Trends in outpatient cataract surgery in the Islamic Republic of Iran, 2006–2010

This study aimed to determine the trends in outpatient cataract surgery and its determinants in the Islamic Republic of Iran between 2006 and 2010. In this cross-sectional study, 106 cataract surgery centres were selected in all provinces by multistage randomized cluster sampling. The number of centres in each province was determined from the number of cataract operations and the number of patient charts examined in each centre was proportionate to the number of cataract operations in that centre. The prevalence of outpatient surgery increased from 46.0% [95% CI, 35.3-56.8] in 2006 to 51.4% [95% CI, 40.2-62.7] in 2010 [P = 0.549]. Patients stayed in hospital for more than one night after 10.5% [95% CI, 6.9-14.1] of operations. Use of phacoemulsification and topical anaesthesia increased the prevalence of outpatient surgery and decreased intraoperative complications. Although outpatient cataract surgery increased by 11.7%, use of methods such as phacoemulsification is not widespread, and more attention should be paid to the barriers to outpatient cataract surgery in the Islamic Republic of Iran

Contributions of public and private sectors to the Iranian cataract surgery output

This study determined trends in the contributions of the public and private sectors to the cataract surgery output in the Islamic Republic of Iran. Data about cataract surgeries performed at surgical centres throughout the nation were extracted from patient charts for a 5-year period from 2006 to 2010. Of the total 516 273 surgeries performed in 2010, more were done in public sector centres [61.7%] than private ones [38.3%]. The total number of surgeries increased by 59.1% between 2006 and 2010. Analysis of the relative contributions of the public and private sectors showed a 41.0% increase in surgeries in public centres and 100.5% in private centres over the 5-year period. Thus the rate of growth of cataract surgery in the private sector was 2.7 times greater than that in the public sector. Despite a smaller contribution to the total number of cataract surgeries, the private sector has experienced a substantial rate of growth

[Distribution of pupil diameter and their related factors in 40-64 years old population of Shahroud]

To determine the mean pupil diameter by the Pentacam in the 40-64 year-old population of Shahroud and its association with some related factors. Three hundred clusters were selected through multistage cluster sampling in the first phase of Shahroud Cohort study of whom 82.2% participated in the study. Refraction, slit lamp examination, and imaging by the Pentacam were performed for all participants. The pupil diameter obtained by the Pentacam was analyzed. Any history of previous ocular surgery and invalid Pentacam data were the criteria for excluding data from further analysis. After implementing the exclusion criteria, the data of 3820 individuals [59.3% female] were analyzed. The mean pupil diameter in this study was 2.74 +/- 0.56 mm [95%CI 2.72-2.76]. The 25%, 50%, 95% and 97.5% percentiles of the pupil diameter in the study population were 2.41, 2.67, 3.60 and 3.85 mm, respectively. In this study, the 95% of the normal range of pupil diameter was 1.63-3.85 mm. In the multiple model, the mean pupil diameter was smaller in men compared to women and decreased significantly with aging [P<0.001]. The mean pupil diameter was significantly larger in myopic versus hyperopic participants [P<0.001]. The pupil diameter was significantly smaller in participants with dark brown irises [P=0.005]. Anisocoria was observed in 9.43% [95%CI 8.43-10.44] of the participants. The pupil diameter in normal individuals by the Pentacam is found to be smaller than other techniques. A cut point of 3.85 mm for the pupil diameter is suggested as the critical criterion for refractive surgery. Moreover, it should be noted that men have a smaller pupil diameter, and that the pupil diameter decreases with aging

[ effect of rigid gas permeable contact lens fitting in corneal curvature, central thickness and volume]

Evaluation of the corneal curvature, central thickness and volume three months after fitting the Rigid Gas Permeable [RGP] contact lens in keratoconic eyes. Corneal topography maps of 25 keratoconic eyes with a negative history of using the RGP lens were evaluated by Oculus Pentacam. Corneal curvature in both surfaces of the cornea, central corneal thickness and corneal volume were evaluated before and three months after fitting the aspheric RGP lens. Three months after using the contact lens, decrease in central corneal thickness [-3.43 micro m, P=0.127], decrease in flattest anterior corneal surface power [-0.43D, P=0.339], decrease in anterior corneal steep power [-1.54D, P=0.358], decrease in posterior corneal flat power [-0.1D, P=0.121], an increase in posterior corneal steep power [0.02D, P=0.710] and an increase in corneal volume [0.27 mm[3] P=0.331] were not statistically significant. Lack of significant changes in corneal topographical parameters three months after using the RGP lens may indicate the non progressive nature of keratoconus in this period. Further studies with longer follow-up periods are suggested to obtain more accurate results

[ rate of cataract surgery in Khorasan Razavi, 2006-2010]

To determine the trend of the cataract surgical rate in Khorasan Razavi Province between 2006 and 2010. Five centers were randomly selected from the cataract surgery centers of Khorasan Razavi Province. Using the definition of more than 3000 cataract surgeries per year for a major center, 3 centers were major and 2 were minor. One week of each season was randomly selected for each center and the number of cataract surgeries in that particular week was calculated. A total of 20 weeks for each center were selected. Finally, a percentage of the records, proportionate to the number of surgeries per week, were thoroughly analyzed. The total number of cataract surgeries was estimated 21388, 22750, 23888, 28063, and 30100 from 2007 to 2011, respectively. The cataract surgical rate, considering the population of Khorasan Razavi province, increased linearly from 3782 [95% CI 3732-3833] in 2007 to 5021 [95% CI 4965-5078] in 2011 per 1,000,000 people. In addition, the types of surgeries were intracapsular, extracapsular, phacoemulsification, lensectomy in which were recorded as 0.3%, 15.1%, 84.56%, and 0.1% of the cases, respectively. During the five years of the study, phacoemulsification increased significantly from 74.7% in 2007 to 90.4% in 2011 while the extracapsular method decreased from 14.7% to 9.2% in the same period of time. About 0.87% of the surgeries developed intraoperative complications. This study reported the cataract surgical rate in Khorasan Razavi province exclusively for the first time. The calculated rate was noticeably better than previous reports and was desirable and acceptable according to the WHO standards. However, with regard to the increase in the elderly population of the province, the rate should be even higher to cover all individuals requiring cataract surgery. Therefore, provision of the cataract surgery facilities, especially for the phacoemulsification, and education of this method should receive priority in the health system of this province

[Validity of vision screening in schoolchildren of Iran]

To determine the sensitivity, specificity, and predictive value of visual screening examination in students living in urban areas of Iran. The first grade students of 7 cities of Iran were randomly selected in a population based cross sectional study in 2013 using multistage cluster sampling. After obtaining consent from the students' parents, examinations including corrected and uncorrected visual acuity, cycloplegic and non-cycloplegic refraction, and cover test were performed for all students by an optometrist. The criterion for visual problem was a cut point of 20/32 or worse for uncorrected visual acuity. In addition, the validity of the uncorrected visual acuity measured in the national screening program, which is recorded in the students' health profiles, was calculated. Out of total 4157 individuals who were selected for the study, uncorrected visual acuity was measured in 3645 participants. The sensitivity and specificity of uncorrected visual acuity measured in the national screening program was 35.3% [95% CI 29.2%-41.7%] and 93.9% [95% CI 93.04%-94.7%], respectively. The lowest sensitivity was observed in Dezful [19.6%] and the highest was observed in Ardebil [83.3%]. The predictive value of the examinations was 28.8% [95% CI 23.6%-34.3%] and the best cut point of uncorrected visual acuity was recorded as 20/25 in the national screening program. The validity of the visual screening program which is performed before the first grade of primary school is very low. It should be noted that since many families trust these examinations, they do not follow up their children's condition any more based on the results of these examinations. Therefore, the validity of these examinations, especially their sensitivity, should increase through training the examiners or using more specialized methods

2-year follow-up of spirometric parameters in workers of a tile and ceramic industry, Yazd, southeastern Iran

Respiratory diseases cause a considerable amount of morbidity and mortality in the world. Pulmonary function tests are important measures for the diagnosis and management of respiratory disorders. Workers in tile and ceramic industry are exposed to high amounts of respiratory pollutants. To identify the changes in spirometric parameters in a 2-year period among tile and ceramic workers in Yazd and compare it with a control group. The study was conducted in 5 tile and ceramic factories selected by cluster sampling between 2009 and 2011 in Yazd, southeastern Iran. Demographic data and spirometric parameters of participants were recorded. Spirometric parameters were significantly reduced during the 2 years. The largest decrease was observed in FVC [=500 mL] in ball-mill and grinding after 2 years. Decrease in all spirometric parameters was significantly higher in industrial workers than office workers. Respiratory exposure in tile and ceramic industry can significantly affect pulmonary function tests

Analysis of familial aggregation, co-aggregation and association within person of myopia and four phenotypes of astigmatism based on a conditional model: tehran eye study

Background: To determine the familial aggregation, Coaggregation and within person association of myopia and four phenotypes of astigmatism by a conditional model in Tehran Eye Study

Materials and Methods: Myopia, Total, ATR, WTR and oblique astigmatism were studied through a population based, cross sectional study in 1326 siblings older than 5 years from 531 families with 2-4 siblings using stratified cluster random sampling from August to December 2002 in Tehran Eye Study

Results: Based on the conditional model and via Proc GENMOD SAS 9.1, the conditional odds ratios [95% confidence interval], that indicates conditional familial aggregation, for the total, WTR, ATR and oblique astigmatism and myopia were 1.16 [1.01-1.33], 1.59 [1.17-2.16], 1.77 [1.39-2.26], 2.12 [1.41-3.19] and 1.96 [1.72-2.24], respectively .On the other hand, conditional odds ratios that indicates within person association of two disease, for myopia and WTR, myopia and ATR, myopia and Oblique and at last myopia and total astigmatism were 5.74 [3.99-8.17], 3.41 [2.01-5.82], 4.6 [2.15-9.86] and 6.10 [4.76-7.82], respectively. Although no significant familial co-aggregation has been identified

Conclusion: Based on conditional model and after controlling for the confounders, this analysis yielded, a significant aggregation of four phenotypes of astigmatism and myopia, a large within person association and moderate but non-significant coaggregation of these disorders

Quality of life in the group of patients with chronic eye disease

To assess vision related quality of life and determinants in patients afflicted with chronic eye disease. In this analytical cross-sectional study, consecutive sampling was performed at Noor Eye Hospital between 2008 and 2009. A valid and standard 39-item visual functioning questionnaire [National Eye Institute visual functioning questionnaire, NEI-VFQ 39] was completed. The questionnaire consists of 11 domains related to vision and one domain about general health. The total score range from zero [0] to 100, where a higher score reflects better vision related quality of life. The independent t-test, pearson correlation coefficient as well as simple and multiple linear regression models were employed for statistical analysis. The mean overall score in patient and control groups were 54.5 [95% confidence interval [Cl] 57.3 -71.8] and 96.0 [95% CI: 88.2-103.9], respectively. Patients with cataracts had the highest score [64.6; 95%CI: 57.3 - 71.8] and those with visual acuity of 20/70 or worse showed lowest scores [41.9; 95%CI: 30.7 - 53.1]. Age [P=0.006] and education level [0.001] were associated with quality of life score. Based on our study findings, it could be concluded that low vision patients with a visual acuity of 20/70 or worse hardly received half of the total scores. Diabetic retinopathy, age related macular degeneration, glaucoma, and cataract stand in ascending rank order. The relatively lower scores as compared to results from other countries warrant further research into the causes of such differences

Core shell methyl methacrylate chitosan nanoparticles: in vitro mucoadhesion and complement activation

Studies show that chitosan nanoparticles increase mucoadhesivity and penetration of large molecules across mucosal surface. The aim of the present study was to investigate the use of thiolated chitosan in the development of polysaccharide-coated nanoparticles in order to confer specific functionality to the system. Methyl methacrylate nanoparticles were coated with thiolated chitosan using a radical polymerization method. Thiolation was carried out using glutathione [GSH] to improve mucoadhesivity and permeation enhancing properties of chitosan. Mucoadhesion studies were carried out by calculating the amount of mucin adsorbed on nanoparticles in a specific period of time. Complement consumption was assessed in human serum [HS] by measurement of the hemolytic capacity of the complement system after contact with nanoparticles. The FT-IR and 1HNMR spectra both confirmed the synthesis and showed the conjugation of thiolated chitosan to methyl methacrylate [MMA] homopolymer. Nanoparticles were spherical having a mean diameter within the range of about 334-650 nm and their positive zeta potential values indicated the presence of the cationic polysaccharide at the nanoparticle surface. Increasing the amount of thiolated chitosan led to mucoadhesivity and complement activation. However there was not dose dependent correlation between these phenomenons and the absence of thiolated chitosan led to particles with larger size, and without ability to activate complement process. It can be concluded that nanoparticles could be used for the mucosal delivery of peptides and proteins. Results show that the thiolated chitosan had higher mucoadhesion and complement activation than unmodified chitosan

Comparison of overall performance between moving-bed and conventional sequencing batch reactor

The main objective of present work was to compare the overall performances of [moving-bed] and [conventional] sequencing batch reactor. For this purpose, different experimental parameters including COD and dye concentration, turbidity, MLSS concentration, MLVSS/MLSS ratio, sludge volume index [SVI] and Oxidation-Reduction Potential [ORP] were calculated. One conventional sequencing batch reactor and three moving-bed sequencing batch reactors [MB-SBR] were operated in this study. Each MB-SBR was equipped with a type of moving biofilm carrier. The results of dye, COD and turbidity analysis showed that there were no significant differences between the moving-bed and conventional sequencing batch reactors in the matters of effluent quality. A higher fluctuation of MLSS concentration and also higher SVI were observed in moving-bed compared to that of the conventional sequencing batch reactor. Higher ORP values which mean higher oxidation potential were measured in the reactors equipped with the moving carriers in comparison with those measured in the conventional sequencing batch reactor

[Evaluation of health, environmental, economic and technical aspects of disinfection of WWTP effluent in the north of Isfahan with UV instead of chlorine]

Today, chlorine is the most common material used for effluent disinfection. Chlorination is an established and effective method for effluent disinfection. But the use of chlorine for disinfection of effluent due to several major concerns should be reassessed. The aim of this study was to compare long-term benefits and costs of chlorination/de chlorination with those of UV by pilot studies. This pilot study consisted of pre-treatment units clarification and filtration systems with two types of low pressure and medium pressure UV lamps designed and installed at the wastewater treatment plant in the north of Isfahan. Medium pressure UV systems with dose of 230 mw.s/cm2 for disinfection of filtered effluent with SOR of 1090 lit/m2.hr is more economical than a low pressure system and chlorination/dechlorination process and has the least environmental and health adverse effects. In wastewater treatment plants use of UV disinfection technology should be considered in preference to chlorination, especially if the dechlorination of chlorinated effluent is required. Before application of this system pilot studies on actual effluent at plant sites are required

[Demographic findings in patients with low back pain caused by lumbar spinal stenosis in Imam Khomeini Hospital of Tehran University [2003-2004]]

Low back pain [LBP] is one of the most common clinical problems with a high economic burden. Among the causes of LBP unresponsive to conservative management, is the lumbar spinal stenosis [LSS] that makes the lumbar spinal surgery inevitable. To determine the demographic findings in patients with low back pain caused by lumbar spinal stenosis based on their MRI performed in Imam Khomeini Hospital of Tehran University from June 2003 to September 2004. This was a cross-sectional descriptive study in which 200 patients with low back pain referred to imaging center of Imam Khomeini Hospital in Tehran were consecutively investigated from June 2003 to September 2004. The MRI system used was a 1.5T [General Electric] instrument and the images were interpreted by an expert radiologist. We had 200 patients [mean age: 41.29] .There was a high incidence of lumbar canal stenosis [26.5%]; 34% of whom were women and 66% men [p>0.005]. Among the patients, 38.5% were with degenerative disc disorders and 26% with lumbar stenosis. Canal stenosis was found to be higher at lower ages in Iran. Furthermore, 49% of patients with spinal stenosis weighed 75 kg or more, 62.3% with a height less than 170 cm, and 58.5% with occupations involved in lumbar spinal overuse. Mean age of patients with canal stenosis was 41 years old. There was no significant relationship between lumbar stenosis and obesity, short or tall stature, and occupation. Normal or slight bulging disc was more frequent in patients with no stenosis [66% to 49%] and the frequency of disc herniation in the stenotic group was higher than that of non-stenotic group [51% to 34%]. Further investigations using large scale sampling are recommended

[Prevalence of degenerative disc disorders in patients with lumbar stenosis[2003 - 2004]]

Determining the prevalence of degenerative changes by MRI in patients with low back pain [LBP] and lumbar canal stenosis is valuable for better understanding of important LSS issue. This study was designed to determine the prevalence of disc degeneration changes through MRI images obtained from patients with low back pain and lumbar spinal stenosis. This was a cross sectional study in which 53 patients [selected through examining 200 MRI images from patients seeking medical care because of low back pain [LBP] and referred to our MRI imaging center] with MRI findings compatible with lumbar canal stenosis [LSS], were investigated between June 2003 to September 2004. Intervertebral disc conditions such as normal status, bulging, and herniation were evaluated in patient's MRI images. Findings: In 53 patients with lumbar canal stenosis, 34% were women and 66% men [P<0.005]. Degenerative disc disorders [especially herniation] were found in 51% of our patients and 49% shown to have isolated bony canal stenosis occasionally with bulging discs. The isolated or combined anteroposterior [AP] diameter narrowing between patients with LBP was 94.35% in the current study compared to the previous estimation in our imaging center [80%] found in 1998. There was 5.65% isolated LR narrowing and 7.5% AP and LR narrowing in our study. Based on our results, 51% of patients had degenerative disc disorder in the form of disc herniation associated with spinal canal stenosis; 24.5% with no disc pathology, and 24.5% with bulging discs. Disc degeneration was more prevalent in stenotic group compared to non-stenotic group [51% versus 34%; p>0.03]

[Residual refractive errors following cataract surgery and its determinants]

To evaluate residual refractive errors after cataract surgery and its determinant factors at Farabi Eye Hospital, Tehran. Simple random sampling was done among cataract surgery scheduled patients over a 4 year period [2003-2006]. Exclusion criteria were uveitis, previous intraocular surgery and ocular trauma. After applying the exclusion criteria, 423 patients were studied. Lens calculation was performed using the SRK-II formula. Unexpected refractive errors were defined as the difference between postoperative refractive errors with target refraction. Mean and percentage of this variable were reported based on 0.5, 1 and 2 D of ametropia. Of 558 studied patients, 78.1% had biometric data before and refractive data after surgery. Mean absolute unpredictable refractive error was 0.84 +/- 0.89 D. Eyes with normal axial length [AL] had the least [0.76 +/- 0.84] and those with long AL had the most unpredictable refractive errors [P<0.001]. 45.9%, 73.9%, and 91.7% of the study cases had refractive errors within 0.5, 1 and 2 D of emmetropia, respectively. Eyes with short AL had positive refraction and those with long AL had negative refraction after surgery. The majority of keratometric astigmatism followed extra-capsular surgery while the least measures were associated with phacoemulsification [P<0.001]. Axial length was one of the important factors influencing residual refractive errors after cataract surgery. Unpredictable refractive errors were more common in eyes with long and short AL than those with normal AL

Removal of reactive blue 19 by adding polyaluminum chloride to sequencing batch reactor system

The main objective of this study was to evaluate Reactive Blue 19 dye removal efficiency in aerobic sequencing batch reactor [SBR] process by adding polyaluminum chloride [PAC1]. PAC1 was added to the reactors in concentrations of 0, 1, 5, 15 and 30 mg-Al/L [SBR[1] to SBR[5]] after filling periods. Initial dye concentrations were selected to be 40 mg/L for all reactors. The averages of dye removal efficiencies were more than 57% in all reactors. The maximum and minimum dye removal efficiencies were 71.7% +/- 13.6 and 57.7% +/- 34.3 in SBR3 and SBR4, respectively. According to the obtained results, PAC1 had not any significant effects on the COD removal efficiency. The MLSS and MLVSS concentration of SBRs had an increasing rate during whole operation time and reached from 2500 mg/L [1[st] day] to 4900 mg/L [39[th] day]. The maximum increasing rate was 50% in SBR[5]

[Survey on possibility of disinfection of Isfahan north wastewater treatment plant effluent by low and medium pressure ultraviolet systems in pilot scale]

Today, due to health, environmental and economical problems, of chlorine application, UV radiation is better option than chlorine for disinfection of effluent. The aim of this study was disinfection of secondary effluent with UV radiation. Two types of UV disinfection system including low pressure [LP] and medium pressure [MP] was used to disinfection of Isfahan North Wastewater Treatment Plant [INWWTP] effluent without pretreatment. Single and combined lamps were operated to evaluate the removal of total and fecal coliforms [TC and FC], and fecal streptococcus [FS]. TSS, iron, hardness, UV absorption and transmittance were analyzed in order to observe the fouling of the quartz sleeves. After using LP lamp with dose of 161 mws/cm[2], TC and FC content was declined to standard level [1000 TC, and 400 FC/100ml]. In addition, disinfection with MP lamp was led to FS content of 400 MPN/100 mL. Combination of LP and MP, with dose of 460 mws/cm[2] could be met the environmental requirements of TC and FC, and the FS count was reached to 400 MPN/100 mL with dose of 237 mws/cm[2]. Maximum photo-reactivation percentage of coliforms after LP and MP lamps were appeared 15 and 3 percent respectively, while it was not observed for FS. High fluctuation in secondary effluent quality of INWWTP mainly TSS concentration was caused to decline of the UVT value. Therefore, disinfection of effluent by LP, MP and even combined both systems are not applicable in conventional UV dose. Hence, using advanced process unit before UV disinfection system is necessary for removal of TSS

[Duodenal kissing ulcer [sealed anterior perforated duodenal ulcer combined with hemorrhagic posterior ulcer]: report of a case]

Peptic ulcer disease and its complications have long been studied but the coexistence of two major complications in a kissing ulcer is uncommon. We present our experience with this entity and review the related literature. A 27 year old man was suffering from concomitant major complication of duodenal kissing ulcer, huge anterior perforation and uncontrolled posterior bleeding, presenting as hemorrhagic shock to emergency department. The posterior ulcer containing pulsatile bleeding from gastroduodenal artery oversewed and the ruptured anterior ulcer converted to pyloroplasty followed by truncal vagotomy. Presence of anterior perforated duodenal ulcer in a patient of bleeding peptic ulcer is an uncommon presentation that needs a high degree of suspicious for preoperative and intraoperative diagnosis

[Evaluating the performance of clarification and ultraviolet units in disinfection of Isfahan North waste water treatment plant [WWTP] effluent in pilot plant]

Usage of municipal waste water treatment plant [WWTP], especially in agricultural applications, requires disinfection to standards level. Application of UV radiation due to fewer disadvantages in comparison with other disinfectants is being increased around the world. The aim of this study was to evaluate treatment and disinfection of Isfahan North Wastewater Treatment Plant effluent by clarification and UV radiation. The combined system was used in series in pilot scale including: Clarifier + Low Pressure [LP] + Medium Pressure [MP] UV Lamps. Total coliform [TC], fecal coliform [FC] and fecal streptococcus [FS] were analyzed as microbiological parameters in all effluent samples. TSS, iron, total hardness, absorbtivity and transmittance [%UVT] were tested as physicochemical parameters before and after of units. Results of this study showed that the mean value of UVT in 254 nm and absorbance in clarified effluent were 34 percent and 0.47 au/cm, respectively. In disinfection of clarified effluent with LP, MP, and combination of LP and MP lamps, doses of 400, 576 and 407 mws/cm[2], the number of TC, FC, and FS was declined to standards of 1000 TC, and 400FC/100ml for effluent discharge. In addition, in doses of 400, 422 and 407, number of FS was reduced to 5 Log. Maximum regrowth of coliforms was seen after LP lamp and it was 7 percent. Maximum fouling on quartz sleeve was formed in TSS of 48mg/l, while concentration of iron and hardness was 0.48, 249 mg/l, respectively. Improving UV light penetration due to removal of coarse particles and flocks in clarifier, disinfection of clarified effluent with high irradiation time was possible in conventional doses. However, for upgrading the effluent quality and disinfection of high flow rate, using advanced treatment systems such as filtration is recommended