Exploring the role of gut microbiota in autoimmune thyroid disorders: a systematic review and meta-analysis.

Background: Autoimmune thyroid diseases (AITDs) are characterized by unique immune responses against thyroid antigens and persist over time. The most common types of AITDs are Graves' disease (GD) and Hashimoto's thyroiditis (HT). There is mounting evidence that changes in the microbiota may play a role in the onset and development of AITDs. Objective: The purpose of this comprehensive literature study was to answer the following query: Is there a difference in microbiota in those who have AITDs? Methods: According to the standards set out by the PRISMA statement, 16 studies met the requirements for inclusion after being screened for eligibility. Results: The Simpson index was the only diversity measure shown to be considerably lower in patients with GD compared to healthy participants, whereas all other indices were found to be significantly greater in patients with HT. The latter group, however, showed a greater relative abundance of Bacteroidetes and Actinobacteria at the phylum level, and consequently of Prevotella and Bifidobacterium at the genus level. The strongest positive and negative relationships were seen for thyroid peroxidase antibodies and bacterial load. Conclusion: Overall, both GD and HT patients showed significant changes in the gut microbiota's diversity and composition. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023432455.

Long COVID syndrome: psychological and sexual dysfunction among survivors of COVID-19 infection.

Background: To explore the neuropsychiatric symptoms, sleep disturbances, and sexual dysfunction in patients with long COVID syndrome, which can help in building better follow-up strategies for coronavirus disease 2019 (COVID-19) survivors. Material and methods: A cross-sectional research was undertaken at the premises of a psychiatry unit at a tertiary care unit in Karachi, Pakistan, between August 2022 and April 2023. All individuals aged 18 years or older, who had a history of contracting COVID-19 infection in the last 12 months presented to the department of Psychiatry with neuropsychiatric symptoms were recruited. Using a predefined questionnaire, data was collected from the participants. A linear logistic regression was used to find the impact of age, sex, hospitalization, and duration of home isolation on the likelihood of persistent neuropsychiatric symptoms or sexual dysfunction. Results: A total of 457 patients were included. It was found that individuals were less likely to experience neuropsychiatric symptoms as age increased (OR=0.968, 95% CI: 0.949-0.986, P=0.001). Females were 4.8 times more likely to experience neuropsychiatric symptoms than males, and the association was extremely significant (OR=4.851, 95% CI: 3.085-7.626, P<0.0001). An increase in age raised the odds of having sleep disturbances among the survivors by 2.7 times (OR=2.672, 95% CI: 2.654-2.684, P<0.0001). The odds of having sleep disturbances were three times more likely in female participants as compared to male participants (OR=3.00, 95% CI: 1.771-5.094, P<0.0001). Conclusion: The majority of the COVID-19 survivors are presenting with persistent neuropsychiatric and sexual symptoms in our setting. Therefore, it is necessary to maintain proper follow-up with the survivors of COVID-19 and counsel the patients to inform the family physician if these symptoms persist for longer than a month. Increasing such practices of regular follow-ups with COVID-19 survivors can help in detecting early neuropsychiatric and sexual changes.

Immunomodulatory Therapy for Giant Cell Myocarditis: A Narrative Review.

Giant cell myocarditis (GCM) is a rare, often rapidly progressive, and potentially fatal disease because of myocardium inflammation due to the infiltration of giant cells triggered by infectious as well as non-infectious etiologies. Several studies have reported that GCM can occur in patients of all ages but is more commonly found in adults. It is relatively more common among African American and Hispanic patients than in the White population. Early diagnosis and treatment are critical. Electrocardiogram (EKG), complete blood count, erythrocyte sedimentation rate, C-reactive protein, and cardiac biomarkers such as troponin and brain natriuretic peptide (BNP), echocardiogram, cardiac magnetic resonance imaging (MRI), myocardial biopsy, and myocardial gene profiling are useful diagnostic tools. Current research has identified several potential biomarkers for GCM, including myocarditis-associated immune cells, cytokines, and other chemicals. The standard of care for GCM includes aggressive immunosuppressive therapy with corticosteroids and immunomodulatory agents like rituximab, cyclosporine, and infliximab, which have shown promising results in GCM by balancing the immune system and preventing the attack on healthy tissues, resulting in the reduction of inflammation, promotion of healing, and decreasing the necessity for cardiac transplantation. Without immunosuppression, the chance of mortality or cardiac surgery was 100%. Multiple studies have revealed that a treatment combination of corticosteroids and immunomodulatory agents is superior to corticosteroids alone. Combination therapy significantly increased transplant-free survival (TFS) and decreased the likelihood of heart transplantation, hence improving overall survival. It is important to balance the benefits of immunosuppression with its potentially adverse effects. In conclusion, immunomodulatory therapy adds significant long-term survival benefits to GCM.

Supratotal Resection: An Emerging Concept of Glioblastoma Multiforme Surgery-Systematic Review And Meta-Analysis.

BACKGROUND: The severe neurologic tumor known as glioblastoma (GBM), also referred to as a grade IV astrocytoma, is rapidly progressive and debilitating. Supratotal resection (SpTR) is an emerging concept within glioma surgery, which aims to achieve a more extensive resection of the tumor than is possible with conventional techniques. METHODS: We performed a language-independent search of PubMed, Scopus, and Cochrane CENTRAL to identify all available literature up to August 2022 of patients undergoing SpTR assessing survival outcomes in comparison to other surgical modalities. RESULTS: After screening for exclusion, a total of 13 studies, all retrospective in design, were identified and included in our meta-analysis. SpTR was associated with significantly increased overall survival (hazard ratio 0.77, 95% CI 0.71-0.84; P < 0.01, I2 = 96%) and progression-free survival (hazard ratio 0.2, 95% CI 0.07-0.56; P = 0.002, I2 = 88%). CONCLUSION: SpTR is associated with greater overall survival and PFS when compared with other glioblastoma surgeries like GTR or SubTR.

Open, Laparoscopic, and Robotic Approaches to Treat Colorectal Cancer: A Comprehensive Review of Literature.

Surgery is usually required to treat colorectal cancer (CRC). Medical technology has advanced, providing various approaches to tackle this disease. Different surgeries are available, such as laparoscopic surgery, single-incision laparoscopic surgery, natural orifice transluminal endoscopic surgery, and robotic surgery. Laparoscopic surgery has several benefits including reduced blood loss and shorter recovery time. It can also improve lung function and minimize complications. However, it requires more time to perform and has a higher risk of complications during the procedure. Robotic surgery provides a three-dimensional view of the surgical area allowing for greater precision in rectal surgeries and access to difficult-to-reach pelvic regions. This method utilizes robotics technology which reduces surgical time and speeds up recovery for patients. There are various surgical options available for treating CRC; however, laparoscopic surgery and robotic surgery offer unique advantages despite their own drawbacks. As technology continues to evolve, medical techniques will continue improving existing methods while providing new options resulting in better outcomes for patients. Compared to laparoscopy, robotic surgery has a lower rate of operative conversions and a shorter learning curve. However, it also has some drawbacks, such as a longer docking time, lack of tactile sensation, and higher cost. Therefore, the choice of surgical method should depend on patient characteristics, surgeon preference and expertise, and available resources. Currently, specialized centers offer robotic surgeries which are more expensive and take longer compared to open and laparoscopic approaches. Nonetheless, they are considered safe and feasible when compared to traditional surgery. Short-term outcomes for robotic surgeries are better, while long-term postoperative complication rates remain similar. However, there is a need for additional well-defined randomized control trials conducted across multiple centers to validate the use of robotic surgery over open and laparoscopic approaches. Improving patient care and outcomes is the objective of this comprehensive literature overview on surgical approaches for CRC.

Effectiveness of Cardiac Rehabilitation in Myocardial Infarction Patients After Percutaneous Coronary Intervention.

Background Post myocardial infarction rehabilitation can have a positive impact on overall patient health. Therefore, the present study investigated the role of cardiac rehabilitation in reducing the frequency of arrhythmias, recurrent angina, readmission, and mortality in patients who underwent percutaneous coronary intervention. Methodology A prospective observational study was conducted at the Cardiology Department, Khyber Teaching Hospital, Pakistan, between 1st March 2021 and 30th May 2021. All patients who were discharged after being diagnosed with acute myocardial infarction were included in the study. Patients who were not able to give consent, had physical fragility, mental impairment, or those who have critical illness were excluded from the study. 40 patients underwent cardiac rehabilitation while the other 40 acted as controls. The cardiac rehabilitation group patients were asked to engage in 15-30 minutes of activity daily and keep a record of all their activities. Death, recurrence, rhythm abnormalities, rehospitalizations, and BMI (body mass index) were all documented on a predesigned proforma and compared between intervention and control. A three-month-long follow-up plan was established. Results A total of 80 patients were enrolled in the study. Post-infarction angina (p = 0.0012) was significantly higher in patients who did not receive cardiac rehabilitation (CR). The incidence of arrhythmias was significantly higher in the control group as compared to the rehab group (p=0.002). Moreover, the mean left ventricular ejection fraction (LVEF) was also significantly higher in patients who underwent CR as compared to the control group (44.76 ± 13.8 vs. 42.9 ± 13.5, p = 0.01). There was no significant difference between the post-intervention BMI in the rehab group. Conclusion In conclusion, the present study findings revealed that mild to moderate cardiac rehabilitation (CR) was related to the less frequent occurrence of post-infarction angina and arrhythmias. Moreover, we found that patients who received CR experienced a significant improvement in left ventricular ejection fraction (LVEF) as compared to the control group. However, further large-scale studies from multiple centers are warranted.

Incidence of Rhegmatogenous Retinal Detachment (RRD) in a Tertiary Care Center of Pakistan.

Background Regardless of the advancements in ophthalmology, rhegmatogenous retinal detachment (RRD) remains a substantial issue for physicians. The present study assessed the incidence of RRD among our population. Methodology A cross-sectional study was performed at the Layton Rehmatullah Benevolent Trust (LRBT) between June 2020 and May 2021. All the patients of RRD, irrespective of gender, within the age bracket of 20 years or more and diagnosed by a consultant ophthalmologist were included in the research study. Patients with serous retinal or tractional detachment and RRD with vitreous leakage were excluded from the study. A slit lamp and dilated fundus examination was performed preoperatively to assess the type of retinal detachment and associated factors as mentioned above. All data were collected on predesigned pro forma. Results About 25,000 individuals were presented to the outpatient department during the study period. Out of these, 100 patients were diagnosed with RRD. The incidence rate of the RRD in our center was 0.4%. There were a majority of the males. The mean age of patients did not vary significantly with respect to gender (p < 0.797). The most common type of RD was the total RD with a frequency of 53 cases followed by inferior RD with 19 cases. The majority of those with total RRD were males, i.e., 37%; however, the difference was statistically insignificant (p = 0.476). The study revealed that most of the RRD was diagnosed in patients < 45 years of age; however, the difference was not statistically significant (p < 0.227). Conclusion The present study highlighted the incidence of RRD and explored the sociodemographic and other clinical features in the Pakistani population. However, it is possible that the RRD condition is still under-diagnosed in our hospital settings. Further exploration is warranted to study comprehensively the risk factors associated with RRD.

Interruptions to Enteral Nutrition in Critically Ill Patients in the Intensive Care Unit.

Background Malnourishment has been linked with increased morbidity and mortality among critically ill patients. The current study aimed to assess the factors contributing to the interruption of enteral nutrition so that preventive measures can be formulated to avoid the malnourishment of critically ill patients. Methodology A prospective, observational study was conducted at the Department of Intensive Care Unit, Shifa International Hospital, Islamabad, between November 2020 and May 2021. All patients admitted in the intensive care unit (ICU) during the study period aged between 18 and 80 years, who remained admitted in the medical ICU for at least 72 hours were included in the study. Those who had ileostomy or colostomy were excluded from the study. Diagnostic categories were defined as surgical and medical. Data on clinical parameters including admitting diagnosis and airway-related issues were recorded in a predefined proforma. Results The mean duration of enteral nutrition interruption in males was 13.96 ± 13.12 days while that of females, 12.48 ± 12.43 days. Non-invasive ventilation dependency was significantly associated with an interruption in enteral nutrition (p=0.002). The mean duration of interruption of enteral nutrition was not correlated with airway issues (p=0.569). However, the mean duration of interruption of enteral nutrition was significantly lower in patients who underwent spontaneous breathing trials with T-piece (p = 0.032). Those who were advised nil per oral before surgery had a significantly longer duration of enteral nutrition interruption (p < 0.0001) with a mean length of 30.18 ± 5.83 days. The duration of enteral nutrition interruption was significantly longer in patients who had tracheostomy than those who did not have a tracheostomy (26.3 ± 6.34 vs. 9.54 ± 11.61 days) (p < 0.0001). Conclusion The present study revealed that at least three-forth of the patients admitted in ICUs had documented orders to the interruption of enteral nutrition. The most significant causes that correlated with interruptions to enteral nutrition were non-invasive ventilation dependency, tracheostomy, spontaneous breathing trials with T-piece, and orders of nil per oral before surgery.

The Association Between Deficiency of Vitamin D and Diabetes Mellitus Type 2 (DMT2).

Background  The impact of vitamin D deficiency on the incidence of various diseases and its relationship with the progression of diabetes mellitus type 2 (DMT2) is still controversial. The present study evaluated the incidence of vitamin D deficiency in patients with DMT2. Methodology  A cross-sectional study was conducted in a tertiary care hospital, Sindh, Pakistan from October 2020 to September 2021. A total of 525 patients of DMT2 were recruited. Another 525 patients acted as healthy controls. In patients with DMT2, blood samples were taken in the morning to measure vitamin D levels. All socio-demographic and clinical data were documented in a predefined pro forma. The association between the incidence of DMT2 and hypovitaminosis was explored.  Results The mean age of the patients was 50 ± 5.5 years. There were 100 (54.1%) male and 85 (45.9%) female patients. The mean duration of diabetes of the patients was 6.8 ± 2.4 years. The mean serum 25-hydroxy vitamin D level was 22.3 ±10.4 ng/ml. In the case group, the majority of the patients had vitamin D deficiency i.e. 54.1%, while only 25.9% of controls had hypovitaminosis. Vitamin D deficiency was significantly correlated with the occurrence of DMT2 (p<0.0001).  Conclusion The current study indicates that patients with diabetes mellitus type 2 (DMT2) more frequently suffer from vitamin D deficiency. Those patients with vitamin D deficiency and DMT2 can benefit from vitamin D replenishment. This may help improve glycemic control in these patients. This study served as a catalyst for future studies where the relationship between hypovitaminosis and insulin resistance can be thoroughly explored.

Subclinical Hypothyroidism in Perimenopausal Abnormal Uterine Bleeding Patients.

Background  Abnormal uterine bleeding (AUB) can be very troublesome and is common in women with thyroid dysfunction. The current study aimed to assess the incidence of subclinical hypothyroidism in women with perimenopausal AUB. Methodology  A cross-sectional study was conducted at Hayatabad Medical Complex (HMC), Peshawar, Pakistan, between September 2020 to February 2021. All outdoor female patients with complications in the obstetrics and gynecology department, aged between 40 to 55 years of age, and no obvious cervical and genital lesions were included in the study. Patients with a history of suspected inflammatory disease, use of oral contraceptives, and malignant lesions of the cervix were excluded from the study. All cases were evaluated for AUB and their thyroid profile was evaluated. Data regarding menstrual irregularities were recorded in a pre-defined proforma and clinical examination was performed. Results A total of 500 women were enrolled with a mean age of 47.2 ± 7.3 years. Of these, 234 (46.8%) women were overweight and the mean levels of the thyroid-stimulating hormone were 4.4 ± 2.5 mIU/L. The mean triiodothyronine and thyroxine were 3.2 ± 1.9 and 1.5 ± 0.7 pmol/L, respectively. The rate of subclinical hypothyroidism was 33%. It was shown that the body mass index was significantly correlated with subclinical hypothyroidism (p=0.03). Furthermore, the rate of oligomenorrhea was significantly higher in patients with subclinical hypothyroidism (p=0.05). Conclusion  This study highlights the association between thyroid dysfunction in women with menstrual disorders. Screening and surveillance of thyroid-related abnormalities are warranted in patients with menstrual irregularities to avoid complications of the disease.

Fecal Loading at Caecum as a New Radiological Sign for Diagnosing Acute Appendicitis.

Background The present study aimed to address the importance of a new radiological sign - the presence of fecal loading at the caecum - for the diagnosis of acute appendicitis. Methodology A cross-sectional study was conducted at the Department of General Surgery, Jinnah Postgraduate Medical Centre, Karachi from January 2020 to June 2020. Patients who presented in the emergency with acute pain at the right iliac fossa fulfilling the criteria of acute appendicitis (AA) according to the Alvarado scoring system, and were planned for appendectomy were included. Before surgery plain abdominal radiographs were taken in anteroposterior view in the supine position and were evaluated for the presence of fecal loading at the caecum. After that all patients underwent surgery and radiologic findings were correlated with histopathologic findings. Results The mean age of patients was 32.19±7.34 years. There were 83 (55.3%) male and 67 (44.7%) female patients. Out of 150, there were 144 (96.0%) patients in whom fecal loading in the caecum was diagnosed on plain radiographs. On histopathology reporting, acute appendicitis was diagnosed in 143 (95.3%) patients. Regarding accuracy, fecal loading at the caecum was found to have a sensitivity of 98.6%, specificity of 83.3%, a positive predictive value of 99.3%, and a negative predictive value of 71.4%.  Conclusion According to the results of the present study and existing literature, we suggest using fecal loading at the caecum along with a clinical scoring system for the diagnosis of acute appendicitis. As per our findings, fecal loading at the caecum is a valuable sign on plain abdominal radiograph for the diagnosis of AA. It has a sensitivity of 98.6% and a specificity of 83.3%. This sign typically becomes undetectable after an appendectomy. It will help to improve the accuracy of diagnosis of acute appendicitis, and hence will reduce the chances of negative appendectomy.

Efficacy of Magnesium Sulfate in Addition to Melatonin Therapy in Neonates With Hypoxic-Ischemic Encephalopathy.

BACKGROUND: One of the most important causes of neonatal deaths in developing nations is birth asphyxia. Though the probability of a complete recovery is very low, hypoxic-ischemic encephalopathy (HIE) associated with asphyxia can be managed with multiple treatment options. The study evaluated the efficacy of the addition of magnesium sulfate (MgSO4) to melatonin therapy in neonates with HIE. METHODOLOGY: A prospective, observational study was conducted in the department of neonatal intensive care, Pakistan Institute of Medical Sciences Hospital, Islamabad, Pakistan from October 2020 to March 2021. All neonates with an Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score of less than five at five minutes, umbilical blood pH of less than 7.0, and moderate neonatal encephalopathy as detected on the modified Sarnat score which is a clinical tool used for the assessment of the severity of HIE were included in the study. Neonates with congenital abnormalities, intrauterine growth retardation, neonatal sepsis, and infants born to mothers with diabetes mellitus type 2 were excluded from the study. The infants were randomly assigned to either of the groups, i.e., i) group 1 included neonates who were administered at least three doses of magnesium sulfate (MgSO4) infusion in addition to melatonin, or ii) group 2 included neonates who were administered melatonin only. Blood samples of all neonates were evaluated and compared between the two groups. RESULTS: A total of 90 neonates with HIE were included in the study. There was a predominance of female neonates. The mean ages of babies in group 1 and group 2 were 37.2 ± 0.43 and 37.3 ± 0.59 weeks, respectively. The mean weight on the term was 2.88 ± 0.11 and 2.89 ± 0.10, respectively. The Apgar score at 5 mins in group 1 was 1.73 ± 0.81 while in group 2, 1.82 ± 0.94. It was found that there was a more significant improvement in pH after 3 days and after one week of treatment in group 1 as compared to group 2. The mean pH in babies after three days of intervention was 7.23 ± 0.03 in group 1 which was significantly better than group 2 (p<0.0001). After seven days, the mean normalized to 7.39 ± 0.04 in group 1 (p < 0.0001). It was found that in patients in group 1, the mortality was lower than in group 2 (p < 0.0001). CONCLUSION: HIE patients who were administered melatonin in combination with magnesium sulfate yielded better patient outcomes. Thus, it was concluded that the use of magnesium sulfate as dual therapy with melatonin improved patient outcomes for HIE. However, it is recommended that similar studies are conducted with a wider range of parameters, such as duration of hospital stay and assessment of the neurological outcomes of the patients.

Efficacy of Oral Tranexamic Acid Versus Combined Oral Contraceptives for Heavy Menstrual Bleeding.

Introduction Heavy menstrual bleeding (HMB) is characterized by high blood loss (>80 mL per cycle) at regular menstrual intervals. It can have an impact on a woman's bodily, mental, and/or material well-being. The etiology is varied and can be local, systemic, or iatrogenic. The occurrence of HMB is between 4% and 27%, depending on objective menstrual bleeding measurements and on high estimates based on subjective bleeding measures. This study was conducted to assess the efficacy of oral tranexamic acid versus combined oral contraceptive (COC) pills in the management of excessive menstrual bleeding. Methodology A comparative study was conducted at the Obstetrics and Gynecology Department of Combined Military Hospital Peshawar, Pakistan, from October 2020 to March 2021. Women aged above 18 years who presented with heavy menstrual bleeding (HMB) were included in the study. The exclusion criteria included all women with contraindications to the use of tranexamic acid, such as lactating mothers, pregnancy, use of oral contraceptives or steroids, history of renal malfunction or stroke, family history of thromboembolic disease, and ovarian or endometrial carcinoma. Patients with diagnosed leiomyomas with a size between >1 and 10 cm were included in the study. Women were allocated randomly into group A who received oral tranexamic acid 3.9-4 g per day or group B who received oral COC pills containing a combination of ethinyl estradiol 30 µg and norgestrel 0.3 mg. The efficacy of treatment was considered successful if there was a mean reduction in menstrual blood loss that was significantly greater than the baseline values. Results There were 178 patients in total, with 89 patients in each group. It was found that both oral tranexamic acid and combined oral contraceptives were equally effective in reducing the mean blood loss among patients and there was no statistical difference observed between the two groups. Upon stratification, it was found that both treatment groups were highly effective in younger age groups. Similarly, there was no significant difference in efficacy with respect to diabetes mellitus or hypertension. However, in individuals with leiomyomas, efficacy was significantly higher in patients who were in group B (combined oral contraceptives) (p = 0.004), and 46.1% of women in group A and 60.6% of women in group B did not experience any discomfort. Conclusion The current study revealed that both oral tranexamic acid and COC pills were equally effective in reducing the mean blood loss among patients with HMB. It was further found that the efficacy of both therapies was significantly higher in younger age groups. The efficacy of therapy was significantly reduced with the increasing age of the patient. Moreover, it was found that patients with leiomyomas benefitted more significantly from COC pills. There were no severe adverse effects reported in the study. However, future researches can explore the long-term side effects of both therapies. In short, both therapies were comparable in terms of efficacy and safety. Heavy menstrual bleeding can negatively impact a woman, emotionally and physically. Therefore, it is encouraged that physicians use their expert judgment while prescribing either oral tranexamic acid or COC pills to patients with HMB.

Changes of Patterns and Outcomes of Ocular and Facial Trauma Among Children in Jordan.

Introduction The eye is the second most common organ affected by trauma after hands and feet. Eye trauma is a common cause of visual morbidity and may result in irreversible visual impairment and blindness. Ocular and facial trauma contribute to significant proportions of visual deficits among young children. This study aimed to explore the changes in trend including the pattern and outcomes of ocular and facial trauma among children between the last twenty years.  Methodology A retrospective study was conducted between January 2020 and April 2021. The medical records of the patients who attended the Royal Medical Services (RMS) military hospital between January 1999 and December 2019 suffering from eye trauma which required hospitalization were enrolled in the study and reviewed regarding age, gender, mechanism of trauma, the severity of the trauma, eye structures involved, and visual outcome. The patients were divided into three groups based on the time of trauma: Group A for injuries in the period (January 1, 1999 to December 31, 2005), Group B for the period (January 1, 2006 to December 31, 2012), and Group C for the period (January 1, 2013 to December 31, 2019). The collected data was analyzed and compared to explore whether there is any change in the pattern and visual morbidity of eye injuries over time. The most frequent finding of eye injury was corneal wound in Groups A and B patients, while in Group C the most common ocular injury was ecchymosis or sub-conjunctival hemorrhage. Results Three-thousand one-hundred and thirty only patients (3130 eyes) aged between 2 and 14 years (mean 7.11 ± 3.13) were included in the study. The male to female ratio was 2:1. 1864 patients (56.6%) were at five years of age or younger. The most common place of injury in the three groups was on the street. This ratio decreased from 64.0% in Group A to 48.8% in Group C. Stone was the commonest etiology of injury in Group A (38.0%) while wood and fall were the commonest in Group B (28.5%) and Group C (37.1%) respectively. Open globe injuries constituted 67.0% of patients in Group A, 64.7% of patients in Group B, and 51.2% of patients in Group C. Normal or mild visual impairment was noted in patients of Group C (43.9%) as compared to the patients in Groups A (7.5%) and B (8.3%) at presentation. The final vision of normal or mild visual impairment was reported in 37.1%, 38.5%, and 77.5% of patients in Groups A, B, and C respectively. Conclusion The current study is a retrospective analysis of twenty years in Jordan and has comprehensively explored the trends and patient outcomes with respect to ocular and facial trauma among children. We revealed that over time, such injuries became less frequent and less serious than before with better patient outcomes. Furthermore, higher rates of closed globe injuries were reported in recent years. There was a dramatic increase in the rate of indoor injuries compared with outdoor ones which were mostly caused by falls with better initial and final visual outcomes. These injuries are preventable with the implementation of adequate safety measures which would significantly reduce the burden of visual impairment and cosmetic disfigurement among youngsters.

The Role of Tumor Markers: Carcinoembryonic Antigen and Cancer Antigen 15-3 in Patients With Breast Cancer.

Introduction  Breast cancer is a major cause of mortality among females, worldwide. The present study was intended to evaluate the significance in the management of carcinoembryonic antigen (CEA) and cancer antigen 15-3 (CA15-3) in patients with breast cancer. Methodology A cohort study was conducted at the Jinnah Postgraduate Medical Center, Karachi, Pakistan from June 2020 to May 2021. All diagnosed cases of breast cancer who underwent surgical excision of tumor were eligible to partake. Patients who had metastatic breast cancer or had a recurrence were excluded. The patient's sociodemographic and clinical data were documented in a predefined pro forma. It included information about the age, sex, weight, as well as serum CEA and CA15-3. The CA15-3 and CEA levels for each patient were assessed by taking a 5ml blood sample and sending it to the laboratory for further workup. preoperatively on the second, seventh, and 28th postoperative days. Results A mean ± SD age of 52.6 ± 8.89 years was reported. Family history of breast cancer was positive in one-fourth of the patients. Nodal metastasis was negative in 114 (46.72%) patients. Three-fourth of patients had Stage II-IV with only a minority diagnosed with Stage I. The mean levels for CA15-3 in women with Stage I cancer was significantly lower on the seventh day and 28th postoperative day, compared to preoperative levels (p = 0.05). Similar associations were seen for stages II and III. Higher CEA levels were significantly associated with stage III breast cancer preoperatively (5.88 ng/ml, p = 0.05) compared to postoperative values. Conclusion The current study revealed that preoperative values of serum CEA and CA15-3 significantly reduced postoperatively. Moreover, patients with advanced cancers had significantly higher levels of both tumor markers than those with less advanced diseases. The current study highlighted the importance of regular assessment of serum CEA and CA15-3 in breast cancer patients. Both these biomarkers are substantially elevated in breast cancer patients, preoperatively. Determining the levels of serum CEA and CA15-3 pre- and postoperatively may determine the prognosis and aid in forming the most optimal patient care regime with respect to the stage and subtype of cancer.

Impact of Neodymium-Doped Yttrium Aluminum Garnet (ND-YAG) Posterior Capsulotomy Laser Treatment on Central Macular Thickness: A Prospective, Observational Study From a Tertiary Care Center.

Introduction Opacification of the posterior capsule is labeled as a secondary cataract. The objective of the current study was to assess central macular thickness (CMT) changes following neodymium-doped yttrium aluminum garnet (ND-YAG) posterior capsulotomy and to find out the correlation between CMT with the age, energy, and total shots utilized during the procedure. Methodology In this single-centered prospective observational study, 137 patients with a mean age of 57 ± 12.61 years, who had cataract surgery previously and were candidates for ND-YAG posterior capsulotomy were recruited through consecutive sampling. The study was conducted at Layton Rahmatulla Benevolent Trust (LRBT) Free Eye Hospital, Township, Lahore, Pakistan, between April 2020 to April 2021. The CMT, total energy, and sum total of shots used were recorded. The thickness of the central macula was measured preoperatively and postoperatively after two weeks. The paired sample t-test was used to find out any significant changes in CMT pre and two weeks postoperatively. The comparison of changes in CMT to age, energy, and the total number of shots was made through Pearson correlation. Means of CMT were compared using an independent sample t-test, at two weeks postoperatively among two energy groups. Results No statistically significant differences were found between preoperative and two weeks postoperative values of the CMT (P-value= 0.209). No significant difference was found in CMT statistically among the two energy groups (p=0.11). The patient's age, sum total of laser shots, and aggregate of laser energy did not have any significant correlation with CMT changes. The time period between cataract surgery and ND-YAG surgery showed a moderately positive correlation with a p-value of 0.01. Conclusion The current study revealed that ND-YAG capsulotomy does not affect the CMT significantly postoperatively. The patient's age, total energy applied, and the total number of laser shots used do not influence the macular thickness. However, the length of duration from the last cataract surgery to the current surgery was significantly associated with a change in the CMT.

Ocular and Dental Causes of Headaches Among School-Age Children in Jordan: A Retrospective Study.

Introduction Headache disorders are becoming increasingly prevalent among the younger population. In this study, we aimed to explore the varying causes of headaches among school-age children in Jordan. Methodology This was a retrospective observational study conducted at the Queen Rania Hospital for Children between June 2019 and June 2020. All the data of the patients were extracted from the patient files with the permission of the administration. All children who were referred to the ophthalmology and dental clinic with headaches as the presenting complaint were included in the study. A detailed history was initially obtained regarding age, gender, medical history, as well as the duration and characteristics of headaches. The patients underwent detailed ocular examination including best-corrected visual acuity (BCVA) using the Snellen chart, anterior and posterior eye segment examination, and intraocular pressure measurement. Refraction under the effect of cyclopentolate was performed for all patients. A detailed dental and oral exam was performed on all children at the dental clinic by the same dentist. Results A total of 712 patients aged between five and 13 years (mean ± SD: 9.3 ± 2.86 years) presented with headaches during the study period. Headaches were more frequent in males [n=441 (61.9%)], but a slight female predominance was found among patients aged 11 years and older. At the ophthalmology clinic, 230 (32.3%) patients with headaches had positive findings; the majority of these patients [n=228 (32%)] had refractive errors with astigmatism as the most common type. Of note, 515 patients (72.3%) had dental caries with a Decayed, Missing, and Filled Permanent Teeth (DMFT) score ranging from 1.5 to 4.3. Conclusion Refractive errors, particularly astigmatism, were found at higher rates among children with headaches. Also, temporomandibular disorders were more prevalent among children with headaches, particularly those aged between 11 and 14 years. Routine ophthalmic and dental assessment is recommended for children presenting with chronic headaches.

Black colon.

Early diagnostic endoscopic evaluation is useful in evaluation of mucosal viability and possible endoscopic reduction in patients with sigmoid volvulus. Black-brown mucosa is consistent with gangrene, a life-threatening complication requiring surgery.