Laser Trabeculoplasty and Aqueous Dynamics

For the past four decades, laser trabeculoplasty has been a staple in the treatment armamentarium against glaucoma. Although the exact mechanism of laser trabeculoplasty has not been fully elucidated, its clinical utility in lowering intraocular pressure has been well established. Aqueous dynamic studies uniformly reveal an increase in aqueous outflow facility at the trabecular meshwork. Accumulating evidence suggests that the mechanism is the result of complex cellular and biochemical processes. Histopathological studies of the trabecular meshwork tissue after argon laser suggest an additional mechanical role. The traditional treatment algorithm for glaucoma placed laser trabeculoplasty as an intermediary between medical therapy and incisional surgery. However, because of the safety profile of selective laser trabeculoplasty, recent studies have challenged this treatment paradigm. One such study was a multicenter trial headed by our department that compared laser trabeculoplasty and medical therapy as initial treatment for glaucoma. We showed a similar efficacy between the two modalities, reinforcing the possibility of using laser as the initial treatment in the right clinical setting

The effects of dried tomato pomace and a multipleenzyme mixture supplementation (Rovabio ExcelTM) on performance and carcass quality of broiler chickens

An experiment was conducted to study the effect of dried tomato pomace (DTP) and a multienzyme preparation supplementation (Rovabio ExcelTM) on the performance and carcass quality of broiler chickens. A 4 × 2 factorial arrangement of treatments comprising 4 dietary DTP levels (0, 8, 16 and 24%) with and without enzyme supplementation was used. Each diet was fed to 4 replicates pens of 8 broiler chicks from 1 to 42 days posthatch as a coarse mash. The addition of DTP up to 16% to broiler diets did not significantly affect feed intake (FI), body weight gain (BWG) and feed conversion ratio (FCR) during starter (1 to 21 days), growing (22 to 42 days) and entire experimental (1 to 42 days) periods. Inclusion of 24% DTP into the diet significantly decreased FI at starter and entire experimental periods. Also, inclusion of 24% DTP into the diets significantly decreased BWG and increased FCR at all periods. Birds fed the diets supplemented with Rovabio ExcelTM had significantly higher BWG during the starter and entire experimental periods. No significant effect of enzyme addition was observed on FI and FCR. The dietary treatments with or without enzyme did not significantly affect mortality. The 8% DTP-fed group had comparable carcass weight, carcass yield, yield of breast, thigh, abdominal fat, heart, liver and gizzard with those of control group. The higher levels of DTP significantly decreased carcass weight and yield, yield of breast and thigh when compared to the control group. Enzyme supplementation significantly increased carcass weight and yield of abdominal fat. No significant interactions between the DTP and enzyme were observed for performance parameters and carcass characteristics. These results demonstrate that supplementation of DTP up to 8% to broiler diets had no significant adverse effects on performance parameters and carcass characteristics. The enzyme had a significant effect on BWG, carcass weight and yield of abdominal fat.Key words: Dried tomato pomace, enzyme, performance, carcass quality, broiler

Controversies in the Use of MIGS

Abstract Minimally invasive glaucoma surgery (MIGS) has fulfilled an unmet need in the management of glaucoma. This chapter highlights some controversial issues regarding the use of MIGS in clinical practice, including (1) whether there is sufficient evidence to advocate combining MIGS with cataract surgery over cataract surgery alone, (2) the merits and drawbacks of different approaches to trabecular bypass and canal-based MIGS procedures, (3) the effect of MIGS on endothelial cell loss, (4) suprachoroidal MIGS devices and whether there is still a role for these procedures, and (5) a comparison between subconjunctival MIGS and trabeculectomy. Several questions are still left unanswered and hopefully, further research and more clinical experience with these new technologies will help improve surgical outcomes for patients

An investigation of Breast Feeding Self Efficacy and its Relationship with exclusive breast feeding

Child nutrition in different aspects is important in the first years especially the first two years after birth. The most important feature of this period is that the physical and cerebral damage of malnutrition after this period is not compensable. Successful breastfeeding not only depends on psychological and social factors, but also depends on the physiological conditions that can affect the onset of lactation. In addition, other factors are involved in the duration of breastfeeding including: age and maternal education, family income, the first time to decide for breastfeeding, First time feeding, maternal skill and breastfeeding self-efficacy. The aim of this study, was to determine breastfeeding self efficacy and its relationship with exclusive breast-feeding. In this descriptive study, the data collection instrument, was a questionnaire consisted of the demographic characteristics and standard items of breastfeeding self efficacy. The number of participants in this study was 331 persons that selected continuously from the Primiparous women at Shahid Akbarabadi hospital in Tehran. The findings of this study showed promising results in all samples studied, standard deviation and mean score of breastfeeding self-efficacy in exclusive breast-feeding group was 53.64±9.8 and in non exclusive breast-feeding group was 46.11±9.23, which showed that the mothers with exclusive breast-feeding, had higher breastfeeding self-efficacy scores than those fed with the non-exclusive. Therefore according to the reported reduced rate of breast feeding in the recent years, it is necessary to provide appropriate strategies in order to increase breastfeeding self efficacy, especially in primiparous mothers in order to increase breastfeeding rates

Broiler performance in response to different methionine levels

Abstract The effect of different levels of Met on performance and carcass quality of broilers was investigated. Based on a completely randomized design, three treatments including T1 (+10% NRC requirement of Met), T2 (NRC requirement of Met), and T3 (-10% NRC requirement of Met) were used. Feed intake (FI) , body weight (BW) and feed conversion ratio (FCR) were measured weekly. The effects of treatments on BW and FCR were not significant. Birds fed T1 had the highest FI among treatments, as the difference between T1 and T2 was significant. Significantly, carcass yield of T3 was lower than others. Birds fed control diet decreaes abdominal fat, significantly. The effects of treatments on other parameters (thigh, breast and liver percentages) were not significant. It can be concluded that diet formulation based on low Met level (-10% NRC) results in negative effects on broiler chickens

Efficacy of wavefront-guided photorefractive keratectomy with iris registration for management of moderate to high astigmatism by advanced personalized treatment nomogram

Purpose: To evaluate the efficacy of photorefractive keratectomy (PRK) using the advanced personalized treatment (APT) nomogram for correction of moderate to high astigmatism. Methods: This prospective interventional case series included 60 consecutive eyes of 30 patients undergoing wavefront-guided PRK (Zyoptix 217 Z100 excimer laser, Bausch & Lomb, Munich, Germany) using the APT nomogram and iris registration for myopic astigmatism. Mitomycin-C was applied intraoperatively in all eyes. Ophthalmic examination was performed preoperatively and 1, 3 and 6 months postoperatively. Results: Preoperatively, mean sphere was -1.68 ± 2.08 diopters (D), mean refractive astigmatism was -3.04 ± 1.05 D and mean spherical equivalent (SE) was -3.12 ± 1.77 D. Six months postoperatively, mean sphere was + 0.60 ± 0.64 D (P < 0.005), mean cylinder was -0.43 ± 0.46 D (P < 0.005) and mean SE was + 0.28 ± 0.48 D (P < 0.005). Hyperopic overcorrection (≥ +1.0 D) occurred in 3 (5%) eyes. Postoperatively, root mean square (RMS) of higher order aberrations (HOAs) was significantly increased (P = 0.041). RMS of spherical aberration (Z [4, 0]) showed no significant change after surgery (P = 0.972). Conclusion: Considering the acceptable residual refractive error, low rate of hyperopic overcorrection, acceptable uncorrected visual acuity, and low risk of postoperative corneal haze, PRK using the APT nomogram with iris registration and mitomycin-C use is a safe and effective modality for treatment of moderate to high astigmatism

Influence of xylanase and vitamin A in wheat-based diet on performance, nutrients digestibility, small intestinal morphology and digesta viscosity in broiler chickens

The effect of wheat-based diet (WBD), supplemented with xylanase and surplus vitamin A, on performance, nutrient digestibility, intestinal morphology and digesta viscosity of broiler chickens was investigated. Based on a completely randomized design, 240-day-old chickens were randomly divided into six experimental diets and four replications with 10 chickens each. Experimental diets consisted of corn-based diet (CBD) (T1), WBD with routine amounts of vitamin A (9000 IU kg-1) (T2), T2 without vitamin A in premix (T3), T2 + 6000 IU kg-1 vitamin A (T4), T2 + 420 IU kg-1 xylanase (T5), and T2 + 6000 IU kg-1 vitamin A + 420 IU kg-1 xylanase (T6). For Feed Conversion Rate (FCR) between day 1 and 21 and between day 21 and 42 WBD supplemented with vitamin A and enzyme was less than CBD (p < 0.05). Also, supplementation of surplus vitamin A singly, and vitamin A and enzyme improved digestibility of crude protein (CPD) and crude fat (CFD) than WBD with routine amounts of vitamin A (p < 0.05). The villus (duodenum, jejunum and ileum) was longer (p < 0.05) in broilers fed on diet supplemented with vitamin A and enzyme than those with CBD. It may be concluded that enzyme and vitamin A supplementation to WBD may improve mentioned parameters

Effect of Self-care Training based on Acceptance and Commitment Therapy on Perceived Stigma and Burden of Care in Caregivers of Patients with Schizophrenia: A Randomized Controlled Trial

Background and purpose: Stigma and burden of care in caregivers of patients with schizophrenia have negative effects on the patient and their families. This research aimed to determine the effect of self-care training based on Acceptance and Commitment Therapy (ACT) on perceived stigma and caregiver burden of schizophrenic patients. Materials and methods: This randomized clinical trial included 80 caregivers of schizophrenia patients in Sari Zare Hospital. Participants in intervention group received self-care training based on ACT in 8 sessions twice a week, while the control group received only routine care. The scores for stigma and care burden were measured in both groups before and after the intervention using Shamsaei stigma questionnaire and Zarit Burden Interview (ZBI, 22-item). T-test and paired t-test and descriptive statistical methods were used to analyze the data. Results: The mean changes of the total score for perceived stigma before and after the intervention were found to be significantly different between the intervention group (65.45±6.79) and the control group (80.25±10.34)(P<0.05). Also, intergroup comparison showed a significant difference in mean changes of the total scores for burden of care before and after the intervention between the intervention group (44.35 ± 6.37) and the control group (55.05 ±10.29) (P <0.05). Conclusion: According to current study, self-care training based on Acceptance and Commitment Therapy will improve perceived stigma and reduce burden of care in caregivers of patients with schizophrenia and such non-invasive interventions are recommended. (Clinical Trials Registry Number: IRCT20171203037723N6

Evolution of cyclophotocoagulation

Cyclodestructive techniques have been a treatment option for refractory glaucoma since its first use in the 1930s. Over the past nine decades, cyclodestruction has advanced from the initial cyclodiathermy to micropulse transscleral cyclophotocoagulation (MP-TSCPC) which is the current treatment available. Complications associated with cyclodestruction including pain, hyphema, vision loss, hypotony and phthisis have led ophthalmologists to shy away from these techniques when other glaucoma treatment options are available. Recent studies have shown encouraging clinical results with fewer complications following cyclophotocoagulation, contributing greatly to the current increase in the use of cyclophotocoagulation as primary treatment for glaucoma. We performed our literature search on Google Scholar Database, Pubmed, Web of Sciences and Cochrane Library databases published prior to September 2017 using keywords relevant to cyclodestruction, cyclophotocoagulation and treatment of refractory glaucoma