Hyperbaric oxygen therapy for the treatment of radiation-induced macular ischemia

Shamim A Haji1,2, Ronald EP Frenkel1,2,31Eye Research Foundation, Stuart, FL, USA; 2East Florida Eye Institute, Stuart, FL, USA; 3Bascom Palmer Eye Institute, Miami, FL, USAPurpose: To report a case of radiation-induced macular ischemia where vision and macular perfusion improved after hyperbaric oxygen (HBO) therapy.Methods: A 62-year-old male patient developed radiation-induced macular ischemia after he was treated with radiation for brain glioma. The patient presented with best spectacle-corrected visual acuity (BSCVA) acuity of 20/400 in his right eye. Optical coherence tomography (OCT) showed central macular thickness of 468 μm. The patient received focal laser, intravitreal triamcinolone, and HBO therapy.Results: The patient’s vision improved from 20/400 to 20/100 after focal laser and intravitreal triamcinolone. His central macular thickness improved from 468 μm to 132 μm. After receiving HBO therapy, his VA improved to 20/50 and fluorescein angiography showed improvement in macular perfusion.Conclusion: HBO therapy improves macular perfusion in patients with radiation-induced macular ischemia.Keywords: macular ischemia, visual acuity, hyperbaric oxygen therapy, macular perfusio

Observer variation in MRI evaluation of patients with suspected lumbar disc herniation and nerve root compression: Comparison of neuroradiologist and neurosurgeon\u27s interpretations

Objective: To analyse inter-observer variation between a neuroradiologist and neurosurgeon in the MRI diagnosis of lumbar nerve root compression. Although lumbar MFI is primarily analyzed and reported by a radiologist, neurosurgeons often analyse it independently as they have sufficient clinical background as well as radiological expertise to diagnose most spinal pathologies on Magnetic Resonance Imaging (MRI).Methods: Retrospective analysis was carried out for images of 54 patients who underwent MRI between March and July 2010 of lumbar spine with suspected lumbar disc herniation and nerve root compression, at Aga Khan Hospital, Karachi, Pakistan. One fellowship trained neuroradiologist and one neurosurgeon evaluated the images on PACS system separately. Both observers were unaware of the patient\u27s clinical history and each other\u27s findings. Lumbar discs at L3-L4, L4-L5 and L5-S1 levels were evaluated by both observers for disc disease and nerve compression. Findings were recorded on a proforma and analysed with SPPS Version 16.Results: Total 162 lumbar discs were studied by both readers in 54 patients. Excellent inter-observer agreement was seen for the presence or absence of nerve root compression (Percentage agreement = 88.89%; k = 0.774; p = 0.737). For disc bulge, inter-observer agreement was fair but statistically insignificant (Percentage agreement = 72.84%; k = 0.414; p = 0.132). In case of disc herniation, although inter-observer agreement was fair, but the difference was statistically significant (Percentage agreement = 84.57%; k = 0.511; p = 0.002).Conclusion: Inter-observer agreement between neuroradiologist and neurosurgeon in diagnosing nerve root compression due to lumbar disc disease was excellent. Agreement regarding disc bulge and herniation was fair

Examining the Effectiveness of Mindfulness-Based Cognitive Therapy on Quality of Life in primary Infertile Women

The present study aimed to examine the effectiveness of mindfulness-based cognitive therapy on quality of life in infertile women. Semi-experimental design, a randomized controlled trial with assessment in baseline, after intervention and two- month follow-up was conducted on participants of control group. A total of 24 female patients with primary infertility diagnosis among patients who referred to the Infertility Center of Shariati hospital in Tehran were selected as volunteers and were assigned randomly into the experimental (n=12) and control groups (n=12). All participants completed Infertile Couples’ Quality of Life Questionnaire in three phases of baseline, after treatment and follow-up. Data were analyzed using multivariate repeated measurement of variance analysis. Results showed that mindfulness-based cognitive therapy improve the quality of life in social and psychological components, depression, aggression and jealousy in participants of experimental group. Results of this study showed that mindfulness - based cognitive therapy can be effective in improving quality of life in infertile women

Examining the Effectiveness of Mindfulness-Based Cognitive Therapy on Quality of Life in primary Infertile Women

The present study aimed to examine the effectiveness of mindfulness-based cognitive therapy on quality of life in infertile women. Semi-experimental design, a randomized controlled trial with assessment in baseline, after intervention and two- month follow-up was conducted on participants of control group. A total of 24 female patients with primary infertility diagnosis among patients who referred to the Infertility Center of Shariati hospital in Tehran were selected as volunteers and were assigned randomly into the experimental (n=12) and control groups (n=12). All participants completed Infertile Couples’ Quality of Life Questionnaire in three phases of baseline, after treatment and follow-up. Data were analyzed using multivariate repeated measurement of variance analysis. Results showed that mindfulness-based cognitive therapy improve the quality of life in social and psychological components, depression, aggression and jealousy in participants of experimental group. Results of this study showed that mindfulness - based cognitive therapy can be effective in improving quality of life in infertile women

Fluorophotometry as a diagnostic tool for the evaluation of dry eye disease

BACKGROUND: Dry eye disease is a common debilitating ocular disease. Current diagnostic tests used in dry eye disease are often neither sensitive nor reproducible, making it difficult to accurately diagnose and determine end points for clinical trials, or evaluate the usefulness of different medications in the treatment of dry eye disease. The recently developed fluorophotometer can objectively detect changes in the corneal epithelium by quantitatively measuring its barrier function or permeability. The purpose of the study is to investigate the use of corneal fluorescein penetration measured by the fluorophotometer as a diagnostic tool in the evaluation of dry eye patients. METHODS: Dry eye patients (16 eyes), who presented with a chief complaint of ocular irritation corresponding with dry eye, low Schirmer's one test (<10 mm after 5 minutes) and corneal fluorescein staining score of more than two, were included in the study. Normal subjects (16 eyes), who came for refraction error evaluation, served as controls. Institutional Review Board (IRB) approved consent was obtained before enrolling the subjects in the study and all questions were answered while explaining the risks, benefits and alternatives. All Fluorophotometry of the central corneal epithelium was done utilizing the Fluorotron Master (TradeMark). Each eye had a baseline fluorescein scan performed, after which 50 l of 1% sodium fluorescein dye was instilled. Three minutes later, the fluorescein was washed with 50 ml of normal saline. Fluorescein scans were then started immediately after washing and were recorded at 10, 20, 40, and 60 minutes thereafter. The corneal peak values of fluorescein concentration were recorded within the central cornea in both dry eyes and in controls. RESULTS: Ten minutes after fluorescein installition, patients with dry eye disease averaged a five-fold increase in corneal tissue fluorescein concentration (mean = 375.26 ± 202.67 ng/ml) compared with that of normal subjects (mean = 128.19 ± 85.84 ng/ml). Sixty minutes after dye installation, patients with dry eye disease still revealed higher corneal tissue fluorescein concentration (mean = 112.87 ± 52.83 ng/ml) compared with that of controls (mean = 40.64 ± 7.96 ng/ml), averaging a three-fold increase. CONCLUSION: Patients with dry eye disease demonstrated an increased corneal permeability and a slower rate of elimination to topically administered fluorescein when measured by the fluorophotometer. This suggests that fluorophotometry may serve as a valuable quantitative and objective tool for the diagnosis of dry eye disease, and in following patients' response to new treatment modalities. Fluorophotometry may serve as an objective non-invasive tool for end-point analysis in clinical trials of new treatments for dry eye disease

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries