Effects of intravitreal injection of ranibizumab on intraocular pressure

Background: the administration of anti-vascular endothelial growth factor [anti-VEGF] agents has become an application of IVIs to treat a variety of retinal and choroidal neovascular diseases including neovascular age-related macular degeneration, vein occlusion with macular edema, and diabetic maculopathy. ranibizumab is the most commonly used anti-VEGF treatments for retinal disease. While Intravitreal ranibizumab appears to be safe and effective but it can cause adverse effects as intraocular inflammation, cataract, vitreous haemorrhage, and increased intraocular pressure

Aim of the work: this study aimed to Evaluation of Iop changes after intravitreal injection of Ranibizumab retinal and choroidal neovascular diseases as neovascular age-related macular degeneration [AMD], central vein or branch vein occlusion with macular edema, and diabetic maculopathy

Patients and Methods: this prospective study was carried out from March 2018 to September 2018 on 35 eyes of patients attending outpatient clinic of Al-Azhar University Hospitals and Ophthalmology Department of Research Institute of Ophthalmology in Giza. All participant names were hidden and were replaced by code numbers to maintain privacy of the patients. IOP was measured Using Applanation tonometer and Perkins tonometer before IVI of ranibizumab immediately after injection, 30 minutes, 1ST day, 1st week, and 1st month after injection

Results: IOP was highly increased immediately after injection of ranibizumab, preoperative mean IOP 15.31+/-3.70, immediate after injection mean IOP 24.62+/-11.38, then it started to decrease till reaching normal values in the first 24h after injection, 1st 24hours mean IOP 16.31+/-3.60.The mean IOP for patients who were previously injected was 16.47+/-3.74 pre injection, and it was 30.88+/-12.55 immediately after injection, it still decreasing till reaching 20.24+/-2.77 after 30 minutes, we follow the patients after 1 day it was 18.41+/-3.12, then it became 18.29+/-3.62 after 1 week, and 17.88+/-3.33 after 1 month. The mean IOP for patients who were the first time to be injected was 14.22+/-3.41 pre injection, Immediate after injection the mean IOP was 18.72+/-5.92, after 30 minutes of injection the mean IOP was 15.44+/-3.99 mm Hg, after 1 day of injection the mean IOP was 14.33+/-2.87 mm Hg, We followed up the patients to one week after injection and we checked the IOP. The mean IOP after one week was 13.72+/-2.93mm Hg, We continue following the patients for one month and checked IOP, The mean IOP was 14.06+/-3.21 mm Hg

Conclusion: IOP tends to increase after intravitreal injection of Ranibizumab 0.05ml [0.5 mg]. It causes mainly a transient immediate increase in intraocular pressure especially in patients who exposed to repeated intravitreal injection. This elevation of IOP tends to normalize after one day

Recommendations: this study recommend monitoring of IOP after intravitreal injection of ranibizumab and Care should be taken for cases with multiple injections and predisposing risk factors like glaucoma and glaucomatous patients

Comparison of usefulness of percutaneous coronary intervention guided by angiography plus computed tomography versus angiography alone and its impact on instent restenosis

Background: Optimal stent selection and placement would be expected to improve clinical outcomes. Coronary computed tomography angiography [CCTA] may permit better preprocedural planning

Objectives: To assess the impact of incorporating coronary computed tomography angiogaphy guidance in defining reference value for stent length and diameter on angiographic and clinical outcomes in comparison to quantitative coronary angiography and its effect on incidence of instent restenosis

Methods: The study was conducted on 153 diabetic patients with stable coronary artery disease. Patients were divided into two groups: group A and group B according to PCI guidance either with quantitative computed tomography angiography [QCTA] datasets or quantitative computed tomography [QCA] datasets respectively. Follow up clinically for six months to assess incidence of major adverse cardiac events [MACE] and angiographically by coronary angiography at six months or before if clinically indicated to assess incidence of instent restenosis [primary end point]

Results: QCTA was associated with longer lesions [p=0.001] and larger reference vessel diameter [p=0.001] than that measured by invasive QCA in group A. No statistical significant difference between group A and group B regarding restenosis rate, minimum lumen diameter at follow up and incidence of MACE

Conclusions: CCTA guided percutaneous coronary intervention [PCI] is a safe and effective strategy for treatment of coronary artery disease however it didn't add a beneficial role in reducing incidence of instent restenosis or MACE in comparison to angiographic guidance alone

Role of multisclice and virtual cystoscopy versus ultrasound and color doppler study in evaluation of urinary bladder neoplasms

The virtual cystoscopy and the color Doppler examinations are good modalities in assessment of the urinary bladder neoplasms. This study is done to assess the accuracy of CTVC and color Doppler ultrasound in detection of the urinary bladder neoplasms. The examination was done between June 2010 and December 2012 on 60 patients known or suspected to have urinary bladder neoplasm. They were examined using CTVC and color Doppler ultrasound. Bladder scanned using multislice CT at a slice thickness of 1 mm. The data were transferred to a workstation for interactive navigation. Findings obtained from CTVC and ultrasound were compared with results from conventional cystoscopy and with pathological findings. By the conventional cystoscopy; the 43 patients in the group A showed 53 lesions. There were [35/43 patients] with single lesion while there were [8/43 patients] more than one lesion. While the other 17 patients in group B showed 11 patient with no focal lesions and 6 patients with 6 focal lesions. By virtual cystoscopy; 56 lesions were detected in both groups; 51 plus 5 lesions in group A and B respectively. There were 3 false negative lesions with a failure rate of 3/56. By ultrasound; 56 lesions were detected in both groups; 53 plus 3 lesions respectively. So in virtual cystoscopy and ultrasound the results were as follows: positive predictive values: 100%; negative predictive value: 78.6%; sensitivity: 94.9%; specificity: 100%. Although the definitive diagnosis of some suspected urinary bladder tumors is only possible with conventional cystoscopy and biopsy, CTVC and color Doppler ultrasound are a minimally or non-invasive techniques which provide beneficial information about urinary bladder lesions

Study of fatigue among selected occupational groups in Egypt

Fatigue is a common yet not fully understood complaint both in general population and work environment. Due to its potential impact on performance in the workplace, it is important to examine fatigue determinants. To test use of a validated Arabic questionnaire to compare the fatigue scores in doctors, teachers and engineers, and to relate fatigue scores to personality traits and physical and psychological stresses in the work place. Three volunteer samples from each group were selected and subjected to a short questionnaire, the Eysenck Personality Questionnaire and the Multidimensional Fatigue Symptom Inventory [MFSI]. General fatigue was reported by 8.5% of doctors, 3.5% of the teachers and 3% of the engineers. In the different fatigue scales, fatigue score among doctors were the highest, followed by teachers and lastly engineers. The highest fatigue score differences were observed in somatic fatigue and cognitive fatigue scores followed by the affective and global scales and lastly the behavioral scale, Age, presence of chronic diseases, neuroticism score and extraversion score were independent determinants of fatigue scores while the respondents' personal perception of physical and psychological stresses in the work environment played minor roles. Fatigue is a common complaint among doctors, teachers and engineers. Age, personality traits, presence of a chronic disease as Well as the nature of the work are determinants of all fatigue scales

Depressive phenomena and physical symptom distress among women with breast cancer and their impact on women's quality of life

Breast cancer accounts for about 30% of cancer deaths in women in developed countries and about 15% in developing countries. Breast cancer commonly produces depressive symptoms and physical symptoms distress which have a direct and profound impact in all aspects of quality of life. Therefore the study aimed to assess the nature and scope of depressive phenomena and physical symptoms distress in women after breast cancer diagnosis, to determine the relationship between depressive symptoms and physical symptom distress among breast cancer women, examine the relation of depression as well as physical symptom distress of patient's quality of life. A descriptive correlation design was used on the study sample which consisted of 50 female patients and 50 women who haven't cancer as a control group in total. The study was conducted at outpatient breast cancer clinic, at Assiut University Hospital. Socio- demographic data sheet was developed and used by the investigator in addition to quality of life questionnaire for women with advanced breast cancer which included four domains mobility impairment, GIT toxicity, bone pain and fatigue, Beck Depression Inventory Scale [BDI] and symptoms Distress Scale [SDS]. Results revealed that, depression is a common response to breast cancer in both its early and late stages. Most of breast cancer women suffer from moderate to sever symptom distress, there was a significant relation between depression and symptom distress and they had direct and indirect impact on quality of life among breast cancer women. It was recommended that, an educational training program should be provided to women with breast cancer to foster their potential rehabilitation and improve their quality of life

[Comparative study of the conservative and surgical treatment of femoral fractures in children in Aleppo University Hospital]

This subject is a comparative study of surgical and conservative treatment of femoral shaft fractures in children admitted in Aleppo University Hospital. Study was conducted on one hundred cases in period 1986 - 1989. Of the /100/patient$ [68%] were boys and [32%] were girls. The age group mostly effected was / 2-8 / the right limb was [59%] the left [41%]. The majority of fractures occurred in the middle of femoral shaft [71%]. The most frequent fractures were transverse and spiral. The Road traffic accident accounted for [52%] of cases. The indirect injury accounted for [78%]. The simple fractures accounted for [90%] but the compound and complicated fractures were [10%]. The conservative treatment accounted for [58%] while surgical treatment for [42%] of cases. The results were: Excellent 60.3%, Conservative Surgical treatment 61.9%. The results were: Good 32.8%, Conservative Surgical treatment 23.8%. The results were: Nonaccepted66.9% Conservative Surgical treatment14.3%. Complications were: Maltmion 5.2%, Conservative Surgical treatment 2.4%. Delay union 1.7%, Conservative Surgical treatment 9.5%. Osteomylitis 1.7%, Conservative Surgical treatment 7.1%. Refracture, Conservative Surgical treatment 2.4%. Nonunion, Conservative Surgical treatment 2.4%