Effect of Nigella sativa Versus Wheat Germ Oil on the Healing of Traumatic Ulcers in Albino Rats.

BACKGROUND AND OBJECTIVE: Nigella sativa (NS) oil has been used as an ointment for relief from abscesses, nasal ulcers, orchitis, eczema, and swollen joints. The nutritional and biological values of wheat germ oil (WGO) are imperative points for testing its wound healing properties in traumatic ulcer. The aim of the study was to evaluate and compare the ability of NS versus WGO in promoting the healing of induced traumatic ulcer in albino rats clinically and histologically. MATERIALS AND METHODS: This study was carried out after the approval of the Research Ethics Committee (REC) of the Faculty of Dentistry, Suez Canal University, in Ismailia, Egypt, on 60 albino rats with induced labial ulcer according to calculated sample size. All animals were anaesthetized with an intraperitoneal injection of 10% ketamine. The ulcer was produced on the labial mucosa corresponding to the midline between the lower two incisors of each rat. After induction of the ulcer, rats were randomly divided into four groups according to the treatment medicament: Group A (negative control group): 15 rats which remained without treatment; Group B (positive control): 15 rats which received daily a topical application of 1 ml of cetylpyridinium chloride (CPC) and lidocaine gel; Group C (NS group): 15 rats which received a daily topical application of 1 mm of NS oil painted by a brush covering the whole area of the ulcer; and Group D (WGO group): 15 rats which received 1 mm of WGO. The ulcers were measured using a digital caliper and were recorded using a digital camera at days 0, 3, 7, and 9, the largest (D) and smallest (d) diameters of the lesion were recorded, and the ulcer area was calculated using the following formula: A=π×D/2×d/2. Tissue samples were taken for histological examination, and the labial mucosa was dissected out and embedded in paraffin wax blocks. The blocks were cut with microtome to obtain sections of 4-5 µm thickness to be stained with hematoxylin and eosin stain and Masson's trichrome stain. All sections were examined under a light microscope, and the presence of inflammatory cells and collagen tissue remodeling were evaluated. RESULTS: Within the control group, there are statistically non-significant changes in the mean of the surface area of ulcer when comparing changes in 10 rats who survived till the seventh day and inflammatory cell count when comparing changes in five rats who were sacrificed at the seventhday. There was a significant decrease in surface area and inflammatory cell count in five rats who survived till the ninth day. Within the WGO group only, all survived rats had healed ulcer at the ninth day. There is a significant decrease in inflammatory cell count in five rats who survived till the ninth day. CONCLUSION: WGO was significantly more effective in the treatment of animal-induced ulcer compared to NS oil or CPC and lidocaine oral gel.

Correlation between multifocal electroretinogram and optical coherence tomography findings with visual acuity after vitrectomy surgery for retinal detachment: an observational study.

BACKGROUND: Despite the marked increase in the anatomical success rates of macula-off rhegmatogenous retinal detachment (RRD) surgery, patients may still complain about unsatisfactory visual outcome. This study aims to correlate the postoperative corrected distance visual acuity (CDVA) with the mf-ERG (multifocal electroretinogram) and OCT (optical coherence tomography) findings following vitrectomy surgery for RRD. PATIENTS AND METHODS: This retrospective observational study included 40 eyes of 40 patients who underwent successful vitrectomy surgery for macula-off RRD. CDVA, mf-ERG amplitudes, mf-ERG latencies, the central macular thickness (CMT) and the integrity of the inner segment/outer segment (IS/OS) junction assessed by OCT, were evaluated 6 months postoperatively. The correlations between CDVA with mf-ERG amplitudes, mf-ERG latencies, central macular thickness, and IS/OS junction integrity were analyzed. RESULTS: There was a statistically significant moderate positive correlation between CDVA of the studied eyes with mf-ERG amplitudes of N1, P1 and N2 in ring 1 (P = 0.008; P < 0.001 and P = 0.004, respectively), CMT (P < 0.001), and the integrity of IS/OS junction (P < 0.001). There was no significant correlation between CDVA and mf-ERG latencies in ring 1 (P > 0.05). Linear regression analysis revealed that CDVA was significantly associated with mf-ERG amplitudes and the IS/OS junction integrity. In addition, there was a strong positive correlation between mf-ERG amplitudes in ring 1 and the IS/OS junction integrity. CONCLUSIONS: The integrated interpretation of postoperative CDVA, multifocal ERG parameters, and OCT findings provides useful information about functional visual recovery and retinal microstructural changes following vitrectomy for macula-off RRD surgery. The positive correlation between the IS/OS junction integrity and the mf-ERG amplitudes was stronger than the correlation between the IS/OS junction integrity and CDVA suggesting that mf-ERG may be superior to CDVA in reflecting the extent of microstructural damage in the photoreceptor layer. TRIAL REGISTRATION: Clinicaltrials.gov, NCT05993208. Registered 15 August 2023 - Retrospectively registered, https://classic. CLINICALTRIALS: gov/ct2/show/NCT05993208 .

Twelve-month outcomes of single-step transepithelial photorefractive keratectomy for moderate hyperopia and hyperopic astigmatism.

BACKGROUND: Conventional mechanical or alcohol-assisted photorefractive keratectomy (PRK) techniques for correction of hyperopia and hyperopic astigmatism were associated with inconsistent results. The aim of this study is to evaluate the 12-month visual and refractive outcomes of the relatively new single-step transepithelial photorefractive keratectomy (TE-PRK) for moderate hyperopia and hyperopic astigmatism. METHODS: This is a prospective interventional study. Forty-eight eyes of 30 patients with moderate hyperopia or hyperopic astigmatism with a cycloplegic spherical equivalent refraction (SEQ) between 2.0 and 4.5 diopters (D) underwent single-step StreamLight® TE-PRK using EX500 excimer laser (Alcon Laboratories, USA). The main outcome measures were recorded at 6 and 12 months postoperatively including assessment of logarithm of the minimum angle resolution (logMAR) uncorrected and corrected distance visual acuity (UDVA, CDVA), cycloplegic refraction, corneal topographic changes as well as post-PRK peripheral haze grading. RESULTS: The mean preoperative cycloplegic SEQ was significantly reduced from 3.21 ± 0.61 D to 0.35 ± 0.04 D and 0.41 ± 0.04 D at 6 and 12 months, respectively (P < 0.001). The mean preoperative UDVA significantly improved from 0.53 ± 0.02 logMAR to 0.07 ± 0.01 logMAR and 0.08 ± 0.01 logMAR at 6 and 12 months, respectively (P < 0.001) while the mean preoperative logMAR CDVA showed non-significant change over time throughout the study (P = 0.135). At the end of the study, 41 eyes (85.4%) achieved UDVA of 20/25 or better and no eye lost any lines of CDVA. Thirty-eight eyes (79.1%) had a postoperative cycloplegic cylinder of 0.5 D or less at 12 months. The mean preoperative mean keratometry showed significant increase at 6 and 12 months postoperatively (P < 0.001) while there was no significant change between the two postoperative visits denoting topographic stability (P = 0.058). The mean postoperative Q value at 6 and 12 months showed a significant prolate shift (P < 0.001). No haze was observed in 62.5% and 85.4% of the enrolled eyes at 6 and 12 months, respectively. CONCLUSIONS: Single-step StreamLight® TE-PRK for moderate hyperopia and hyperopic astigmatism achieved acceptable visual and refractive outcomes. TRIAL REGISTRATION: (Clinicaltrials.gov): NCT05261685, 2 March 2022, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05261685.

Transepithelial photorefractive keratectomy: a prospective randomized comparative study between the two-step and the single-step techniques.

OBJECTIVES: To assess and compare the six-month outcome of the two-step transepithelial phototherapeutic keratectomy- photorefractive keratectomy (PTK-PRK) and the single-step transepithelial PRK for myopia and myopic astigmatism. METHODS: A prospective randomized study. The study enrolled 100 eyes of 50 patients with mild to moderate myopia or myopic astigmatism stratified into two groups, PTK-PRK (n = 50 eyes) and single step PRK (n = 50 eyes). Primary outcome measures were visual acuity and manifest refraction. Secondary outcome measures were epithelial healing duration, post-PRK pain scores and 3-month postoperative haze grading. RESULTS: Preoperative characteristics were similar in both groups (p value > 0.05). The mean uncorrected distance visual acuity (UDVA) at 1 week, 1 month, 3 and 6 months was significantly better in the single-step PRK group than in the two-step PTK-PRK group (p < 0.001). The mean manifest sphere, cylinder and spherical equivalent showed a significant difference at all follow up visits in favour of the single-step PRK (p value < 0.001). Epithelial healing duration was faster in single-step PRK (p value < 0.001). Pain scores were significantly lower following single-step PRK at 8 h, 1 day, 3 days (p value < 0.001) but were similar at the 7th day. Haze scores showed no statistical difference between the two groups at 3-month follow-up. CONCLUSION: The two transepithelial PRK techniques were effective in correcting mild to moderate myopia and myopic astigmatism. However, Single-step transepithelial PRK achieved faster visual recovery, better refractive outcome and shorter epithelial healing time with less post-PRK pain. CLINICAL TRIALS REGISTRY: (Clinical Trials.gov Identifier): NCT04710082.

Twelve month outcome of manual small-incision cataract surgery in Assiut, Egypt: A retrospective study with a large sample size.

BACKGROUND: To assess the visual outcome of manual small-incision cataract surgery (MSICS) as well as safety, cost, and time of the procedure. PATIENTS AND METHODS: A retrospective study involving candidates for cataract surgery with baseline-corrected distance visual acuity (CDVA) ≤20/120. Visual acuity (VA) was the primary outcome measure while surgical complications, cost, and time of surgery were the secondary outcome measures. Follow-up visits were scheduled at 1 day, 1 week, 1 month, and at 6 and 12 months following surgery. RESULTS: The study enrolled 3007 patients with a mean age of 66.45 ± 17.3 years. Out of 3007 patients, 2774 (92.2%) were legally blind before surgery (CDVA <20/200) which was significantly reduced to 55 patients (1.9%) by 1 month following surgery. Uncorrected distance visual acuity was 20/60 or better in 2098 eyes (69.8%) at 1 month, in 2035 eyes (67.7%) at 6 months, and in 2017 eyes (67.1%) at 12 months. The posterior capsular rupture was the most common intraoperative complication. Corneal edema was the most common immediate postoperative complication while the development of posterior capsular opacification was the leading cause for later impaired VA. The mean cost was approximately equivalent to 20 US dollars. The median duration of surgery was 10 min. CONCLUSION: MSICS is a safe, cost-effective, and time-saving technique for improving the vision of cataract patients in areas with high cataract surgery volume and limited facilities.

ANATOMICAL CHANGES BETWEEN ARGUS II RETINAL PROSTHESIS AND INNER RETINAL LAYERS DETECTED BY SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IN FIRST YEAR: A CASE REPORT.

PURPOSE: To report and describe the anatomical changes detected by spectral domain optical coherence tomography between an Argus II retinal prosthesis and the inner retinal layers during 1-year follow-up. METHODS AND RESULTS: A patient presented with epiretinal fibrosis 12 months after implant of an Argus II epiretinal prosthesis. One month after uneventful surgery in March 2016, an evident hyporeflective space was detected between the epiretinal prosthesis and the inner retinal surface by spectral domain optical coherence tomography. An epiretinal hyperreflective band was noticed during follow-up and 1 year after surgery. Spectral domain optical coherence tomography showed close contact of the band with the array, which greatly increased the electrical threshold of stimulation for most of the electrodes. Some electrodes were no longer functioning. No changes in visual performance were detected. CONCLUSION: Argus II epiretinal prosthesis implant may be complicated by the formation of a hyperreflective epiretinal band, detectable by spectral domain optical coherence tomography. The band may alter prosthesis function; to date, the patient did not scored any decrease in visual function.

Utility of local anesthesia for open carpal tunnel release in patients with psychiatric diagnoses.

PURPOSE: Carpal tunnel release, one of the most commonly performed procedures in Veterans Affairs (VA) medical centers, is often performed under local anesthesia alone. In this patient population, there is an increased prevalence of psychiatric disorders. Our hypothesis is that there is no difference in operating time, request for sedation, or complications in the veteran population with or without a recognized psychiatric history. METHODS: A retrospective cohort study was performed at a VA medical center from January 2013 to January 2017 by the senior surgeon (E.S.L). Patients were divided into two groups: patients with no known psychiatric history (n = =33) and patients with an active psychiatric diagnosis (n = =25), including post-traumatic stress disorder, anxiety disorder, bipolar disorder, depression, substance abuse, or panic disorder. Primary endpoints included operation time, time in operating room, request for sedation, and complication rates. RESULTS: Fifty-nine percent of patients successfully underwent wide-awake hand surgery, while 41% requested sedation. Patients with no known psychiatric history had a 45.5% rate of requesting sedation compared to 36% in those with a psychiatric diagnosis. No patients converted from wide-awake surgery to sedation. There was no statistically significant difference in operation time, time in the operating room, need for sedation, or complication rate between all groups. CONCLUSIONS: Wide-awake hand surgery is an excellent technique that can be safely used in patients with a history of psychiatric illness. Without the need for monitored anesthesia care, the cost for carpal tunnel releases done in military medical centers could decrease dramatically. TYPE OF STUDY: Prognostic. LEVEL OF EVIDENCE: Level II.

The forearm fillet flap: 'spare parts' reconstruction for forequarter amputations.

Radical forequarter amputation is often performed for recurrent proximal extremity tumors. A free forearm fillet flap is used to provide excellent coverage of the resultant defect without donor site morbidity. Use of a free flap from the distal portion of the extremity with proximal tumor burden is safe and effective.

Age-Related Trends of Patients Undergoing Thyroidectomy: Analysis of US Inpatient Data from 2005 to 2013.

OBJECTIVES: As the country ages, thyroidectomies can be expected to be performed more frequently among the elderly. In this study, we stratified patients by age to explore demographics and complications of patients undergoing thyroidectomy. STUDY DESIGN: Retrospective study with a national database. SETTING: Nationwide Inpatient Sample. SUBJECTS AND METHODS: A total of 414,079 thyroidectomy cases from 2005 to 2013 were identified. Complications, outcomes, demographics, length of stay, and hospital charges were evaluated among patients and stratified by age into 4 cohorts: younger (<65 years), advanced age (65-74 years), elderly (75-84 years), and superelderly (≥85 years). RESULTS: Of 414,079 thyroidectomy cases identified, patients aged <65 years accounted for 75.6% of cases, while those aged 65-74, 75-84, and ≥85 years accounted for 16.3%, 7.2%, and 0.9%, respectively ( P < .001). There was a significant difference in length of stay, total hospital charges, and mortality throughout the different age groups ( P < .001), all trending upward with advancing age. In the aging population, incidence of recurrent laryngeal nerve injury, transfusion of erythrocytes, and acute cardiac complications increased with increasing age ( P < .001), while hypoparathyroidism decreased with age ≥65 but ≤85 years ( P < .001). Patients aged ≥75 years had increased odds of mortality as compared with their younger counterparts ( P < .001). CONCLUSION: This study utilized a national database to describe and elucidate trends in older populations undergoing thyroidectomy. Thyroid-related complications, including blood transfusion and recurrent laryngeal nerve injury, increased with increasing patient age. This information will help to guide pre- and postoperative care for aging patients undergoing thyroidectomy.

Impact of liver disease on outcomes of patients hospitalized for epistaxis.

OBJECTIVES: Liver disease (LD) often results in coagulation abnormalities that may predispose to more severe epistaxis. The purpose of this analysis was to examine characteristics of patients hospitalized for epistaxis with LD and explore the impact of LD on patient outcomes. METHODS: The 2002 to 2013 National Inpatient Sample was queried for cases with a primary diagnosis of epistaxis. Cases with additional codes meeting the Agency for Healthcare Research and Quality's definition of LD were identified and compared to the non-LD cohort. RESULTS: Out of 39,879 cases meeting inclusion criteria, 3.6% had LD. LD was associated with younger age (55.7 years vs. 67.5 years; P < 0.001), longer hospital stay (3.9 days vs. 3.2 days; P < 0.001), and greater hospital charges ($26,141 vs. $18,200; P < 0.001) compared to the non-LD cohort. LD patients had higher rates of alcohol abuse, coagulopathy, chronic blood loss anemia, and renal failure. LD patients also had higher rates of sepsis, urinary/renal complications, respiratory failure, and infectious pneumonia. LD was associated with decreased rates of aggressive management (defined as ligation or embolization) (6.6%-9.0%; P < 0.002) and anterior or posterior nasal packing. In our multivariate logistic regression model correcting for age, gender, race, and significant comorbidities, LD was associated with 1.520 (1.336-1.729; P < 0.001) greater odds of transfusion and 2.264 (1.372-3.736; P = 0.001) greater odds of in-hospital mortality. CONCLUSION: Among patients hospitalized for epistaxis, LD resulted in greater morbidity and mortality. Clinicians should be aware of the particular risk that LD bears on the hospitalized epistaxis patient. LEVEL OF EVIDENCE: 2C. Laryngoscope, 127:2691-2697, 2017.