Safety and effectiveness of primary transscleral diode laser cyclophotoablation for glaucoma in Nigeria.

IMPORTANCE: To investigate the safety, effectiveness and follow-up rates after transscleral diode laser cyclophotocoagulation as primary treatment for seeing eyes with primary open angle glaucoma in Bauchi, Nigeria. BACKGROUND: There is a high prevalence of primary open angle glaucoma in Africa where adherence to medical treatment and acceptance of surgery are poor. DESIGN: Prospective case series. PARTICIPANTS: New glaucoma patients where surgical intervention was recommended. METHODS: A diode 810 nm laser G-probe was used under retrobulbar anaesthesia to deliver approximately 20 shots for 2000 ms, titrating the power. If both eyes were treated the first was the study eye. Repeat treatment offered if the intraocular pressure (IOP) was >21 mmHg on two consecutive visits. MAIN OUTCOME MEASURES: IOP < 22 mmHg, change in ≥2 lines of Snellen visual acuity (VA), and complications. RESULTS: 201 out of 204 eyes with complete data analysed. Mean age 52 years, 17 (8.3%) eyes were re-treated. Mean pre-treatment IOP was 39 (SD 11) mmHg. 106 (53%) attended at 12 months when the mean IOP was 19 (7-45) mmHg; 77 (73%) had IOP < 22 mmHg. VAs were better in 13 (12.3%) and worse in 23 (21.7%) eyes. Postoperative complications included mild uveitis (5.5%), corneal oedema (2.5%), severe uveitis (0.5%) and transient hypotony (2.0%). No hypotony at 12 months. CONCLUSIONS AND RELEVANCE: Transscleral diode laser cyclophotocoagulation controlled IOP in almost three quarters of eyes at 12 months with short-term preservation of vision and minimal complications. Poor follow-up in this setting highlights the need for an effective, safe and acceptable treatment where regular follow-up is less critical

Medical applicant general practice experience and career aspirations: a questionnaire study

Background: Increasing access to general practice work experience placements for school students is a strategy for improving general practice recruitment, despite limited evidence and concerns surrounding equity of access to general practice experiences. Aims: To examine the association between undertaking general practice experience and the perceptions of general practice as an appealing future career among prospective medical applicants. To identify socioeconomic factors associated with obtaining general practice experience. Design & setting: Cross-sectional questionnaire study in the UK. Method: Participants were UK residents aged ≥16 years and seriously considering applying to study medicine in 2019/2020. They were invited to take part via the University Clinical Aptitude Test (UCAT). Questionnaire data were analysed using a linear regression of general practice appeal on general practice experience, adjusting for career motivations and demographics, and a logistic regression of general practice experience on measures of social capital and demographics. Results: Of 6391 responders, 4031 were in their last year of school. General practice experience predicted general practice appeal after adjusting for career motivation and demographics (b = 0.37, standard error [SE] = 0.06, P<0.00001). General practice experience was more common among students at private (odds ratio [OR] = 1.65, 95% confidence interval [CI] = 1.31 to 2.08, P<0.0001) or grammar schools (OR = 1.33, 95% CI = 1.02 to 1.72, P = 0.03) and in the highest socioeconomic group (OR = 1.62, 95% CI = 1.28 to 2.05, P<0.0001), and less likely among students of ‘other’ ethnicity (OR = 0.37, 95% CI = 0.20 to 0.67, P = 0.0011). Conclusion: Having general practice experience prior to medical school was associated with finding general practice appealing, which supports its utility in recruitment. Applicants from more deprived backgrounds were less likely to have had a general practice experience, possibly through lack of accessible opportunities

Soluble Nutrient Production During Fermentation of Three Melon Varieties in the Leaves of Musa spp, Thaumatococcus danielli and Carica papaya

The amount of soluble nutrient production (soluble sugars and free amino acids) in three varieties of melon seeds, Citrullus colocynthis (A), Cucumis melo (B) and Cucumeropsis mannii (C) during fermentation in Musa spp (M), Thaumatococcus danielli (D) and Carica papaya (P) leaves were&nbsp; investigated. Proximate compositions of the three varieties revealed that they were very rich in fat with variety C having the highest content&nbsp; (55.93%) while it was the least rich in protein (24.42%). In contrast to the fat composition, carbohydrate content was the least in all three varieties with variety B having the highest (16.31%) and A the least (7.86%). Variety A, however, was the richest in protein (37.14%) while C had the lowest value (24.42%). Fermentation increased the amounts of free amino acids in all varieties of melon and in all leaf types. Varieties fermented in Musa spp leaf gave the highest amounts with C having 275 &plusmn; 19.6 mg/g dry weight, B and A having 240 &plusmn; 19.6 mg/g and 155&plusmn;9.8 mg/g&nbsp; respectively. Varieties fermented in Thaumatococcus danielli had higher retention levels of free amino acids than those fermented in Carica papaya. Fermentation however decreased the total soluble sugar levels in all three varieties of melon and in all leaf types. On the average, varieties fermented in Musa spp gave highest retention levels of soluble sugars with C (720 &plusmn; 29.3 mg/g dry weight), B (567 &plusmn; 13.72 mg/g), A (295&plusmn;9.8 mg/g). Enzymatic activities (amylase, proteinase and lipase) increased throughout fermentation in all varieties of melon and in all leaf types, with proteinase being the highest as observed in variety B (10.33 &plusmn; 1.67, 10.00 &plusmn; 1.96 and 9.67&plusmn;1.5 mg tyrosine/min) for all leaves. Amylase activity followed the same trend (0.252 &plusmn; 0.03, 0.236 &plusmn; 0.02 and 0.224 &plusmn; 0.02 mg maltose/min). Lipase activity was highest in variety A (0.53 &plusmn; 0.003 mg oleic acid/min) than in B and C (0.48 &plusmn; 0.02 and 0.49 &plusmn; 0.002 mg/g) respectively. Of the three types of leaves used in the fermentation process, Musa spp and Thaumatococcus danielli were observed to serve as better materials for fermentation while melon varieties C and B were better suited for fermentation into condiment