Arteriovenous Fistulas: The Pathological Bridge

An intracranial dural arteriovenous fistula (DAVF) is a type of intracranial vascular malformation in which there is a connection between an intracranial artery and a dural venous sinus. It accounts for 10–15% of all intracranial arteriovenous malformations. This malformation derives its arterial supply primarily from meningeal vessels, and the venous drainage is either via dural venous sinuses or through the cortical veins. DAVFs have a reported association with dural sinus thrombosis, venous hypertension, previous craniotomy, and trauma, though many lesions are idiopathic. Digital subtraction angiography remains the gold standard for diagnosing these fistulas. Endovascular treatment is one of the first line options available for their management. In this chapter, we will discuss and review the etiopathogenesis, natural history, common classification systems, and various available diagnostic options

Effect of Depth of Total Intravenous General Anesthesia on Intraoperative Electrically Evoked Compound Action Potentials in Cochlear Implantation Surgery.

PURPOSE: This study aims to compare the effect of the depth of total intravenous anesthesia (TIVA) on intraoperative electrically evoked compound action potential (e-ECAP) thresholds in cochlear implant operations. METHODS: Prospectively, a total of 39 patients aged between 1 and 48 years who were scheduled to undergo cochlear implantation surgeries were enrolled in this study. Every patient received both light and deep TIVA during the cochlear implant surgery. The e-ECAP thresholds were obtained during the light and deep TIVA. RESULTS: After comparing the e-ECAP means for each electrode (lead) between the light and deep anesthesia, no significant differences were detected between the light and deep anesthesia. CONCLUSION: The depth of TIVA may have no significant influence on the e-ECAP thresholds as there was no statistical difference between the light and deep anesthesia

The Economic Burden of Diabetic Retinopathy in Jordan: Cost Analysis and Associated Factors

Rami A Al-Dwairi,1 Abdelwahab Aleshawi,1 Laith Abu-zreig,1 Wafa Al-Shorman,1 Seren Al Beiruti,1 Ali Omar Alshami,1 Mohammed Z Allouh2 1Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan; 2College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, 15551, United Arab EmiratesCorrespondence: Rami A Al-Dwairi, Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine Jordan University of Science and Technology, P. O. Box: 3030, Irbid, 22110, Jordan, Tel +962795355056, Fax +962 2 7201064, Email [email protected] Mohammed Z Allouh, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, 15551, United Arab Emirates, Email [email protected]: Diabetic retinopathy (DR) is the leading cause of visual loss worldwide in patients with diabetes mellitus (DM). The aims of our study are to describe the costs associated with (DR) and to evaluate its economic impact in Jordan.Methods: Retrospectively, we included all patients with DM and classified them according to the severity of DR. Data regarding medical history, ophthalmic history, stage of DR, presence of DME, and the ophthalmic procedures and operations were collected. The total DR-related cost was measured as a direct medical cost for the outpatient and inpatient services.Results: Two hundred and twenty-nine patients were included in the study. Only 49.7% of the patients presented without DR, and 21% presented with diabetic macular edema (DME) unilaterally or bilaterally. The DR-related cost was significantly associated with insulin-based regimens, longer duration of DM, higher HbA1c levels, worse stage of DR at presentation, the presence of DME at presentation, the presence of glaucoma, and increased mean number of intravitreal injections, laser sessions, and surgical operations. Multivariate analysis should the presenting stage of DR, presence of DME, and the presence of DME be the independent factors affecting the DR-related cost.Conclusion: This study is the first study to be conducted in Jordan and encourages us to establish a screening program for DR for earlier detection and treatment. DM control and treatment compliance will reduce the heavy costs of the already exhausted healthcare and financial system.Keywords: diabetic retinopathy, economic burden, intravitreal injections, diabetic macular edem

Successful and Complete Recovery of the Ulnar Nerve After Eight Years of Chronic Injury Through Local Steroid Injections: A Case Report

Abstract Peripheral neuropathy is a common neurodegenerative disease, with vastness of inducers and causalities. The acquired form peripheral neuropathy can be caused by traumatic injuries caused by nerve lacerations or compressions. Such injuries are usually followed by Wallerian degeneration, and inflammatory reaction. We present a case of a 33-year-old female with a chronic loss of the ulnar nerve function for 8 years after traumatic laceration. After that, she regained the functions of ulnar nerve after nerve stimulation by peri-ulnar nerve injection of methylprednisolone and lidocaine. The theory behind using steroids is related to the fact that the immune system could induce a secondary injury that interferes with the recovery. Many studies have shown effectiveness in using steroids alone or when combined with other substances on nerve regeneration in animal models. We believe that this is the first report of nerve recovery using local steroidal injections after a traumatic injury

Silicone Oil Utilized in Pars Plana Vitrectomy for Patients with Advanced Proliferative Diabetic Retinopathy: Physico-Chemical and Optical Properties

Rami Al-Dwairi,1 Ahmad A Ahmad,2 Abdelwahab Aleshawi,1 Areen A Bani-Salameh,2 Ihsan A Aljarrah,2 Qais M Al-Bataineh,2,3 Seren Al Beiruti,1 Ali Omar Alshami,1 Edina Rusen,4 Gabriela Toader5 1Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan; 2Department of Physics, Thin Films and Nanotechnology Laboratory, Faculty of Science and Art, Jordan University of Science & Technology, Irbid, 22110, Jordan; 3Leibniz Institut für Analytische Wissenschaften‐ISAS‐e.V., Dortmund, 44139, Germany; 4Faculty of Chemical Engineering and Biotechnologies, University POLITEHNICA of Bucharest, Bucharest, 011061, Romania; 5Military Technical Academy “Ferdinand I”, Bucharest, 050141, RomaniaCorrespondence: Rami Al-Dwairi, Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, P. O. Box: 3030, Irbid, 22110, Jordan, Tel +962799273019, Fax +962 2 7201064, Email [email protected]: Silicone oils have the role in maintaining the attachment of the retina in conditions where the risk of retinal re-detachment is high. However, silicone oils have the tendency to emulsify with subsequent complications. In this work, analyses have been performed to understand changes that occurred to the optical, and physical characteristics of the oil after removal from the vitreous cavity of patients underwent pars plana vitrectomy (PPV) for fibrovascular membranes/tractional retinal detachment (FVM/TRD).Methods: Four samples of silicone oil were allocated from patients who underwent PPV for FVM/TRD. The Fourier-transform infrared (FTIR) spectroscopy, micro-viscometry, and ultraviolet-visible spectrometer analyses were utilized to determine the changes in its chemical bondings, viscosity, absorbance, transmittance, buoyance, and specific gravity.Results: The mean age of the patients was 49.0 years. The mean duration of silicone oil implantation was 18.9 months. FTIR analysis showed significant breaking in the chemical bonding that was related to the lens status during the primary PPV, the presence of significant retinal hemorrhages, the duration of silicone oil implantation, and the degree of silicone oil filling. Similarly, viscosity and contact angle analyses revealed a reduction in the viscosity with similar factors to the FTIR analysis. Moreover, absorbance and transmittance were largely affected by the aggressiveness of FVM/TRD.Conclusion: This study revealed that certain factors such as the age of the patient, duration of silicone oil implantation, lens status, and the presence of retinal hemorrhages, the degree of silicone oil filling and aggressiveness of FVM/TRD may contribute to the emulsification process.Keywords: silicone oil, tractional retinal detachment, emulsification, viscosit