Diabetic macular edema; role of intravitreal bevacizumab in treating clinically significant diabetic macular edema

To evaluate the effect of Intravitreal Bevacuzimab on Best Corrected Visual Acuity in patients with clinically significant diabetic macular edema. A prospective uncontrolled interventional case series in which 42 eyes of 31 consecutive diabetic patients with clinically significant macular edema and no significant comorbid ocular association presenting in the outpatients department of Holy Family Hospital and EYE SURGERY clinic, Rawalpindi Pakistan and opting for the treatment from 1st September 2013 to 31st January 2014 were given an intravitreal injection of Bevacizumab. BCVA was documented prior to and four weeks after the injection. Main outcome measure was changes in BCVA. Out of the 31 patients included in the study 14[45.16%] were male and 17 [54.83%] female. Average age was 56.1 +/- 7.6. All 31 patients [42 eyes] came for follow up and their BCVA recorded. 41 [97.61%] eyes showed an improvement of one or more line on Snellen's chart at 4 weeks. 14 [33.33%] eyes showed an improvement of one line, 19 [45.23%] eyes an improvement of two lines, 6 [14.28%] eyes three lines and just 2 [4.76%] eyes had an improvement of four lines on Snellen's chart at 4 weeks. Only 1[2.38%] eye remained same with no worsening. On log MAR conversion scale for Snellen's letters the BCVA improved from 0.76 +/- 0.27 to 0.47 +/- 0.27 [p< 0.001]. No significant complications were observed in any of the eyes. The use of intravitreal Bevacizumab [1.25mg/0.05ml] is a safe and effective moe of treatment for clinically significant diabetic macular edema

Clinical manifestations of Goldenhar syndrome

Goldenhar syndrome is a congenital disorder with diverse clinical presentation. This case series describes various clinical manifestations of Goldenhar Syndrome. 11 patients at least two of the described features of Goldenhar syndrome were randomly included in the study to form a case series. Clinical data of all these subjects was documented, described in percentages and analyzed. Out of the 11 patients studied, 6 were females and 5 males. Mean age was 7.3 years [ranging from 1 year to 23 years]. 7 [63.6%] patients had a limbal dermoid, 6 [54.5%] patient had mandibular hypoplasia, whereas only 3 [27.3%] presented with hemifacial microsomia. Spinal defects and polydactyly were present in [36.4%] patients each. There was one patient [9%] who had both microphthalmia and lid coloboma in addition to limbal dermoid. Similarly, renal defect [atrophic kidney], cleft upper lip and palate and CNS defect [7th nerve palsy] were present in one patient [9%] each. None of our patients had either cardiac or GIT defect. In our study we were able to document the variable manifestations of Goldenhar syndrome with their frequencies. This knowledge base will help us in planning treatment and assistance strategies or these patients

Granulocyte macrophage colony stimulating factor: role in induction of monocyte CD14 receptor and adhesion molecules expression in chronic liver diseases

This study included 36 chronic liver disease [CLD] patients who suffered from viral hepatitis and / or schistosomiasis and 12 age and sex matched healthy individuals who represent the control group. The study aimed at clarifying the role of rhGM-CSF on the release of sICAM-1 and sCD14 from PBMNC. According to the severity of liver disease, patients were classified to Child A, B and C groups. All patients and controls were subjected to thorough history taking and clinical examination, a full routine laboratory investigation including hemogram, liver function tests and hepatitis markers. PB mononuclear cell culture was performed to all the study groups with and without the addition of rhGM-CSF to the culture media. Afterwards, slCAM-1 and sCDl4 were measured in culture supernatant fluid using ELISA technique, Levels of sICAM-1 in culture supernatants with and without addition of rhGM-CSF showed significant progressive increase with advancement of CLD which may reflect the increase ofsICAM-1 in sera of CLD patients with progression of the disease. As well, the addition of rhGM-CSF to PBMNC culture resulted in a significant reduction of sICAM-1 level in culture supernatants in control and patients groups in comparison to its level without the addition of rhGM-CSF. There was a significant progressive increase in sCD14 level with the advancement of the disease. The increase in sCD14 level with and without addition of rhGM-CSF was significant in all patients groups in comparison to the control group. As well, the addition of rhGM-CSF to culture media led to significant reduction of sCD14 concentration in supernatants in control group and in each of the patients groups in comparison to their levels without the addition of rhGM-CSF. It can be concluded that rhGM-CSF might be considered as one of the potential future tools against defective monocyte functions in CLDs. Using rhGM-CSF to improve monocyte functions will be associated with reduction of sICAM-1 and sCD14 levels which might be implicated or contribute to liver pathology