous hemorrhage [n = 1]. A histopathologic confirmation was obtained in retinoblastoma [four patients], choroidal melanoma [two patients], ciliary body capillary hemangioma [one patient] and choroidal metastasis [one patient]

optimal sedation of propofol versus midazolam in geriatrics during regional anaesthesia for hip orthopedic surgery

The main goals of intraoperative sedation are anxiolysis, hypnosis and amnesia. These objectives are required to produce a calm comfortable, but communicative patient. The sedation of a geriatric represents a continuum. These patients can move easily from light level of sedation to obtundation. The distinction between conscious sedation and deep sedation is made for the purpose of describing the proper level of physiologic monitoring. Midazolam and propofol are the most popular sedative agents due to their attractive pharrnacokinetic profile and wide therapeutic index. This study was carried out on 40 old patients above 60 years scheduled for hip surgical correction under spinal anaesthesia. They were randomely class into two equal groups according to the sedative regimen used. The propofol was used in one group at initial dose 1-1.5 mg/kg followed by ascending infusion scale5-50 ug/ kg/min. every 5 minutes. The midazolam was used in the second group at initial dose 10-20 ug/kg followed by ascending infusion scale 0.2-2 ug/kg/min every 5 minutes. The infusion rate adjusfed till reach the optimum sedation score [=3] in both groups. Sedation and recovery [durations and degrees] were assessed by Ramsay sedation scale and recovery room score respectively. The haemodynamics and concomitent events were recorded. This study showed the sign lower haemodynamic data of propofol group in comparison with the midazolam one, but with superior titrability, at the optimum sedation level, and faster recovery time. The midazolam group is superior in its amnestic action with less paradoxical agitation but with delayed recovery and difficult titrability at the desired sedation level like propofol

Correlation between acoustic reflex threshold and most comfortable level

Hearing aids are selected for evaluation primarily on the basis of their electroacoustic characteristics relative to the patient's performance on a battery of audiological tests. One of the most important characteristics is the gain, which is determined by the most comfortable level [MCL]. The level require subjective test, i.e. cooperation of the patient, which is not there in children and mentally retarded persons who are the main candidates for hearing aids. Those groups arises the need for objective test to find out the MCL. Acoustic reflex threshold [ART] test were used by many researchers to get the relation between it and MCL. Some have identified a relationship and others, not. In our research we used 9 stimuli on 10 normal persons, 30 individuals of unilateral conductive hearing loss and 30 persons of unilateral or bilateral sensori-neural hearing loss. For each in the 3 groups, we got ART and MCL for each of the 9 stimuli. At first, the mean differences between MCL and ART across stimuli were investigated to see whether or not their means differ significantly. Whole data were used in the analysis and estimation by the squares regression method, the results were not quite good, because of the outliers, but when rescaled data used, results appeared to be statistically significant. When the least squares regression method applied 88% of the predicted MCL occur within + 6 rescaled data. It is apparent that, predicted results are statistically significant, they are not constant value, but varies according to ART change, stimulus used and hearing situation [normal, conductive or perceptive loss]

Evaluation of neuromuscular blocking effect of cisatracurium in patients with liver cirrhosis

Cisatracurium is one of the ten stereoisomers of atracurium, it is a potent intermediate duration non-depolarizing neuromuscular blocking agent. and its pharmacokinetics and pharmacodynamics are similar to atracurium. it is degraded in plasma by Hofmann degradation and ester hydrolysis. In this study we evaluated its neuromuscular blocking effect in patients with bilharzial liver cirrhosis. We studied 20 patients which were divided into 2 groups, 10 patients each, the patients of the first group were ASA, I or II and patients of the second group had hepatic cirrhosis child II all patients received thiopentone sodium, cisatracurium 0.1mg/kg, then intubation was done and anaesthesia was maintained with N20: O2 and halothane with controlled ventilation. There was significant prolongation in the onset time of relaxation after injection of the bolus dose in hepatic patients, however there was insignificant difference between the two groups as regard the duration of neuromascular block or total dose of cisatracurium. So, we can conclude that cisatracurium is a suitable muscle relaxant in patients with liver cirrhosis

Extra adrenal phaeochromocytoma: a case report

phaeochromocytoma of extra adrenal origin is a rare tumour. We present here such a case encountered in Kuwait. Although the clinical manifestations in our case were straightforward because of its extra adrenal origin localisation was delayed. Eventually the tumour was located and successfully resected

46XX male hermaphrodite

This report involves a case of a 46XX male who presented at birth with hypospadias and congenital absence of the right testicle