Dacryocystitis presenting as post-septal cellulitis: a case report

Dacryocystitis is relatively common, the majority of patients present with pre-septal cellulitis and not an orbital abscess due to anatomical barriers. The authors report a case of dacryocystitis presenting as post-septal cellulitis in a postmenopausal lady with an underlying malignancy. Following antibiotic therapy and elective dacryocystorhinostomy the patient is still under follow-up, and has no further recurrence of symptoms. Orbital abscess in postmenopausal women presenting with dacryocystitis should be considered, as prompt recognition and early surgical intervention is required to prevent visual loss

Photorefractive keratectomy in patients with mild to moderate stable keratoconus: a five-year prospective follow-up study

Elias Chelala,1 Hala El Rami,1 Ali Dirani,1 Ali Fadlallah,1 Omar Fakhoury,1 Elias Warrak2 1Saint-Joseph University, Faculty of Medicine, 2Clemenceau Medical Center, Beirut, Lebanon Background: The purpose of this study was to evaluate the visual outcome of photorefractive keratectomy (PRK) in patients with mild to moderate stable keratoconus and to assess the risk of progression of the disease after the excimer laser procedure. Methods: In this prospective study, carried out at the Clemenceau Medical Center, an affiliate of Johns Hopkins International, in Beirut, Lebanon, 119 eyes from 72 patients with grade 1&ndash;2 keratoconus (Amsler&ndash;Krumeich classification) underwent PRK. Forty-seven patients had both eyes treated and 25 patients had one eye treated. The procedure was done using the Wavelight Eye Q Excimer laser. Uncorrected and best-corrected visual acuity, corneal topography, and pachymetry were assessed before the procedure and 3, 6, 12, 36, and 60 months after the procedure. Results: Mean uncorrected visual acuity showed a statistically significant improvement (P < 0.05) at one, 3, and 5 years follow-up. One hundred and seventeen eyes (98.3%) showed no progression while two eyes (1.7%) showed progression of the disease at 5 years follow-up, as documented by corneal topography and pachymetry. These two eyes were treated with corneal collagen crosslinking. Conclusion: PRK in mild to moderate keratoconus is a safe and effective procedure for improving uncorrected vision in patients with mild refractive errors. However, close follow-up of patients is needed to detect any progression of the disease. Longer follow-up is needed to assess the overall effect of this procedure on progression of the disease. Keywords: stable keratoconus, photorefractive keratectom

Electroejaculation functions primarily by direct activation of pelvic musculature: Perspectives from a porcine model

Ejaculatory dysfunction is a significant cause of infertility in men that have incurred spinal cord injury or iatrogenic lesions to the sympathetic nerves in the retroperitoneum. For such patients, electroejaculation – whereby a voltage is applied transrectally under general anesthesia – is a highly-effective procedure to obtain ejaculate. At present, however, there remains uncertainty as to the physiological mechanism by which electroejaculation prompts seminal emission in males with neurogenic anejaculation. Thus, in the present study, we aimed to determine, for the first time, whether electroejaculation functions by mimicking a neurophysiological response, or by directly activating local pelvic musculature. Using electroejaculation in a novel porcine model, we monitored the strength of contraction of the internal urethral sphincter (a smooth muscle involved in ejaculation) before and after lesioning its sympathetic innervation with a combination of progressively-worsening surgical and pharmacological insults in three anesthetized boars (46.1 ± 7.4 kg). Importantly, prior to this investigation, we confirmed the comparative structural anatomy of the porcine model to humans through gross dissection and histological analysis of the infrarenal retroperitoneal sympathetic nerves and ganglia in 18 unembalmed boars. Prior to sacrifice, three of these boars underwent functional testing to confirm control of the internal urethral sphincter by the hypogastric nerves. Our results demonstrate that electroejaculation-induced contraction of the internal urethral sphincter was preserved following each progressive neural insult compared to the control state (p > 0.05). In contrast, these same insults resulted in paralysis/paresis of the internal urethral sphincter when its sympathetic innervation was directly stimulated with bipolar electrodes (p < 0.05). Taken together, our results provide the first empirical evidence to suggest that electroejaculation does not initiate ejaculation through neural mechanisms, but rather activates pelvic musculature in an independent and non-physiological manner

O uso de contratos de gestão e incentivos profissionais no setor público de saúde The use of management contracts and professional incentives in the public health sector

A gestão por resultados constitui um dos pilares da reforma na gestão pública, inclusive na área da saúde, tendo como principais inovações: a institucionalização de contratos de gestão e a utilização de incentivos profissionais. O objetivo deste artigo de revisão de literatura é apresentar e discutir a utilidade e aplicabilidade de contratos de gestão e incentivos profissionais na gestão por resultados no setor público de saúde. A gestão por resultados só será possível quando existir corresponsabilidade e compromisso mútuo entre os trabalhadores e o nível diretivo. Por isso, as metas preestabelecidas devem ser pactuadas entre todos os atores envolvidos e avaliadas de forma periódica para que os incentivos profissionais sejam garantidos. Para efetivamente aumentar a responsabilização sobre os resultados desejados é preciso aprimorar os mecanismos de controle e monitoramento, definir de forma mais precisa indicadores e seus padrões no campo da assistência e da gestão, capacitar as partes envolvidas na elaboração do plano e aperfeiçoar o uso de incentivos profissionais.<br>Results-based management is a cornerstone of reform in public administration, including the health field, and has become the basis for other innovations such as the institutionalization of management contracts and the use of professional incentives. This review article aims to introduce and discuss the use of such management contracts in the public health sector. Management by results has developed means and tools that highlight the importance of shared responsibility and mutual commitment between workers and management-level directors. Thus, preset goals are negotiated among all the stakeholders and are evaluated periodically in order to grant professional incentives. It is necessary to improve the mechanisms for control and observation, to more precisely determine the healthcare and management indicators and their patterns, to train stakeholders in designing the plan, and to improve the use of professional incentives in order to effectively increase accountability vis-à-vis the desired results