Effectiveness of Suprachoroidal Injection of Triamcinolone Acetonide in Diabetic Macular Edema Following Pars Plana Vitrectomy Using a Modified Custom Microneedle.

Purpose: The present study evaluated the efficacy of suprachoroidal injection of Triamcinolone Acetonide (SCTA) in diabetic macular edema (DME) following pars plana vitrectomy (PPV) using a modified microneedle. Patients and methods: A prospective interventional study was conducted on 60 eyes of 60 patients with centrally involved diabetic macular edema following pars plana vitrectomy (PPV). SCTA was performed at the baseline and repeated after 3 months in case of persistent subretinal or intraretinal fluid, central macular thickness (CMT) more than 300 µm or visual loss by more than one line of the Snellen chart. Results: The present study detected significant reduction of the CMT from 498.3 ± 94.8 µm at the baseline to 212.3 ± 11.9 µm after 12 months of injection with p < 0.001 and a significant improvement of best corrected visual acuity (BCVA) from 1 (0.9-1.2) at the baseline to 0.5 (0.3-0.7) after 12 months of injection with p < 0.001. The intraocular pressure (IOP) increased significantly after 3 months of injection with p < 0.001 and then gradually declined to its normal level after 6 months. Inner segment/outer segment (IS/OS) disruption was the only significant predictor of the final CMT; however, the number of injections, IS/OS disruption, baseline BCVA and the HbA1C level were the significant predictors of the final BCVA after injection. Conclusion: Suprachoroidal injection of TA using this microneedle resulted in significant anatomical and functional improvement in previously vitrectomized diabetic macular edema patients with no recorded ocular or systemic adverse events.

Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units.

Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs). Earlier initiatives used the concept of ventilator care bundles (sets of interventions), with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization). The approach of the Comprehensive Unit-based Safety Program (CUSP) was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs) (a total of 271 beds) in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP) that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia.

H1N1 influenza A. Preliminary evaluation in hospitalized patients in a secondary care facility in Saudi Arabia.

OBJECTIVE: To assess the epidemiologic and clinical manifestations of the first wave of H1N1 influenza A patients. METHODS: This study is a retrospective chart review of all patients admitted in King Saud Medical Complex, Riyadh, Kingdom of Saudi Arabia, from 22nd May to 31st August 2009, with a proven diagnosis of H1N1 influenza A. Only patients with a positive nasopharyngeal swab were included, and excluded when the swab was negative. Charts were then analyzed for epidemiological and clinical data. RESULTS: A total of 153 patients with proven H1N1 infection were admitted, with a predominance of male patients (108 [71%]). Most patients were Saudis (111 [73%]), with 83 males (75%), and 28 females (25%). The mean age was 25 years (standard deviation; 9.45 years), and median age was 24 years. The most common symptoms in order of frequency were; fever (143 patients), cough (126 patients), sore throat (70 patients), headache (18 patients), shortness of breath (17 patients), myalgia (11 patients), diarrhea (9 patients), and vomiting (7 patients). Average duration of symptoms before admission was 3.55 days, and the average time of hospitalization was 4.8 days. Full recovery was obtained in 150 patients. Death occurred in 3 patients. CONCLUSION: True to its designation as a pandemic, H1N1 influenza A, has reached Saudi Arabia and poses a risk to the young population without immunity, and those with co-morbid disease, particularly of the lungs (bronchial asthma), and the pregnant. Despite its virulence in infecting people, deaths are far less than anticipated for such a novel virus. Social distancing can be recommended. However, further observation has to continue to substantiate these tentative preliminary findings.