Managing a patient with open-angle glaucoma: a case study.

How would a panel of experts manage the case presentation of Mr AA

Glaucoma, "the silent thief of sight": patients' perspectives and health seeking behaviour in Bauchi, northern Nigeria.

BACKGROUND: In Nigeria, glaucoma has a high prevalence and is the second cause of blindness among adults after cataract. People with glaucoma frequently present very late with advanced disease, and acceptance of and adherence to treatment is low. The purpose of the study was to explore how patients' understand and respond to glaucoma in order develop an intervention to improve adherence to treatment. METHOD: Hospital based qualitative study. Six focus group discussions were held with patients with advanced disease and who had either undergone glaucoma surgery, were receiving medical treatment, or had neither surgery nor medical treatment. Two traditional healers who treat eye conditions were interviewed. Audio files were transcribed, translated into English and recurring themes coded and categorized as the impact of vision loss, and understandings of the disease and its management. RESULTS: Visual loss impacted significantly on the lives of people with glaucoma in many ways. Many heard the term "glaucoma" for the first time during the study. Local terms to describe the symptoms included Hawan jinin ido ("hypertension of the eye"). Patients sought treatment in pharmacies, or with traditional healers who had different interpretations of glaucoma and its treatment to biomedical understandings. Cost and forgetfulness were the main reasons for low adherence to treatment while fear was a reason for not accepting surgery. Lack of money and negative staff attitudes were reasons for low follow up. CONCLUSION: Halting the progression of glaucoma is possible with treatment but the condition will remain a "silent thief of sight" in West Africa unless awareness, uptake of services and adherence to treatment improve. Understanding how glaucoma is locally conceptualised, lived with and responded to by patients is essential to aid the design of interventions to prevent glaucoma blindness in Africa. Findings have been used to adapt a motivational interviewing intervention, which is being evaluated in a clinical trial

Primary open angle glaucoma in northern Nigeria: stage at presentation and acceptance of treatment.

BACKGROUND: To determine the stage of primary open angle glaucoma at presentation at a tertiary eye unit, to assess patient's knowledge of glaucoma and acceptance and subsequent adherence to treatment. METHOD: Information collected prospectively on new glaucoma patients aged 30 or more years included distance from residence and what they knew about glaucoma and its treatment. Treatment offered took account of disease severity and socioeconomic factors. Reasons for not accepting surgery were recorded. At follow up intraocular pressure (IOP) was measured and adherence to medication assessed verbally. Four categories of severity were defined based on visual acuity and visual fields defects in the worse eye. RESULTS: 131 patients were recruited (mean age 52.8 years; 62% male). Most attended because of symptoms (70%). Mean IOP in affected eyes was 31.9+/-SD 12.4 and mean vertical cup:disc ratio was 0.8. 99 eyes (47%) had a visual acuity of light perception or worse. Risk factors for advanced/end-stage disease were age >50 years, living >10 km from the hospital, some awareness of glaucoma, not being literate, being unemployed and presenting with symptoms. In multivariable analysis older age and poor knowledge of glaucoma remained independent risk factors. 75 were offered trabeculectomy: five agreed but only one underwent surgery. Reasons for rejecting surgery were fear (37%), preferred medical treatment (27 %) and cost (15 %). 32/85 (24 %) participants started on topical medication attended follow up. 72% reported excellent compliance but only 56% of glaucomatous eyes had IOPs less than 21 mmHg. CONCLUSIONS: To prevent glaucoma blindness strategies are required which promote earlier detection, with counselling to promote acceptance of and adherence to treatment

The basics of good postoperative care after glaucoma surgery.

Glaucoma patients are treated by lowering the intraocular pressure (IOP) to a level that it is not harmful to the optic nerve. This prevents or delays loss of vision. Lowering of the IOP can be achieved through use of eye medication, surgery or laser procedures. The most common glaucoma surgery is trabeculectomy

Coverage of hospital-based cataract surgery and barriers to the uptake of surgery among cataract blind persons in nigeria: the Nigeria National Blindness and Visual Impairment Survey.

PURPOSE: To determine cataract surgical coverage, and barriers to modern cataract surgery in Nigeria. METHODS: Multistage stratified cluster random sampling was used to identify a nationally representative sample of 15,027 persons aged 40+ years. All underwent visual acuity testing, frequency doubling technology visual field testing, autorefraction, and measurement of best corrected vision if <6/12 in one or both eyes. An ophthalmologist examined the anterior segment and fundus through an undilated pupil for all participants. Participants were examined by a second ophthalmologist using a slit lamp and dilated fundus examination using a 90 diopter condensing lens if vision was <6/12 in one or both eyes, there were optic disc changes suggestive of glaucoma, and 1 in 7 participants regardless of findings. All those who had undergone cataract surgery were asked where and when this had taken place. Individuals who were severely visually impaired or blind from unoperated cataract were asked to explain why they had not undergone surgery. RESULTS: A total of 13,591 participants were examined (response rate 89.9%). Prevalence of cataract surgery was 1.6% (95% confidence interval 1.4-1.8), significantly higher among those aged ≥70 years. Cataract surgical coverage (persons) in Nigeria was 38.3%. Coverage was 1.7 times higher among males than females. Coverage was only 9.1% among women in the South-South geopolitical zone. Over one third of those who were cataract blind said they could not afford surgery (36%). CONCLUSIONS: Cataract surgical coverage in Nigeria was among the lowest in the world. Urgent initiatives are necessary to improve surgical output and access to surgery

منهج السلفية المعاصرين في العقيدة

Salafi has emerged as a new school of thought in the modern era. They are alleged to be propagating the Muslims of returning to the belief of the so-called salaf al-salih (the pious of the past) from the Prophet’s Companions and their successors in the matter of `aqidah using method that claimed to be true compared to methods used by other Islam’s school of thoughts. However, their claim for the use of such method has been objected by the ulama of Ahl Sunnah wa al-Jamaah. As the method used by this group in understanding the teachings of Islam has negative impact on the Muslim society, an objective study in recognising the method of this new school of thought is needed in warranting the extent of its compatibility with the method of the Salaf ulama. Hence, this study will employ deductive method in assembling ideas and statements made by contemporary Salafi ulama. These ideas will be analysed critically and then compared to the ulama Ahl Sunnah wa al-Jamaah’s views. The result of the study shows that the Salafi method has its root from the 3rd Hijrah school of thought. It also shows that the method is in contrast with the method of the Ahl Sunnah wa al-Jamaah as explicated by the Muslim ulama. The dissemination of this school of thought among the Muslim society has raised distorted understanding and conflict among Muslim youth especially with regard to furu` (the branch of religion) issues related to discourse in `aqidah

The Effect of Integration by Bio-fertilization, Organic and Metallic in the Growth of the Product and the Output of Luz-be-otono and Absorption of Some Nutrients

نفذت تجربة أصص سعة 15 كغم تربه باستعمال&nbsp; تربه رمليه غرينية جمعت من كتـف شط الديوانية - محافظة القادسية لدراسة تأثير التكامل في التسميد الحيوي والعضوي والمعدني في نمو الباقلاء وحاصلة صنـف (Luz-be-otono) اسباني المنشأ لموسم النمو 2015 / 2016 شملت التجربة التلقيح بالمعزز الحيوي والتسميد العضوي و50)و100)% معدني وتداخلاتهما فضلا عن معاملة المقارنة في تجربه كاملة التعشية (CRD) وبعد اكتمال مرحلة امتلاء القرنات تم قياس معالم النمو, ارتفاع النبات ووزن الأجزاء الهوائية الطري وحاصل القرنات الطري وحاصل المادة الجافة وزن الجذور الجاف والكلوروفيلSPAD وتراكيز كل من NوPوK% في الأوراق. أظهرت نتائج التحليل الإحصائي لأقل فرق معنوي(LSD) تفوق المعاملات الثلاثية من التسميد (الحيوي +العضوي +100 % معدني) و(الحيوي +العضوي +50% معدني) تلتها معاملات التسميد الثنائي (عضوي+معدني100%) و(عضوي+معدني50%)و(حيوي+معدني100%) و(حيوي+معدني50%) و(عضوي+حيوي) والتأثير المنفرد للاسمده (معدني100%) و(معدني50%) و(عضوي)و(حيوي) قياسا بالمقارنة. وبلغت القيم &nbsp;64.25)و54.70 و 60.90و 56.80و54.75 و 48.90و 46.70و 50.10و 45.90و44.10 و 41.35 و31.95)سم و 210.7)و 190.5و 172.7و 152.3و 144.4و 135.6و 136.9و 138.8و 114.0و 123.0و 88.0 و69.8) غم أصيص-1و4.05) و 3.75و 3.55و2.85 و2.65 و2.65 و2.35 و3.25 و2.95 و2.25 و2.35 و (2.05%&nbsp;&nbsp; لارتفاع النبات وحاصل القرنات الطري وتركيز النتروجين في الأوراق على التوالي.An&nbsp; experiment was conducted by using pots contain 15 kg&nbsp; of slity sand soil collected from one located in Al-diwania river, Al-Qadisiya province to studythe effect of integrated fertilizers bio,organic and mineralfertilizer in growth and yield of broad bean cultivar Spain (varietyLuz -be -otono)in growth season of 2015-2016. The experiment included inoculation of probiotic(bio health),application oforganic fertilizer,(50&amp;100)% mineral fertilizer and their interaction as well as by using complete randomized design(CRD). After full pods filling , the growth features, height of plant, total dry yield,fresh weight of plants and weight of fresh pods, weight of dry roots, chlorophyll SPAD and concentration of N,Pand K% in leaves were estimated. LSD showed superiority of fertilizers application (triple) treatment, (bio+ organic+100% mineral), (bio+organic+50% mineral) for both practice followed by (dual) (0rganic+ 100% mineral) (0rganic+50% mineral),(bio+100%mineral), (bio+50%mineral), (bio+0rganic) and (mono) (100%mineral), (50% mineral),(organic) and (bio) respectively compared with control. (64.25, 54.70, 60.90, 56.80, 54.75, 48.90, 46.70, 50.10, 45.90, 44.10, 41.35and 31.95) cm,( 210.7, 190.5, 172.7,152.3, 144.4,135.6, 136.9, 138.8, 114.0, 123.0, 88.0 and 69.8)gm pot-1 ,(4.05, 3.75, 3.55, 2.85, 2.65, 2.65, 2.35, 3.25.2.95,2.25, 2.35and 2.05) %to the plant height, yield fresh pods and nitrogen concentration in leaves &nbsp;respectively

Counselling in a glaucoma care service.

Glaucoma patients often think that their condition is synonymous with blindness and disability, leaving them feeling worried and vulnerable. They may also develop mental health issues such as depression or anxiety. Unfortunately glaucoma patients may have mental health issues even if these concerns are addressed. The glaucoma care team must offer patients balanced information that will help them to understand their options, regain hope for their future, and take practical action to protect their eyes and vision. This support – known as counselling – will help to improve patient’s quality of life

Epidemiology of glaucoma in sub-saharan Africa: prevalence, incidence and risk factors.

PURPOSE: The purpose of this study is to review the epidemiology of different types of glaucoma relevant to Sub-Saharan Africa (SSA) and to discuss the evidence regarding the risk factors for onset and progression of glaucoma, including risk factors for glaucoma blindness. METHODS: Electronic databases (PubMed, MedLine, African Journals Online- AJOL) were searched using the full text, Medical Subject Headings (MeSH) terms, author(s) and title to identify publications since 1982 in the following areas: population-based glaucoma prevalence and incidence studies in SSA and in African-derived black populations outside Africa; population-based prevalence and incidence of blindness and visual impairment studies in SSA including rapid assessment methods, which elucidate the glaucoma-specific blindness prevalence; studies of risk factors for glaucoma; and publications that discussed public health approaches for the control of glaucoma in Africa. RESULTS: Studies highlighted that glaucoma in SSA is a public health problem and predominantly open-angle glaucoma. It is the second-leading cause of blindness, has a high prevalence, an early onset and progresses more rapidly than in Caucasians. These factors are further compounded by poor awareness and low knowledge about glaucoma even by persons affected by the condition. CONCLUSION: Glaucoma care needs to be given high priority in Vision 2020 programs in Africa. Many questions remain unanswered and there is a need for further research in glaucoma in SSA in all aspects especially epidemiology and clinical care and outcomes involving randomized controlled trials. Genetic and genome-wide association studies may aid identification of high-risk groups. Social sciences and qualitative studies, health economics and health systems research will also enhance public health approaches for the prevention of blindness due to glaucoma