Sensitivity and specificity of nassar color test in early detection of diabetic macular edema

Purpose: To evaluate the sensitivity and specificity of Nassar color discrimination test in the presence of diabetic macular edema [DME] as a sensitive diagnostic tool for the detection of early functional changes

Design: A prospective, comparative case-control study

Setting: Multicenter study in the outpatient clinic of Beni Suef University, Fayoum University, and Misr University for Science and Technology

Methods: The study included 120 eyes with Type I diabetes recruited from the outpatient clinic. All patients were received ophthalmic exams and tested with Nassar color plate test, fluorescein fundus angiography [FFA], and optical coherence tomography [OCT]. The main outcome measures are the presence of mild or moderate tritans indicating early DME changes that were documented in each group. Statistical Analysis Used: Student's t-test and ANOVA f-test were used for statistical analysis. P <0.05 were considered statistically significant

Results: The mean age of the patients was 41.15 +/- 5.61 years [range 23-49 years] with the mean disease duration of 13.56 +/- 2.59 years [range 10-20 years]. All patient with dry macula [n = 60, 50%] were normal on Nassar color test while patients with DME showed normal [n = 6, 5%], mild tritan [n = 14, 11.66%], and moderate tritan [n = 40, 33.33%], respectively. Hence, the Nassar color test is 90% sensitive and 100% specific

Conclusions: The Nassar color plate is an affordable and effective for early detection of DME and recommended to be used in all primary ophthalmic examination especially in areas where no access to comprehensive ophthalmic exams such as OCT and FFA

Possible protective effect of vitamin E on the joined cardio-renal effects of lead toxicity and noise stress in rats

Pollution is a worldwide problem and its potential to influence the physiological systems of human population is great. Many studies found that some pollutants have detrimental effects on human growth, particularly prenatal growth. Lead is one of the heavy metals commonly found in human populations. Lead toxicity was reported to be related to haemopoietic, hepatic, renal, nervous, gastrointestinal and reproductive disorders in man and animals. Recent studies have reported lead's potential for inducing oxidative stress which plays a role in the pathophysiology of lead toxicity. Noise stress from transportation sources also is related to different physiological effects on human, as well as impairment of auditory function and growth. Studies showed that combined exposure to noise and different pollutants affects heart and other organs. On the other hand, antioxidants were reported to reduce incidence to various physiological alterations accompanied by oxidative stress. Previous studies suggested that antioxidants may play an important role in abating some hazards of lead. The aim of the present work was to evaluate the possible ameliorating effect of vitamin E, as an antioxidant, on some alterations caused by lead or noise alone or in combination on kidney and heart biomarkers in adult male rats. Vitamin E was administered orally in a dose of 200 mg/kg two hours before lead dosage [15 mg/kg, i.p]. Animals were exposed to horn noise of about 110 dB for 30 minutes after administration of lead and/or vitamin E. The experiment was conducted for 14 consecutive days. The evaluated parameters included assessment of serum levels of urea, creatinine, Aspartate aminotransferase [AST], creatine kinase [CK] and lactate dehydrogenase [LDH] and levels of reduced glutathione [GSH] and malondialdehyde [MDA] in kidney and heart tissues. The histolopathological changes in both kidney and heart were reported. The obtained results revealed that lead and noise either alone or in combination caused statistically changes in the examined parameters with a good potential for vitamin E to protect against these changes

Factors affecting radiographers' participation in continuing professional development in Oman

Continuing Professional Development [CPD] became an ongoing, lifelong activity for health care professionals. Radiographers must participate in CPD to sustain and improve their knowledge and professional competence. This study aimed at assessing different factors affecting radiographers' participation in CPD in Oman. A cross sectional study was carried out on 93 radiographers working in primary and secondary health care facilities of 3 regions in Oman. Data were collected using a pre-tested, self-administered and anonymous questionnaire sheet including: personal data, inquiring about current participation in any CPD activities, CPD activities mostly attended, compulsory or voluntary CPD preferred, radiographer 's perception, thought and agreement on importance, benefits and barriers of CPD. The results revealed that 66.7% of radiographers reported current participation in CPD activities, 51.6% reported monthly attendance, while 17.2% never attended. Lectures had the highest percentage of attendance [38.7%] among CPD activities. Two thirds of participants [66.7%] preferred voluntary CPD activities than compulsory ones with significant difference in relation to regions and institutions. Respondents who preferred compulsory CPD activities reported significantly higher scores than those who agreed with voluntary ones regarding their perception of being encouraged by their departments to carry out CPD activities [78.2% vs 69.4%]. Those working in secondary care facilities recorded significantly higher scores than those working in primary ones regarding their perception that their departments offer enough courses at their clinical area. Finance was perceived by radiographers to be a greater barrier to participate in CPD [mean score=76.9%]. Participants who believed that they are responsible for introducing and developing CPD activities reported significantly higher scores than those who mentioned superintendents regarding most perceptions and attitudes. Significant positive correlation was reported regarding radiographers' agreement of importance of CPD to the radiography profession and its benefit in improving the clinical practice [means scores=90.9% and 8 1.2% respectively]. Most radiographers showed a positive attitude in participating in CPD activities. Departmental managers should take active role in encouraging staff to participate in CPD activities. The responsibility to introduce and develop CPD activities should be shared between employers, managers, and radiographers. Follow-up studies are recommended to determine if the aims of CPD activity have been achieved

Retinal histopathological changes following intravitreal injection of different doses of bevacizumab: an electron microscopic study

To determine the retinal toxicity of intravitreal bevacizumab in rabbits by electron microscopy. Six albino rabbits received one injection of intravitreal bevacizumab in one eye, and no injection [control] in the fellow eye. Two rabbits received 1.25 mg in 0.05 ml, two received 2.5 mg in 0.1 ml, and two received 5mg in 0.2 ml. for each dose of bevacizumab, one rabbit was sacrificed one day after injection, and the other one week later. The retina was then examined by transmission electron microscopy. The control eyes showed no abnormality. At 1.25 mg there was no change compared with controls. At 2.5 mg, there was mild transient cytoplasmic degeneration in the inner segments of the photoreceptors and the horizontal cells of the outer nuclear layer. At 5mg, there was, in addition to the changes above, marked cytoplasmic degeneration of the retinal pigment epithelial [RPE] cells with shrinkage of the nucleus, and numerous vacuoles in the nerve fiber layer. At one week, there was significant resolution of these changes. There was no evidence of bevacizumab toxicity to the rabbit retina after a single intravitreal injection of 1.25 mg. At 2.5mg, there were mild transient changes, whereas definite toxicity to the RPE cells and nerve fiber layer were seen at 5mg. The maximum recommended dose of intravitreal bevacizumab is therefore 2.5 mg

Double atrial potentials as a marker for isthmus block during ablation of atrial flutter

Assessment of success is an integral part in atrial flutter ablation. This work is concerned with evaluating the added value of recording double potentials along the ablation line induced to interrupt the macro-reentrant circuit of atrial flutter. Atrial flutter was ablated in 24 consecutive patients, 7 males and 7 females, their ages ranged from 10-65 years, with mean age of 37 +/- 12.5 years. The ablation was done through burning a continuous line across the cavo-tricuspid right atrial isthmus. In all patients pace-mapping indicated complete bidirectional isthmus block, we tried to record double potentials along the ablation line during pacing from the coronary sinus ostium. The patients were followed up for 6 months, recurrent cases were reablated. the acute success rate was 100% in both the initial and the second procedures. Nine recurrences [37.5%] occurred during the period of follow up, which were reablated; none of the reablated cases had any recurrence during six months of follow up, with overall late recurrences of nine patients out of 33 procedures [27%]. Whenever double atrial potentials were recorded along the ablation lines, there was no recurrence [specificity of 100%], but in cases in which these potentials were not recorded, it did not predict recurrence except in 40% of cases [sensitivity 60%]. Predictors of late recurrence, in this study, were age of the patient and Duration of symptoms. We compared between 4 and 8 mm tip ablation catheters, it turned to be that the recurrence and the procedure duration was lower with the use of 8 mm tip catheters. Patient with structural heart disease in this study were older, with more duration of symptoms and their procedures were longer. In conclusion, there was an added value of recording double atrial potentials to the conventional mapping technique used to identify bidirectional isthmus block in patients with atrial flutter. In addition, 8 mm tip catheters were considered safe and effective in the term of reducing the time of the procedure and recurrence rate specially when combined with SVC approach. Abbreviations: SVC: superior vena cava

Relation between cytotoxin producing Helicobacter pylori and Helicobacter pylorielated upper gastrointestinal disease

Helicobacter pylori [H. pylori], a major aetiological agent in gastritis, peptic ulcer and gastric cancer, is estimated to infect more than 50% of the world's population. However, only about 10% will develop peptic ulcer disease and 1 - 2% gastric malignancy. Virulent strains carrying the cag A gene and vac A s1 genotype and capable of cytotoxin production have been proposed to be associating with the severer forms or disease, although this was not universal. We were interested in studying the relation between cytotoxin-producing H. pylori strains and the H. pylori-related upper gastrointestinal disease in our community. Sixty patients were allocated into 3 predefined groups according to their endoscopic picture: gastroesophageal reflux disease [GERD], peptic ulcer disease, and gastritis groups. Gastric biopsies from the patients were examined for the presence of H. pylori by urease test and culture. The isolated H. pylori strains were subjected to cytotoxic assay to detect cytotoxin-producing strains. Forty-one patients [68.3%] were H. pylori positive, of them 19 [46.3%] were positive for cytotoxin production. Cytotoxin-producing H. pylori strains significantly associated peptic ulcer disease where 73.3% of peptic ulcer patients were infected with cytotoxin-producing strains. GERD was significantly associated with absence of H. pylori infection [66.7% of GERD patients were free of H. pylori infection]. The presence of gastritis did not correlate with the H. pylori status, however, there was a significant association between cytotoxin-producing strains and atrophic gastritis. Cytotoxin-producing H. pylori strains are associated with severer H. pylori-related upper gastrointestinal diseases such as atrophic gastritis and peptic ulcer disease. Our findings support the hypothesis of cag A [+] H. pylori being protective against GERD. Determination of cag A status of H. pylori strains bears importance in clinical practice in detecting patients at increased risk for developing gastric cancer and in helping planning treatment strategies

Chloramphenicol drug failure in typhoid fever

Two hundred positive blood culture typhoid patients admitted to Embaba Fever Hospital, Giza province, were subjected to: 1] Careful history and thorough clinical examination. 2] Complete blood picture. 3] Widal agglutination teat. 4] Urine and stool cultures for Salmonellae. 5] To the isolates of the cultures, disk diffusion chloramphenicol susceptibility test, minimum inhibitory concentrations and chloramphenicol acetyl transferase test were performed. The dose of chloramphenicol was restricted to 50 mg per Kg body weight daily, whatever the route used; whether oral, rectal or intravenous. When fever did not drop up to 5 days or the patient presented with typhoid complications or the blood culture revealed resistant Salmonellae, quinolones or third generation, cephalosporins were administered. Measurement of the level of chloramphenicol in the blood was performed for every patient. Fifty [25%] patients were found to be resistant in vitro and in vivo to chloramphenicol. All their Salmonellae isolates were resistant to chloramphenicol the mean zone size was 10 mm, the mean inhibitory concentration was 64 microgram per ml. and all were positive for chloramphenicol acetyl transferase. There was no significant difference in the serum level of chloramphenicol between susceptible and resistant groups to the drug. Results were interpreted and discussed

Histochemical studies on rectal mucosa in active intestinal schistosomiasis

Thirty patients suffering from active intestinal S. mansoni infection, were classified into 3 groups. The first group: 13 cases with early active intestinal schistosomiasis without hepatosplenomegaly. The second group: 11 cases with hepatoslenomegaly and the third group: 6 cases with splenomegaly and ascites. Also 10 normal individuals were included as a normal control group. Histopathological examination of rectal mucosa showed hyperaemia with extravasation of blood in early cases and grarulomatous lesions in the second group with hepatosplenomegaly. The structural changes were severe in the late ascitic group. In this group the rectal mucosal glands showed distorted irregular tubular branching in addition to the granulomatous and the fibrous reactions. Histochemical studies including periodic acid schiff, alkaline phosphatase and acetyl cholinestrase reactions were done. Using the periodic acid shiff stain, the goblet cells showed strong reaction for neutral mucin in cases of group I [early cases] and group II [late hepatosplenomegalic cases]. In group III [late ascitic cases] the goblet cells were faintly stained. A notable difference was observed between the lightly and heavily infected patients of this group. No alkaline phosphatase reactivity could be identified in rectal crypts of patients and controls. Alkaline phatase reactivity was sharply localised in S. mansoni egg shell. There was obvious decrease in the acetyl cholinesterase stained nerve fiber in the rectal mucosa of all studied patients. The decrease was more in chronic and heavily infected cases rather than in the acute and lightly infected ones

role of plasma prolidase enzyme assay in the diagnosis of early cases of bilharzial hepatic fibrosis

In this work, 40 male Egyptian patients having schistosomiasis were classified into early and late cases of bilharziasis accoding to the duration of the disease, they were subjected to the estimation of their plasma prolidase levels in an attempt to elucidate its role in the diagnosis of hepatic fibrosis. Our results indicate that the prolidase enzyme could help as a marker for the diagnosis of hepatic fibrosis in cases of early hepatic schistosomiasis. To the last of our Knowledge, this was the first attempt for the estimation of this enzyme in liver fibrosis concurrently occurring in cases of intestinal schistosomiasis. The results were analysed and discussed

Management of failures after non-drainage procedures in retinal detachment oprerations

Sixty seven cases of rhegmatogenous retinal detachment were operated by the non-drainage technique. Reoperation was considered in eleven failure cases, seven of these eleven cases were reoperated by the same non-drainage technique with success. The study presents an analysis of the causes of failure and emphasizes sticking to non-drainage technique even in recurrent cases. The situations where drainage is indicated ore discussed

Transcanalicular dacryocystorhinostomy

A simplified procedure for Dacryocystorhinostomy was introduced. It is easy to be done in a limited period of time, with no external scar, with minimal or no complications, and can be repeated

Delayed hypersensitivity skin and leukocyte migration inhibition tests in chronic liver disease

Cell mediated immunity was evaluated in 30 patients with chronic liver disease and 10 healthy controls The patients were 14 with chronic active hepatitis or active cirrhosis, 9 with bilharzial hepatic fibrosis 4 with liver cirrhosis of mixed etiology and 3 with primary liver cell carcinoma. Delayed hypersensitivity skin test to PPD antigen and leucocyte migration inhibition test was performed. Results indicate that patients with chronic active hepatitis or active cirrhosis, bilharzial hepatic fibrosis and primary liver cell carcinoma exhibit marked depression of cell mediated immunity and also failure to secrete migration inhibition factor