Proliferative diabetic retinopathy: Role of bevacizumab in decreasing the occurrence of vitreous hemorrhage after panretinal photocoagulation.

PURPOSE: To investigate the beneficial effect of bevacizumab injection one week prior to panretinal photocoagulation (PRP) on the occurrence of vitreous hemorrhage (VH) following PRP in high-risk proliferative diabetic retinopathy (PDR). METHODS: This was a case-control pilot study conducted on two groups: an anti-VEGF treatment group, treated with bevacizumab injection one week prior to the first PRP session, and a control group of treatment-naive PDR patients who underwent PRP treatment and were not given an intravitreal bevacizumab injection, consecutively recruited. In both groups, a complete ophthalmological examination was conducted prior to PRP and at 4, 9, and 16 weeks following treatment. The primary endpoint studied was the occurrence of VH. RESULTS: The control group included 69 patients (mean age 63±12.3 years) with high-risk PDR who received PRP treatment only, and the anti-VEGF treatment group included 67 patients (mean age 63.13±10.3 years). None of the demographic variables or comorbidities showed any significant difference between the two groups. The number of PRP sessions was not significantly correlated to the occurrence of VH in either of the groups (P=0.167). Vitreous hemorrhage within 16 weeks following laser treatment occurred in 10 patients (14.5%) in the control group and in only 3 patients (4.5%) in the anti-VEGF group (P=0.047). CONCLUSION: Our case-control pilot study demonstrates that a bevacizumab injection preceding the initial PRP session might be beneficial in reducing the occurrence of VH in the first 16 weeks following PRP.

Bullying Behaviour In Operating Theatres.

BACKGROUND: Bullying is a well-recognized negative behaviour, involving a perpetrator and a victim, with negative physical and/or psychological consequences. Bullying, as a multifaceted form of mistreatment, came to the attention of academic and administrative teams in schools and the workplace, more than three decades ago. Workplace bullying is well recognized to lead to anxiety, depression, feeling of helplessness, higher risks of cardiovascular disease and suicidal ideation among its victims. Healthcare teams face high odds and challenging roles in intensive care units and operating theatres. The objective of the study was to determine the prevalence of bullying behaviour through (Revised), Negative Attitudes Questionnaire (NAQ-R), among healthcare team members in an operating theatre of a Tertiary Care hospital in Lahore. METHODS: A cross-sectional pilot study was conducted, through a validated tool, Negative Attitude Questionnaire-Revised (NAQ-R). An online survey was posted through Survey Monkey. Data analysed through SPSS Version- 19 by computing descriptive statistics as frequency and percentages with graph construction. RESULTS: One hundred thirty-one complete responses received out of 139 with a response rate of 94.24%. Responses were from both government (53%) and private sector (47%) hospitals. Norway cut off values used for analysis. Overall, 32% were not bullied whereas 68% were bullied, 47.6% were victims of bullying frequently and rest occasionally. Bullying behaviour across gender confirmed higher frequency in women as compared to men (83% vs 58%) with frequent bullying also more common in women when compared with males (51% versus 18%). CONCLUSIONS: Bullying occurs in both genders although, predominantly more among women.

Assessment of birth preparedness and complication readiness among pregnant women attending the Obs/Gynae wards in two teaching hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan.

OBJECTIVE: To assess the knowledge of pregnant women receiving antenatal care at the study sites about birth preparedness and complication readiness (BPCR) and their knowledge about warning signs during pregnancy, labor, and postpartum. METHODS: A cross-sectional study was conducted from October 2018 to April 2019 in two teaching hospitals in Peshawar, Pakistan. Pregnant women aged 15-49 years were recruited after consent. A structured questionnaire was used for data collection. RESULTS: Among 170 enrollees, 72.4% had not heard about BPCR. Transportation arrangements were done by 4.7%, blood donor arrangements by 10%, saving for emergency by 22.4%, and 42.4% identified a skilled provider. Prior selection of a health facility for delivery were done by 65.9%, and 71.8% received four or more antenatal visits. Vaginal bleeding (68%), placenta not delivered within 30 minutes of delivery (62.9%), and vaginal bleeding ( 51.8%) were reported as warning signs during pregnancy, delivery, and postpartum, respectively. CONCLUSION: Knowledge of BPCR and warning signs during all three phases of pregnancy was low. The increased antenatal visits are an opportunity to educate the mothers about BPCR and warning signs.

Informed consent practice for obstetric and gynaecologic procedures: A patients' perspective from a developing country.

OBJECTIVES: To assess the surgical informed consent (SIC) practices for obstetric and gynaecological (OB-GYN) procedures at different hospitals in Pakistan. METHODS: Study was conducted in five hospitals (three public and two private) of Peshawar, Pakistan. A pretested structured tablet-based questionnaire was administered from October 2016 through January 2017 among post-op OB-GYN patients. RESULTS: About 27% of the patients (significantly more in private hospitals, P = 0.001) did not remember a formal consent administration. Most patients (80%) felt they had no choice about signing the consent. About 65% (mostly in public as compared with private hospitals) mentioned that they would have signed it regardless of the specifics in it (P < 0.001). Patients had increased odds to recall consent if they felt empowered, odds ratio (OR) = 4.5; had an opportunity to ask questions, OR = 7.2; wanted more explanation, OR = 2.8; and had consent administered in their mother tongue, OR = 6.9. DISCUSSION: Patients' recall of key elements of consent was low. The time spent with the patient for consenting was much shorter than recommended. The printed consent forms were mostly not available in patients' mother tongue. CONCLUSIONS: Consent practice for OB-GYN procedures was suboptimal in studied hospitals. Patients' attitude toward informed consent practices largely reflected providers' focus on obtaining a legally valid signed consent as opposed to administering a consent that empowers patients to make an informed decision in the absence of any external pressure.

Secondary intraocular lens implantation with absence of capsular support: Scleral versus iris fixation.

PURPOSE: To assess the outcomes of iris fixated (IF) posterior chamber (PC) intraocular lens (IOL) versus scleral-fixated (SF) PC IOL implantation, and compare them with the results reviewed from the literature. SETTING: The study took place in the ophthalmology department of the Eye and Ear Hospital (Lebanon). DESIGN: This is a retrospective institutional study that collected the records of patients admitted for secondary IOL implantation between January 2007 and December 2016. METHODS: A total of 28 eyes that underwent PC IOL fixation were included, 13 of which underwent trans-scleral PC IOL fixation and 15 of which underwent iris PC IOL fixation. Data were analyzed over a period of 3 years. RESULTS: Of the 28 patients, 18 (64.3%) were male and 10 (35.7%) were female (mean age at intervention 36.78±23.47 [standard deviation, SD] years). There were no significant intergroup differences with regard to baseline values and demographic characteristics. Trauma was the most common etiology for posterior capsule insufficiency (82.1%). The mean preoperative baseline BCVA was 0.58±0.27 logMAR for SF and 0.27±0.20 logMAR for IF (P=0.07). Both groups had significant improvement in vision during the follow up period. No significant differences were noted regarding early or late postoperative complications between the two groups. CONCLUSION: SF and IF techniques for PC IOL have similar outcomes and result in a significant improvement in BCVA. When compared to AC (anterior chamber) IOL, both techniques seem to yield fewer complications.

Ahmed glaucoma valve in various etiologies of refractory glaucoma: Surgical outcomes and success factors.

PURPOSE: To study the epidemiology and mid-term results of the Ahmed glaucoma valve (AGV) in various etiologies of refractory glaucoma in a Lebanese center, and to assess complications and factors that influence the surgical success rate. METHODS: In this retrospective epidemiological study, we reviewed 108 eyes with refractory glaucoma that underwent an AGV implantation in a tertiary care center in Lebanon between January 2002 and August 2014. Findings including best-corrected visual acuity (BCVA), intra-ocular pressure (IOP), number of antiglaucoma medications, factors influencing the surgical outcome, success rate and complications were also reviewed. RESULTS: The mean duration of follow-up was 29.85±21.45 months [range, 3-60 months]. As in other Arab countries and compared to the rest of the world, the rate of neovascular glaucoma (NVG) was particularly high, occurring in 63 eyes (58.3%), and represented the primary cause of refractory glaucoma. Mean IOP was significantly reduced to 17.97±7.35mmHg at the last follow-up visit (P<0.05). Similarly, a significant decrease was noted in the number of antiglaucoma medications (P<0.05). The surgical success rate, defined as a postoperative IOP<21, was significantly higher (62.0%), in older patients, those with baseline BCVA≤2 LogMAR and those with a history of hypertension (P<0.01). Hyphema was the most noted complication. CONCLUSION: The AGV is a safe and effective procedure for lowering IOP in refractory glaucoma patients, with hyphema being the most frequent complication. Both the presence of hyperstension and initial BCVA≤2 LogMAR seem to increase the success rate of the procedure. NVG remains the most common etiology for implantation, probably due to uncontrolled diabetes in the Middle East and North Africa.

Spatial structure of peptides determined by residual dipolar couplings analysis.

The gated decoupled (13)C NMR spectra of a dipeptide (Glu-Trp) and a tetrapeptide (NAc-Ser-Phe-Val-Gly-OMe) were recorded in D(2)O and in a lyotropic alignment medium (pentaethylene glycol monododecyl ether/n-hexanol). The residual dipolar couplings were extracted as the differences between the observed couplings for the magnetic nuclei dissolved in the latter and former media. Using a computational optimization, the spatial structures of the compounds were calculated starting from their respective low energy conformations obtained on a semiempirical basis. The uniformity of each conformation was confirmed by the solid-state (13)C NMR spectra of powder samples. Differences between the starting structures and final ones, optimized when employing residual dipolar couplings, are discussed.

Cytokine patterns in maternal blood after premature rupture of membranes.

OBJECTIVE: To compare two types of cytokines, type 1, which activate cell-mediated reactions and are important in cytotoxic and delayed-type hypersensitivity reactions, and type 2, which encourage vigorous antibody production and are commonly found in association with humoral immune responses, in blood of women with premature rupture of membranes (PROM). METHODS: Forty-four women with histories of at least three successful pregnancies and who currently delivered normally served as controls. The PROM group consisted of 30 women with spontaneous rupture of fetal membranes at term. Peripheral blood mononuclear cells were stimulated separately with a mitogen, placental cells, and a trophoblast antigen extract, and the supernatants examined for type 1 and type 2 cytokines. RESULTS: Mitogen-stimulated blood cells produced significantly higher levels of type 1 cytokines in PROM women than in normal controls. Higher levels of the type 1 cytokine interferon-gamma were produced by PROM samples stimulated with autologous placental cells and with trophoblast antigens. Ratios of type 1 to type 2 cytokines were higher in PROM compared with normal pregnancy, and in some cases as much as 25-fold higher. CONCLUSION: Women in the PROM group had a stronger type 1 reactivity whereas normal women were more predisposed to type 2 immunity; thus, PROM appears to be associated with a maternal type 1 bias.

Circulating cytokines and CD30 in normal human pregnancy and recurrent spontaneous abortions.

Concentrations of the T-helper (Th) 1 cytokines interleukin (IL)-2, tumour necrosis factor (TNF) -alpha, TNF-beta and interferon-gamma, Th2 cytokines IL-4, IL-5, IL-6, IL-10 as well as those of soluble CD30 in sera have been examined during the three trimesters of gestation, at delivery in normal pregnancy, and at the time of spontaneous abortion in women with a history of unexplained recurrent spontaneous abortion (RSA). Significantly higher concentrations of the Th2 cytokines IL-6 and IL-10 were found at normal delivery than in women with RSA, and conversely significantly increased concentrations of the Th1-type cytokine TNF-alpha were found in RSA as compared with successful pregnancy. In abortion-prone women who had a successful pregnancy, significantly higher concentrations of IL-6 and significantly lower concentrations of TNF-alpha were found as compared with abortion-prone women who had another abortion, supporting the notion that Th2- and Th1-bias are associated with successful and unsuccessful pregnancy respectively. Serum CD30 concentrations did not correlate with the outcome of pregnancy. These findings support observations drawn from experiments on the cytokine secretion profiles of peripheral blood mononuclear cells and decidual lymphocytes which suggest that normal pregnancy is Th2-biased and that unexplained RSA is associated with Th1-type reactivity.

Cytokine production by maternal lymphocytes during normal human pregnancy and in unexplained recurrent spontaneous abortion.

It has been proposed that successful pregnancy is a T helper 2-type phenomenon, and that T helper (Th)1-type reactivity is deleterious to pregnancy. The objective of this study was to compare the concentrations of Th1 and Th2 cytokines produced by peripheral blood mononuclear cells from women undergoing unexplained recurrent spontaneous abortion (RSA) with those produced during normal pregnancy at a similar gestational stage. The control group consisted of 24 women with a history of successful pregnancies and the abortion group comprised of 23 women with a history of unexplained RSA. Blood from the control group was obtained at the end of the first trimester as gestational age controls for the abortion group from whom blood was collected at the time of abortion. Phytohaemagglutinin-stimulated peripheral blood cell culture supernatants were analysed for concentrations of cytokines. Significantly higher concentrations of Th2 cytokines were produced by the first trimester normal group than by the RSA group, while significantly higher concentrations of Th1 cytokines were produced by the abortion group as compared to first trimester normal pregnancy, indicating a distinct Th2-bias in normal pregnancy and a Th1-bias in unexplained RSA.