Comparison of COVID-19 laboratory diagnosis by commercial kits: Effectivity of RT-PCR to the RT-LAMP.

Coronavirus disease 2019 or COVID-19 caused by novel coronavirus/severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or 2019-nCoV) is an ongoing pandemic that has emerging global effects and requires rapid and reliable diagnostic testing. Quantitative reverse transcription-polymerase chain reaction (q-RT-PCR) is the gold standard method for SARS-CoV-2 detections. On the other hand, new approaches remedy the diagnosis difficulties gradually. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) as one of these novel approaches may also contribute to faster and cheaper field-based testing. The present study was designed to evaluate this rapid screening diagnostic test that can give results in 30-45 min and to compare the effectiveness of LAMP to the q-RT-PCR. The 30 randomly chosen patient samples were generated by nasopharyngeal swabs with a portion of the SARS-CoV-2 nucleic sequence. The sample of quantification cycle (Cq) values was tested using RT-LAMP as well as by conventional q-RT-PCR. The patient samples were tested with four different kits (SENSObiz COVID-19 [SARS-CoV-2] LAMP Assay, the QIAseq DIRECT SARS-CoV-2 kit, Biospeedy SARS-CoV-2 Variant Plus kit, and CoVirion-CV19-2 SARS-CoV-2 OneStep RT-PCR kit) and two different PCR devices (GDS Rotor-Gene Q Thermocycler and Inovia Technologies GenX series). Based on 30 patient samples, the positive/negative ratio (P/N) was 30/0 as Biospeedy and Covirion (positivity 100%), 28/2 as Qiagen kit (positivity 93.3%) for the samples studied on the Inovia device while the same samples on the Rotor-Gene device were 30/0 as Biospeedy and Covirion (positivity 100%), 29/1 as Qiagen kit at the first day (96.7%). On the fifth day, the samples were studied in the Inovia device and the respective results were obtained: 27/3 as Biospeedy (positivity 90%), 16/14 as Qiagen (positivity 53.3%), 28/2 as Covirion kit (positivity 93.3%). When these samples were studied in the Rotor-Gene device, it was 29/1 in Biospeedy and Covirion (positivity 96.7%), 19/11 in the Qiagen kit (positivity 63.3%). When these samples were compared with the LAMP method it was found to be 19/11 (positivity 63.3%) on the first day and 18/12 (positivity 60%) on the fifth day. SARS-CoV-2 test studies will contribute to a proactive approach to the development of rapid diagnosis systems. The LAMP approach presents promising results to monitor exposed individuals and also improves screening efforts in potential ports of entry.

Does circumcision have a relationship with ejaculation time? Premature ejaculation evaluated using new diagnostic tools.

The aim of the study is to investigate whether there is an effect of adult circumcision on ejaculation parameters and to research the relationship between intravaginal ejaculation latency time (IELT) and premature ejaculation diagnostic tool (PEDT). Adults who underwent voluntary circumcision between September 2010 and November 2011 were enrolled in this prospective study. The IELT before and 3 months following circumcision was recorded. Also, PEDT was filled out before and 3 months after circumcision. During statistical evaluation, the comparison of situations before and after circumcision was made using IELT averages and PEDT total scores. Furthermore, the correlation between changes in IELT and PEDT has also been evaluated. A total of 30 volunteers (mean age 21.25±0.44) were enrolled in the study. The volunteers' mean and median IELT before were 104.36±66.21 and 88 (26-307) seconds, whereas mean and median IELT after circumcision were 123.56±54.44 and 107.5 (67-300) seconds, respectively. The increase after circumcision was statistically significant (P=0.001). The mean and median PEDT score were 4.26±2.91 and 3 (1-12) before, and 2.63±1.82 and 2 (0-7) after circumcision. Improvement was statistically significant (P<0.0001). No correlation could be found between ejaculation time and PEDT scores. Circumcision during adulthood does not adversely affect ejaculatory function; it may slightly improve. However, it could not be interpreted as a justification for circumcision in men with premature ejaculation (PE).

Risk factors for retinal arteriolar emboli in coronary artery disease.

This study determined the prevalence of retinal arteriolar emboli risk factors in 148 patients (86 males) diagnosed with coronary artery disease who required coronary artery bypass graft surgery (mean +/- SD age 59.1 +/- 12.9 years). The prevalence of smoking was 50.7%, hypertension was 49.3%, diabetes mellitus was 27.0% and obesity was 31.1%. Retinal arteriolar emboli were detected using binocular indirect ophthalmoscopy of both eyes. They were found in 10 patients (6.8%) and identified as the cholesterol type. Patients were divided according to their baseline low-density lipoprotein cholesterol (LDL-C) serum level; retinal arteriolar emboli were significantly more frequent in patients with LDL-C levels > 100 mg/dl. These results demonstrate that the prevalence of hypercholesterolaemia and high LDL-C were increased in patients with retinal arteriolar emboli. Identification and treatment of modifiable risk factors, such as high LDL-C and hypercholesterolaemia, might be beneficial in these individuals.

Transient cortical blindness after coronary angiography.

Transient cortical blindness is rarely encountered after angiography of native coronary arteries or bypass grafts. This paper reports a case of transient cortical blindness that occurred 72 h after coronary angiography in a 56-year old patient. This was the patient's fourth exposure to contrast medium. Neurological examination demonstrated cortical blindness and the absence of any focal neurological deficit. A non-contrast-enhanced computed tomographic scan of the brain revealed bilateral contrast enhancement in the occipital lobes and no evidence of cerebral haemorrhage, and magnetic resonance imaging of the brain showed no pathology. Sight returned spontaneously within 4 days and his vision gradually improved. A search of the current literature for reported cases of transient cortical blindness suggested that this is a rarely encountered complication of coronary angiography.

Spatially defined oxygen gradients and vascular endothelial growth factor expression in an engineered 3D cell model.

Tissue hypoxia results in rapid angiogenesis in vivo, triggered by angiogenic proteins, including vascular endothelial growth factor (VEGF). Current views of tissue viability are founded on whether 'deeper-lying' cells receive sufficient nutrients and oxygen for normal activity and ultimately survival. For intact tissues, levels of such essential nutrients are governed by micro-vascular perfusion. However, there have been few effective quantitatively defined 3D models, which enable testing of the interplay or interdependence of matrix and cell density, and path diffusion on oxygen consumption in vitro. As a result, concepts on cell vulnerability to low oxygen levels, together with the nature of cellular responses are ill defined. The present study has adapted a novel, optical fibre-based system for in situ, real-time oxygen monitoring within three-dimensionally-spiralled cellular collagen constructs, which were then unfurled to enable quantitative, spatial measurements of VEGF production in different parts of the same construct exposed to different oxygen levels. A VEGF response was elicited by cells exposed to low oxygen levels (20 mmHg), primarily within the construct core.

A comparative study of the effectiveness of disinsertion and anterior transposition of the inferior oblique in the treatment of unilateral superior oblique palsy.

PURPOSE: To compare the effectiveness of disinsertion of the inferior oblique muscle (DIO) with anterior transposition of the inferior oblique muscle (ATIO) in the treatment of vertical deviations resulting from superior oblique palsy. METHODS: In this prospective randomized study, 22 patients with unilateral superior oblique palsy were evaluated. Eleven patients underwent the DIO procedure (DIO group), and the other eleven underwent the ATIO procedure (ATIO group). Statistics were analyzed using the Wilcoxon and Mann-Whitney U tests. RESULTS: The mean preoperative primary-position hypertropia was 22.2 +/- 6.2 prism diopters (Delta) in the DIO group and 23.1 +/- 6.6 Delta in the ATIO group; the mean preoperative hypertropia in adduction was 31.7 +/- 6.9 Delta in the DIO group and 31.8 +/- 8.1 Delta in the ATIO group. The mean follow-up was 18.8 months (SD: 10.2, range: 6-40 months). The mean reduction of hypertropia in primary-position in the ATIO group (mean: 18.5 +/- 3.9 Delta) was found to be significantly greater than in the DIO group (mean: 13.3 +/- 1.9 Delta) (p = 0.001). Even though the mean reduction of hypertropia in adduction in the ATIO group (mean: 27.7 +/- 9.6 Delta) was greater than in the DIO group (mean: 20.6 +/- 6.2 Delta), no statistically significant difference was found (p = 0.067). There was residual hypertropia in three (27.3%) patients who underwent the DIO procedure. No major postoperative complication was encountered in any of the patients. CONCLUSION: In vertical deviations resulting from superior oblique palsy, ATIO was found to be more effective than DIO in the reduction of primary-position hypertropia.

A case of traumatic globe luxation.

We observed a case of traumatic globe luxation. A 26-year-old man who was sitting at the back seat of the car without fastening his safety belt was admitted to the emergency room after an automobile accident. He was in semi-comatose condition. His left globe was dislocated anteriorly, and the lids were tightly closed behind it. No laceration was observed in cornea, sclera and extraocular muscles. The pupil was dilated and did not respond to light stimulation. Computerized tomography scan analysis revealed a normal optic nerve, but multiple fractures in the nasal, inferior and temporal walls of the orbit and in the nasal bone. Phthisis of the eye was detected by the end of second month. We believe that the back seats of automobiles should also be furnished with air bags for better security of passengers.

Intraoperative mitomycin C in the treatment of pterygium.

PURPOSE: To evaluate the effectiveness of intraoperative mitomycin C in preventing the recurrence of primary pterygium. METHODS: In this prospective, randomized study, 38 eyes of 35 patients with primary pterygium were evaluated. In 19 eyes, the "bare sclera technique" combined with intraoperative application of 0.2 mg/mL (0.02%) mitomycin C for five minutes was performed (mitomycin C treated group). The other 19 eyes--taken as control group--underwent surgical excision alone. Statistics were analyzed using the Mann-Whitney U test and the Fischer's exact test. RESULTS: Patients were 20-38 years of age. The mean age was 25.29 +/- 5.08 in the mitomycin C treated group and 25.00 +/- 5.19 in the control group. During the mean follow-up of 17.04 months (range, 12-36 months; SD = 5.89), 4 recurrences (21%) were observed in the mitomycin C treated group and 11 (57.8%) in the control group. The difference between the two groups was significant (p = 0.045). No postoperative complication was encountered in both groups except for recurrences. CONCLUSION: Intraoperative mitomycin C was found to be effective in preventing the recurrence of primary pterygium.

The effect of povidone iodine on the corneal endothelium.

PURPOSE: Povidone iodine has been proven to be a valuable antiseptic solution in preparing the eye for surgery and is an alternative to postoperative topical antibiotics. No study has addressed the intraocular toxicity of povidone iodine after injection into the anterior chamber. We investigated the potential toxicity of povidone iodine on the corneal endothelium after injections into the anterior chamber in a rabbit model. METHODS: In this study we used 24 eyes of 12 albino rabbits. The eyes were divided into the following three groups according to the drugs tested: group A, 5% povidone iodine; group B, 10% povidone iodine; group C, balanced salt solution. The injected eyes were evaluated by biomicroscopy, specular microscopy, corneal pachymetry, and transmission and scanning electron microscopy. RESULTS: Corneal edema was observed in all eyes of groups A and B. In groups A and C, the endothelial cell morphology was not significantly changed and the mean endothelial cell count of the eyes did not change significantly (p = 0.5054). There was no significant difference in corneal thickness between groups A and C (p = 0.3823), but there was a significant difference between groups B and C ( = 0.0002). Transmission and scanning electron microscopy results were normal in group C but not in groups A and B. CONCLUSION: Povidone iodine in both 5% and 10% concentrations demonstrates severe toxicity when one drop of either concentration is placed directly in the anterior chamber. When povidone iodine is used in preparing the eye for intraocular surgery and as an alternative to postoperative antibiotics, the inadvertent leakage of povidone iodine into the anterior chamber must definitely be prevented.

The short-term effect of adding brimonidine 0.2% to timolol treatment in patients with open-angle glaucoma.

Brimonidine, a highly selective alpha(2)-adrenoceptor agonist, was studied to determine its ocular hypotensive effect and side effects in patients with elevated intraocular pressure (IOP) while on continuing therapy with timolol. This was a prospective, randomized, placebo-controlled study in 15 patients with primary open-angle or pseudoexfoliation glaucoma on therapy receiving timolol 0.5% twice daily, with IOP greater than or equal to 22 mm Hg in one eye. IOP measurements, blood pressure and pulse rate were assessed on 2 days at a baseline and 1, 2, 4, 6 and 8 h later. A single drop of brimonidine 0.2% or placebo was added to treatment with timolol. The reductions in IOP at all time intervals observed with brimonidine + timolol were significantly greater than those with timolol + placebo. The maximum mean net decrease in IOP was 19.23 +/- 10.60% at 4 h. Statistically significant decreases in systemic blood pressure and pulse rate without clinical symptoms were observed in the group receiving brimonidine + timolol. This study suggests that a combination of brimonidine and timolol may have potential in the treatment of glaucoma. Further clinical trials with brimonidine are indicated to assess its further role as adjunctive agent.

Decentralisation of general management within the New Zealand health system.

The radical organisation changes implemented in the New Zealand health system in recent years are discussed and analysed in this study which is based upon a review of documents and interviews with general managers of area health boards. Service management, which involves the decentralisation of general management to programme or product groupings (medicine, child health etc) has been widely implemented in almost all boards completely replacing the traditional disciplinary hierarchies. It is also leading to a population-rather than an institutional-based system of management. General managers report positively on the achievements of service management including greater accountability and commitment of clinical staff, innovation and team building, improved performance and service quality, the integration of hospital and community-based care and a customer rather than an occupational orientation. There is an increasing trend towards the recognition of primary health care as a key service entity.