The evaluation of the efficacy of etofenamate spray in postoperative cesarean pain: Randomized, double-blind, placebo-controlled trial

Objective: It was aimed to investigate the effect of etofenamate spray to be applied around the postoperative incision on pain control in cesarean section in this trial. Material and methods: This was a prospective, randomized, double-blind, and placebo-controlled trial. 187 patients (93 cases and 94 controls) were recruited for the study. In the trial group, we applied the etofenamate spray (Doline® 50 ml) after closing the cesarean skin incision and go on four times a day on the skin incision for 24 h. In the control group, we applied a placebo. All patients received paracetamol IV (Paracerol®) as standard analgesic doses. If analgesia was insufficient, tramadol (Contramal®) 50 mg IV doses were added and recorded. A visually analog pain scale (VAS) was performed on both groups at 6–12–18–24th hours. Independent t-tests were performed for data showing normal distributions. Results: There were no significant differences in the mean of differences VAS scores between the two groups at 6–12, and 6–18 h. However, a significant difference was obtained in the mean of differences VAS score at the 6-24th hour (p < 0.05). When the groups were compared in terms of additional paracetamol need, a significant difference was found again (p < 0.05). There was no significant difference between the groups in terms of tramadol need. Conclusion: Postoperative administration of etofenamate spray provided an analgesic effect at 24 h and additional analgesic usage decreased. Postoperative analgesia can also be used by administering NSAIDs around the cesarean section incision. In this way, the side effects of other systemic analgesics are avoided. Clinical trial id: PACTR201811864509898. Clinical trial web link: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5745

Specular Microscopy Data of Cornea Bank Donors at Kartal Training and Research Hospital

Objective: To evaluate the correlation between donor cornea endothelial cell morphology, epidemiological features of the donor and time of death in terms of necessity of specular microscopy (SM) in eye bank. Materials and Methods: SM data acquired from Dr. Lütfi Kırdar Kartal Training and Research Hospital Cornea Bank between 2010 and 2012 were retrospectively evaluated. Results: One thousand one hundred eighty cornea tissues were excised from 606 donors. The mean age of the donors was 40.11±15.51 years. Four hundred forty-nine (74.1%) donors were male and 157 (25.9%) donors were female. The mean duration of corneal excision was 1.52±0.6 hours after the time of death. The mean endothelial cell density (ECD) was 2852.07±542.15 cells/mm2 and there was no significant difference with respect to gender (p>0.05). According to age groups, the endothelial cell density was highest at age 20 years and below, and there was a significant difference compared to the other age groups (p<0.001).The mean cell area (MCA) was 367.86±86.30 µm2; the hexagonality rate was 49.29±7.76 (%); the coefficient of variation (CV) was 31.52±6.37 and there was a statistically significant correlation between these variables and age (p<0.001).The MCA was significantly different between males and females (p0.05). According to the time of death and time of corneal excision, there was no significant difference in ECD, MCA, CV, and hexagonality values between the groups (p>0.05). Seventy-nine percent of the donors with endothelial cell density less than 2000cells/mm2 were younger than the age of 60 years and 78% of the donors over the 61 ages had a number of endothelial cells more than 2000cells/mm2. Conclusion: Although morphological parameters of donor cornea show significant correlation with age, distribution of the donors with endothelial cell density less than 2000 cells/mm2 suggests that the evaluation of donor cornea with SM should be performed as a standard procedure before keratoplasty. (Turk J Ophthalmol 2014; 44: 190-5

The ocular surface side effects of an anti-psychotic drug, clozapine

Purpose: The purpose of this study is to investigate the effects of long-term clozapine usage on tear film stability and corneal topographic parameters.Material and methods: The study was conducted between March 2014 and November 2014. Thirty patients who were diagnosed of schizophrenia and have been under clozapine treatment for 2.730.73 years (range 2-4 years) were involved in this study (group 1). Thirty healthy subjects (group 2) who have statistically similar demographic features compared with the group 1, were involved as a control group. Full ophthalmologic examination with biomicroscopy and indirect ophthalmoscopy was applied. Corneal topographic parameters were measured using the Pentacam HR and Schirmer test was done. Statistical analysis of the subjects was evaluated by using SPSS (for Windows version 16.0; SPSS Inc., Chicago, IL) program.Results: K-1 value was measured as 43.39 +/- 0.17D (43-43.50D) and K-2 value was measured as 43.39 +/- 0.06D (43.30-43.50D) in groups 1 and 2, respectively. In groups 1 and 2, K-2 values were noted as 43.86 +/- 0.27D (43.50-44.50D) and 43.72 +/- 0.18D (43.50-44.00D), respectively. Central corneal thickness was found to be 523.93 +/- 15.66 mu m (495-554 mu m) and 550.13 +/- 1.03 mu m (520-580 mu m) in groups 1 and 2, respectively. Corneal apex thickness was 525.86 +/- 15.75 mu m (497-556 mu m) in group 1 and 551.60 +/- 14.99 mu m (521-581 mu m) in group 2. The corneal thickness of thinnest location was 520.93 +/- 15.60 mu m (492-551 mu m) and 548.06 +/- 15.17 mu m (518-578 mu m) in groups 1 and 2, respectively. Corneal volume was determined as 58.13 +/- 3.46mm(3) (52-64mm(3)) in group 1 and 60.73 +/- 3.76mm(3) (54-66mm(3)) in group 2. The Schirmer test showed thichkness of 3.33 +/- 0.72mm (2-4mm) and 13.60 +/- 1.59mm (11-16mm) in groups 1 and 2, respectively. The mean fluorescein break-up time was 5.40 +/- 1.50s (3-8s) and 12.46 +/- 1.40s (10-14s) in groups 1 and 2, respectively. There was a statistically significant difference in the Schirmer test, fluorescein break-up time, central corneal thickness, corneal apex, and the thinnest corneal location thickness between the two groups.Conclusion: Clozapine may induce dry eye syndrome and thus may lead to morphological alterations in corneal parameters through its anticholinergic and antidopaminergic activities. Because of these corneal alterations, one should be aware of evaluating patients having diseases like glaucoma or preoperative selection of corneal refractive surgery candidates

Retinal nerve fibre layer, ganglion cell layer and choroid thinning in migraine with aura

Background: The aim of this study was to investigate the thickness of the retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), and choroid thickness (CT) in patients who have migraines, with and without aura, using spectral optical coherence tomography (OCT)