Patient expectations and satisfaction in robotic-assisted total knee arthroplasty: a prospective two-year outcome study.

INTRODUCTION: The impact of fulfillment of patient expectations throughout recovery on satisfaction in total knee arthroplasty (TKA) is not well understood. Utilizing a standardized TKA method with a robotically assisted (RA) platform, we investigated the impact of expectation fulfillment at 3-month (M) and 6-M on 1-year (Y) and 2-Y satisfaction. We hypothesize that early fulfillment of patient expectations is associated with improved midterm patient satisfaction. We also compare improvements in outcomes with RA-TKA to those of a recent large national TKA cohort study to determine whether RA-TKA meets or exceeds the current standard of care. MATERIALS AND METHODS: One hundred six patients were prospectively enrolled and underwent robotic-assisted TKA by a single surgeon using the OMNIBotics system. Patients completed KOOS and New Knee Society Score (KSS) preoperatively and at 3M, 6M, 1Y, and 2Y postoperatively. Expectation fulfillment was subdivided into patients who were below or above the average expectation score pre-operatively, or fulfillment of expectation score at 3M and 6M post TKA. The satisfaction of each group was then compared at 1Y and 2Y post TKA. Study cohort outcomes were compared to contemporary literature from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) database. RESULTS: Patients with greater than average KSS expectation fulfillment at 3M reported significantly higher KSS satisfaction scores at 1Y (34.9 ± 5.3 vs 30.6 ± 6.7, p = 0.0012), and patients with greater than average 6M expectation fulfillment reported improved satisfaction at 1Y (33.9 ± 5.9 vs 31.1 ± 6.7, p = 0.0330) and 2Y (35.2 ± 4.8 vs 32.4 ± 6.8, p = 0.0323). When compared to the FORCE-TJR database, no significant differences in post-operative KOOS outcomes were observed except for Sports and Recreation, for which the RAS group demonstrated higher scores (65.5 ± 30.0 vs 53.0 ± 27.1 p < 0.0001); however, the study cohort reported significantly greater improvements in KOOS Pain, Symptoms, Sports and Recreation, and Quality of Life at multiple time points up to 2 years post TKA. CONCLUSION: High early-expectation fulfillment was associated with improved satisfaction at 1Y and 2Y, indicating the importance of managing patient-specific post-operative care to ensure patients reach their pre-operative goals. Greater improvements in all KOOS sub-scores and in absolute Sports and Recreation at 1Y and 2Y were observed in this robotic-assisted cohort compared to a large contemporary database, indicating that RAS meets or exceeds current standard of care benchmarks for patient-reported outcomes.

Complete genome sequence of datura leaf curl virus, a novel begomovirus infecting Datura innoxia in Sudan, related to begomoviruses causing tomato yellow leaf curl disease.

Several species in the genus Datura (family Solanaceae) are hosts for begomoviruses (family Geminiviridae), both in the New World and the Old World. Here, we report the genome characterization of two isolates of a novel Old World monopartite begomovirus infecting Datura innoxia in Sudan, which we propose to be named "datura leaf curl virus" (DaLCV). Pairwise sequence comparisons and phylogenetic analysis showed that DaLCV isolates are related to begomoviruses causing tomato yellow leaf curl disease, a global menace for tomato crops. Thus, the novel begomovirus could pose an additional threat to tomato cultivation in Africa.

Antimicrobial susceptibility and multi-drug resistance of Salmonella enterica subspecies enterica serovars in Sudan.

This study was undertaken to determine the antimicrobial resistance patterns of Salmonella enterica subspecies enterica recovered from human, food, water, and animal samples collected in Khartoum State, Sudan. A total of 64 Salmonella isolates belonging to 28 different serovars were tested for their susceptibility to 13 antimicrobial agents. The majority of isolates (98.4 %) were resistant to at least one antimicrobial agent. Isolates were frequently resistant to ampicillin (90.6 %), cephalexin (50.0 %), nalidixic acid (25.0 %), streptomycin (21.9 %), kanamycin (18.8 %), gentamicin (17.2 %), and co-trimoxazole and trimethoprim (12.5 %). The most common pattern of multiple drug resistance included resistance to ampicillin and cephalexin. Most isolates were sensitive to chloramphenicol (98.4 %), ciprofloxacin (93.8 %), and norfloxacin (90.6 %). Two chicken- and the two human-origin S. Kentucky isolates were resistant to both ciprofloxacin and norfloxacin. All S. Kentucky isolates and the one S. Rissen isolate demonstrated multi-drug resistance. The results indicate the significance of multi-drug-resistant Salmonella serovars isolated from chickens and other animals and foods as sources for multi-drug-resistant Salmonella in humans in Sudan.

Estimating atmospheric radon deviation using statistical coefficients: Sulaymaniyah city, Iraq, as a case of study.

The authors studied the atmospheric radon concentration with associated meteorological parameters variation during the dust events from July to November 2017. We obtained the meteorological parameters data in weather station of Sulaymaniyah city, Iraq. In the environmental monitoring plan, the atmospheric radon fluctuated from 15 to 48 Bq m-3 around the mean value of 31.5 ± 7 Bq m-3 within the summer. In autumn, varied from 22 to 46 Bq m-3 with a mean value of 34 ± 12 Bq m-3. We employed this to determine the radon level anomalously. Using the modified statistical coefficients, such as the residual deviation (RD), residual fluctuation ratio (RFR), F-test, and p-value coefficients. Among the atmospheric radon fluctuation values, particularly one anomalous (42 Bq m-3) on 25 July was determined because the excessive value of the RD was 1.9 σ, and the RFR value was 66 %. Corresponding to our coefficients criteria, the minimum level of atmospheric radon (22 Bq m-3) does not consider anomalous because of increasing wind speed. Based on this, our method for determining the atmospheric radon anomalies that are influenced by the missed factors beyond the mentioned meteorological parameters is accurate.

The study of relationship between ocular biometry and exophthalmometry in adult Malay population of Kelantan, Malaysia.

PURPOSE: Exophthalmometry value has great clinical significance in the presence of many orbital diseases which can cause proptosis, including thyroid-associated orbitopathy, tumors, inflammation, head and orbital trauma, and craniofacial abnormalities. Measurements of exophthalmometry and ocular biometry vary between races and countries. This study aimed to present the normative values of exophthalmometry in adult Malays of Kelantan and the relationship between ocular biometry (axial length, corneal curvature, anterior chamber depth, and white-to-white) with the obtained exophthalmometry values. MATERIALS AND METHODS: This was a hospital-based, cross-sectional study in the Ophthalmology Clinic of Universiti Sains Malaysia, Kubang Kerian, Kelantan, where 267 individuals above 20 years old participated between August 2018 and May 2020. Participants were examined with Hertel exophthalmometer and intraocular lens Master by the same investigator. Data were analyzed using the Statistical Package of the Social Science software (version 24.0). Multiple linear regression was used to assess any significant correlation between exophthalmometric value and each biometric variable. RESULTS: In the data collected, the mean exophthalmometric value for the right eye was 13.93 ± 2.221 mm and the left eye was 13.93 ± 2.232 mm. Overall, male had a higher exophthalmometric value than the female with a statistically significant P = 0.001. Axial length was uniquely significant for the amount of variance in the exophthalmometric value with P < 0.001, while corneal curvature, anterior chamber depth, and white-to-white showed no statistical significance. CONCLUSION: Our study had established the normal exophthalmometric value for Malay adults in Kelantan for future clinical reference. The axial length had shown to have a significant positive correlation with exophthalmometric values.

The Effect of Binaural Beat Audio on Operative Pain and Anxiety in Cataract Surgery under Topical Anaesthesia: A Randomized Controlled Trial.

Background: The aim of this paper was to examine the analgesic and anxiolytic effects of binaural beat audio in patients undergoing cataract surgery under topical anaesthesia. Methods: This was a prospective, randomized controlled trial of 61 patients undergoing cataract surgery under topical anaesthesia. They were divided into two research conditions; the binaural beat audio group, and a sham-control group (ear phones with no music). Patients completed the State-Trait Anxiety Inventory questionnaire (STAI), and their blood pressure (BP) and heart rate (HR) were measured pre- and post-intervention. Intraoperative pain levels were ascertained using a visual analog scale (VAS) completed immediately after the surgery. Results: The binaural beat group had significantly lower pain scores (p < 0.001), HR (p < 0.001), diastolic BP (p = 0.003), mean arterial pressure (p = 0.007) and anxiety (p = 0.009) than the control group. Within the binaural beat group, subjects experienced a statistically significant reduction in HR (p = 0.004) and anxiety (p < 0.001) levels compared to baseline values, while all parameters, except anxiety, increased significantly in the control group. Conclusions: Binaural beat audio decreases operative pain and anxiety in cataract surgery under topical anaesthesia. It may have additional benefits in modulating the tachycardic response to stress.

Evaluating the Antagonistic Potential of Actinomycete Strains Isolated From Sudan's Soils Against Phytophthora infestans.

Soil microorganisms play crucial roles in soil fertility, e.g., through decomposing organic matter, cycling nutrients or through beneficial interactions with plants. Actinomycetes are a major component of soil inhabitants; they are prolific producers of specialized metabolites, among which many antibiotics. Here we report the isolation and characterization of 175 Actinomycetes from rhizosphere and bulk soil samples collected in 18 locations in Sudan. We evaluated the strains' metabolic potential for plant protection by testing their ability to inhibit the mycelial growth of the oomycete Phytophthora infestans, which is one of the most devastating plant pathogens worldwide. Most strains significantly reduced the oomycete's growth in direct confrontational in vitro assays. A significant proportion of the tested strains (15%) were able to inhibit P. infestans to more than 80%, 23% to 50%-80%, while the remaining 62% had inhibition percentages lesser than 50%. Different morphologies of P. infestans mycelial growth and sporangia formation were observed upon co-inoculation with some of the Actinomycetes isolates, such as the production of fewer, thinner hyphae without sporangia leading to a faint growth morphology, or on the contrary, of clusters of thick-walled hyphae leading to a bushy, or "frozen" morphology. These morphologies were caused by strains differing in activity levels but phylogenetically closely related with each other. To evaluate whether the isolated Actinomycetes could also inhibit the pathogen's growth in planta, the most active strains were tested for their ability to restrict disease progress in leaf disc and full plant assays. Five of the active strains showed highly significant protection of potato leaves against the pathogen in leaf disc assays, as well as substantial reduction of disease progress in full plants assays. Using cell-free filtrates instead of the bacterial spores also led to full protection against disease on leaf discs, which highlights the strong crop protective potential of the secreted metabolites that could be applied as leaf spray. This study demonstrates the strong anti-oomycete activity of soil- and rhizosphere-borne Actinomycetes and highlights their significant potential for the development of sustainable solutions based on either cell suspensions or cell-free filtrates to safeguard potatoes from their most damaging pathogen.

Acute Proptosis in a Diabetic Patient: Diagnostic and Therapeutic Dilemmas.

An elderly diabetic lady presented with a painful swollen right eye and blurred vision for one week, preceded by right eye redness for six months. Her right eye best-corrected visual acuity was finger counting at 1 m. There was right eye proptosis, limited extraocular muscle movements, corkscrew vessels, chemosis and elevated intraocular pressure, but no bruit. Fever was absent. Computed tomography of the brain and orbit showed thickened extraocular muscles and intraconal fat streakiness, with normal superior ophthalmic vein and concavity of the cavernous sinus. Intravenous antibiotics resulted in limited clinical improvement. The subsequent response to oral prednisolone was dramatic, with the improvement of visual acuity to 20/60 after three doses. In cases of atypical orbital cellulitis where antibiotics fail, one should consider differential diagnoses such as orbital inflammatory disease, vascular anomalies and masqueraders. We discuss the approach to the diagnosis of acute proptosis in a diabetic patient and highlight the role of corticosteroids in idiopathic orbital inflammatory disease.

Lower eyelid fornix deepening: A new indication for the facial artery myomucosal flap.

Eye socket contracture is a well-known late complication of enucleation surgery, and the additional insult of radiotherapy at an early age causes even further fibrosis and scarring of the socket. Management of the contracted socket is challenging, and several methods have been proposed. We report a case of eye socket contracture after enucleation and radiotherapy in which multiple reconstructive procedures failed. The recurrent contracture caused difficulty in housing and retaining the eye prosthesis. We reconstructed the lower eyelid with a facial artery myomucosal flap and nasolabial flap, and the upper eyelid with a Fricke flap following reconstruction of the orbital rims (supraorbital and infraorbital rims with a calvarial bone graft, and further augmentation of the infraorbital rim with a rib bone graft). Cosmesis post-reconstruction was acceptable and the prosthesis was retained very well.

Spontaneous bilateral anterior lens dislocation in an 8-year-old girl.

The authors describe recurrent lens dislocation into the anterior chamber in a young girl with homocystinuria. The patient's 12-year-old sister died after a cerebrovascular accident caused by the same disease. This report highlights the importance of early dietary restrictions and treatment.

Hemicrania Continua With Scintillating Scotoma: A Rare Presentation.

Headache can be a primary or secondary disorder. The characteristics of headache and its associated features, especially the presence of red flag signs, are important in distinguishing secondary from primary causes. Hemicrania continua is a type of primary headache disorder characterized by a continuous unilateral headache with episodes of exacerbations and association with cranial autonomic symptoms, which include several ocular symptoms. The absolute response to indomethacin remains the hallmark of this disease. We would like to report a rare case of hemicrania continua with scintillating scotoma during exacerbations apart from the typical autonomic features of conjunctival injection, ptosis, eyelid edema, and lacrimation.

Primary non-Hodgkins lymphoma of the lacrimal sac: mortality-related epiphora.

We report a case of primary non-Hodgkins lymphoma of the lacrimal sac in a 60-year-old Asian lady, who presented with persistent epiphora and recurrent medial canthal swelling. Primary lymphoma of the lacrimal sac is rare and it can be easily misdiagnosed. Delayed in diagnosis may be related to mortality. To minimize the risk of overlooking specific pathology it is important to assess the appearance of the lacrimal sac and its surrounding structures intraoperatively. Biopsy of the lacrimal sac is required in cases where specific pathology is suspected.

Eyelid Juvenile Xanthogranuloma: A Case Report and Literature Review.

Juvenile xanthogranuloma (JXG) is an uncommon condition affecting the eye. We herein report a rare case of eyelid swelling in paediatric age group. A three-year-old Malay boy presented with chronic painless left upper eyelid mass which did not resolve with topical steroid. Clinically, the mass was a non-tender and firm nodular swelling which located at the lateral 1/3 of the left upper lid. Total excisional biopsy of the swelling was done and histopathological findings were consistent with JXG. The systemic associations and the treatment options for ocular JXG are discussed.

Conjunctiva Necrosis Following Subconjunctival Amphotericin B Injection in Fungal Keratitis.

A 30-year-old Bangladeshi gentleman presented with history of sand entering his left eye and was diagnosed as having fungal keratitis by private ophthalmologist. He was treated with three doses of conventional subconjunctival amphotericin B injections (1.5 mg of amphotericin B and 1.2 mg of deoxycholate) over the inferior bulbar conjunctiva and topical antibiotics. Subsequently, he developed conjunctival necrosis over the site of injections and there was no clinical improvement of the keratitis. He was then treated with intensive antifungal and antibiotics eye drops. Debridement of epithelial plug was done and he was given intracameral amphotericin B injection. There was gradual improvement observed then with conjunctival epithelialization. The conjunctival tissue was completely healed after three months along with the corneal ulcer. Subconjunctival injection of Amphotericin B (AMB) may be considered as an adjunct therapy in severe fungal keratitis to address the issue of compliance. Close monitoring is needed due to its known complication of scleritis, scleral thinning and conjunctival necrosis. Liposomal AMB which is known to cause less toxicity given via subconjunctival injection in human subjects needs to be further studied.

Study of Visual Function in Adult Epileptic Patients on Sodium Valproate or Carbamazepine Monotherapy.

Objective Epilepsy is a debilitating disease. Visual function changes have been reported and may be attributed to the epileptic changes or as a result of medication side effect. Sodium valproate and carbamazepine are both first line anti-epileptic medications used in Malaysian health care. Sodium valproate inhibits glutamate and γ-aminobutyric acid (GABA) transaminase while carbamazepine acts on the sodium channel - both are an important part of the retina. This study aimed to compare the visual functions of epilepsy patients on carbamazepine or sodium valproate monotherapy. Design A cross-sectional study was conducted at a tertiary hospital between June 2016 and November 2018. Methods Patients with idiopathic epilepsy that fulfill the inclusion and exclusion criteria were recruited from the neurology clinic. They were divided into two groups and underwent complete eye examinations. Visual functions such as color vision testing, contrast sensitivity, visual field and retinal nerve fiber layer measurement were subsequently performed. Statistical analysis was done using Statistical Package for the Social Science, version 24 (SPSS Inc, Chicago, IL, USA). Results A total of 100 patients (sodium valproate: 50 patients; carbamazepine: 50 patients) were recruited for the study. There were no statistically significant changes in anatomical or visual function between the sodium valproate and carbamazepine group. However, patients from both groups displayed color vision defect in the blue and green axes. Changes in color vision could indicate early retina toxicity secondary to the medication. Although there were no visual field changes, patients recorded a slight reduction of mean deviation. Changes of mean deviation could be attributed to the side effect of medication or the disease process. Conclusions Epileptic patients taking sodium valproate or carbamazepine did not demonstrate statistically significant change in visual function.

Evaluation of Optic Nerve Head Parameters, Retinal Nerve Fiber Layer Thickness, and Ocular Perfusion Pressure in Migraine Patients.

Background Neurovascular changes occur during the migraine is believed to cause alteration in cerebral and retinal circulation that possible result in damage to the brain and even retina or optic nerve. Retinal nerve fiber layer (RNFL) thickness measurement can be used as an index to assess ganglion cell and retinal nerve fiber damages. The aim of this study was to evaluate the optic nerve head (ONH) parameters, RNFL thickness, and ocular perfusion pressure (OPP) in migraine patients. Methods This was a cross-sectional study, conducted in Hospital Universiti Sains Malaysia, Kelantan from July 2016 to November 2018, involving patients with a confirmed diagnosis of migraine and controls. Ninety-four eyes of 47 migraine patients and 94 eyes of 47 healthy subjects were included in this study. Blood pressure and intraocular pressure were measured and OPP was calculated. ONH parameters and RNFL thickness were measured using optical coherence tomography (OCT) after pupillary dilatation. Statistical analysis was done using Statistical Package for the Social Science (SPSS Inc Version 24). Results With respect to all means values of ONH parameters, there was no statistically significant difference between migraine patients and controls. For RNFL, there were significant reductions in average and superior RNFL thickness on both eyes with adjustment of age and gender (P-value: right eye (RE) average = 0.027; RE superior = 0.034; left eye (LE) average = 0.037; LE superior = 0.031). In view of OPP, there was no significant difference between migraine patients and controls (P-value = 0.172). Weak correlations were found between the ONH parameters and RNFL thickness with OPP, respectively, in migraine patients. Conclusion This study showed no difference in ONH parameters between migraine patients and healthy subjects. There was significant thinning in average and superior RNFL for migraine patients. No difference found in OPP between both groups. ONH parameters and RNFL thickness had a weak correlation with OPP in migraine patients.

Rare Kodamaea ohmeri keratitis following a trivial vegetative trauma.

Kodamaea ohmeri keratitis is an opportunistic pathogen seen in patients who have undergone invasive procedures and immunocompromised state. It has been identified in septicemia patients, resulting in mortality. To the best of our knowledge, we identified the first case of K. ohmeri keratitis following an injury with vegetative material. A 57-year-old woman with underlying, poorly controlled diabetes mellitus was gardening when a tree leaf accidentally poked her in the eye. Two weeks later, the patient presented with right eye pain, redness and progressive blurring of vision due to a traumatised right cornea. Slit-lamp examination showed a small inferior paracentral corneal stromal infiltrate with overlying epithelial defect. A corneal scraping sample yielded K. ohmeri from Analytical Profile Index (API) 20C yeast identification system. She was treated with intensive topical amphotericin B and fluconazole. After 6 weeks of treatment, the keratitis resolved with faint scar tissue, and her visual acuity improved.

Tear cytokine levels in allergic rhinitis without ocular symptoms.

OBJECTIVE: To compare cytokine levels in the pre-corneal tear film between patients with allergic rhinitis, allergic rhinoconjunctivitis and the normal population. DESIGN: A comparative cross sectional study. PARTICIPANTS: Patients were divided into Group 1 (allergic rhinitis without conjunctivitis), Group 2 (allergic rhinoconjunctivitis), and Group 3 (normal population). METHODS: A comparative cross-sectional study was conducted. Patients were divided into; Group 1 (allergic rhinitis without conjunctivitis), Group 2 (allergic rhinoconjunctivitis), and Group 3 (normal controls). Tears were collected using Schirmer strips and cytokine analysis performed using enzyme linked immunosorbent assay. RESULTS: There were a total of 68 subjects. Median values of cytokines in the allergic rhinitis group were as follows; TNFa (45.34 pg/ml), IL-4 (61.91 pg/ml), IL-5 (8.92 pg/ml), IL-6 (538.37 pg/ml) and IL-8 (1438.72 pg/ml). Cytokine levels in the group with allergic rhinoconjunctivitis were approximately two-fold higher than in the group with allergic rhinitis only. The median cytokine level in the control group was lowest. A significant inter-group difference was observed for TNF-alpha, IL-4, IL-6 and IL-8 levels, with allergic rhinoconjunctivitis patients demonstrating significantly elevated cytokines compared to those with allergic rhinitis only (p<0.001). These four cytokines were also significantly higher in those with allergic rhinitis than in controls (p<0.005). Although the group with allergic rhinoconjunctivitis had the highest levels of IL-5, no statistically significant inter-group difference was noted (p=0.479). CONCLUSION: This study demonstrated the presence of raised tear film inflammatory cytokines even in allergic rhinitis patients without ocular symptoms. These patients may be at increased risk of developing allergic conjunctivitis. These findings not only substantiate the immunological theory of the naso-ocular reflex, but have clinical and therapeutic implications for the holistic management of allergic rhinitis and conjunctivitis.

Clinical Profile and Visual Outcomes of Ocular Syphilis: A Five-year Review in Hospital Universiti Sains, Malaysia.

Introduction Ocular syphilis is a sight-threatening condition. It can occur at any stage of syphilis infection, which present either with acute inflammation during the primary, secondary, and early latent stages or with chronic inflammation during tertiary infection, affecting virtually every ocular structure. This study was to report on the clinical presentation of ocular syphilis that presented to eye clinic Hospital Universiti Sains Malaysia. Methodology This was a retrospective study where medical records of ocular syphilis patients who attended eye clinic in Hospital Universiti Sains Malaysia from January 2013 to June 2017 were reviewed. Results A total of 10 patients (13 eyes) with ocular syphilis were identified out of 106 cases that presented with ocular inflammation. The mean age of presentation was 69.8 ± 6.4 years and seven of them (70%) were female. All patients were Malay and human immunodeficiency virus (HIV) was negative. The ocular manifestations included panuveitis (four eyes, 30.8%), anterior uveitis (two eyes, 15.4%), posterior uveitis (seven eyes, 53.8%) and optic neuritis (two eyes, 15.4%). Seven (53.8%) eyes presented with visual acuity of worse than 6/60, five (38.5%) eyes had visual acuity between 6/15 to 6/60, and one (7.7%) eye had visual acuity of 6/12 or better. Nine patients received an intravenous benzylpenicillin regime and one patient received an intramuscular penicillin injection. Out of 13 eyes affected, 11 (84.6%) eyes had improved visual acuity of at least one Snellen line after treatment. Visual acuity of 6/12 or better increased to four (30.8%) eyes. Conclusions Posterior uveitis was the commonest presentation of ocular syphilis in HIV-negative patients. Early detection and treatment of ocular syphilis can result in resolution of inflammation and improvement of vision.

Atypical Cavernous Sinus Thrombosis: A Diagnosis Challenge and Dilemma.

Cavernous sinus thrombosis (CST) is an ocular emergency because of its devastating effect and it is prone to cause serious complications. Diagnosis of cavernous sinus thrombosis is a challenging task despite medical advancement. Efforts to promptly diagnose and initiate treatment require a high index of suspicion and a deep understanding of the disease. Unfortunately, patients suffering from CST may not always present with typical symptoms, thus making diagnosis all the more challenging. We would like to describe a 22-year-old man who presented with atypical symptoms and radiological presentations of CST. The patient was admitted and treated in our institution with full recovery demonstrated after the treatment.