Comparative study between fundus fluorescein angiography and optical coherence tomography angiography in evaluation of diabetic maculopathy

Background Diabetic maculopathy is a serious consequence of diabetic retinopathy (DR) that greatly affects the visual acuity. Diabetic macular edema (DME) and diabetic macular ischemia (DMI) are major causes of vision affection in diabetic patients. Purpose The aim of this study was to compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) in evaluation of diabetic maculopathy. Patients and methods This comparative cross-sectional study was performed on 87 eyes of 54 patients with type I or type II diabetes, older than 18 years old with any diabetic retinal changes, and 108 eyes of 54 control subjects. An ocular examination was performed as well as color fundus photography, FA, and OCTA. Investigations were done on the same day. FA and OCTA findings were summarized and compared. Results The mean age of the patients was 59.4±8.5 years. OCTA was statistically significantly superior to FA in diagnosing DMI. The foveal avascular zone (FAZ) was ischemic (enlarged) in 74 (85.06%) eyes by OCTA compared with only 46 (52.87%) eyes by FA, with a statistically significant difference (P = 0.001). In addition, OCTA detected microaneurysms significantly more than FA (P = 0.001). The mean FAZ area of the control eyes by OCTA was significantly less than in the ischemic eyes (U = 56.602, P < 0.001), while the superficial capillary plexus (SCP) vascular density (VD) and the deep capillary plexus (DCP) VD in the control eyes was statistically significantly higher than in the ischemic eyes (U = 36.984, P < 0.001, and U = 35.955, P < 0.001, respectively). FA showed diffuse leakage (edema) at the macula as the most common pattern of DME that was detected in 37.9% of the eyes followed by focal macular leakage in 18.4% of the eyes and cystoid leakage in 8% of the eyes while 35.5% of the eyes showed no macular edema. Conclusion OCTA is a cornerstone in DMI diagnosis both qualitatively and quantitatively. In addition, it is essential in evaluating the deep retinal vasculature, while FA is essential in diabetic retinopathy grading and in the diagnosis of DME in a qualitative manner. Both investigations are complementary to each other in diabetic maculopathy evaluation

A Simple Surgical Approach for the Management of Acquired Severe Lower Punctal Stenosis

Purpose. Evaluation of using pigtail probe to detect and open severely stenosed lower lacrimal punctum followed by self-retaining bicanalicular intubation. Study design. A prospective nonrandomized clinical study. Methods. The study included 24 patients with severe lower punctal stenosis (grade 0 according to Kashkouli scale) attending at Menoufia University Hospitals. The upper punctum and canaliculus were patent. All patients were complaining of epiphora and had a thorough ophthalmological examination including dye disappearance test and slit-lamp examination. Pigtail probe was used from patent upper punctum to detect the lower stenosed punctum which was opened with a scalpel. Syringing of the lower lacrimal passages was done to confirm its patency, and self-retaining silicone bicanalicular stent was inserted. The silicone tube was left in place for 6 months before it was removed. Patients were then followed-up for 1 year after the surgery. Results. One year after surgery, epiphora was absent (grade 0) in 16 eyes (66.7%) and was present only occasionally (grade 1) in 4 eyes (16.7%). The difference from preoperative epiphora was statistically significant. One year after surgery, fluorescein dye disappearance time was grade 1 (<3 minutes) in 20 cases (83.3%), and grade 2 (3–5 minutes) in 4 cases (16.7%). There was a statistically significant difference compared with preoperative results. Conclusion. Using the pigtail probe is effective in treatment of severe punctal stenosis. Maintaining the punctal opening and prevention of restenosis can be achieved by using self-retaining bicanalicular stent after confirmation of nasolacrimal duct patency. This trial is registered with NCT03731143

The Role of Epithelial Cell Adhesion Molecule Cancer Stem Cell Marker in Evaluation of Hepatocellular Carcinoma

Background and Objectives: Hepatocellular carcinoma (HCC) is a prevalent form of malignancy that is characterized by high mortality rates and prognosis that remain suboptimal, largely due to treatment resistance mechanisms. Recent studies have implicated cancer stem cells (CSCs), particularly those expressing epithelial cell adhesion molecule (EpCAM), in HCC progression and resistance. In the present study, we sought to assess EpCAM expression in HCC patients and its correlation with various clinicopathological parameters. Materials and Methods: Tissue samples from 42 HCC patients were subjected to immunohistochemical staining to evaluate EpCAM expression. Clinicopathological data were obtained including the size, grade and stage of tumors, vascular invasion status, alpha-fetoprotein levels, and cirrhosis status. The Chi square and Fisher’s exact tests were employed to assess the association between categorical groups. Independent Student-t test or Mann–Whitney U test was used to investigate the association between continuous patient characteristics and survival. Results: Immunohistochemical analysis revealed EpCAM expression in 52.5% of HCC cases. EpCAM-positive tumors exhibited characteristics indicative of aggressive disease, including larger tumor sizes (p = 0.006), greater tumor multiplicity (p = 0.004), higher grades (p = 0.002), more advanced stages (p = 0.003), vascular invasion (p = 0.023), elevated alpha-fetoprotein levels (p = 0.013), and cirrhosis (p = 0.052). Survival analysis demonstrated that EpCAM expression was significantly associated with lower overall rates of survival and higher rates of recurrence in HCC patients. Conclusions: Our findings suggest that EpCAM expression may serve as a prognostic biomarker for HCC with a potential role in patient management. Targeting EpCAM-positive CSCs may represent a promising approach to overcome treatment resistance and improve clinical outcomes in HCC. However, further investigation into the molecular mechanisms underlying EpCAM’s role in HCC progression is warranted to facilitate the development of personalized therapeutic interventions

Predictors of embolism and death in left-sided infective endocarditis: the European Society of Cardiology EURObservational Research Programme European Infective Endocarditis registry

International audienceBackground and Aims Even though vegetation size in infective endocarditis (IE) has been associated with embolic events (EEs) and mortality risk, it is unclear whether vegetation size associated with these potential outcomes is different in left-sided IE (LSIE). This study aimed to seek assessing the vegetation cut-off size as predictor of EE or 30-day mortality for LSIE and to determine risk predictors of these outcomes. Methods The European Society of Cardiology EURObservational Research Programme European Infective Endocarditis is a prospective, multicentre registry including patients with definite or possible IE throughout 2016–18. Cox multivariable logistic regression analysis was performed to assess variables associated with EE or 30-day mortality. Results There were 2171 patients with LSIE (women 31.5%). Among these affected patients, 459 (21.1%) had a new EE or died in 30 days. The cut-off value of vegetation size for predicting EEs or 30-day mortality was &gt;10 mm [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.13–1.69, P = .0015]. Other adjusted predictors of risk of EE or death were as follows: EE on admission (HR 1.89, 95% CI 1.54–2.33, P &lt; .0001), history of heart failure (HR 1.53, 95% CI 1.21–1.93, P = .0004), creatinine &gt;2 mg/dL (HR 1.59, 95% CI 1.25–2.03, P = .0002), Staphylococcus aureus (HR 1.36, 95% CI 1.08–1.70, P = .008), congestive heart failure (HR 1.40, 95% CI 1.12–1.75, P = .003), presence of haemorrhagic stroke (HR 4.57, 95% CI 3.08–6.79, P &lt; .0001), alcohol abuse (HR 1.45, 95% CI 1.04–2.03, P = .03), presence of cardiogenic shock (HR 2.07, 95% CI 1.29–3.34, P = .003), and not performing left surgery (HR 1.30 95% CI 1.05–1.61, P = .016) (C-statistic = .68). Conclusions Prognosis after LSIE is determined by multiple factors, including vegetation size