Rate of diabetic retinopathy among the diabetic patients with a best corrected visual acuity of 6/9 or better

Background: Diabetic retinopathy is one of the leading causes of blindness worldwide, broadly it is defined as a complication of diabetes that affects the retina; by damaging its blood vessels, which at first may be symptomless, though eventually can lead to serious and sight-threatening complications like hemorrhages, macular edema, and even blindness

Aim: The study aimed at detecting the presence of diabetic retinopathy in the diabetic patients having a best corrected visual acuity "BCVA" of 6/9 or better, attending Retina Clinic in Elsaiem Eye Hospital, to prove a hypothesis' that states: diabetic patients with a BCVA of 6/9 or better are unlikely to have a diabetic retinal complications, and if found they rarely need intervention

Results: Six hundred and eighteen eyes were included in the study; 59.2% of the eyes with BCVA 6/9, 75.6% of the eyes with BCVA of 6/6, and 86.2% of the eyes with BCVA 6/5 were found to have neither diabetic retinopathy nor maculopathy

Conclusion: As it can be stated out of the results; the better the visual acuity than 6/9 the lesser the prevalence of diabetic retinopathy, so visual acuity "among other factors" could be considered as one of the simple screening methods or predictors of the diabetic retinopathy that is of great importance in developing countries with minimal facilities and resource-poor settings

The effect of weight loss on the outcome after coronary artery bypass grafting in obese patients.

The role of body mass index (BMI) in the setting of coronary artery bypass graft (CABG) surgery has been a focus of past studies. However, the effects of postoperative weight loss in patients after CABG is yet to be known. We performed a retrospective study of 899 patients who underwent CABG at our institution. Perioperative patient information was collected from an onsite electronic record system. Patients were grouped into four BMI categories: normal controls, overweight, obese and morbidly obese. Based on the postoperative BMI changes, patients were then grouped into three categories: gainers, no change and losers. Statistical analyses were performed using analysis of variance and linear regression to establish an association among the data. Hazard ratios (HR) and cumulative survival were obtained by the Cox-Mantel and Kaplan-Meier analyses, respectively. The normal controls exhibited a markedly higher mortality postoperatively, at 27.9%, especially when compared with the obese individuals (16.1%). Patients who lost weight faced a significantly increased risk of mortality than those who experienced no changes or gained weight after surgery. This trend was especially salient among the obese patients, who more than tripled their mortality risk (HR = 3.24) versus individuals who gained weight, and more than doubled their risk (HR = 2.87) versus those who had no changes. We conclude that obesity confers a survival advantage in the setting of the CABG surgery. Weight loss among all BMI categories of patients studied results in an adverse effect on postoperative survival.

Laparoscopic nissen fundoplication for management of hiatal hernia with selective use of mesh in some cases

Laparoscopic repair of hiatal hernia with selective use of mesh was carried out in 20 patients [9 men "45%" and 11 women "55%"] with the mean age 48 years, in the period from January 2002 to January 2005. The patient suffering from, heart burn, regurgitation, dysphagia, epigastric or chest pain, cough and epigastric fullness. Esophagogastroduodenoscopy and barium meal studies reveal, type I: 12 cases [60%], type II: 2 cases [10%], type III: 6 cases [30%]. Laparoscopic fundoplication without use of mesh was done in 15 [75%] of cases and with use of mesh in 5 [25%] cases. The average operative time was 115 minutes. The mean hospital stay ranged from 4 to 11 days. The operation was successful in 19 [95%] patients. One [5%] case are converted to open surgery because of gastric perforation. The long term follow up reveals 4 cases [20%] complaining of heart burn and dysphagia. Two [10%] of the 4 patients developed recurrence. The aim of our work was to evaluate the accuracy of laparoscopic repair of hiatus hernia with selective use of mesh in some cases

Prevalence of polycystic ovary syndrome [PCOS] in anovulatory infertility is serum inhibin raised in PCOS?

Hundred anovulatory Infertile women had been studied by high resolution ultrasonography and the incidence of PCOS in them has been assessed. Serum inhibin levels had been determined in 10 healthy ovulatory women during the early follicular, late follicular and mid luteal phases of the cycle and at comparable time intervals in 10 cases of PCOS. The results of the study showed that 49 percent of anovulatory infertile women had PCOS and PCOS is more likely when anovulation is associated with hirsutism and or oligomenorrhea. In PCOS serum inhibin levels did not show any significant change by time and were comparable to early follicular phase level in the control group, but in the normal control women the levels in the late follicular and mid luteal phases were significantly higher [P < 0.005] than in PCOS group. These results denote that inhibin is not a factor in the disturbed gonadotrophin secretion in PCOS. Moreover serum inhibin like estradiol represents, a marker for FSH action on the ovary and could be used as a clinical indicator of follicular health

Histopathologic study of the placental bed vasculature in hypertensive disorders of pregnancy

Placental bed biopsies have been taken at the time of cesarean section from 10 normal control cases, 25 preeclamptic [PE] cases and 10 cases with chronic non-proteinuric hypertension. Histopathologic study of the placental bed vasculature has been done using H and E and PAs stains. The decidual spiral arteries showed no obvious difference as regards the normal physiologic changes in the control and study groups. The myometrial segment of the spiral arteries however showed marked difference as regards the extent of physiologic changes in the control and study groups. In the control group, 90% of cases showed complete physiologic changes and only one of the 10 cases showed partial changes. In the group of PE, none of the cases showed normal physiologic changes, 20% showed partial changes and 80% showed complete absence of physiologic changes denoting that in PE there is a defect in the normal interaction between the migratory trophoblasts and the maternal uterine tissue. The group of chronic hypertension showed all grades of physiologic changes, 30% had normal physiologic changes, 20% had partial changes and 50% showed complete absence of the physiologic changes. Acute atherosis and subinimal lymphocytic aggregation were found only in the group of PE but not in all such groups. Medial hyperplasia was found in 42% of PE cases and in 40% in chronic hypertension group. Atheromatous changes were found in 4 cases in PE group and in 2 of the group of chronic hypertension. Thrombosis was found in 2 cases of PE and 1 of chronic hypertension Group

Value of Ca 125 determination in preoperative diagnosis of pelvic masses

Preoperative determination of serum CA125 in patients with clinically diagnosed pelvic masses was done in 60 patients with an age range from 25 to 70 years. 20 [33.3%] of these cases had elevated CA125 Level [> 35U/ml], but of these 20 cases only 7 [35%] proved to be malignant. Of the 40 case with normal CA125 level only one case proved to be malignant and her age was above 50 years. No single case below 50 years and normal CA125 had a malignant mass, thus a normal CA125 level by itself is a more reliable predictor of benignity than an elevated level of malignancy and a normal CA125 level with an age below 50 years is a good predictor that the mass is benign. Elevated CA125 level with an age above 50 years raises the possibility [up to 75% in this study] for a pelvic mass to be a malignant one. Of the benign masses encountered in the study, elevated CA125 levels were found in 60% of cases of endometriosis, in 25% of inflammatory pelvic masses, in 18.2% of leiomyomata and lastly in 8.33% of cases in benign ovarian masses. The common occurrence of these non malignant conditions in younger age groups and the fact that malignancies could be associated with inflammatory reaction limit the value of an elevated CA125 in the diagnosis of malignancy in this age group

Value of ultrasonography in the prediction of postmaturity and in improving pregnancy outcome in post-term pregnancy

Forty women in whom pregnancy has extended beyond 42 weeks has been studied by ultrasonography to assess its value in the prediction of post-maturity and in improving the outcome in post-date pregnancy. Post-maturity was found in 25% of cases of post-date pregnancy. The most valuable ultrasonic finding in the prediction of post-maturity was found to be oligohydramnios, 87.5% of cases of oligohydramnios have given birth to post-mature infants and 90.6% of post-date pregnancies with adequate amount of amniotic fluid gave birth to term appearing infants. The outcome of pregnancy was favourable in all cases without post-maturity however respiratory distress happened in half of the post-mature, infants, but no deaths occurred among them. Placental grading, gross fetal body motion as well as fetal respiratory movements were of limited value in the prediction of post-maturity in post-date pregnancy, but if grade [0] or [1] placenta is found, the pregnancy dates should be highly suspected. So, ultrasonography is mandatory in all cases of post-date pregnancy for prediction of post-maturity and taking the necessary measures as regards management as well as the immediate neonatal care and so the outcome of pregnancy could be improved