Bilateral giant full thickness macular holes: an infrequent manifestation of alport syndrome

Purpose: To report a case of Alport syndrome presenting with bilateral giant full-thickness macular holes, hypertensive chorioretinopathy, and exudative retinal detachment. Case Report: A 20 year-old man, a known case of Alport syndrome on hemodialysis, was referred to our clinic with bilateral vision loss initiated about 10 years prior to presentation, which exacerbated in the month prior to our visit. Bilateral large full-thickness macular holes, hypertensive chorioretinopathy, and exudative retinal detachment were detected in fundus examination. The patient had previous genetic counseling confirming the diagnosis of Alport syndrome. During follow-up, macular holes were covered with a thick epiretinal membrane and visual acuity decreased progressively in two weeks. Pars plana vitrectomy was performed in the right eye. Two weeks following surgery, the macular hole was closed and visual acuity improved significantly. Conclusion: Bilateral giant full-thickness macular holes are uncommon presentations of Alport syndrome. The retinal findings may be caused by an inefficient type IV collagen presenting in the Bruch's membrane and in the internal limiting membrane. Pars plana vitrectomy can be considered to repair macular holes in these patients.

Association of White Blood Cell Counts, Leukocyte Ratios, and Serum Uric Acid with Clinical Outcome of Intravitreal Bevacizumab in Diabetic Macular Edema

Purpose@#To investigate the role of serum uric acid and leukocyte counts and ratios as predictors of clinical outcomes of intravitreal bevacizumab in diabetic macular edema. @*Methods@#In this prospective study, the patients were treated with three monthly intravitreal bevacizumab. The correlation of serum uric acid and immune cell indices with the changes of best-corrected visual acuity and central macular thickness at the end of month 3 were evaluated through univariate and multivariate linear regression analysis. @*Results@#A total of 80 eyes from 80 diabetic patients were included in the study. The difference of uric acid level and immune indices between groups with different retinopathy severity was not statistically significant (p > 0.05). Lower duration of diabetes (p = 0.045), monocyte count (p = 0.021), and uric acid level (p < 0.001) were correlated with larger improvement in visual acuity at 3-month visit. Higher logarithm of the minimum angle of resolution of baseline visual acuity (p = 0.007), lymphocyte count (p = 0.008), lymphocyte to neutrophil ratio (p < 0.001) and lymphocyte to platelet ratio (p < 0.001) were correlated with larger improvement in visual acuity at 3-month visits. According to multivariate analysis, baseline logarithm of the minimum angle of resolution (r = 0.125, p = 0.009), duration of diabetes (r = -0.216, p = 0.047), lymphocyte to neutrophil ratio (r = 0.712, p < 0.001), lymphocyte to platelet ratio (r = 0.238, p < 0.001), and uric acid level (r = -0.397, p < 0.001) were the significant predictors of changes in visual acuity in our subset of patients. @*Conclusions@#Serum uric acid and leukocyte counts and ratios may predict the response of diabetic macular edema to intravitreal injection.

Subfoveal choroidal thickness and central macular thickness changes following cataract surgery in diabetic patients / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the changes of subfoveal choroidal thickness(SFCT)and central macular thickness(CMT)following phacoemulsification cataract surgery in diabetic and non-diabetic patients.<p>METHODS: In this prospective study, 53 patients with mild or moderate non-proliferative diabetic retinopathy(NPDR)without macular edema and 53 non-diabetic patients underwent uneventful phacoemulsification cataract surgery. Subfoveal choroidal thickness and central macular thickness were measured before and one month and three months after the surgery using enhanced depth imaging optical coherence tomography(EDI-OCT)and the changes of SFCT and CMT were compared between the two study groups.<p>RESULTS: In diabetic cases, the mean CMT at the baseline was 267±32 μm. The CMT significantly increased after surgery with a mean value of 291±77 μm at 1mo(<i>P</i>=0.034)and 293±75 μm at 3mo(<i>P</i>=0.047). The mean SFCT at the baseline was 199±72 μm. The SFCT significantly increased after surgery with a mean value of 231±73 μm at 1mo(<i>P</i>=0.035)and 248±91 μm at 3mo(<i>P</i>=0.026). In non-diabetic cases, the mean CMT at the baseline was 264±29 μm. The CMT significantly increased after surgery with a mean value of 278±42 μm at 1mo(<i>P</i><0.001)and 276±56 μm at 3mo(<i>P</i>=0.028). The mean SFCT at the baseline was 236±60 μm. The SFCT significantly increased after surgery with a mean value of 265±64 μm at 1mo(<i>P</i><0.001)and 240±60 μm at 3mo(<i>P</i>=0.234). The changes of CMT were not significantly different between the study groups(all <i>P</i>>0.05). Although the non-diabetic cases had thicker choroid at the baseline, the change of SFCT was not significantly different between study groups 1mo postoperative(<i>P</i>=0.97)and was borderline 3mo after surgery(<i>P</i>=0.05).<p>CONCLUSION: CMT and SFCT significantly increased post operatively in both groups. The changes of CMT and SFCT were not significantly different between diabetic and non-diabetic cases.

Views of health system experts on macro factors of induced demand

The probability and severity of effects of induced demand are because of the interaction between a range of factors that can affect physicians and patients behavior. It is also affected by the laws of the markets and organizational arrangements for medical services. This article studies major factors that affect the phenomenon of induced demand with the use of experts' experiences of the Isfahan University of Medical Sciences. The research is applied a qualitative method. Semi-structured interview was used for data generation. Participants in this study were people who had been informed in this regard and had to be experienced and were known as experts. Purposive sampling was done for data saturation. Seventeen people were interviewed and criteria such as data "reliability of information" and "stability" were considered. The anonymity of the interviewees was preserved. The data are transcribed, categorized and then used the thematic analysis. In this study, thematic analysis was conducted, and 77 sub-themes and 3 themes were extracted respectively. The three main themes include infrastructural factors, social factors, and organizational structural factors affecting induced demand. Each of these also has some sub-themes. Results of this research present a framework for analyzing the major causes of induced demand. The causes identified here include complexity of medicine, information mismatch between service providers and consumers, clinical uncertainty, false beliefs, advertisements, insufficient supervision, scarcity of clinical guidelines, weakness of education system, and ignorance of medical ethics. These findings help policymakers to investigate the induced demand phenomenon clear-sighted

[Assessment of district health information system evolution province according to world health organization framework]

Since, accurate, appropriate, precise, timely, valid information, and valid interpretation of information is required and the basis for policy and decision making and planning in various levels of the organization management, this study was conducted to evaluate the district health information system evolution in Isfahan province according to World Health Organization framework. This research was an applied, descriptive cross-sectional study, in which a total of twelve urban and eight rural facilities, and one district health center at Falavarjan district were surveyed by using a questionnaire with 334 items. Content validity was confirmed. The reliability of the questionnaire was confirmed with a Cronbach's alpha of 0.99. Obtained data were analyzed with SPSS software and descriptive statistics were used to examine measures of central tendencies. The mean score of evaluation of district health information system framework was 35.75 percent. The maximum score of compliance with district health information system belonged to the data collection process [70 percent]. The minimum score of compliance with district health information system belonged to information based decision making process [10 percent]. The results showed that information entities of the district health information system in Isfahan province are not in compliance with WHO framework. Consequently, it seems that health system managers engaged with underlying policy and decision making processes at district health systems should try to restructure and decentralize district health information system and develop training management programs for their managers