Treatment of refractory diffuse diabetic macular edema with lntravitreal bevacizumab

To analyze the short term visual acuity and anatomic response after a single dose of off-label intravitreal injection of bevacizumab in diffuse diabetic macular edema [DME] not responding to conventional laser photocoagulation. Prospective analysis of consecutive case series of 45 eyes of 38 patients with refractory diffuse DME who had one intravitreal injection of 1 .25 mg of bevacizumab [Avastin] and followed up for 3 months. All patients passed at least six months since their last laser treatment before inclusion in the study. Patients underwent best corrected visual acuity determination, intraocular pressure measurement, stereoscopic biomicroscopy of the macula and measurement of the retinal thickness by optical coherence tomography [OCT] at base line and follow up visits. At 1 month post-injection, visual acuity improved by 1 line in 7 eyes, unchanged from the pre-injection levels in 24 eyes and deteriorated in 14 eyes. At 3 months post injection, visual acuity improved in 1 8 eyes, it remained unchanged in 13 eyes and deteriorated in 14 eyes. The mean logMAR visual acuities were 0.60 [SD +/- 0.34], 0.64 [SD +/- 0.31] and 0.61 [SD +/- 0.32] at pre-injection, at 1 month post-injection and at 3 months post-injection respectively; but this mean decrease in vision was statistically not significant [P value=0.099]. The foveal thickness on optical coherence tomography had decreased in 27 eyes and it increased in 1 8 eyes at 1 month post-injection. At 3 months following injection, foveal thickness was reduced in 34 eyes, but was increased in 11 eyes. The mean foveal thicknesses were 444.95 micro [SD +/- 1 27.36], 394.95 micro [SD +/- 138.03] and 378.32 micro [SD +/- 112.01] at pre-injection, 1 month post-injection and 3 months post-injection respectively. This decrease in the foveal thickness was statistically significant [P value<0.001]. Intravitreal bevacizumab is effective in patients with diffuse DME which is refractory to treatment with conventional macular laser photocoagulation

Current concepts in intravitreal drug therapy for diabetic retinopathy

Diabetic retinopathy [DR] is a major cause of preventable blindness in the developed countries. Despite the advances in understanding and management of DR, it remains a challenging condition to manage. The standard of care for patients with DR include strict metabolic control of hyperglycemia, blood pressure control, normalization of serum lipids, prompt retinal laser photocoagulation and vitrectomy. For patients who respond poorly and who progressively lose vision in spite of the standard of care, intravitreal administration of steroids or/and anti-vascular endothelial growth factor [anti-VEGF] drugs appear to be a promising second-line of therapy. This review discusses the current concepts and the role of these novel therapeutic approaches in the management of DR

Intravitreal injection of triamcinolone acetonide for the treatment of refractory diabetic macular edema

A prospective descriptive / non-comparative pilot study was used to evaluate the efficacy of intravitreal injection of triamcinolone acetonide [TA] for the treatment of patients with refractory diabetic macular edema that had not responded to laser treatment. Forty eyes of 35 patients with visual acuity [VA]

Outcome of the treatment of retinopathy of prematurity in Qatar

To evaluate the results of the treatment of Retinopathy of Prematurity [ROP] patients in Qatar a retrospective analysis was made of 43 infants treated between January 1999 and December 2002 initially with indirect laser transpupillary photocoagulation. Cryotherapy was used only on those needing re-treatment. A favorable outcome overall was obtained in 40 cases [90%] after ten received re-treatment. The statistical interpretation, complicating factors and outcomes are discussed. It is concluded that the results of threshold ROP treatment in Qatar are encouraging

Endometrial histological changes observed by light and electron microscopy among norplant Ousers

Endometrial biopsies were taken from 40 women attending the Fertility Care Unit [FCU], Mansoura University Hospitals who were using Norplant for more than 6 months, thirty cases were complaining of menstrual disturbances and ten were regularly menstruating, Endometrial biopsies were also taken from 10 women attending the FCU and asking for IUCD insertion with no previous use of any hormonal therapy in the last six months and these cases were considered as control. Endometrial biopsies were subjected to light and electron microscopical examination to identify the ultrastructural changes of the endometrium among Norplant users aiming at better understanding of the mechanism of bleeding that occur in some Norplant users. Regressive to atrophic, suppressed and hyperplastic changes were observed in the endometrium of Norplant users complaining of irregular bleeding. It was found that Norplant induces alteration in the ultrastructure of endometrial cells, as gaping areas in the basement membrane, defective ciliogenesis, and irregularity of epithelium including necrosis and denudation. Moreover, endothelial hypertrophy of small blood vessels, and loss of the epithelium of the uterine lumen exposing blood vessels in the underlying stroma were also observed, especially among Norplant users with abnormal uterine bleeding. These endometrial ultrastructural changes may explain the mechanism of bleeding and hence can be a helpful guidance to the best therapeutic modality of abnormal bleeding in some Norplant users

Effect of increasing dietary calcium on lipid metabolism in rats

The influence of increasing dietary calcium level from 0.5% to 2.5% on serum and tissue lipids in a low fat, cholesterol free diet containing sucrose or starch with corn oil or ghee was studied in male albino rats for six weeks. The concentration of serum total cholesterol tended to be lower [not significant] with higher calcium level. Liver cholesterol was lower for rats fed starch diets, also, for rats fed sucrose-oil diets. Cholesterol in heart was lower for rats fed oil- starch diet. Triacylglycerol concentration was lower in serum and liver of rats fed ghee-sucrose and higher in liver of rats fed oil- starch diets. The concentration of phospholipids was lower in serum and heart in rats fed oil-starch and ghee-sucrose diets, also, in liver in rats fed starch diets. Total lipids were decreased in serum of rats fed ghee diets, while total lipids in heart increased by increasing dietary Ca level except in ghee-starch group. Percentage of serum HDL-cholesterol/total cholesterol was higher [not significant] in rats fed 2.5% calcium, as well LDL-C/total cholesterol was higher for rats fed sucrose diets. Feeding starch diets resulted in lower serum total cholesterol, triacylglycerol, phospholipids and total lipids compared with sucrose diets

Effect of pectin, high bran, low bran bread and potato on weight loss and serum lipids in obese rats fed low fat low calorie diet

The effect of pectin, high bran bread [HBB], low bran bread [LBB] and cooked potato added to low fat restricted calorie diets on body weight, serum lipids, HDL-cholesterol and liver lipids were studied in adult male obese rats for 8 weeks. Results were compared with fiber depleted low calorie diet. The HBB group had the highest weight loss [77 g]. Pectin and potato groups had comparable weight loss [67 g]. Pectin group had the highest fat loss and the lowest protein loss. Pectin displayed the most hypocholesterolemic effect, increased HDL- cholesterol and decreased serum triglycerides. HBB, LBB and potato groups exerted a hypocholesterolemic effect and increased HDL- cholesterol. Potato lowered serum triglycerides. In addition, liver cholesterol and triglycerides were reduced significantly for the four groups. The four regimens used proved effective in weight reduction and serum lipids modification

Effect of calorie-restricted low fat diet and fiber on digestibility and body composition in obese male rats

Five groups of adult obese male rats were fed for 8 weeks on a low fat [6%] restricted calorie diets. The diets were supplemented with pectin, high bran bread [HBB], low bran bread [LBB] or potato. Results were compared with fiber depleted low calorie diet. The four treatments used significantly affected N and fat digestibility [p <0.01]. HBB diet had significantly lower fat and N digestibility than the other 3 diets [p <0.01]. Pectin diet had the highest N digestibility, its value was significantly different from potato diet [p <0.01]. Pectin had a lower fat digestibility than potato and LBB, but the difference was not significant. Control and pectin groups had the highest carcass protein, values were significantly different from those fed potato [p <0.01]. Pectin also had the lowest carcass fat being significant from those fed control diet [p <0.05] and LBB diet [p <0.01], while LBB had the highest carcass fat, the lowest carcass protein and moisture

Effect of elevating dietary calcium level upon the fecal excretion of some metals in male rats

The effect of three levels of dietary calcium upon the excretion of seven minerals was studied in adult male albino rats [114 +/- 4 g] for 6 weeks using diets containing 5% corn oil. Increasing dietary calcium from 0.25% to 0.5% increased excretion of fat, copper, iron, magnesium, zinc, sodium, potassium and lead. Also, increasing dietary calcium from 0.5% to 2.5% increased the ability of elevated dietary calcium to cause increased excretion of these metals. Although, supplementation of the diet with some minerals may be required, increasing dietary calcium increased fecal excretion of fat and deleterious metals

Serum magnesium in myocardial ischemia and acute infarction

To evaluate the hypothesis of hypomagnesaemia as a risk factor for arrhythmias in acute myocardial infarction, and its possible correlation to the development of myocardial ischemia, this study was conducted on 60 patients classified into two groups. Group I included 30 patients [15 males and 15 females] having ischemic heart disease, and group II comprised 30 patients [19 males and 11 females] who had acute myocardial infarction. Thirty healthy subjects were included as controls, colorimetric determination of serum magnesium levels had been done for all patients and controls. The results showed insignificant difference [p < 0.05] between the ischemic heart group [mean 1.87 +/- 0.61 mg/dl] and the controls [mean 1.85 +/- 0.73 mg/dl]. A highly significant difference [P < 0.001] was found between serum magnesium level in the first 24 hrs. among the infarction group [mean 1.42 +/- 0.84 mg/dl] and the controls, however, insignificant difference was found between both groups after the first 24 hrs. following infarction. A significant difference [P < 0.05] was found between magnesium level in cases who developed arrhythmias [mean 1.16 +/- 0.32 mg/dl] and those who escaped this complication [mean 1.54 =/- 0.41 mgldl] among the infarction group. Insignificant difference was found between males and females, and also between patients above 50 years old and those below this age [P < 0.05] among all groups studied. It may be suggested that, all patients with acute myocardial infarction or severe coronary spasm should be assayed for serum magnesium level, and treatment with i.v. magnesium, if needed, must be started immediately to avoid the development of fatal arrhythmias or heart failure

effect of warfarin and heparin on T-lymphocyte activation and opsonophagocytic activity

Some immunological effects of heparin and warfarin [coumarin] were studied in the present work dealing with macrophage migration inhibition test [MIF] and opsonophagocytic activity. This was accomplished on three groups: one group on heparin therapy [17 patients], a second group on warfarin therapy [23 patients] and a third group was control group not on either one [15 subjects]. At a therapeutic level, neither heparin nor coumarin have any effect on T cell or phagocytic functions. The significance of these results compared with what was previously reported was then discussed

Prevalence of hepatitis B among Saudi diabetics

Some apparently healthy Saudi individuals are HBsAg +ve [6.51%]. However still this antigenaemia is more prevalent among Saudi diabetics whether under insulin or oral hypoglycaemics. This is because these patients repeatedly subjected to insulin injection, sampling for blood sugar estimations, contact with the same nursing staff, and furthermore the role played by the impaired immunity among diabetics

Human placental lactogen and estriol in high risk pregnancies

The plasma levels of hpl and estriol were measured in normal pregnants and complicated pregnacies using radio-immunoassay methods. It can be suggested that maternal plasma hpl and estriol values deviated from normal when the pregnancies complicated by conditions that diminish functional placental mass, low hpl and estriol values correlate to some extent with faetal outcome in complicated pregnancies. Elevated values in third trimester pregnancies may be helpful in identifying multiple gestations while hpl and estriol values are of little help in controlled diabetic where the major fetal risks are unrelated to chronic placental insufficiency. The clinical value of the. measurment of hpl and estriol is virtully identical. While the complication of both hpl estriol was found to be the best indicator of high risk pregnancies. Finaly from our results pregnancies complicated by IUGR, PET, hypertension, IUFD, post-maturity and diabetes mellitus where the fetus may be in jeopardy, hpl and estriol determination can be used by the obstetricions as an aid in deciding whether to allow a pregnancy to continue or to terminate it

In vitro study of the effect of estrogens and progestins on human chromosomes

Many workers have reported increased frequencies of malformations and chromosome breakages in lymphocyte cultures from women taking oral contraceptives, whereas other studies have shown no increase in aberration frequencies in cultures from pill users. Because estrogens and progestins make up the ingredients of the widely used oral contraceptives, we planned to study synthetic and natural estrogens and progestines in an in-vitro system, and in different concentrations