The Use of Corneal Cross-linking in Treatment of Progressive Keratoconus: a Review

AbstractKeratoconus is a common corneal ectatic disorder which affects approximately 1 in 2,000 people. The traditional treatments for keratoconus are the use of inserts, deep anterior lamellar keratoplasty (DALK) and anterior lamellar keratoplasty (ALKP). Corneal cross-linking is a relatively new minimally invasive therapeutic approach for treatment of progressive keratoconus, which increases the structural integrity of the cornea. In corneal cross-linking the production of oxygen free radicals by ultraviolet A (UVA) light increases the biomechanical strength of cornea while riboflavin acts as a photo synthesizer for production of oxygen free radicals by UVA. Treatment of progressive keratoconus is the most widespread use of cross-linking technique. In the present manuscript we will summarize different aspects of the utilization of cross-linking in treatment of corneal keratoconus. Keywords: Corneal Cross-linking; Treatment; Progressive; Keratoconu

The Effect of Topical Betamethasone Eye Drops on Postoperative Haze among Patients Undergoing Corneal Collagen Cross-Linking: a Randomized, Double Blind Placebo Controlled Study

Objective: To evaluate the effect of topical betamethasone eye drops on postoperative haze among patients undergoing corneal collagen cross-linking (CXL). Patients and Methods: Patients with mild to moderate keratoconus, aged 18 to 30 years, who were a candidate for CXL treatment and had the evidence of disease progression based on topographic findings entered the present study. One eye of each patient randomly received betamethasone and topical antibiotics after CXL and the other eye received topical antibiotics and placebo in place of betamethasone. The eyes were compared regarding BCVA, UCVA, refraction, keratometric and pachymetric findings using Pentacam, as well as changes of corneal haze using confocal microscopy, before CXL as well as one month and six months after CXL. Results: There was no difference in BCVA, UCVA, refraction, keratometric and pachymetric findings between the two groups before and six months after surgery. Based on confocal findings, the difference in light reflectance intensity between the case and control groups was statistically significant in anterior (P = 0.021) and posterior (P = 0.017) corneal stroma one month postoperatively, indicating higher haze in the placebo group. This difference was also statistically significant in anterior (P = 0.001) mid (P = 0.002) and posterior (P = 0.002) stroma six months postoperatively.Conclusion: Betamethasone had no effect on visual acuity, refraction, keratometric and pachymetric findings six months after CXL. It reduced corneal haze in both the first and the sixth months postoperatively. Keywords: Keratoconus; Cornea; Cross-Linking; Haze; Betamethason

Local Infiltration of Tramadol versus Bupivacaine for Post Cesarean Section Pain Control: A Double-Blind Randomized Study

Background: Postoperative pain control after cesarean section (C/S) is important because inadequate postoperative pain control can result in a prolonged hospital stay. In this study, we compared postoperative somatic wound pain control between patients receiving tramadol and bupivacaine, infiltrated at the wound site. Methods: In this randomized clinical trial, 98 patients, eligible for elective C/S under general anesthesia, were randomly allocated to 2 groups. Before wound closure, 20 cc of 0.025% bupivacaine and 2 mg/kg of tramadol, diluted to 20 cc, were infiltrated at the wound site in groups A and B, respectively. After surgery, the pain score was measured using the visual analogue scale (VAS). Additionally, 24-hour total morphine consumption, nausea and vomiting, and respiratory depression were compared after 2, 4, 8, 16, and 24 hours between the 2 groups. The data were analyzed using SPSS with the Student independent t test, χ2 test, Fisher exact test, and repeated measure test. Results: Postoperatively, there was no significant difference between these 2 groups in their VAS scores until 16 hours (P>0.05). However, at the 16th and 24th hours, the mean VAS scores were 3.20±2.24 and 2.51±2.55 in the bupivacaine group and 2.51±0.99 and 1.40±0.88 in the tramadol group, respectively (P<0.05). There was no difference in nausea and vomiting during the 24-hour period between the 2 groups. Also, no respiratory depression was detected in the both groups. Conclusion: Local infiltration of tramadol (2 mg/kg) at the incision site of C/S was effective in somatic wound pain relief without significant complications. Trial Registration Number: IRCT2013070111662N

Restudy of Conception of “House” in Islam: An Approach to Describe Functional Aspects of House According to Verses of Holy Quran

Abstract Islam specified some rules for supplying real needs of human communities so that the human beings may live together with upmost security and health far from the concerns and problems by observing such principles, and one of the most important endowments pointed by the Quran is human’s place of residence. Conception of house in Islam is a subject studied in this paper. House, in fact, is one of the most important human requirements, and Muslims shall live under conditions and based on the religious values that they may worship God and provide the immortal life. The religious teachings in human life -lead the men to have a special imagination- based on the functional and aesthetic values are defined. Architecture and house construction are a field for the creation and description of human religious beliefs, and also a criterion for evaluation of meeting the said values. The purpose of this paper is to express necessary recognition of the principles and philosophy of verses of Holy Quran in terms of the house and shelter, and also its compliance with the social, cultural and functional structure in designing architectural buildings. Therefore, the verses of the Holy Quran are used in this research as the source of the principles and fundamentals of Islamic thinking and ontology in explaining the functional dimensions of house by enjoying the analytical-descriptive methodology

Cardioprotective Effect of Extended Remote Ischemic Preconditioning in Patients Coronary Artery Bypass Grafting Undergoing: A Randomized Clinical Trial

Background: The cardioprotective effect of ischemic preconditioning has been known for many years. Since the temporary ischemia in the heart may cause lethal cardiac effects, the idea of creating ischemia in organs far from the heart such as limbs was raised as remote ischemic preconditioning (RIPC). We hypothesized that the extension of RIPC has more cardioprotective effect in patients undergoing coronary artery bypass graft (CABG) surgeries. Methods: In this triple-blind randomized clinical trial study, 96 patients were randomly divided into 3 groups and two blood pressure cuffs were placed on both upper and lower extremities. In group A, only upper extremity cuff and in group B upper limb and lower limb cuff was inflated intermittently and group C was the control group. RIPC was induced with three 5-min cycles of cuff inflation about 100 mmHg over the initial systolic blood pressure before starting cardiopulmonary bypass. The primary endpoints were troponin I and creatine phosphokinase-myoglobin isoenzyme (CK-MB). Results: Six hours after the termination of CPB, there was a peak release of the troponin I level in all groups (group A=4.90 ng/ml, group B=4.40 ng/ml, and group C=4.50 ng/ml). There was a rise in plasma CK-MB in all groups postoperatively and there were not any significant differences in troponin I and CK-MB release between the three groups. Conclusion: RIPC induced by upper and lower limb ischemia does not reduce postoperative myocardial enzyme elevation in adult patients undergoing CABG. Trial Registration Number: IRCT2012071710311N