Critical analysis of postoperative outcomes in rhegmatogenous retinal detachment associated with giant tears : a consecutive case series study

Abstract Background: Currently there remains controversy in the surgical management of rhegmatogenous retinal detachment (RRD) due to giant retinal tears (GRTs), a potentially blinding condition. To clarify which surgical technique is better depending on the origin and magnitude of the giant tear this study aimed to analyze the anatomic and functional outcomes. To analyze trans- and postoperative surgical complications, we used long-term final postoperative structural, optical coherence tomography (OCT) and correlated the results with the final postoperative best-corrected visual acuity (BCVA) in three different groups of eyes. Methods: A long-term, comparative, retrospective, consecutive case series on seventy-six eyes of 66 patients that were recruited and classified according to the degree of GRT-associated RRD extension as follows: group 1 (n = 42 eyes) with GRT-associated RRD extension 270°. Structural and functional outcomes were compared across groups. Results: Of the 76 eyes analyzed, 63 were phakic, and 13 were pseudophakic. The mean age of the patients was 43.0 ± 13.0 years (range, 19-76 years); 36 females, and 40 males. The mean preoperative time for GRT surgery was 1.8 weeks, the mean preoperative and postoperative BCVA was 1.87 logMAR and 0.35 logMAR, respectively (p < 0.05), and the mean postoperative follow-up was 28.1 months. Five patients (6.6%) had bilateral GRT-associated RRD, 61 patients (80.3%) had a monocular condition, and 21 eyes (27.6%) had final BCVA of ≥ 20/40. Proliferative vitreoretinopathy resulted in multiple surgeries in 31.6% of the eyes. Postoperative OCT yielded abnormal retinal thickness, ellipsoid zone (EZ) disruptions, and external limiting membrane (ELM) line discontinuities in all groups, predominantly in GRTs macula off-associated RRD requiring multiple surgeries. Conclusions: Multiple structural alterations in spectral- domain OCT biomarkers were observed. Eyes that developed secondary epiretinal membrane (ERM) proliferation showed significantly improved BCVA after proliferation and the internal limiting membrane (ILM) was removed. The structural findings correlated with the BCVA allow us to conclude severe consequences of the macular structure and that, despite a fully reattached retina without ERM proliferation, GRTs-associated RRD has a guarded functional prognosis. Keywords Giant retinal tears, Rhegmatogenous retinal detachment, Brilliant blue dye, Epiretinal membrane, Internal limiting membrane, Macula-off giant retinal tear-associated rhegmatogenous retinal detachment, Primary vitrectomy, Scleral buckl

Ferritin level : a predictor of severity and mortality in hospitalized COVID-19 patients

Introduction: This study aims to investigate in-hоsрitаl mоrtаlity in severe асute resрirаtоry syndrоme соrоnаvirus 2 раtients strаtified by serum ferritin levels. Methods: Patients were stratified based on ferritin levels (ferritin levels ≤ 1000 or >1000). Results: Approximately 89% (118) of the patients with ferritin levels > 1000 had pneumonia, and 51% (67) had hypertension. Fever (97, 73.5%) and shortness of breath (80, 61%) were two major symptoms among the patients in this group. Logistic regression analysis indicated that ferritin level (odds ratio [OR] = 0.36, 95% confidence interval [CI] = 0.21–0.62; p 1000. Conclusion: In this study, higher levels of serum ferritin were found to be an independent predictor of in-hоsрitаl mоrtаlity

Estimating air pollution and its long and short run causality with chronic diseases using vector error correction model (VECM)

Air pollution has been linked to a number of health impacts and has been studied in a variety of contexts using a variety of studies and methodologies. This thesis is made up of a collection of papers that cover a wide range of research subjects and illustrate different study analysis and design methodologies. Multiple imputation (MI) techniques were used to deal with the missing data, where missForest had the lowest imputation error among the other imputation approaches. Time series modelling was used to predict Rheumatoid Arthritis (RA) disease activity score (DAS28) using the information of air pollution. This thesis examined the linkage among SO2, NO2, O3 and disease activity scores for patients with RA in Kuwait. The association was investigated using the Granger causality test (using the VECM approach and other time series approaches) (in analysis of static causality) and the Impulse Response Functions (IRFs) analysis (in analysis of dynamic causality). A comprehensive conceptual framework was used in the study, which included a cointegration test, unit root test, and panel VECM. Long-run causation and asymptotic convergence among the variables were determined using the panel VECM. The empirical outcomes show that NO2 and O3 are statistically significant in cases when DAS28 is the dependent variable, in most of the study locations (ASA, FAH, MAN and JAH). The results demonstrate that the lagged error correction term (ECT) coefficients in DAS28 and air pollution emissions are statistically significant. Overall, the main conclusion found in this thesis and according to the cointegration test, the results show that there exists a long run relationship between the emissions of air pollution and the change of DAS28 among RA patients.Air pollution has been linked to a number of health impacts and has been studied in a variety of contexts using a variety of studies and methodologies. This thesis is made up of a collection of papers that cover a wide range of research subjects and illustrate different study analysis and design methodologies. Multiple imputation (MI) techniques were used to deal with the missing data, where missForest had the lowest imputation error among the other imputation approaches. Time series modelling was used to predict Rheumatoid Arthritis (RA) disease activity score (DAS28) using the information of air pollution. This thesis examined the linkage among SO2, NO2, O3 and disease activity scores for patients with RA in Kuwait. The association was investigated using the Granger causality test (using the VECM approach and other time series approaches) (in analysis of static causality) and the Impulse Response Functions (IRFs) analysis (in analysis of dynamic causality). A comprehensive conceptual framework was used in the study, which included a cointegration test, unit root test, and panel VECM. Long-run causation and asymptotic convergence among the variables were determined using the panel VECM. The empirical outcomes show that NO2 and O3 are statistically significant in cases when DAS28 is the dependent variable, in most of the study locations (ASA, FAH, MAN and JAH). The results demonstrate that the lagged error correction term (ECT) coefficients in DAS28 and air pollution emissions are statistically significant. Overall, the main conclusion found in this thesis and according to the cointegration test, the results show that there exists a long run relationship between the emissions of air pollution and the change of DAS28 among RA patients

An Arab perspective on social media : how banks in Kuwait use instagram for public relations

This study examines the public relations functions of eight Kuwaiti banks listed in the Kuwait Stock Exchange Market (KSEM) that post on their Instagram accounts. It also uses market-size, organization, and individual level predictors to model Instagram postings. A content analysis of 1502 posts revealed the banks use Instagram for promotion, information dissemination, community building, and interactive engagement, in that order of prominence. The findings suggest banks operate at the confluence of visual communication through Instagram and integration of religious sym- bolism to serve a public relations function predicated on image and influence. In doing so, the banks tap into the wellspring of social media use by target publics by navigating a balance between obedience to Allah and meeting bank business objectives. The resulting tension between sacred and secular highlights Arab cultural values and suggests Instagram fosters individualism, which challenges Arab emphasis on collectivism and fractures the notion online platforms can effectively build meaningful relationships that characterize Arab culture. The study posits Instagram is more effective in an Arab context at image building than relationship building, threading the importance of visual communication through social media across Arab culture and global public relations practices

Don't close the book on tocilizumab for the treatment of severe COVID-19 pneumonia - the jury is still out. The Kuwait experience

Purpose This cross-sectional observational study aims to report preliminary data from the first experience using tocilizumab for patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in three of Kuwait's largest public hospitals City. Patients and methods This chart review study examined the benefits of tocilizumab treatment among 127 patients diagnosed with severe coronavirus disease of 2019 (COVID-19) pneumonia. Results 90 of 127 patients (71%) survived. Mortality was highest in the elderly with multiple medical conditions. Conclusion Despite the small sample size and retrospective nature of the work, our findings are consistent with recent studies suggesting tocilizumab administration in patients presenting with severe COVID pneumonia with associated hyperinflammatory features conferred mortality benefit

Outcomes of tocilizumab therapy in severe or critical COVID-19 patients: A retrospective cohort, single-centre study

Objectives: To assess the effectiveness and safety of tocilizumab, a humanised anti-interleukin-6 receptor antibody, in the treatment of critical or severe coronavirus disease 2019 (COVID-19) patients. Methods: This was a retrospective cohort study of severe or critical COVID-19 patients (≥18 years) admitted to one hospital in Kuwait. Fifty-one patients received intravenous tocilizumab, while 78 patients received the standard of care at the same hospital. Both groups were compared for clinical improvement and in-hospital mortality. Results: The tocilizumab (TCZ) group had a significantly lower 28-day in-hospital mortality rate than the standard-of care-group (21.6% vs. 42.3% respectively; p = 0.015). Fifty-five per cent of patients in the TCZ group clinically improved vs. 11.5% in the standard-of-care group (p < 0.001). Using Cox-proportional regression analysis, TCZ treatment was associated with a reduced risk of mortality (adjusted hazard ratio 0.25; 95% CI: 0.11–0.61) and increased likelihood of clinical improvement (adjusted hazard ratio 4.94; 95% CI: 2.03–12.0), compared to the standard of care. The median C-reactive protein, D-dimer, procalcitonin, lactate dehydrogenase and ferritin levels in the tocilizumab group decreased significantly over the 14 days of follow-up. Secondary infections occurred in 19.6% of the TCZ group, and in 20.5% of the standard-of-care group, with no statistical significance (p = 0.900). Conclusion: Tocilizumab was significantly associated with better survival and greater clinical improvement in severe or critical COVID-19 patients. © 2021 John Wiley & Sons Ltd

Environmental Air Pollution Is a Predictor of Poor Response to Biological Drugs in Chronic Inflammatory Arthritides

There is increasing evidence that environmental air pollution is associated with the development of chronic inflammatory arthritides (CIA). The role of air pollutants on the biological treatment (biological disease-modifying antirheumatic drugs [bDMARDs]) response of CIA is still unclear

The outcome of autologous hematopoietic stem cell transplantation in patients with multiple myeloma. The experience of King Fahad Specialist Hospital in Dammam, Saudi Arabia

Background: Aautologous hematopoietic stem cell transplants (HSCT) is the standard of care for newly diagnosed patients with multiple myeloma (MM) who are eligible for autologous transplantation. Although cryopreservation is routinely employed, autologous HSCT can be performed using non-cryopreserved stem cells.Methods and materials: A retrospective study of patients with MM who received autologous HSCT between the 10th of October 2010 and the 31st of January 2022 at King Fahad Specialist Hospital (KFSH) in Dammam, Saudi Arabia was performed.Results: Over 11 years and 113 days, a total of 135 autologous HSCTs were performed for 119 patients with MM at our institution. Single autologous HSCTs were performed for 119 patients, while 16 of these patients received either planned tandem autologous transplants or second autografts due to either progression or relapse of their myeloma. The median age of patients with MM at autologous HSCT was 51.5 years. At presentation of their MM, the following high-risk (HR) features were encountered: stage III disease according to the revised international scoring system (RISS) in 12.3%; adverse cytogenetics in 31.93% of patients; advanced bone disease in 60.50%; and renal dysfunction or failure in 11.76% of patients.&nbsp;A total of 104 autologous HSCTs (77.04%) were performed without cryopreservation while 31 autografts (22.96%) were performed using cryopreserved apheresis stem cell products. Additionally, 54 autologous HSCTs (40.00%) were done at outpatient while 81 autografts (60.00%) were performed in an inpatient setting. Survival for 100 days post-HSCT for all patients with MM who received autologous transplants including those done at outpatient was 100%. The 4 years overall survival (OS) an progression-free survival (PFS) for patients with MM who received non- cryopreserved or fresh autologous HSCTs were 82% and 68% respectively.Conclusion: Autologous HSCT without cryopreservation is safe, and feasible and can lead to short-term as well as long-term outcomes that are comparable to autologous transplantation with cryopreservation. Non- cryopreserved autologous grafts allow the performance of autologous transplants in an outpatient setting to save beds and reduce costs

Ferritin level: A predictor of severity and mortality in hospitalized COVID-19 patients

Introduction: This study aims to investigate in-hоsрitаl mоrtаlity in severe асute resрirаtоry syndrоme соrоnаvirus 2 раtients strаtified by serum ferritin levels. Methods: Patients were stratified based on ferritin levels (ferritin levels ≤ 1000 or >1000). Results: Approximately 89% (118) of the patients with ferritin levels > 1000 had pneumonia, and 51% (67) had hypertension. Fever (97, 73.5%) and shortness of breath (80, 61%) were two major symptoms among the patients in this group. Logistic regression analysis indicated that ferritin level (odds ratio [OR] = 0.36, 95% confidence interval [CI] = 0.21–0.62; p 1000. Conclusion: In this study, higher levels of serum ferritin were found to be an independent predictor of in-hоsрitаl mоrtаlity. © 2021 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd

In-hospital mortality in SARS-CoV-2 stratified by gamma-glutamyl transferase levels

Background: This study investigates in-hospital mortality amongst patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its relation to serum levels of gamma-glutamyl transferase (GGT). Methods: Patients were stratified according to serum levels of gamma-glutamyl transferase (GGT) (GGT<50 IU/L or GGT≥50 IU/L). Results: A total of 802 participants were considered, amongst whom 486 had GGT<50 IU/L and a mean age of 48.1 (16.5) years, whilst 316 had GGT≥50 IU/L and a mean age of 53.8 (14.7) years. The chief sources of SARS-CoV-2 transmission were contact (366, 45.7%) and community (320, 40%). Most patients with GGT≥50 IU/L had either pneumonia (247, 78.2%) or acute respiratory distress syndrome (ARDS) (85, 26.9%), whilst those with GGT<50 IU/L had hypertension (141, 29%) or diabetes mellitus (DM) (147, 30.2%). Mortality was higher amongst patients with GGT≥50 IU/L (54, 17.1%) than amongst those with GGT<50 IU/L (29, 5.9%). More patients with GGT≥50 required high (83, 27.6%) or low (104, 34.6%) levels of oxygen, whereas most of those with GGT<50 had no requirement of oxygen (306, 71.2%). Multivariable logistic regression analysis indicated that GGT≥50 IU/L (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.20–3.45, p=0.009), age (OR: 1.05, 95% CI: 1.03–1.07, p<0.001), hypertension (OR: 2.06, 95% CI: 1.19–3.63, p=0.011), methylprednisolone (OR: 2.96, 95% CI: 1.74–5.01, p<0.001) and fever (OR: 2.03, 95% CI: 1.15–3.68, p=0.016) were significant predictors of all-cause cumulative mortality. A Cox proportional hazards regression model (B = −0.68, SE =0.24, HR =0.51, p = 0.004) showed that patients with GGT<50 IU/L had a 0.51-times lower risk of all-cause cumulative mortality than patients with GGT≥50 IU/L. Conclusion: Higher levels of serum GGT were found to be an independent predictor of in-hospital mortality. © 2022 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals LLC