Last Guidelines Overview of Consecutive Esotropia Management: Review Article

Background: Consecutive esotropia (ET) is persistent esodeviation for 24 weeks afterward bilateral lateral rectus recession (BLRR) for correcting exotropia (XT) with or without diplopia. Some patients may have limited eye movement; amblyopia and loss of binocularity can result. Early postoperative overcorrection has been recommended in surgical treatment of intermittent XT due to tendency towards postoperative exotropic drift. ET with small angles (within 15 PD) vanishes naturally over time, whereas bigger angles are more likely to be present at the start. Patients who have ET that has persisted for at least 24 weeks after BLRR and has been present for more than 15 postoperative days should have surgery. Objective: Hallmark the updated lines of management of consecutive esotropia. Conclusion: For the purpose of maintaining one MR muscle for a future intervention, several research have shown that ET can be performed consecutively after BLR recession by advancement of LR muscle previously recessed and MR muscle recession in the more deviating eye. Studies in recent years have sought to determine the effectiveness of the use of lateral rectus advancement in the treatment of consecutive ET

Serum and Circulatory Omentin mRNA Gene Expression as Predictive Markers of Systemic Lupus Erythematosus Disease Activity and Lupus Nephritis

Background: Lupus nephritis (LN) affects 50% of systemic lupus erythematosus (SLE). LN often leads to renal failure. Thus, early diagnosis of LN is mandatory for the prevention of complications. Objective: We aimed to evaluate serum and relative omentin mRNA gene expression levels as a noninvasive diagnostic test of LN and to assess their correlations with disease activity, clinical and laboratory features of SLE.Patients and Methods: Case-control study included 104 subjects, 60 patients with SLE were stratified into two subgroups LN group (n=25) and the non-LN group (n=35). Disease activity was assessed by the SLE disease activity index (SLEDAI). Measurement of serum omentin was done by ELISA and investigation of omentin mRNA relative expression was done by real-time PCR.Results: Our results detected that serum omentin levels were significantly lower in the LN group and non-LN group compared to controls. Intriguingly, omentin mRNA relative expression levels were significantly lower in the LN group and non-LN group compared to controls. Among the LN group, there were significant negative correlations between serum and relative omentin mRNA expression with SLEDAI, clinical, and laboratory features of LN. Moreover, SLEDAI, proteinuria, and serum creatinine were independently correlated with them. The sensitivities and the specificities of serum omentin were 91% and 65.5% respectively. While the relative omentin mRNA expression diagnostic power showed sensitivities and specificities of 93% and 68.8% respectively.Conclusion: LN group had significantly lower values of serum and relative omentin mRNA expression compared to non-LN and control groups. Additionally, it was negatively correlated with SLEDAI, clinical and laboratory features of LN. Thus, they could be used as non-invasive predictive markers of LN

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially