The Effect of Primary Open Angle Glucoma on Progression of Diabetic Retinopathy in Type 2 Diabetic Patients in Alsayem Eye Hospital

Background: Diabetic retinopathy is a serious complication of diabetes. Five percent of patients of type 2 diabetes (NIDDM) have signs of eye problems when diabetes is diagnosed.Control of blood sugar, blood pressure and cessation of smoking, have an important role in slowing the progression of retinopathy and other eye problems caused by diabetes.  Objectives: To determine whether there is a difference in progression of diabetic retinopathy among patients with and without primary open angle glucoma (POAG). Design: comparative cross –sectional study.  Participants: 160 patients who were on regular follow up and treatment in both retina and glaucoma clinics in Al-Sayem Eye Hospital were enrolled in the study. Patients were divided into 2 groups, the study group: included 80 patients who were type 2 diabetics with POAG (group A) .The control group were having type 2 diabetes without POAG (group B).The patients were compared for the grade of diabetic retinopathy according to international clinical diabetic retinopathy disease severity scale. For maculopathy patients were also classified according to international clinical diabetic macular edema disease severity scale. Risk factors for both groups were studied as follow: age, duration of DM, control of DM, systemic hypertension and smoking. Results: In multivariate analyses adjusting for above risk factors and examination for both groups. Diabetic retinopathy was not found in the study group (100%), compared to patients in the control group (patients without POAG) in which no diabetic retinopathy was found in only 8.8%. Mild NPDR was found in 14 patients (43.7%), moderate non prolifrative diabetic retinopathy(NPDR) was observed in 70 patients (32.5%), and severe NPDR in 24 patients (15%). Mild maculopathy was observed in only 4 patients in the study group (5%), all of them were poorly controlled with duration of diabetes of >11 years.In the control group, the majority of patients had no diabetic macular edema(DME) (65%). Mild DME was found in 48 patients (30%). Eight patients only in the control group had moderate DME. Conclusion: POAG and increased cup disc ratio are associated with a lower risk of DR, particularly vision-threatening retinopathy.&nbsp

Predictors of Antibiotics Co-prescription with Antimalarials for Patients Presenting with Fever in Rural Tanzania.

Successful implementation of malaria treatment policy depends on the prescription practices for patients with malaria. This paper describes prescription patterns and assesses factors associated with co-prescription of antibiotics and artemether-lumefantrine (AL) for patients presenting with fever in rural Tanzania. From June 2009 to September 2011, a cohort event monitoring program was conducted among all patients treated at 8 selected health facilities in Ifakara and Rufiji Health and Demographic Surveillance System (HDSS).It included all patients presenting with fever and prescribed with AL. Logistic regression was used to model the predictors on the outcome variable which is co-prescription of AL and antibiotics on a single clinical visit. A cohort of 11,648 was recruited and followed up with 92% presenting with fever. Presumptive treatment was used in 56% of patients treated with AL. On average 2.4 (1 -- 7) drugs was prescribed per encounter, indicating co-prescription of AL with other drugs. Children under five had higher odds of AL and antibiotics co-prescription (OR = 0.63, 95% CI: 0.46 -- 0.85) than those aged more than five years. Patients testing negative had higher odds (OR = 2.22, 95%CI: 1.65 -- 2.97) of AL and antibiotics co-prescription. Patients receiving treatment from dispensaries had higher odds (OR = 1.45, 95% CI: 0.84 -- 2.30) of AL and antibiotics co-prescription than those from served in health centres even though the deference was not statistically significant. Regardless the fact that Malaria is declining but due to lack of laboratories and mRDT in most health facilities in the rural areas, clinicians are still treating malaria presumptively. This leads them to prescribe more drugs to treat all possibilities