Mother-Infant, Father-Infant Relationships

This study was designed to determine the contributions of mothers and fathers to infant social development. Nine 1 0-month-olds , 12 fourteen-month- olds, and 12 eighteen-month-olds were observed with their mothers and fathers in a laboratory situation. Parent-infant interactions were videotaped during three different episodes: Mother-infant dyad, father-infant dyad, and mother- father-infant triad. Findings revealed different interaction patterns as a result of the ages of infants and the interaction situation. Older infants and their parents engaged in more verbal behavior (responsive talk, social speech, and story reading) than younger infants and their parents. It was found that parents and infants interacted with each other more when observed in dyads than in triads. However , it is argued that situation may not be a significant factor, if the duration of interactions, is controlled for. There were no significant differences between mothers and fathers in the amount of interaction they engaged in with their infants . Likewise, there were few gender differences across age groups in parent-infant interaction. The data are discussed with respect to the importance of early interaction patterns and the need to control for interaction time when examining second-order effects

Intracameral Antibiotics as Prophylaxis in Cataract Surgery; a Mini-Review of Literature

Purpose: To conduct a mini-review of intracameral antibiotics usage as prophylaxis for post cataract surgery endophthalmitis.Materials and Methods: We conducted a brief search of English literature regarding the recent developments in use of various intracameral antibiotics as anaphylaxis for post cataract surgery endophthalmitis.Results: The effect of prophylactic intracameral antibiotics in reducing post cataract surgery endophthalmitis is still a controversial subject.  Randomized clinical trials (RCTs) are great sources to confirm benefits from prophylactic intracameral antibiotics. Several recent surveys have reported higher rates of endophthalmitis among cataract patients not receiving prophylactic intracameral antibiotics compared with those receiving antibiotics.Conclusion: Based on the latest findings it seems that more surgeons should set aside their doubts and use intracameral antibiotics as routine prophylaxis to reduce the rate of post cataract surgery endophthalmitis

Intra Corneal Cleft Secondary to Ocular Massage after Ahmed Valve Surgery

Purpose: To report a case of acute intra corneal cleft in a patient undergoing ocular massage following Ahmed valve implantation. Case Report: Acute intra corneal cleft occurred in a patient following the use of ocular massage to reduce IOP and bleb formation after Ahmed glaucoma valve insertion. Previous history of the patient was Fuchs heterochromic iridocyclitis without any report of trauma to his eye or any other ophthalmic disorders. The slit lamp examination revealed huge localized corneal bulla formation with a diameter of 3 mm in the superior mid peripheral corneal region in the right eye just after ocular massage, which persisted in the 6 months of follow up. Conclusion: Digital ocular massage might cause the occurrence of intra corneal cleft. Although this might be a very rare complication, we should consider it as an adverse effect of ocular massage.Keywords: Glaucoma; Cornea; Cleft; Massage

Serum ferritin levels and irregular use of iron chelators predict liver iron load in patients with major beta thalassemia: a cross-sectional study

Aim To determine whether serum ferritin, liver transaminases, and regularity and type of iron chelation protocol can be used to predict liver iron load as assessed by T2* magnetic resonance imaging (MRI) in patients with beta thalassemia major (TM). Methods This cross-sectional study, conducted from March 1, 2014 to March 1, 2015, involved 90 patients with beta TM on regular packed red blood cell transfusion. Liver and cardiac iron load were evaluated with T2* MRI. Compliance with iron-chelating agents, deferoxamine or deferasirox, and regularity of their use, as well as serum ferritin and liver transaminase levels were assessed.Results Patients with high serum ferritin were 2.068 times (95% confidence interval 1.26-3.37) more likely to have higher liver or cardiac iron load. High serum aspartate aminotransferases and irregular use of iron chelating agents, but not their type, predicted higher cardiac iron load. In a multiple regression model, serum ferritin level was the only significant predictor of liver and myocardial iron load. Conclusions Higher serum ferritin strongly predicted the severity of cardiac and liver iron load. Irregular use of chelator drugs was associated with a higher risk of cardiac and liver iron load, regardless of the type of chelating agent

Anterior Uveitis after Subconjunctival Injection of Mitomycin C in a Patient with Previous Trabeculectomy

Objective: To report a case of anterior uveitis after subconjunctival mitomycin C injection in a patient with a history of trabeculectomy. Case Report: A 45 year old patient, with anterior uveitis in his right eye after postoperative injection of mitomycin C one month after trabeculectomy, was treated in Basir eye clinic, Tehran, Iran. The Patient had no history of previous ocular infection. Topical prednisolone and tropicamide drops were effective in improving vision and reducing pain in our case.Conclusion: Anterior uveitis might happen after trabeculectomy surgery; however, in our case, it was more likely the result of mitomycin C administration one month after trabeculectomy. This should be considered as a differential diagnosis of postoperative bleb infections. Keywords: Uveitis; Mitomycin C; Trabeculectomy

Association of Meibomian Gland Dysfunction Severity and Glycohemoglobin Levels in Type 2 Diabetic Patients

Purpose: To investigate the association of meibomian gland dysfunction severity and glycated hemoglobin A (HbA1c) levels among type 2 diabetic patients. Patients and Methods: In this cross-sectional, 40 type 2 diabetic patients with meibomian gland dysfunction (MGD) were studied at Basir Eye Clinic, Tehran, Iran. An expert ophthalmologist determined the MGD stage based on staging scale outlined in American academy of ophthalmology's basic and clinical science course. The HbA1c level was measured applying a standard method, certified by the National Glycohemoglobin Standardization Program (NGSP). We divided patients to two groups based on their HbA1C level; the first group included patients with HbA1c < 6.5 % and the second group included patients with HbA1c ≥ 6.5  %.Results: Our results demonstrated that 12.5 % of the participants had minimal, 52.5 % had mild and 35 % had moderate to severe MGD. We observed that different levels of HbA1c (over or under 6.5 %) were significantly associated with MGD severity (P < 0. 013). Moderate to severe MGD stage was observed in 43.7 % of individuals with HbA1c ≥ 6.5 %, while it was found in none of participants with HbA1c < 6.5 %. With increase in HbA1c level, the risk of moderate to severe MGD occurrence increased (OR = 3.57; 95 % CI: 1.05-12.13; P = 0.041). This association was not confounded by age or gender.   Conclusion: Meibomian gland dysfunction severity has an association with HbA1c levels in diabetic type 2 patients, and a rise in HbA1c noticeably aggravates the MGD stage.Keywords: Glycated hemoglobin A; Meibomian gland dysfunction; Diabetes mellitus; Dry eye syndromes; Diabetes

Downregulation of Autophagy-related Genes in Macrophages from Patients with Behcet's Disease

Objective: Overwhelming inflammatory chemokines and cytokines characterize the immunological profile and inflammatory settings of Behcet disease (BD). The connection between autophagy-related genes (ATGs) and various perspectives of innate and adaptive immunobiology such as antigen presentation, immune tolerance, lymphocyte development and differentiation, cytokine signaling, and inflammation have been implicated. The aim of this study was to evaluate the mRNA expression profile of ATGs in macrophages of patients with BD. Materials and Methods: Whole blood samples were obtained from 10 BD patients and 10 healthy controls. Monocytes were isolated from the blood samples and then differentiated to macrophages using macrophage colony-stimulating factor (M-CSF). After total RNA extraction and cDNA synthesis, quantitative analysis of ATGs including ATG5, ATG7, ATG12, LC3b, mTOR, RAPTOR, and RICTOR was conducted by SYBR Green master mix and real-time polymerase chain reaction (PCR). Results: mRNA expression of all ATGs was downregulated in macrophages of BD patients compared with healthy controls. It is worth to note that the downregulation of ATG12 and LC3b mRNAs in macrophages of BD patients was statistically significant in comparison to that of healthy control group (P = 0.007 and 0.021, respectively). Conclusion: Considering the role of autophagy in initiation of immune responses and then clearance of dead cells as well as its participation in the development and differentiation of immune cells, downregulation of ATGs in macrophages of BD patients may be involved in uncontrolled immune response and overproduction of inflammatory cytokines

Global, regional, and national burden of Alzheimer's disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

BACKGROUND: The number of individuals living with dementia is increasing, negatively affecting families, communities, and health-care systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortality, and overall burden of dementia as captured by the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, and highlight the most important messages for clinicians and neurologists. METHODS: GBD 2016 obtained data on dementia from vital registration systems, published scientific literature and surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from 195 countries and territories from 1990 to 2016, through systematic review and additional data-seeking efforts. To correct for differences in cause of death coding across time and locations, we modelled mortality due to dementia using prevalence data and estimates of excess mortality derived from countries that were most likely to code deaths to dementia relative to prevalence. Data were analysed by standardised methods to estimate deaths, prevalence, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs; computed as the sum of YLLs and YLDs), and the fractions of these metrics that were attributable to four risk factors that met GBD criteria for assessment (high body-mass index [BMI], high fasting plasma glucose, smoking, and a diet high in sugar-sweetened beverages). FINDINGS: In 2016, the global number of individuals who lived with dementia was 43·8 million (95% uncertainty interval [UI] 37·8-51·0), increased from 20.2 million (17·4-23·5) in 1990. This increase of 117% (95% UI 114-121) contrasted with a minor increase in age-standardised prevalence of 1·7% (1·0-2·4), from 701 cases (95% UI 602-815) per 100 000 population in 1990 to 712 cases (614-828) per 100 000 population in 2016. More women than men had dementia in 2016 (27·0 million, 95% UI 23·3-31·4, vs 16.8 million, 14.4-19.6), and dementia was the fifth leading cause of death globally, accounting for 2·4 million (95% UI 2·1-2·8) deaths. Overall, 28·8 million (95% UI 24·5-34·0) DALYs were attributed to dementia; 6·4 million (95% UI 3·4-10·5) of these could be attributed to the modifiable GBD risk factors of high BMI, high fasting plasma glucose, smoking, and a high intake of sugar-sweetened beverages. INTERPRETATION: The global number of people living with dementia more than doubled from 1990 to 2016, mainly due to increases in population ageing and growth. Although differences in coding for causes of death and the heterogeneity in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future analyses should improve on the methods for the correction of these biases. Until breakthroughs are made in prevention or curative treatment, dementia will constitute an increasing challenge to health-care systems worldwide

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. FINDINGS: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30-30·30 million) new cases of TBI and 0·93 million (0·78-1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40-57·62 million) and of SCI was 27·04 million (24·98-30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (-0·2% [-2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (-3·6% [-7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0-10·4 million) YLDs and SCI caused 9·5 million (6·7-12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. INTERPRETATION: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49\ub74% (95% uncertainty interval [UI] 46\ub74–52\ub70). The TFR decreased from 4\ub77 livebirths (4\ub75–4\ub79) to 2\ub74 livebirths (2\ub72–2\ub75), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83\ub78 million people per year since 1985. The global population increased by 197\ub72% (193\ub73–200\ub78) since 1950, from 2\ub76 billion (2\ub75–2\ub76) to 7\ub76 billion (7\ub74–7\ub79) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2\ub70%; this rate then remained nearly constant until 1970 and then decreased to 1\ub71% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2\ub75% in 1963 to 0\ub77% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2\ub77%. The global average age increased from 26\ub76 years in 1950 to 32\ub71 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59\ub79% to 65\ub73%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1\ub70 livebirths (95% UI 0\ub79–1\ub72) in Cyprus to a high of 7\ub71 livebirths (6\ub78–7\ub74) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0\ub708 livebirths (0\ub707–0\ub709) in South Korea to 2\ub74 livebirths (2\ub72–2\ub76) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0\ub73 livebirths (0\ub73–0\ub74) in Puerto Rico to a high of 3\ub71 livebirths (3\ub70–3\ub72) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2\ub70% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation