Optociliary shunt vessels in multiple sclerosis.

BACKGROUND/INTRODUCTION: Optociliary shunt vessels develop as a result of chronic retinal venous obstruction. Optic neuritis has never been reported as a causative influence. OBJECTIVE: To determine whether optic neuritis predisposes to the development of optociliary shunts in patients with multiple sclerosis. CASES: This case series follows two patients with multiple sclerosis from August 1st, 2019 to April 24th, 2024, who developed optociliary shunt vessels after attacks of optic neuritis. A 43-year-old female presented with left visual loss and bilateral superior optociliary shunt vessels. Perimetry showed bilateral peripheral visual field loss. Optical coherence tomography showed bilateral retinal thinning and ganglion cell complex loss. Optical coherence tomography angiography showed reduced capillary density bilaterally. We investigated her and eventually diagnosed her with multiple sclerosis. The second, a 49-year-old female, developed right-sided optociliary shunt vessels after an episode of neuroretinitis. Perimetry revealed bilateral central scotomata; optical coherence tomography showed disc and retinal nerve fiber layer edema, and serous retinal detachment; later, ganglion cell complex loss; and reduced capillary density on optical coherence tomography angiography. Neuroimaging revealed demyelination in both, leading to a diagnosis of multiple sclerosis, and therapy was instituted. CONCLUSIONS: We hypothesize, that demyelinating optic neuritis due to multiple sclerosis causes chronic retinal hypoperfusion, leading to subsequent optociliary shunt development in affected eyes. Our case series reveals that eyes with optic neuritis, both previous episodes and fresh cases, can contribute to sufficient retinal vein hypoperfusion to cause the development of optociliary shunts, which should be reported in the literature.

Does optic neuritis in multiple sclerosis cause optociliary shunt vessels? Our case study shows that optociliary shunt vessels have developed in eyes having previous as well as fresh optic neuritis in two multiple sclerosis patients, as demonstrated by examination and investigations. We hypothesize that multiple sclerosis causes decreased retinal perfusion predisposing to the development of optociliary shunts. This will guide neurologists and ophthalmologists in diagnosing this debilitating condition upon the visualization of optociliary shunts; heralding previous or recurrent attacks of optic neuritis. @SanaNadeemS.

Surface-enhanced Raman spectroscopy for the study of interaction of an antibacterial agent ([bis(1,3-dipentyl-1H-imidazol-2(3H)-ylidene)silver(i)]bromide) with Bacillus subtilis bacterial biofilms.

Bacterial resistance towards antibiotics is a significant challenge for public health, and surface-enhanced Raman spectroscopy (SERS) has great potential to be a promising technique to provide detailed information about the effect of antibiotics against biofilms. SERS is employed to check the antibacterial potential of a lab synthesized drug ([bis(1,3-dipentyl-1H-imidazol-2(3H)-ylidene)silver(i)] bromide) against Bacillus subtilis and to analyze various SERS spectral features of unexposed and exposed Bacillus strains by observing biochemical changes in DNA, protein, lipid and carbohydrate contents induced by the lab synthesized imidazole derivative. Further, PCA and PLS-DA are employed to differentiate the SERS features. PCA was employed to differentiate the biochemical contents of unexposed and exposed Bacillus strains in the form of clusters of their representative SERS spectra and is also helpful in the pairwise comparison of two spectral data sets. PLS-DA provides authentic information to discriminate different unexposed and exposed Bacillus strains with 91% specificity, 93% sensitivity and 97% accuracy. SERS can be employed to characterize the complex and heterogeneous system of biofilms and to check the changes in spectral features of Bacillus strains by exposure to the lab synthesized imidazole derivative.

Choroidal thickness in juvenile open angle glaucoma: insights from a south asian case-control study.

PURPOSE: The purpose of this study is to compare choroidal thickness in juvenile open angle glaucoma (JOAG) and healthy controls using spectral domain optical coherence tomography (SD-OCT) and study its correlations. METHODS: In this case-control study, 56 eyes of 28 JOAG patients and an equal number of controls were recruited. SD-OCT was used to measure the choroidal thickness (ChT), in the macular region at 5 locations: subfoveal, 1500 µm and 3000 µm nasal and temporal to the foveal center, and in the peripapillary region at 6 locations: up to 1500 µm, nasal and temporal to the disc, respectively. The ChT and its correlations with age, intraocular pressure, cup-to-disc ratio, central corneal thickness, mean deviation, and axial length were studied. RESULTS: The average macular ChT in JOAG was 306.30 ± 56.49 µm vs. 277.12 ± 64.68 µm in controls. The average peripapillary ChT in JOAG was 197.79 ± 44.05 µm vs. 187.24 ± 38.89 µm in controls. The average total ChT (p = 0.042), the average macular ChT (p = 0.022), the subfoveal ChT (p = 0.022), the ChT 1500 µm (p < 0.001), and 3000 µm temporal to the fovea (p = 0.002) were significantly thicker in the JOAG group. In the JOAG group, the average macular ChT had a significant negative correlation with age, whereas axial length was positively correlated with the average peripapillary ChT. CONCLUSIONS: In this South Asian cohort of JOAG, the average total ChT, average macular ChT, subfoveal ChT, and ChT at 1500 µm, and 3000 µm temporal to the fovea were significantly thicker when compared to healthy controls.

Surface enhanced Raman spectroscopy for the characterization of the metabolites of the biodesulfurization of dibenzothiophene carried out by Tsukamurella paurometabola.

Large amount of sulphur is released by the combustion of fossil fuels in the form of SoX which affects human health and leads to acid rain. To overcome this issue, it is essential to eliminate sulphur moieties from heterocyclic organo-sulphur compounds like Dibenzothiophene (DBT) present in the petrol. In this study Surface enhanced Raman scattering (SERS) spectroscopy is used to analyze the desulfurizing activity of Tsukamurella paurometabola bacterial strain. The most prominent SERS peaks observed at 791, 837, 944 and 1032 cm-1, associated to C-S stretching, are solely observed in dibenzothiophene and its metabolite-I (DBTS) but absent in 2-Hydroxybiphenyl (metabolite-II) and extraction sample of supernatant as a result of biodesulfurization. Moreover, the SERS peaks observed at 974 (characteristic peak of benzene ring) and 1015 cm-1 is associated to C-C ring breathing while 1642 and 1655 cm-1 assigned to CC bonds of aromatic ring. These peaks are only observed in 2-Hydroxybiphenyl (metabolite-II) and extraction sample of supernatant as a result of biodesulfurization. Notably, these peaks are absent in the Dibenzothiophene and its metabolite-I which indicate that aromatic ring is carrying sulfur in this fraction. Moreover, multivariate data analytical tools like principal component analysis (PCA) and PCA-loadings are applied to further differentiate between dibenzothiophene and its metabolites that are Dibenzothiophene sulphone (metabolite-I) and 2-Hydroxybiphenyl (metabolite-II).

Surface-enhanced Raman spectroscopy for the characterization of bacterial pellets of Staphylococcus aureus infected by bacteriophage.

Drug-resistant pathogenic bacteria are a major cause of infectious diseases in the world and they have become a major threat through the reduced efficacy of developed antibiotics. This issue can be addressed by using bacteriophages, which can kill lethal bacteria and prevent them from causing infections. Surface-enhanced Raman spectroscopy (SERS) is a promising technique for studying the degradation of infectious bacteria by the interaction of bacteriophages to break the vicious cycle of drug-resistant bacteria and help to develop chemotherapy-independent remedial strategies. The phage (viruses)-sensitive Staphylococcus aureus (S. aureus) bacteria are exposed to bacteriophages (Siphoviridae family) in the time frame from 0 min (control) to 50 minutes with intervals of 5 minutes and characterized by SERS using silver nanoparticles as SERS substrate. This allows us to explore the effects of the bacteriophages against lethal bacteria (S. aureus) at different time intervals. The differentiating SERS bands are observed at 575 (C-C skeletal mode), 620 (phenylalanine), 649 (tyrosine, guanine (ring breathing)), 657 (guanine (COO deformation)), 728-735 (adenine, glycosidic ring mode), 796 (tyrosine (C-N stretching)), 957 (C-N stretching (amide lipopolysaccharides)), 1096 (PO2 (nucleic acid)), 1113 (phenylalanine), 1249 (CH2 of amide III, N-H bending and C-O stretching (amide III)), 1273 (CH2, N-H, C-N, amide III), 1331 (C-N stretching mode of adenine), 1373 (in nucleic acids (ring breathing modes of the DNA/RNA bases)) and 1454 cm-1 (CH2 deformation of saturated lipids), indicating the degradation of bacteria and replication of bacteriophages. Multivariate data analysis was performed by employing principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) to study the biochemical differences in the S. aureus bacteria infected by the bacteriophage. The SERS spectral data sets were successfully differentiated by PLS-DA with 94.47% sensitivity, 98.61% specificity, 94.44% precision, 98.88% accuracy and 81.06% area under the curve (AUC), which shows that at 50 min interval S. aureus bacteria is degraded by the replicating bacteriophages.

Normative retinal nerve fiber layer thickness in a healthy pediatric South Asian cohort: a spectral-domain optical coherence tomography study.

Currently, the normative values for retinal nerve fiber layer (RNFL) thickness in our population have not been widely studied. Our study aimed to assess the peripapillary RNFL thickness (RNFLT) with Optopol Copernicus REVO80® spectral-domain optical coherence tomography (SD-OCT) amongst healthy children and its associations. One hundred eighty-two eyes of 91 consecutive healthy children 3 to 16 years of age with a refractive error ≤ ± 5 D were included after a thorough eye exam including visual acuity, refraction, tonometry, pachymetry, axial length estimation, and slit lamp exam including fundus assessment. RNFLT was measured via Optopol Copernicus REVO80® high resolution SD-OCT by a single experienced observer with 3D disc mode within a circular area of diameter 3.45 mm and the ring further divided into four quadrants: inferior, superior, nasal, and temporal. The mean age was 11.12 ± 3.12 years (range, 3-16). The average RNFLT was 120.13 ± 12.6 µm. The mean superior RNFL was the thickest at 138.21 ± 16.6 µm, next was the mean inferior RNFLT at 137.62 ± 17.2 µm, followed by the nasal 91.61 ± 18.5 µm and then the temporal at 74.58 ± 11.7 µm. No significant differences in RNFLT were noted between the two eyes. The mean RNFLT was significantly higher in males as compared to females, in vertical quadrants and at an average (p < 0.05). No significant relationship was found between the average RNFLT and factors such as age, axial length, corneal thickness, cup-to-disc ratio, intraocular pressure, or refractive error. This study establishes normative values of RNFLT for this subgroup of Pakistani children for the Optopol Copernicus REVO80® SD-OCT device.

Anterior Segment Optical Coherence Tomography in Pediatric Ocular Pathology: Imaging Study of 115 eyes.

OBJECTIVE: To assess the pediatric anterior segment characteristics in ocular pathology using spectral domain optical coherence tomography (SD-OCT). METHODS: This case series follows 115 eyes of 78 children (2-17 years) with anterior segment pathology in an academic facility. The anterior segment OCT (AS-OCT) analysis was done using the Optopol Revo 80 high-resolution SD-OCT using an imaging adapter. All pathological features visible on imaging were observed, studied, tabulated, and analyzed. RESULTS: The average age was 11.84 years, with 44 males and 34 females. The primary clinical diagnosis was cataract in 40 (34.8%) eyes, followed by corneal disease in 28 (24.3%) eyes, glaucoma in 18 (15.7%) eyes, and trauma in 15 (13%) eyes. Systemic diseases were associated with 20.9% of the cases. The most common imaging pathology observed was lens opacification in 43 (37.4%), increased reflectivity of the cornea in 31 (28.2%), corneal stromal thinning in 34 (29.6%), increased corneal thickness in 28 (24.3%), a shallow anterior chamber in 17 (14.8%), and cells in the anterior chamber in 18 (15.7%) eyes, along with a multitude of other findings. CONCLUSION: This study demonstrates that anterior segment OCT is a useful non-contact technique for the detailed anatomic and pathologic assessment of pediatric ocular diseases.

Macular choroidal thickness and correlations in a healthy pediatric South Asian cohort: A spectral domain optical coherence tomography study.

PURPOSE: The objective of this study is to assess the normative macular choroidal thickness (ChT) in healthy children with spectral domain optical coherence tomography (SD-OCT) and study its correlations with age, intraocular pressure, axial length, corneal thickness, cup-to-disc ratio, and spherical equivalent. METHODS: This study recruited 89 healthy children. Macular ChT was measured in five locations, subfoveal, 1500 µm and 3000 µm nasal, and temporal to the fovea via the Optopol REVO80® SD-OCT. RESULTS: The mean age was 11.17 years. The mean subfoveal ChT was 332.33 ± 73.07 µm, ChT 1500 µm nasal to the fovea; 281.19 ± 66.67 µm, ChT 1500 µm temporal to the fovea; 293.25 ± 71.11 µm, ChT 3000 µm nasal to the fovea; 219.55 ± 67.4 µm, ChT 3000 µm temporal to the fovea; 264.31 ± 70.8 µm. A correlation of subfoveal ChT was not observed with the variables. CONCLUSIONS: This study illustrates the normative pediatric macular ChT profile.

Spontaneous intraocular lens extrusion through Gundersen conjunctival graft after multiple failed keratoplasties: A report of two cases.

PURPOSE: To report the occurrence and the outcomes of 2 cases of spontaneous extrusion of 3-piece intraocular lens (IOL) through a Gundersen conjunctival flap performed for tectonic purposes after multiple failed penetrating keratoplasties (PKs). METHODS: A 70-year-old woman (Patient #1) with severe dry eye disease who had undergone cataract surgery with posterior chamber 3-piece IOL implantation, multiple PKs and Gundersen conjunctival flap in her left eye presented with partial extrusion of the optic and the inferior haptic of the IOL through the conjunctival flap. Inferior symblepharon and keratinization of the entire ocular surface were also present. A 64-year-old diabetic man (Patient #2) with history of cataract surgery with a posterior chamber IOL implantation, multiple PKs for keratoconus and Gunderson conjunctival flap in his right eye presented with partial extrusion of IOL optic through the conjunctival flap. RESULTS: Patient #1 refused a further surgery and IOL was removed at the slit lamp. Currently, 3 months after IOL extrusion, corneal perforation self-sealed, visual acuity of light perception is maintained, and the patient does not complain any symptoms of ocular discomfort or pain. In Patient #2, tectonic PK combined with IOL removal and anterior vitrectomy was performed. Currently, 1 month postoperatively corneal graft is clear, intraocular pressure is normal, and patient's vision is counting fingers. CONCLUSIONS: In both cases, IOL extrusion occurred spontaneously through a Gunderson conjunctival flap. Including the underlying Tenon's capsule in the conjunctival graft could increase its tectonic support, potentially avoiding this complication.

Long-term outcomes of adjustable strabismus surgery at a Pakistani university hospital.

PURPOSE: Strabismus, whether congenital or acquired, is a common visual and cosmetic problem, especially for the young. Adjustable suture strabismus surgery is not in vogue in our country. This technique gives the surgeon a second attempt to provide a better outcome for the patients. Our objective was to assess the long-term success of adjustable strabismus surgery in terms of postoperative alignment. METHODS: We carried out a prospective study utilizing the fornix approach for adjustable strabismus surgery, in mainly horizontal, but also vertical strabismus in adults and cooperative children, to enhance the postoperative outcomes. The patient characteristics, preoperative deviation, type and pattern of strabismus, were evaluated and analyzed. The postoperative alignment was evaluated at 1 year and beyond, to assess the success of this adjustable surgery. RESULTS: This study recruited 50 adults and children with a female predominance of 39 (78%); and with the mean age being 18.34 ± 9.88 years. Exotropia was the primary diagnosis in the majority with 21 (42%) cases; with purely horizontal strabismus in 23 (46%) cases. The mean preoperative horizontal deviation was 48.76 ± 20.35 prism diopters (PD) and the mean postoperative horizontal deviation was 2.73 ± 3.63 PD. The mean preoperative vertical deviation was 4.8 ± 8.54 PD whereas the mean postoperative vertical deviation was 0.86 ± 1.73 PD. The Wilcoxon Signed Ranks test analyzed the difference between the two which was statistically significant (p = 0.000). Surgical success, defined as postoperative horizontal alignment within ≤ 10 PD of orthotropia at the end of one year or more of follow-up after surgery, was achieved in 49 (98%) cases. The average follow-up was 21.47 ± 8.7 months. CONCLUSION: Adjustable strabismus surgery has very good long-term outcomes in terms of postoperative alignment and patient satisfaction.

Ganglion cell complex thickness with spectral domain optical coherence tomography and correlations in a normative pediatric South Asian cohort.

Spectral domain optical coherence tomography (SD-OCT) was used to assess the perifoveal Ganglion cell complex (GCC) thickness in healthy Pakistani children. 174 eyes of 87 healthy children (3 to 16 years) were included after a thorough eye examination. Significant refractive error was excluded (>± 5 DS), glaucoma, ocular pathology, intraocular surgery, trauma, and systemic ailments. The perifoveal GCC analysis was done by Optopol Revo 80® high resolution SD-OCT. The average age was 11.1 ± 3.12 years. The average GCC thickness globally was 120.01 ± 76.74 µm, superiorly; 117.51 ± 8.77 µm, superonasally; 120.47 ± 8.78 µm, superotemporally, 103.83 ± 8.25 µm, inferiorly; 117.41 ± 8.71 µm, inferonasally 120.57 ± 8.88 µm, and inferotemporally; 107.15 ± 7.69 µm. The average GCC thickness was positively correlated with axial length (p = .02) and the GCC thickness in all sectors was significantly higher amongst males as compared to females (p < .05). Our study provides normative data for the macular GCC thickness in healthy children of our population. GCC thickness estimation is an important diagnostic parameter in glaucoma and optic neuropathies. Establishing a normative database for our pediatric population would help immensely in the diagnosis and monitoring of optic nerve disorders. RESEARCH HIGHLIGHTS: Spectral domain optical coherence tomography guided measurement of the ganglion cell complex thickness of the Pakistani pediatric population has not been done before. Our study provides normative data for the macular ganglion cell complex in healthy children of our population and studies its correlations with age, gender, intraocular pressure, axial length, refractive status, and corneal thickness. This will guide us in optic nerve and neurological disease diagnosis and monitoring.

Anterior segment parameters on optical coherence tomography in healthy South Asian children.

PURPOSE: High resolution spectral domain optical coherence tomography (SD-OCT) was used to assess the anterior segment structure parameters in healthy South Asian children. METHODS: 108 eyes of 54 healthy children ≤ 16 years were recruited after a thorough eye exam. The anterior segment analysis was be done by Optopol Revo 80 high resolution SD-OCT. Central corneal thickness (CCT), Angle opening distance (AOD), Anterior chamber (AC) angle, Trabecular iris space area (TISA), Trabecular iris angle (TIA), iris thickness at 2 mm, internal AC diameter and lens vault were evaluated. RESULTS: Mean age was 11.38 years. Mean IOP was 13.63 mmHg, mean axial length, 22.82 mm, mean spherical equivalent, -0.14 D, mean CCT, 532.6 µm and mean CDR was 0.31. The mean internal AC diameter was 11609.15 µm. The nasal and temporal AC angles was 53.54° and 50.37°, respectively [P = .033]. The nasal and temporal AOD500 were 0.9 mm and 0.85 mm, respectively [P = .629]. The nasal and temporal AOD750 were 1.21 mm and 1.06 mm, respectively [P = .583]. The nasal TIA was 41.75°; the temporal TIA; 40.24° [P = .325]. The nasal TISA500 was 0.33 mm2; the temporal TISA500, 0.31 mm2 [P = .012]. The nasal TISA750 was 0. 59 mm2; the temporal TISA750, 0.56 mm2 [P = .746]. The nasal iris thickness at 2 mm was 483.54 µm; the temporal iris thickness, 505.8 µm [P = .273]. The mean lens vault was -519.58 µm. CONCLUSIONS: Our study data depicts the normal anterior segment parameters in healthy Pakistani children.

Isolated inferior oblique pareses.

PURPOSE: To describe etiology, clinical characteristics, radiological features and management of isolated inferior oblique pareses. METHODS: A diagnosis of inferior oblique paresis was made after a thorough strabismus examination and neuroimaging. The patients were managed surgically with adjustable strabismus surgery, or conservatively. Surgical success was defined as average horizontal deviation within ≤ 10 prism diopters [PD] post-operatively and for vertical deviation, it was ≤ 5 PD, at last follow-up. RESULTS: Seven cases were congenital, 6 cases were bilateral, with esotropia in 6 cases; 'A' pattern in 7 cases and hypotropia in 3 cases. The mean preoperative horizontal deviation was 52.5 PD, and the mean postoperative horizontal deviation was 2.37 PD (p = 0.028). The pre-operative vertical deviation was 18 PD and post-operative vertical deviation was 5 PD. MRI showed reduced IO muscle size; average area being 11.27 mm2 in the affected eyes, with normal sized inferior recti (average: 24.63 mm2) and medial recti muscles (average: 30.08 mm2). Surgical success was seen in all six cases. Average follow-up was 265 days. The Parks' three step test was not valid, except for one acquired unilateral case. CONCLUSION: Isolated pareses of inferior oblique muscle exhibit defective elevation in adduction of the affected eye, 'A' pattern and fundus intorsion, and is confirmed by neuroimaging. These can be successfully managed surgically to correct the deviation.

Unilateral Optic Neuropathy due to a Sphenoid Mucocoele.

Isolated sphenoid sinus mucocoeles are rare; whereas, benign lesions usually discovered incidentally. These may present with headache, diplopia, visual loss or ocular motor nerve palsies, due to slow expansion and mass effects. Prompt endoscopic removal is the key to prevent permanent sequelae. We present the case of a 63-year femele, who presented with sudden loss of vision of the left eye, along with periorbital and retrobulbar pain for the last one month. She was found to have "no light perception" vision in the left eye and optic atrophy. Neuroimaging was performed, which revealed a sphenoid sinus mucocoele, impinging on the left optic nerve. Our ENT Department performed endoscopic sinus surgery and removed it, but her vision did not return at 6-month follow-up. Although very rare, sphenoid sinus mucocoeles should be considered in the differential diagnosis of any patient, who presents with sudden visual loss. Key Words: Sphenoid sinus, Mucocoele, Optic neuropathy, Visual loss.

Isolated Bilateral Superior Rectii Paresis: A Rare Anomaly.

We present a case of bilateral isolated superior rectus paresis in a 13-year girl who presented with alternating exotropia and hypertropia. She demonstrated bilateral paresis of elevation in abduction with an overaction of both the contralateral yoke muscles, i.e. inferior obliques. Neuroimaging did not reveal a lesion along the pathway of the third nerve nor hypoplasia of the superior rectus muscle. We performed a bilateral lateral rectus recession on adjustable sutures with bilateral myectomy of the inferior obliques (weakening of contralateral yoke muscle). At 1 year, the patient is well aligned and happy. Isolated extraocular muscle pareses are rare events, which present occasionally to the strabismus surgeons and need to be looked out for if the patient's strabismus looks peculiar. We believe we are the first to report an isolated paresis of the superior rectus muscle in Pakistan.

A comparative, epidemiological study of acute renal colic presentations to emergency departments in Doha, Qatar, and Melbourne, Australia.

BACKGROUND: This study aimed to compare the epidemiology, clinical presentations, management, and outcomes of renal colic presentations in two major academic centers from geographically diverse populations: Qatar (a country in the Afro-Asian stone belt) and South-Eastern Australia (not within a stone belt). METHODS: We undertook a retrospective cohort study of patients with renal colic who presented to the Hamad General Hospital Emergency Department (HGH-ED), Qatar, and The Alfred ED, Melbourne, Australia, during a period of 1 year from August 1, 2012, to July 31, 2013. Cases were identified using ICD-9-CM codes, and an electronic template was used to record the data on predefined clinical variables. RESULTS: A total of 12,223 from the HGH-ED and 384 from The Alfred ED were identified as renal colic presentations during the study period. The rate of renal colic presentations at the HGH-ED was 27.9 per 1000 ED visits compared to 6.7 per 1000 ED visits at The Alfred ED. Patients presenting to the HGH-ED were significantly younger [34.9 years (29.0-43.4) than The Alfred ED [48 years (37-60); P < 0.001]. The median stone size was larger in the HGH-ED group [6 (4-8) mm] versus The Alfred ED group [4 (3-6) mm, P < 0.001]. The intervention rate in the stone-positive population was significantly higher in the HGH-ED group as opposed to The Alfred ED group (38.7 versus 11.9%, P < 0.001). At the time of discharge, The Alfred ED group received fewer analgesic prescriptions (55.8 versus 83.5%, P < 0.001) and more tamsulosin prescriptions (25.3 versus 11.7%, P < 0.001). CONCLUSIONS: Renal colic presentations to the HGH-ED, Qatar, were younger, with larger stone size mostly located in the lower ureter, compared to The Alfred ED, Melbourne, Australia. The findings suggest that the benefits of treatment including medical expulsion therapy will vary between the two populations. Differences in epidemiology and patient mix should be considered while tailoring strategies for effective management of patients with renal colic in a given setting.

Computed tomography abnormalities and epidemiology of adult patients presenting with first seizure to the emergency department in Qatar.

OBJECTIVES: There is little information available from the Middle Eastern region on adult patients presenting with first seizure. The objectives of this study were to describe epidemiological characteristics of patients presenting to the emergency department (ED) in Doha, Qatar, with first seizure and to determine the incidence of computed tomographic (CT) scan abnormalities. METHODS: A retrospective cohort study was conducted on all adult patients with first seizure presenting to Hamad General Hospital ED over a 1-year period (June 2012 through May 2013). Electronic patient records were reviewed for demographics, neuroimaging, electroencephalography, laboratory test results, and medications administered. RESULTS: There were 439 patients who satisfied inclusion criteria. Patients were aged a mean of 35.3 years (95% confidence interval [CI] = 33.92 to 36.69 years) with a male-to-female ratio of five to one. CT abnormalities were detected in 154 patients (35.3%; 95% CI = 30.81% to 39.82%). Out of reported abnormal scans, 14.7% patients had significant abnormalities such as neurocysticercosis (9.2%); brain metastasis and neoplasm (3.4%); and subarachnoid and subdural hemorrhage, cavernous sinus thrombosis, acute stroke, and brain edema (2.0%). None of the patients had any electrolyte abnormalities, and three patients had hypoglycemia. Patients with initial abnormal CT brain results were more likely to have recurrent seizures (OR = 1.65; 95% CI = 1.11 to 2.45) within 6 months. CONCLUSIONS: Adults who presented with first seizure to the ED in Qatar had a young male predominance, and a high proportion of brain CT scans were reported as abnormal. It is recommended that all such patients in this population should undergo prompt CT scanning in the ED, but the utility of routine electrolyte tests requires further investigation.