Autologous serum in dry eye disease

Background: The tear film overlays the ocular surface and provides the interface between the eye and the external environment. The tear film is essential for the nutrition and protection of the ocular surface and for clear vision as the tear film is the first refractive surface of the eye

Aim of the Work: the purpose of this study was to review the efficacy, complications and safety of using autologous serum in dry eye

Patients and Methods: thirty patients of moderate to severe dry eye selected from Ophthalmology Out-Patient Clinics, Al-Hussein University Hospitals. All patients were subjected to Schirmer 1 test, Tear break - up time [TBUT], and Fluorescein clearance test

Results: The mean value of Schirmer 1 test before the use of autologous serum was 2.83 mm +/- 0.83 SD while after use of autologous serum was 5.33 mm +/- 9.99 SD. The mean value of TBUT test before the use of autologous serum was 9.50 sec +/- 1.20 SD while after use of autologous serum was 9.433 sec +/- 1.52 SD. The mean value of FCT before the use of autologous serum was 100 % positive while after use of autologous serum was 76.7 % positive. The difference between before and after use of autologous is statistically significant as P-value < 0.001

Conclusion: this study revealed that autologous serum eye drops were found effective and safe in treatment of severe dry eye disease, as evidenced by improvement in subjective assessment of symptoms, Schirmer's 1teast, tear film break-up time [TBUT] and fluorescein clearance test [FCT]

Cancellation of operations in Saudi Arabian hospitals: Frequency, reasons and suggestions for improvements

To identify the frequency and reasons of operations cancellation in 25 Makkah region hospitals in Saudi Arabia. Retrospective evaluation of the rate of surgery .cancellation in 25 hospitals of Makkah region was performed in this study. The data of scheduled surgeries from 15 different surgical specialties was collected from January to December 2013. Frequency and reasons of cancellation of elective surgical cases in different specialty were studied with a view to recommend suggestions for improvement. Data was analyzed on SPSS -16. There are 120 operating rooms [OR] in 25 Makkah region hospitals and during the year 2013, a total of 16,211 surgery cases were listed, and 1,238 [7.6%] cases were canceled. Contribution to total cancellation was highest in orthopedic 33.8% followed by general surgery 27.5%, obstetrics 7.7% and ENT 5.2%. According to category, 42.81% rate of cancellation was patient related, 20.03% facility related, 9.45% due to improper work-up, 1.45% associated with anesthesia, 7.19% related to surgeons, and 18.90% other/ and not recorded reasons. Present study found 7.6% cancelation rate in Makkah region hospitals and three most common causes for cancellations were patients related, facility related and improper work-up

Tight junction protein claudin 4 in gastric carcinoma and its relation to lymphangiogenic activity

Background and study aims: Gastric cancer is the second most common cause of cancer-related death worldwide. Claudins are a family of tight junction proteins that are biologically relevant in many cancer progression steps. This study aimed to investigate the expression of the intestinal claudin [claudin 4] in gastric carcinoma and to evaluate its relation to the different clinicopathologic prognostic parameters, especially lymphangiogenesis [production of new lymphatic vessels, measured by lymphovascular density [LVD]] and lymphovascular invasion [LVI]

Patients and methods: Fifty-five gastric carcinoma specimens were immunohistochemically stained for claudin 4 and D2-40 [for detection of lymphatic vessel endothelium]

Results: High expression of claudin 4 was detected in 26 of 55 [47.3%] cases. Low expression of claudin 4 was related to poorly differentiated type [p = 0.001], non-intestinal [diffuse] type [p = 0.001], deeper tumour invasion [p < 0.001], lymph node metastasis [p = 0.001], and higher stage [p = 0.001]. In addition, higher LVD was related to poorly differentiated types [p = 0.001], non-intestinal type [p = 0.001], lymph node metastasis [p = 0.015], and higher tumour, node, metastasis [TNM] stage [p = 0.001]. LVI was related to lymph node metastasis [p = 0.025], higher TNM stage [p = 0.001], and LVD [p = 0.001]. Claudin 4 significantly correlated with both LVD [p = 0.009] and LVI [p = 0.009]

Conclusions: High expression of claudin 4 was associated with the more differentiated intestinal-type gastric carcinoma and lost in poorly differentiated diffuse type. So, claudin 4 may be used as one of the differentiating markers between the two major types of gastric carcinoma [intestinal vs. diffuse]. LVD and LVI were related to higher incidence of lymph node metastasis and therefore could be used as predictive markers for lymph node metastasis in limited specimens during early gastric carcinoma to determine the need for more invasive surgery. Low expression of claudin 4 was related to lymphangiogenesis. This may shed light on the relation of tight junction protein expression and lymphangiogenesis

Role of increasing vaginal acidity in histological changes and softening of the cervix prior to dilatation in perimenopausal women

Cervical dilatation, along with hysteroscopy or endometrial curettage, is one of the most common procedures in gynecological practice. However, difficulty in entering the internal cervical os may be encountered; Therefore, there is a need for an effective cervical priming agent which can be used in general gynecological practice. Vaginal acidification might increase collagen degradation, It is known that cervical collagen degradation contributes to the ripening process. The present study was designed to evaluate the efficacy of acidifying vaginal cream in cervical tissue remodeling and softening. This study is a double-blinded clinical trial study, conducted in Obstetrics and Gynecology Department of Al-Azhar University Hospital [Damietta]. It included fifty perimenopausal women, their age ranged from 45-55 ys, planned for cervical dilatation before endometrial biopsy due to irregular uterine bleeding. They were divided into two main groups: Group I: women who were treated with acidifying vaginal cream [Eva base cream melted with acetic acid 5%]. Group II: women who were treated with neutral [placebo] vaginal cream [Eva base cream only]. Efficacy of acidifying vaginal cream on the cervix was assessed on the basis of improved cervical softening and degree of cervical changes on the histological examination. There was no significant difference in both groups during the preoperative assessment of the cervix and premedication. During operation in the study group [I] 1[st] Hegar's passed was No8 in 52% of cases and No9 in 28% of cases denoting the significant effect of acetic acid on cervical dilation in comparison with placebo group [II] in which the cervix was closed in 44% of cases and Hegar's No3 passed in 36% of cases showing statistical significance between the two groups. As regards the histological examination, it was found that in group [I] collagen dissociation grade II represent 56% and grade III 24% with statistical significance in comparison with placebo group [II] in which collagen was grade 0, in 76%. Also, the inflammatory changes in group [I] showed moderate changes in 72% of cases and 20% showed severe changes with statistical significance in comparison with the control group [II] in which 56% of cases showed no inflammatory changes. Vaginal acidification with 5% acetic acid as a cervical softening agent appeared to be safe, effective, with no adverse effects

Pulmonary aspergilloma simulating bronchogenic carcinoma.

When a pre-existing lung cavity is colonized by Aspergilius fumigatus, it forms a fungal ball (pulmonary aspergilloma) and the presenting symptom is usually haemoptysis that may be massive and often-times life threatening. The radiological finding is that of a ball-like structure within a lung cavitation and the typical air crescent around the ball both on plain radiography and CT scan of the chest. The present case is of a 50-year-old male who had a 25-year history of heavy smoking (40 cigarettes per day) and haemoptysis. Although the cavitating lesion, ball-like structure and the crescenteric rim of air were present on the radiographs, the possibility of bronchogenic carcinoma was held high in view. Flexible fibreoptic and transbronchial biopsies were negative for malignancy. Sputum and bronchoalveolar lavage examinations showed neither malignant cells nor fungal elements. Right thoracotomy, cavernostomy, removal of the fungal ball and obliteration of the cavity by suturing (capitonnage) were done with an uneventful postoperative period.