Topographic changes in keratoconic patients after transepithelial [Epi-On] collagen cross-linking

Objectives: To evaluate corneal changes as measured by Pentacam before and after transepithelial corneal collagen cross-linking in cases of Keratoconus

Study design: A prospective consecutive case series study carried out at a private lasik centre

Patients and Methods: 74 eyes of 50 patients with progressive keratoconus underwent transepithelial [Epi-on] CXL using both ParaCel[TM] and vibeX-Xtra

Baseline examination included: Full ocular examination, uncorrected visual acuity [UCVA], best corrected visual acuity [BCVA], corneal topography using Pentacam[TM] to determine; flat corneal curvature [K1], steep corneal curvature [K2], mean corneal curvature [Km], corneal astigmatism, corneal thickness at the thinnest location and posterior surface elevation at the highest point in the central 5 mm. The follow-up visits were scheduled on 3 and 6 months after treatment by checking the BCVA, PentacamTM

Results: Our results showed an improvements in BCVA at the end of the 6[th] month post operative that showed an increase from 0.48 to 0.54 and this was statistically significant [P value 0.007] [<0.01], Pentacam topographic changes were found to be decreased postoperatively and were found to be statistically insignificant

Conclusion: In this study, with a follow-up for 6 months, we found the transepithelial corneal collagen cross-linking is beneficial and safe for patients with keratoconus. Transepithelial CXL treatment appeared to halt keratoconus progression, with a statistically significant improvement in visual acuity by stabilizing or partially reversing the keratectasia process

Isolation and biochemical identification of pathogenic burkholderia cepacia front human sources and related reactivity to different antibiotics

The aim of the present work is to isolate and identify Burkholderia species from different chest hospitalized patients .throat swap and sputum samples were considered. Reactivity of isolates to different antibiotics was considered using both Double Disc Synergy Test and Combined ESBL Test. Data revealed that 21/200 [10.5%] isolated from cystic flbrosis patients; samples were positive as Burkholderia isolation was more prevalent from sputum samples [55%] than throat swapping [45%]. Among the 21 bacterial isolates; 2/21[9.5%] children, 8/21[38.09%] females and 11/21[52.38%] males. The No of isolate was location related; El Sadr hospital [41%], Abbassia Chest hospital [24%], Al-Mattaria teaching hospital [21%] and health institute hospital [14%]. Also, isolation was gender related as male was more susceptible more than the other genders for infection by Burkholderia cepacia recording the highest value [52%] followed by female [38%] and children [10%]. Combined infection was recorded. Burkholderia cepacia was sensitive to Amlkacin, Gentamicin, Kanamycin, Neomycin, Ceftazidime, Ciprofloxacin and Amoxicillin/clavulanic acid, while it were resistant to; Paromomycin, Spectinomycin, Fosfomycin, Cefixime, Levofloxacin, Ofloxacin and Cefazolin. The most active antibiotic was Amoxicillin/clavulanic acid with mean diameter of inhibition zone 38.50 mm

Phylogenetic identification ofburkholderia cepacia isolates from human chest infection from different hospitals

Phylogenetic analysis of Burkholderia cepacia was achieved based on the variation of p-Lactamases production and antibacterial reactivity to different antibiotics. Sub inhibitory concentrations of augmentin down-regulates the production and/or release of exoprotein and this effect increase with increasing of the tested concentration. ESBLs was detected using double disc synergy test and combined ESBL test. Effect of reactivity of B. cepacia spp was influenced by antibiotic where Amoxicillin/ clavulanic acid showed the highest inhibitory effect and in turn clear zone dimension. Also, TEM-1 and SHV-1 genes electrophoretic pattern detected by both PFGE and RAPD. Different isolates showed a similarity to standard B. cepacia ranging from 94-95 %. Data recorded revealed the p-Lactamases genes showed a variable protein bands pattern revealing reactivity to antibiotics

Treatment of primary pterygium: Role of limbal stem cells and conjunctival autograft transplantation

The limbus and its stem cells are very important in the pathogenesis of pterygium. In this study, the efficacy of limbal stem cells and conjunctival autograft transplantation for the treatment of primary pterygium will be assessed. Prospective noncomparative cohort study. Forty-two eyes of 42 patients with grade I-III primary pterygium were included in the study. Pterygium excision was performed followed by superotemporal limbal stem cells and conjunctival autograft transplantation in all cases. Recurrence of pterygium and complications within a mean follow-up period of 18.26 months [10-28 months] was studied. Recurrence of pterygium occurred in two eyes [2/42; 4.75%]. No significant complications were noted. Apart from re-operation in the two recurrent cases, no further surgical interventions were needed in any case. Conclusions: Limbal stem cells and conjunctival autograft transplantation is a safe and effective technique for the treatment of different grades of pterygium. It is very useful in preventing pterygium recurrence, which is a major problem in pterygium surgery

Role of surgical correction of aortic coarctation on hypertension in adults

To diagnose the impact of surgical intervention on systolic hypertension, a retrospective study reviewed 14 adults with a mean age of 27.3 +/- 6.2 years who underwent coarctation repair at Al-Azhar University Hospital between 1995 and 2002. All patients were hypertensive [mean systolic blood pressure 169.3 +/- 21.4 mmHg, range 140 to 220 mmHg] and 9 patients [64.2%] were on a regimen of at least one hypertensive medication at the time of surgical interference. All patients underwent cardiac catheterization and the mean peak systolic gradient across the coarctation was 57.9 +/- 24.4 mmHg [range 25 to 120 mmHg]. Operative procedures included resection of the coarctation segment with an interposition of tube graft [3 patients], resection and end-to-end anastomosis [2 patients], a bypass graft [6 patients] and patch angioplasty [3 patients]. There was no hospital mortality or late morbidity. Early and intermediate follow up was available at a mean of 2.5 +/- 2 years [range 1 to 6 years]. At last follow-up, the peak systolic gradient between the upper and lower body was trivial. All patients had significant improvement in systolic blood pressure compared with preoperative values, specially older patients requiring medication

Pulmonary function changes after cardiopulmonary bypass in cases of rheumatic mitral valve diseases

Measurement of pulmonary function parameters which calculated by spirometry in adult patients undergoing open heart surgery to assess pulmonary reserve is an important procedure to evaluate the operative morbidity. Pulmonary function was done preoperatively, before discharge, and at the 2-month follow-up in 66 randomly selected patients who underwent open-heart surgery for rheumatic mitral valve disease [6 reconstmctions, 60 replacements]. The mean preoperative cardiothoracic ratio was 0.58. Lung function was found to be impaired preoperatively in all l8 smoker patients and the majority suffered from restrictive lung disease. Better preoperative lung function was seen in nonsmokers, patients with a cardiothoracic ratio of less than 0.50, and those with a normal pulmonary artery pressure. After mitral valve surgery, the mean pulmonary artery pressure was 20.6 +/- 2.9 mm Hg, the mean mitral valve pressure gradient was 3.6 +/- 2.4 mm Hg. and the mean cardiothoracic ratio was 0.52 +/- 0.09. A significant deterioration was seen in the before discharge spirometric values of forced vital capacity, forced expiratory volume in one second, peak expiratory f low rate, flow rate at 25% to 75% of expired vital capacity, and maximum volume ventilation. The deterioration was greater in smokers and those who had prolonged cardiopulmonary bypass [more than 60 minutes]. No correlation was found with ventilation because all patients were electively mechanically ventilated during early hours of the postoperative period. There was an overall improvement in spiromctric parameters at the 2-month follow-up although the values remained lower than predicted. Spirometry was found to be useful for assessing lung function in patients undergoing mitral valve surgery and we recommended it as a routine test