Posterior vitreous detachment and retinal detachment after implantation of the visian phakic implantable collamer lens

To evaluate the vitreoretinal complications in myopes after Visian implantable collamer lenses [ICL] implantation. This is a retrospective, observational, non-comparative clinical study that evaluated 617 consecutive myopes who underwent ICL implantation at the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen between July 2006 and May 2010. Follow up ranged from 6 months to 40 months. Preoperative and postoperative patient evaluation included manifest and cycloplegic refractions, uncorrected [UCVA] and best spectacle-corrected visual acuity [BSCVA], slit-lamp biomicroscopy, intraocular pressure and dilated retinal examination. Investigations included corneal topography, central corneal thickness, anterior chamber depth and white to white diameter. Retinal diseases and complications were recorded and analyzed preoperatively and postoperatively. Preoperatively, 61 [9.9%] eyes had posterior segment pathology requiring prophylactic laser photocoagulation. One eye developed spontaneous rhegmatogenous retinal detachment [RRD], one eye developed traumatic retinal detachment and two eyes required laser treatment postoperatively. The overall retinal detachment rate post-ICL was 0.32%. Posterior segment complications are rare after ICL implantation but dilated vitreoretinal assessment is important before and after the procedure. Patients with suspicious retinal lesions need a comprehensive vitreoretinal evaluation by a retinal specialist. If a patient develops floaters or blurry vision he/she requires further assessment by a vitreoretinal specialist

Post-LASIK interface fluid syndrome caused by steroid drops

Interface fluid syndrome after laser in situ keratomileusis [LASIK] is a rare but visually threatening postoperative complication. In this case series we present 8 post-LASIK eyes that developed interface fluid syndrome after prolonged steroid use. Patients presented with signs mimicking diffuse lamellar keratitis [DLK] that worsened with steroid treatment. Slit-lamp examination revealed corneal haze and an optically clear fluid-filled space between the flap and stroma. The IOP was high in all cases. Topical steroids were stopped and replaced with topical and systemic anti-glaucoma medications resulting in a dramatic improvement in visual acuity

[ impact of clinical steps of porcelain fused to metal restorations on periodontal health]

Statement of Problem: Periodontal health plays a key role in the success of restorative treatment and clinical stages of restorative treatments may affect the health of periodontium

Purpose: The aim of the present study was to investigate the effects of clinical stages of porcelain fused to metal [PFM] restorations on free gingival margin [FGM], clinical attachment level [CAL], plaque [PI], and gingival [GI] indices

Material and Method: 15 patients requiring PFM restoration on the maxillary central incisor or maxillary and mandibular premolars [test group] with an intact adjacent counterpart [control group] were selected. FGM, CAL, PI, and GI were measured and recorded at baseline [0], after preparation [1], after impression [2], after final cementation [3], 7 days after cementation [4], 1 and 6 months after cementation [5 and 6]. Independent Sample T-test and Man-Whitney U Test were used for comparison of intra-group and inter-group differences, respectively

Results: Statistically significant differences were seen between the test and control groups in FGM [3], CAL [2, 3 and 6], and GI [6]. In the test group, significant differences were observed in FGM [1-3], CAL [1-6], and GI [3 and 6] compared to the baseline. In the control group, however, the variables did not show any significant difference compared to the baseline except for PI [4-6] and GI [6]

Conclusion: The findings of the present study indicated that clinical stages of making porcelain fused to metal [PFM] restorations were accompanied by a significant loss of clinical attachment level, increase in GI, and deepening of the gingival sulcus

Atopic profile of asthmatic children in Bahrain

This study aimed to define the profile of asthmatic children in Bahrain and the prevalence of sensitization to aeroallergens and foods. A total of 95 children who were clinically diagnosed with asthma were enrolled: 71.6% mild, 20.0% moderate and 8.4% severe asthma [NIH criteria] Serum IgE concentrations were elevated [> 200 kU/L] in 21.1% of patients and highly elevated [> 400 kU/L] in 9.5%. Absolute eosinophil counts were elevated [>350 X 10[6]/L] in 54.8%. Overall, 67.4% of children were atopic; 56.8% were sensitive to inhalant allergens and 39.0% to foods. The atopic profile was generally similar to asthmatic children in the region and worldwide. Conditions significantly associated with atopic asthma included food allergies, allergic rhinitis and eczema

Intraoperative and early postoperative complications of laser in situ keratomileusis in Yemen

To determine the intraoperative and early postoperative complications and visual outcome of laser in situ keratomileusis [LASIK] surgery for the correction of myopia. The first 2000 consecutive myopic LASIK eyes operated at the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen from June 2005 to October 2006 were the study group. This is a retrospective observational noncomparative clinical study.The preoperative and postoperative spherical equivalent, best-corrected visual acuity, and corneal status was recorded. The intraoperative and early postoperative complication were reviewed. There were 15 [0.8%] intraoperative microkeratome-related flap complications recorded namely, buttonhole [5], incomplete cut [3], thin flap [3], epithelial defect [3] and eccentric flap [1]. There were 4[0.2%] non-keratome related surgical events of inability to obtain sufficient suction. There were 46 [2.3%] first-day postoperative complications. Nine eyes required repositioning of the flap for macro-striae[5], or displaced flap [4]. Four needed washing under the flap for severe deep lamellar keratitis [2], and gauze debris under the flap [2]. Laser enhancement was carried out in 28 eyes [1.4%], and uncorrected visual acuity of 20/40 or better was attained in 96.9% of treated eyes. Twenty-four eyes [1.3%] lost more than 2 lines of best-corrected vision. The LASIK is a safe and effective procedure for the correction of myopia. A small number of patients may suffer complications, most of which are not serious, and rarely lead to visual loss of more than 2 Snellen lines

Reasons for not performing keratorefractive surgery in patients seeking refractive surgery in a hospitAl based cohort in "Yemen"

To determine and analyze the reasons why keratorefractive surgery, laser in situ keratomileusis [LASIK] and photorefractive keratectomy [PRK] were not performed in patients who presented for refractive surgery consultation. A retrospective observational study was performed between January 2006 and December 2007 in the Yemen Magrabi Hospital. The case records of 2,091 consecutive new patients who presented for refractive surgery were reviewed. Information from the pre-operative ophthalmic examination, such as refractive error, corneal topography and visual acuity, were analyzed. The reasons for not performing LASIK and PRK in the cases that were rejected were recorded and analyzed. In this cohort, 1,660 [79.4%] patients were advised to have LASIK or PRK from the 2,091 patients examined. LASIK and PRK were not advised in 431 [21%] patients. The most common reasons for not performing the surgery were high myopia >-11.00 Diopters [19%], keratoconus [18%], suboptimal central corneal thickness [15%], cataract [12%] and keratoconus suspect [forme fruste keratoconus] [10%]. Patients who requested keratorefractive surgery have a variety of problems and warrant comprehensive attention to selection criteria on the part of the surgeon. Corneal topographies and pachymetry of refractive surgery candidates need to be read cautiously. High-refractive error, keratoconus and insufficient corneal thickness were found to be the leading reasons for not performing keratorefractive surgery in this study

Vitreoretinal complications in Yemeni patients with keratorefractive surgery

To evaluate vitreoretinal complications in patients undergoing laser keratorefractive surgery. This retrospective observational non-comparative clinical study was carried out between June 2005 and March 2008, and included 4691 consecutive laser keratorefractive surgery procedures for 2480 patients performed in the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen. Patients were followed up for 12-36 months. The preoperative patient evaluation included manifest and cycloplegic refractions, uncorrected visual acuity, best spectacle-corrected visual acuity, slit-lamp biomicroscopy, and dilated vitreoretinal assessment. Retinal diseases were recorded and analyzed during the preoperative and postoperative care. Sixty-five [1.4%] of the 4691 eyes had posterior segment pathology requiring intervention. In the preoperative assessment, 57 eyes had prophylactic laser photocoagulation for retinal lesions. Seven eyes developed posterior vitreous detachment postoperatively, and 4 of these required prophylactic laser therapy for lattice degeneration and retinal breaks. Two eyes [0.04%] developed rhegmatogenous retinal detachment, which occurred spontaneously. One patient developed cystoid macular edema in both eyes. Most complications are related to the refractive outcome or to corneal and anterior segment injury. Posterior segment complications are rare, but dilated vitreoretinal assessment is important before and after laser keratorefractive procedures. Patients with suspicious retinal lesions need a comprehensive vitreoretinal evaluation by a retinal specialist

Portal vein thrombosis and haematemesis in chronic liver disease. Are P-selectin and PSGL-1 clues?

Bleeding and thrombotic complications are common problems in patients with chronic liver disease [CLD]. The aim of the present study was to evaluate the level of soluble P [sP]-selectin, and P-selectin glycoprotein ligand-1 [PSGL-1] [CD162] expression on neutrophils among patients with CLD and to clarify the role of their interaction, by measuring the platelet leucocyte aggregates, on the clinical outcome of the haemostatic balance in those patients. We also investigated the hypothesis that the balance between platelet activation and endothelial biological function is impaired. sP-selectin and thrombomodulin [TM] levels were measured by enzyme-linked immunosorbent assay [ELISA] and flowcytometric detection of CD162 was performed. Platelet-leucocyte aggregation [PLA] in whole blood was measured as positive for CD41a and CD45 in 66 CLD patients divided into the portal vein thrombosis group [PVT] [n = 25], the haematemesis group [n = 21] and the haemostatically stable group [n = 20]. sP-selectin was significantly elevated in all patient groups. Decreased surface expression of CD162 on neutrophils was detected in all patients' groups. PLA was statistically significantly increased in the PVT group. TM was statistically significantly increased in the PVT, haematemesis and haemostatically stable groups. PLA may play a role in the unique PVT outcome of the haemostatic balance in a group of patients whose credentials of hyperdynamic portal circulation predispose them to bleeding rather than thrombosis. Consequently, P-selectin-targeted therapy may be used to prevent this complication

Prevalence and related factors of asymptomatic hyperglycemia among Kurd in Duhok, Iraq

Detection of the unknown cases of diabetes mellitus and its related risk factors is of great medical and public health interest. To estimate the prevalence of and the environmental risk factors associated with asymptomatic hyperglycemia in apparently healthy adults of the general population of Duhok city, northern Iraq. This is a cross sectional survey conducted on a representative sample of the population of Duhok city. The target population for this study were relatives of patients seen at surgical outpatient Clinics located in Azadi Teaching Hospital during one year period, out of the 5,302 contacted healthy adult subjects, 941 [17.9%] were inclusive. The prevalence of previously undiagnosed diabetes mellitus was 10.9% and impaired glucose homeostasis [impaired glucose tolerance and impaired fasting glucose] was 14.3%. A large proportion of subjects had increased body weight [69.2%], sedentary lifestyle [67.7%], married [83.6%], and illiterate [66.5%] and nearly one third [33.0%] had positive family history of diabetes mellitus. The prevalence rate of glucose intolerance was higher in subjects with overweight and obese [52.1%], positive family history of diabetes mellitus [36.1%], no physical activity [32.5%], low educational level [29.95], and married [28.9%] versus normal weight [9.3%], negative family history of diabetes mellitus [19.9%], physical activity [10.2%], high educational level [19.2%] and unmarried [6.5%] respectively [p<0.01] for all parameters. Data of this study has highlighted the risk factors and draws attention to the need for large-scale screening, followed up by appropriate management measures

[Evaluation of alteration in mucogingival junction location following use of connective tissue graft and coronally advanced flap]

One of the most successful procedures in root coverage is free connective tissue graft combined with coronally advanced flap. The assessment of mucogingival junction [MGJ] changes during healing period is of great importance. The aim was to assess the positional changes of MGJ following use of connective tissue graft in combination with coronally advanced flap in 3- 6- and 12- month intervals. In this cross sectional and interventional study, 19 cases of gingival recession in 10 patients with Miller class I and II defects >/= 4 mm were treated with connective tissue graft and coronally advanced flap. After phase I therapy, an acrylic stent was made. Clinical parameters monitored in this study included clinical attachment level [CAL], mucogingival junction [MGJ], keratinized gingival [KG] width and attached gingival [AG] width. Each parameters were measured at baseline, and 3- 6- and 12- month intervals. For comparison, statistical analysis was performed using Paired-T test at p < 0.05.The mean distance from MGJ to acrylic stent at baseline was 5.94 +/- 0.88 mm which during surgery, was moved coronally by 4.39 +/- 0.65 mm. Distance from MGJ to CEJ immediately after surgery was 1.55 +/- 0.58 mm. This distance during healing periods at 3, 6, and 12 months changed to 3.13 +/- 0.87, 3.34 +/- 0.66, and 3.65 +/- 0.64 mm, respectively indicating a gradual regression of MGJ to presurgical position. Keratinized gingival width had remarkable changes in 3-, 6- and 12 month intervals in comparison to the baseline. Mean presurgical width of keratinized gingiva was 1.55 +/- 0.76 mm which increased to 3.44 +/- 0.49 mm [p <0.05]. Mean presurgical attached gingival was 0.36 +/- 0.62 mm and 12 months after surgery it was increased to 2.18 +/- 0.50 mm 12 month after surgery [p <0.05]. Presurgical clinical attachment level was 5.81 +/- 0.88 mm which was decreased to 1.55 +/- 0.57 mm, 12 month after surgery.Based on the findings, it seems that mucogingival junction has a gradual tendency to moved back to its presurgical position after use of free connective tissue graft with coronally advanced flap technique

Diagnostic value of bone sounding technique for estimation of level in periodontal defects

Alveolar bone level measurement in periodontal disease is very important because it may affect planning of forthcoming surgery, treatment response and prognosis. Surgical approach is the most accurate procedure for obtaining this measurement. Nowadays, transgingival probing as a non-invasive and accurate method has been claimed to be a proper substitution for surgical measurement and direct visualization. This study aimed at evaluation of diagnostic value of bone sounding technique in estimation of bone level in I, II and III-wall periodontal defects. Ninety vertical defects in 37 individuals with chronic periodontitis having one, two or three-wall defects were assessed. Bone levels were measured by UNC-15 probe. The resulted values were compared with the values obtained during surgery. Collected data were analyzed using Paired samples T test and Pearson's correlation coefficient. High and significant correlation was found between the results of transgingival probing and surgery methods [0.97, 0.94 and 0.95 in one, two, and three-wall defects respectively [p < 0.001]]. The mean bone levels measured by transgingival probing were 0.21, 0.53 and 0.19 mm less than their assigned values in surgery and there was no significant difference between one and three- wall defects [p < 0.001]. The findings of this study indicated a high correlation between the two procedures, bone sounding and surgery, in detection of bone level. Due to the negligible difference, it seems that trans gingival probing could be considered as a feasible replacement for invasive surgical approach in detection of alveolar bone level

effects of removable partial dentures on the periodontal health status of abutment and non abutment teeth

A removable partial denture [RPD] is a common treatment modality for restoration of partially edentulous ridges. However this type of treatment may produce serious periodontal problems for remaining teeth. The aim of this study was to determine the effects of RPDs with RPI design on the periodontal indices of abutment and non abutment teeth. For this interventional and prospective study, 22 patients [30-68 years old; mean age of 48 years] were selected. All patients has Kennedy class I partial edentulous areas and were supposed to use removable partial dentures. Forty eight abutment and 48 non abutment teeth were assigned for this study. Clinical parameters including clinical probing depth [CPD], clinical attachment level [CAL], keratinized gingival width [KG], gingival index [GI] were measured in abutment and non-abutment teeth at baseline,1,4 and 12 months after delivery of RPDs. Data were analyzed using wilcoxon test. All clinical indices with the exception of gingival index, at the time of baseline to 12 months, showed significant differences between abutment and non-abutment teeth [p < 0.001]. Significant differences were also noted for all indices between abutment and non-abutment teeth after 12 months. The results of this study indicated that removable partial denture with RPI design plays an important role in producing and intensifying the periodontal diseases in both abutment and non abutment teeth. It seems that this effect is due to the accumulation of more bacterial plaque. So, use of appropriate design and recommendation of good oral hygiene may decrease the severity of side effects

Use of three dimensional ultrasound for nuchal translucency measurement in early pregnancy

To evaluate the role of three dimensional ultrasound in Nuchal translucency measurement in the first trimester. Prospective cross sectional study. Forty eight women pregnant in their first trimester were subjected to conventional and there dimensional ultrasound examination by two sonographers at a time using Vulson 730 machine. Scanning was saved and re-evaluated for nuchal translucency measurement. There was a good agreement between two and three dimensional altrasound. There was a positive correlation between nuchal thickness [NT] and crown rump length [CRI] [p<0.01]. There were negligible clinical differences in measurements of NT and CRL between the different observers. Only two cases had NT = 6 mm and both aborted. Nuchal translucency measurement is feasible, safe and accurate. This technique is potentially useful in fetuses that are not in all optimal position for standard 2D nuchal translucency measurement

[Effect of cigarette smoking quantity on periodontal tissue response to phase I therapy]

Although bacterial plaque is the primary ethiologic factor in the initiation of chronic periodontitis, there is some predisposing factors such as smoking which may aggravates disease process and its roll appears to be considered more important recently. The purpose of the present study was the evaluation of the effect of the quantity of cigarette smoking on periodontal tissue response following phase I therapy. Thirty patients [26 male and 4 female] with mean age of 48 +/- 11 years participated in this interventional and cross-sectional study. All patients suffered from generalized moderate chronic periodontitis. The patients were divided into three equal groups of 10 [heavy smokers, light smokers and non smokers], according to the number of cigarette consumption. The smoker groups had a history of cigarette consumption at least for the past two years. Clinical probing depth, clinical attachment level and bleeding on probing were evaluated for the patients at baseline and eight weeks following completion of phase I therapy. The results were analyzed using Wilcoxon rank and Kruskal- Wallis tests. No statistically significant differences were found in the evaluated variables between the groups except for BOP at baseline. All parameters decreased significantly eight weeks after completion of phase I therapy, but in comparison between three groups, only differences of CPD reduction and CAL gained between heavy and non-smokers were statistically significant. The present study indicated that heavy cigarette smoking have a negative effect on periodontal tissue response to phase I therapy. This effect depends on the number of daily smoked cigarettes and is increased with more than 20 cigarettes smoking per day

Impact of neutrophil apoptosis on haemostatic activation in chronic liver disease patients

Recent studies suggest the impact of apoptosis on the mechanisms leading to hypercoagulability. We aimed to clarify the potential role of neutrophil apoptosis in neutropenia and hypercoagulable state encountered in chronic liver disease patients. This study was conducted on fifteen normal controls and fourty five patients with chronic liver disease classified according to modified Child Pugh classification into, Child A, B and C groups [15 cases each]. Studied Haemostatic parameters include, prothrombin time, partial thromboplastin time, tissue factor, protein C antigen, protein S antigen, and markers of haemostatic activation [prothrombin fragment 1+2, thrombus precursor protein and D-dimer]. Flowcytometric study was done for quantitative assay of neutrophil apoptotic subpopulations to detect the percentage of early and late apoptotic, and necrotic neutrophils using AnnexinV-FITC/Propidium iodide dye. Semiquantitative assay of apoptotic neutrophils showing DNA fragmentation was performed on neutrophil culture using terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick end labeling [TUNEL] test. In addition to enzyme linked immunosorbent assay for soluble Fas [APO-1/CD95] in culture supernatant. The results revealed a rise in the neutrophil apoptotic and necrotic markers with progression of the disease, and they were inversely correlated with the absolute neutrophil count. The apoptotic neutrophil cells showed a significant positive correlation with several haemostatic parameters [tissue factor, prothrombin fragment 1+2, thrombus precursor protein and Ddimer], which further incriminate the apoptotic mechanisms in the hypercoagulable state encountered in this clinical setting. Enhanced neutrophil apoptosis and necrosis in patients with chronic liver disease may explain in part the mechanism of neutropenia in these patients and may be one of the important factors which drive the haemostatic balance towards the hypercoagulable state

Evaluation of insulin-like growth factor binding protein-1 in cervico-vaginal secretions as an indicator of premature rupture of membranes: a comparison with nitrazine test and amniotic fluid index

Objective: To evaluate the diagnostic potential of insulin-like growth factor binding protein-1 [IGFBP-1] in cervicovaginal secretions as an indicator of premature rupture of membranes [PROM] in comparison with the nitrazine test and amniotic fluid index [AFI]. The predictivity of these tests on the latency of pregnancy in patients with PROM was also studied

Design: Prospective controlled study

Setting: Department of Obstetrics and Gynaecology, Faculty of Medicine, Alexandria University

Subjects: 50 pregnant females [20 continued PROM, 20 suspected PROM and 10 with intact membranes acting as controls]

Interventions: Patients were subjected to sterile speculum examination, the nitrazine test, measurement of IGFBP-1 in cervicovaginal fluid by a rapid dipstick method [PROM test] and ultrasonographic assessment of AFI by the four quadrant method. All patients were followed up for one week to determine who went into spontaneous labour

Results: The mean gestational age did not differ significantly between groups. The sensitivity. Specificity, positive and negative predictive values of the nitrazine test, AF] and the PROM test in diagnosing PROM were 68.75%, 30%, 64.7%, 37.50% and 75%, 89%, 92.31%, 66.67% and 96.90%, 100%, 100%, 94.70%, respectively. Only a positive PROM test was associated with delivery within 1 week

Conclusion: The dipstick immunochromatographic method of detecting IGFBP-l in cervicovaginal fluid [PROM test] is a. rapid, reliable and non-invasive method in diagnosing PROM. It is the most accurate predictor of the latency of pregnancy in patients with suspected PROM

journey across the wall of varicose veins: what physicians do not often see with the naked eye

To examine varicose veins [VVs] from inside out in order to help surgeons and general practitioners better understand the pathogenesis of the disease and improve their management. A comprehensive examination of the wall of VVs was performed using transmission electron microscopy. The ultrastructural morphology of the collagen, elastin and smooth muscle content of the wall was analyzed in a sample of 10 patients [4 male and 6 female] and 10 matched controls aged between 37 and 50 years. Analysis of the tunica media revealed that the smooth muscle cells were significantly separated from each other by a marked increase in amorphous and fibrous tissue in which many of the collagen and elastin fibers lost their normal structural arrangement. The cells contained a large number of membrane-bound intracellular vesicles and cytoplasmic vacuoles. The collagen fibers were smaller and thinner than what is commonly seen in normal veins, and they were widely separated from each other. A light electron-lucent center was observed in the middle of the fibers. Similar changes were also seen in the intima and were associated with irregular plaque-like intimal thickening. Our study revealed a significant separation among smooth muscle cells in the wall of VVs, and the presence of an abnormal amorphous extracellular matrix and intracytoplasmic vacuoles could reflect unusual possible secretory and phagocytic roles of smooth muscle cells. This could provide an important explanation for the abnormal contractile function of these cells in VVs

Validity of using bovine teeth as a substitute for human counterparts in adhesive tests

Shear and tensile bond strengths of 40 human and 40 bovine teeth were compared. Teeth were randomly assigned to group I, which received light-cured composite resin, or group II, which received light-cured resin-reinforced glass ionomer cement. The groups were subdivided for shear and tensile bond strength tests, which were conducted on a universal testing machine installed to a computer transducer. Statistical analysis revealed a highly significant difference between shear and tensile bond strengths of human and bovine enamel; however, regression prediction equations support the use of bovine teeth as a reliable substitute to human counterparts in bonding studies of orthodontic adhesion

Cyclic nucleotide phosphodiesterase in atopic patients

Phosphodiesterases share with adenylate cyclase the control of intracellular camp level. Cyclic AMP effects in the cells are mediated via camp dependent protein kinase [A kinase]. Therefore, it is expected that control of intracellular camp levels and hence, PDE activation would be predicted on the prequirements for A kinase activation. To evaluate the role of PDE in the atiopathogenesis of AD, 36 patients had been tested for PDE activity is isolated MNL reparation verus fifteen normal age and sex matched normal volunteers. The results data showed that camp specific PED activity in atopic MNL is consistently and significantly elevated compared to normal persons. Also, there is a strong correlation between the severity of the lesions and PED activity which was found to be increased in all phases of AD. These results certainly raise the possibility that elevated PDE activity may reflect a primary biochemical abnormality in AD