[Emigration-an option for African resident physicians? : Opinions from Tanzania and Ethiopia]. / Auswandern ­ eine Option für afrikanische Assistenzärzte? : Ein Stimmungsbild aus Tansania und Äthiopien.

BACKGROUND: Globally, the majority of visually impaired persons live in low- and middle-income countries. One of the reasons is a lack of ophthalmologists in the respective countries. Migration of qualified personnel would be an additional strain on ophthalmological patient care. OBJECTIVE: This analysis aimed at evaluating the attitude of African residents in ophthalmology towards working in their home country or migrating abroad and comparing these findings with existing data also with respect to possible interventions. MATERIAL AND METHODS: In 2016 and 2017, participants of ophthalmological training courses for residents in Dar es Salaam (Tanzania) and Addis Ababa (Ethiopia) as well as residents from Moshi (Tanzania) were interviewed on possible migration with the help of a questionnaire. RESULTS: In total 60 questionnaires were analyzed. The main reasons for staying in the home country were: "want to support/serve community", "family" as well as "high demand of specialists". Prime motives for possible migration were: "better income", "better working structure/equipment" and "better education". CONCLUSION: Links between German and African eye hospitals as they are supported, for example by the working group International Ophthalmology of the German Ophthalmological Society (DOG) and the German Committee for the Prevention of Blindness (DKVB), can contribute to improve some of the main reasons of migration, such as insufficient education, working structures and equipment and thus help to prevent a brain drain.

Severe ocular trauma-The hidden danger of plastic bottles when throwing out the rubbish.

This is the first reported case of ocular trauma caused by a plastic bottle cap occurring accidentally without misuse. The mechanism involved an un-emptied plastic bottle containing orange juice being thrown away with other rubbish. The combination of this minor impact and the pressure built up within the bottle through fermentation caused expulsion of the cap at high velocity. This cap caused severe ocular trauma requiring urgent ophthalmic assessment and intervention. Our simple recommendation is that plastic bottles have their caps removed and are emptied before being thrown away.

[Combined cataract and glaucoma surgery. Trabeculectomy vs Erb:YAG goniotomy]. / Kombinierte Katarakt- und Glaukomchirurgie. Trabekulektomie vs. Erb:YAG-Goniotomie.

BACKGROUND: The surgical therapy of glaucoma aims at an effective IOP lowering as well as at a long-term effect with few complications. The previous gold standard of combined surgery consisted of cataract surgery and trabeculectomy. The combination of cataract surgery and Erb:YAG goniotomy might be an alternative. METHODS AND PATIENTS: A total of 17 eyes were treated with combined Erb:YAG goniotomy. The control group underwent combined trabeculectomy and consisted of 23 eyes. The mean follow-up was 5 years and assessed IOP lowering, visual acuity, antiglaucomatous drugs, and complications. RESULTS: After 5 years the IOP of the Erb:YAG group decreased from 23.3 to 16.9 mmHg. In the control group, the IOP was reduced from 23.3 mmHg to 15.8 mmHg. Two eyes of the Erb:YAG group needed further surgery due to insufficient IOP control, whereas in the control group ten repeat procedures were necessary. CONCLUSIONS: The small number of complications in combination with a sustainable IOP-lowering effect seems to be an advantage in the long-term treatment of glaucoma. We hope that this can be transferred to the new excimer laser trabeculotomy since the 3-year results are already comparable to the Erb:YAG laser.

Development of tolerance to the anticonvulsant effect of diazepam in dogs.

In dogs the development of tolerance to the anticonvulsant effect of diazepam was followed by weekly determinations of the convulsive threshold for pentetrazole, 10-15 min after intravenous (i.v.) injection of 0.25 or 0.5 mg/kg diazepam. As soon as after 1 week of oral treatment with diazepam, 0.25 or 0.5 mg/kg three times daily (t.i.d.), the pentetrazole threshold showed a decline or even a fall to the control level in spite of unaltered or rising concentrations of diazepam and its active metabolites. Tolerance also developed when the dogs were treated with chlorazepate, 2 mg/kg t.i.d., between the weekly diazepam injections for threshold determination. The results favor a functional type of tolerance since there was no indication of a more rapid inactivation of diazepam. Treatment with desmethyldiazepam (2 mg/kg i.v. for threshold determination and oral treatment with the desmethyldiazepam precursor chlorazepate, 2 mg/kg t.i.d.) did not produce tolerance. In further experiments in dogs anesthetized, relaxed with suxamethonium and ventilated, a spike-wave activity in the EEG was induced and maintained by an injection and subsequent infusion of pentetrazole. Out of 6 dogs, receiving 4-5 i.v. injections of 0.25-0.5 mg/kg diazepam, 2 showed the phenomenon of acute tolerance, i.e. the effect of the drug on the spiking activity in the EEG became less from one injection to the next, and thus paralleled a situation which may be observed during treatment of clinical status epilepticus. No acute tolerance was observed in corresponding experiments with desmethyldiazepam.