Comparative study between intravitreal ranibizumab and triamcinolone treatment of diabetic macular edema as regard to optical coherence tomography changes and visual acuity / Estudo comparativo entre o tratamento intravítreo com ranibizumabe e triancinolona do edema macular diabético quanto às alterações na tomografia de coerência óptica e na acuidade visual

Abstract Objectives: To compare the effect of intravitreal Ranibizumab (0.3mg) and Triamicinolone (4mg) on different parameters in spectral domain OCT and their relation to visual acuity of patients with diabetic macular edema. Methods: This study is designed as a prospective randomized study. Patients were randomly divided into 2 groups receiving either Pro re nata intravitreal Ranibizumab (0.3mg) or Triamicinolone acetonide (4mg), to whom Spectral Domain OCT was done as well as best corrected Log MAR visual acuity. Results: 40 patients were included in this study. Comparison and correlation of mean BCVA and mean CMT among and within treatment groups of our study revealed strong and significant relationship between both parameters and showing equal effect of both treatment types regarding them with the consideration that Triamicinolone acetonide treated group (Group B) showed statistically significant lower CMT compared to Ranibizumab treated group (Group A) at three and six months. Also both showed equal effectivity regarding improvement of the photoreceptors integrity and in turn the improvement of the BCVA. Meanwhile the association of CMT and IS/OS integrity was found to be significant only at six months in both groups (p =0.009 in Group A; p =0.031 in Group B). The fading initial effect of a single ranibizumab injection on macular edema can be augmented by following that one injection with two injections of the loading dose. Triamicinolone effect after single injection began to fade at 3 months. Conclusion: Both treatment types had good effect on reduction of CMT and improvement of BCVA and the IS/OS junction with difference in sustainability of their effects due to difference in their pharmacokinetics and need for repeated injections.

Resumo Objetivos: Comparar o efeito do ranibizumabe intravítreo (0,3mg) e triacmicinolona (4mg) em diferentes parâmetros do domínio espectral da OCT e sua relação com a acuidade visual de pacientes com edema macular diabético. Métodos: Este estudo foi concebido como um estudo prospectivo randomizado. Os pacientes foram divididos aleatoriamente em 2 grupos que receberam Ranibizumab Pro rata intravitreal (0,3mg) ou acetonido de Triamicinolona (4mg), a quem foi realizada a Spectral Domain OCT, bem como a melhor acuidade visual de Log MAR corrigida. Resultados: Quarenta pacientes foram incluídos neste estudo. A comparação e a correlação da acuidade visual média e CMT média entre e dentro de grupos de tratamento do nosso estudo revelaram uma relação forte e significativa entre ambos os parâmetros e mostrando um efeito igual de ambos os tipos de tratamento, considerando que o grupo tratado com acetonido Triamicinolona (Grupo B) apresentou significância estatística. menor CMT comparado ao grupo tratado com Ranibizumab (Grupo A) aos três e seis meses. Também ambos mostraram igual efetividade em relação à melhoria da integridade dos fotorreceptores e, por sua vez, a melhora do BCVA. Enquanto isso, a associação de CMT e IS / OS integridade foi significativa apenas aos seis meses em ambos os grupos (p = 0,009 no Grupo A; p = 0,031 no Grupo B). O efeito inicial enfraquecido de uma única injeção de ranibizumabe no edema macular pode ser aumentado seguindo-se aquela injeção com duas injeções da dose de ataque. O efeito triamicinolona após injeção única começou a diminuir aos 3 meses. Conclusão: Ambos os tipos de tratamento tiveram bom efeito na redução da CMT e melhora do BCVA e da junção IS / OS com a diferença na sustentabilidade de seus efeitos devido à diferença em sua farmacocinética e necessidade de injeções repetidas.

Surgical intervention versus endoscopy in the treatment of bile duct stones

Bile duct stones [BDSs] may happen in up to 4%-15% of all patients for whom cholecystectomy is performed. Patients giving CBDS have manifestations including: biliary colic, jaundice, cholangitis, pancreatitis or might be asymptomatic. It is critical to recognize essential and auxiliary stones, in light of the fact that the treatment approach shifts. Stones found some time recently, amid, and after cholecystectomy had likewise contrasting medicines. Distinctive strategies have been utilized for the treatment of CBDS yet the appropriate treatment relies on upon conditions, for example, quiet' fulfilment, number and size of stones, and the specialists involvement in laparoscopy. Endoscopic retrograde cholangiopancreatography with or without endoscopic biliary sphincterotomy, laparoscopic CBD investigation [transcystic or transcholedochal], or laparotomy with CBD investigation [by T-tube, C-tube inclusion, or essential conclusion] are the most regularly utilized strategies overseeing CBDS [Common bile duct stones]. We will survey the pathophysiology of bile duct stones, finding, and distinctive procedures of treatment with particular concentrate on the different surgical modalities

Human leukocyte antigen class II genetic variants are highly associated with rheumatic heart disease in Yemeni patients

To investigate the association of rheumatic heart disease [RHD] with human leukocyte antigen [HLA] class II alleles in Yemeni patients Case control study Al-Thawra Modern General Hospital, Sana'a, Yemen One hundred RHD patients [case group] and 50 healthy subjects [control group] were recruited in this study. Echocardiography was used to include RHD patients [abnormal echocardiography] and healthy subjects [normal echocardiography]. HLA-DRB1 and HLA-DQB1 polymorphisms were genotyped by sequence-specific oligonucleotide-probe polymerase chain reaction [PCRSSOP] reverse dot blot hybridization. The results showed that HLADRB1*07 and HLADQB1*0203 allele as risk factors for RHD [OR = 4.0; 8.7, p = 0.005; 0.02, respectively]. In contrast, the HLADRB1*11, HLADQB1*0305 and HLADQB1*0602 alleles showed a protective association against RHD [OR = 0.32; 0.23; 0.24, p = 0.01; 0.03; 0.01, respectively]. HLA class II genetic variants were a predisposing factor for development of RHD in Yemeni people. This study also replicated the association of HLADRB1*07 with RI-ID and suggested that HLADQB1*0203 allele is a risk factor for RHD

Hypertension control and co-morbidities in primary health care centers in Riyadh

The prevalence of hypertension in Saudi Arabia has been assessed only in preliminary reports. The aim of this study was to determine the degree of control of blood pressure and the prevalence of common hypertension co-morbidities among hypertensive patients attending primary healthcare [PHC] centers in Riyadh. A cross-sectional study was conducted by reviewing medical records of hypertensive patients during May and June 2001. Two hundred fifty-five medical records were selected by a stratified randomization process according to the distribution of the 73 PHC centers in the city and the total number of hypertensive patients registered in the mini-clinic of each PHC center. Trained mini-clinic nurses collected data using a data collection form developed for this purpose. Of 255 patients, 121 [47.5%] were males and 134 [52.5%] were females; the mean age was 57.2 +/- 11.1 years and 8.3% were smokers. The majority, 204 [85.7%], had greater than normal body weight. Only 101 [40.4%] had controlled systolic BP and 129 [51.6%] had controlled diastolic BP. The most common co-morbidity was diabetes mellitus, found in 98 [38.4%], followed by dyslipidemia in 50 [19.6%], bronchial asthma in 28 [11.0%] and renal diseases in 12 [4.7%]. Except for steoporosis, which was reported by females only [P=0.003], the occurrence of hypertensive co-morbidities did not vary from other demographic characteristics. This study demonstrated poor blood pressure control in the mini-clinics in PHC centers. To improve the quality of care for hypertensive patients, we recommend an improvement in PHC physician knowledge of and attitudes toward the importance of achieving targeted blood pressure levels

Head and neck malignancies in Yemen preliminary study

At the histopathology laboratory at Al Thawra Modern General Hospital in Sana'a, 1295 cases of neoplastic lesions of the head and neck were revised to show the relative incidence of malignant lesions in different sites. Squamous cell carcinoma was the predominant lesion [45%]. The site most frequently affected was the mouth [25.1%]. Males were affected more than females by a 11:9 ratio. The mean age was 47.6 years. No data were available regarding residence, occupation, or habits