Association of Well-Being Index and Cognitive Impairment with Primary Open Angle Glaucoma Patients of Malaysia: A Case-Control Study

The purpose of this study was to determine the association of well-being and cognitive impairment with primary open angle glaucoma (POAG) patients attending a tertiary care hospital in Malaysia. Fifty-four individuals were recruited for study as cases were matched with 60 individuals as the control subjects, and data were collected using the WHO well-being index and the validated 6-item cognitive impairment test dementia test. The results showed that there was no significant association between gender, ethnicity, socioeconomic status and POAG. Patients with POAG had significantly lower well-being index scores (mean 67.93) than the control group (mean 81.60) with P-value < 0.001. Similarly, patients with POAG had a significantly higher score of cognitive impairment (CIT test) (mean 6.15) compared to the control group (mean 0.40) with P-value < 0.001. Consequently, POAG is likely to be associated with higher cognitive impairment and lower well-being index.

Fostering critical thinking and collaborative learning skills among medical students through a research protocol writing activity in the curriculum / 한국의학교육

PURPOSE: This intervention was aimed to analyse the effect of academic writing and journal critiquing as educational approaches in improving critical thinking and collaborative learning among undergraduate medical students. METHODS: A research proposal writing format was created for the 4th year medical students of Melaka Manipal Medical College, Malaysia during their ophthalmology clinical postings. The students worked in small groups and developed research protocols through an evidence based approach. This was followed by writing reflective summaries in academic portfolios about the activity undertaken. A mixed methods study was designed to explore the possible role of collaborative research proposal writing in enhancing critical thinking and collaborative learning. RESULTS: Analysis of reflections submitted by 188 medical students after the intervention indicate that majority of them found an improvement in their skills of critical thinking and collaborative learning as a result of research protocol writing. All participants agreed that the model helped in applying concepts to new situations in the form of designing their own study, which reflected in enhanced higher order cognitive skills. CONCLUSION: This study shows that the introduction of a structured module in the core medical curriculum that focuses on research writing skills embedded with collaborative and reflective practices can enhance collaborative learning, critical thinking, and reasoning among medical students.

Visual outcome following posterior capsule rupture during phacoemulsification in a tertiary care hospital in Malaysia

Purpose: To analyse the visual outcomes of cases with posterior capsule rupture (PCR) compared to those without PCR following phacoemulsification. The occurrence of posterior capsule rupture during phacoemulsification surgery for cataract can have serious implications in the visual recovery. However, recognition of PCR and proper management can yield a successful visual outcome. This study analysed the visual outcomes of cases with PCR compared to those without PCR. Methods: This is a case-control study. All patients who underwent cataract surgery from 2011 to 2012 in Hospital Melaka were traced from the National Eye Database (NED) of Malaysia. The visual outcomes were classified as good, borderline and poor as per WHO guidelines. The data was analysed with SPSS version 12 IBM. Results: Out of 80.4% (2519) of eyes that had undergone phacoemulsification (PHACO) type of surgery, 3.06% (77 cases) had posterior capsule rupture complication. There was no significant difference in the visual outcome of borderline between cases with PCR and cases without PCR (Odds Ratio (OR) 0.989; 95% Confidence Interval (CI) 0.382- 2.560). However, cases with PCR were significantly less likely to have good vision compared to those without PCR (OR 0.335; 95% CI 0.157-0.714). Conclusion: The study reveals that a significant number of patients without PCR had good vision, whereas those with PCR did not get good vision. We would like to suggest meticulous care during phacoemulsification surgery to avoid PCR in order to obtain good visual outcomes.

Posterior Capsule Rupture during Phacoemulsification among Patients with Pseudoexfoliation–Is There A Correlation?

This study was done to correlate the occurrence of posterior capsule rupture among patients with pseudoexfoliation during phacoemulsification. This was a retrospective audit of patients who underwent phacoemulsification type cataract surgery from January 2011 to December 2012 in a tertiary hospital in Malaysia. Data was obtained from the National Eye Database (NED) of Malaysia. The data was analysed using SPSS version 21.0. By using logistic regression analysis, it was found that there was no significant increase in the occurrence of posterior capsule rupture among patients with pseudoexfoliation. Hence, we concluded that there was no correlation between the occurrence of posterior capsule rupture and the presence of pesudoexfoliation among patients who underwent phacoemulsification.

HIV- and AIDS-related Ocular Manifestations in Tanzanian Patients

Background: Although around 70% of HIV+ cases used to have ocular manifestations, the late reporting of cases often results in severe forms of ocular morbidity that would otherwise have been prevented. The objective of this study was to describe the ocular manifestations of HIV and AIDS-related patients who had been admitted to TM Jafferji Hospital, Dar-es-Salaam, Tanzania. Methods: Proven cases of HIV were recruited in this study. Detailed slit lamp examination and fundoscopy using a +90D lens were carried out in all cases after thoroughly dilating the pupil with 1% Tropicamide eye drops. Results: Around 90% of the recruited cases were in clinical stage III and IV HIV. The notable ocular manifestations included micro-vasculopathy of the retina in 25%, uveitis in 8%, CMV retinitis in 7%, neuro-ophthalmic manifestation in 6%, Herpes zoster ophthalmicus in 5%, Kaposi’s sarcoma in 3% and conjunctival carcinoma in 2% of cases. Fifty-three percent of the cases had other anterior segment disorders like conjunctivitis, blepharitis and corneal ulcers. Conclusion: Most of the cases recruited in our study were in the late stages of HIV. A significantly high number of cases (70%) had ocular manifestations. Around 53% had additional anterior segment disorders like conjunctivitis, blepharitis and corneal ulcers.

Manual small incision cataract surgery-pearls and pitfalls

To evaluate the amount of post operative astigmatism and post operative Visual prognosis of the operated cases and to note the intra-operative difficulties and postoperative complications encountered in manual small incision cataract surgery. 20 cases were recruited for study. Retrospective analysis was done in all the cases operated by the author [SS] between Nov2006 and Feb 2007. Preoperative keratometry reading and visual acuity along with ultrasound evaluation of posterior segment of all recruited cases noted Per operative difficulties faced by the surgeon as well as postoperative complications were noted.- Postoperative Keratometer reading in 1[st] week after surgery and after 6 weeks- of surgery were taken along with unaided as well as best corrected visual acuity in all cases. Out of 20 cases around 4 [20%] cases had pre-operative corneal astigmatism. Average amount in all cases were around 1D. 2cases [10%] had nuclear cataract. Only few intra operative difficulties faced by the surgeon difficulty in prolapsing nucleus to anterior chamber in 3 cases [15%] and posterior capsular tear with vitreous in A/C in one case [5%]. In only 2 cases [10%,] single horizontal suture at the external wound was given. Two cases [10%] had post operative corneal edema which cleared after 6 days and one case had iritis persisting for a week. The mean postoperative astigmatism during 1[st] week after surgery was around 0.83 diopter; and after 6 weeks the mean astigmatism was around 0.63D. Postoperative VA was 6/18 and better in 1[st] week found in 14 cases [70%]. The postoperative VA of 6/18 or better in 16 cases [80%] after 6 weeks. In our study around 16 [80%] cases out of 20 had non eventful surgery. Most cases [>90%] had minimal SIA. And Visual prognosis excellent astigmatism control and visual recovery after SICTS, minimal per-operative difficulties and with negligible postoperative complications we strongly recommend the trend of cataract surgery should shift towards SICS