The outcome of the Ahmad Glaucoma Valve implantation for refractory glaucoma in Kuwait

AimTo assess the outcomes and incidence of postoperative complications of Ahmad Glaucoma Valve implant in eyes with complicated glaucoma performed in Kuwait.MethodThis is a retrospective study done at the Al-Bahar Eye Center in Kuwait. Charts of all patients who underwent Ahmad Glaucoma Valve implant at the Al-Bahar Ophthalmic Center in Kuwait between 2006 and 2009 were reviewed. Surgical success was defined as intraocular pressure less than 22 mmHg and greater than 5 mmHg without additional glaucoma surgery and without loss of light perception.ResultsA total of 33 eyes from 30 patients with complicated glaucoma not responsive to conventional medical and non-implant surgical treatment received Ahmad Glaucoma Valve implant. The success rate was 79% (26 cases). 20/26 (77%) cases of them required antiglaucoma medications. The most common complication was encapsulated bleb (27%) and transient postoperative hypotony was found in 19% of the cases.ConclusionAhmad Glaucoma Valve implant appears to be effective and relatively safe for complicated glaucoma in Kuwait. The success rate is comparable with those reported in other studies.     

Survival rates and prognostic predictors of high grade brain stem gliomas in childhood: a systematic review and meta-analysis

Diagnosis of a pediatric high grade brain stem glioma is devastating with dismal outcomes. This systematic review and meta-analysis was undertaken to determine the survival rates and assess potential prognostic factors including selected interventions. Studies included involved pediatric participants with high grade brain stem gliomas diagnosed by magnetic resonance imaging or biopsy reporting overall survival rates. Meta-analysis was undertaken using a binomial random effects model. Sixty-five studies (2336 participants) were included. Meta-analysis showed 1 year overall survival (OS) of 41% (95% confidence interval (CI) 38–44%, I-sq 52%, 2083 participants), 2 year OS of 15.3% (95% confidence interval 12–20%, I-sq 73.1%, 1329 participants) and 3 year OS of 7.3% (95% confidence interval 5.2–10%, I-sq 26%, 584 participants). Meta-analyses of median overall survival results was not possible due to the lack of reported measures of variance. Subgroup analysis comparing date of study, classification of tumor, use of temozolomide, non-standard interventions or phase 1/2 versus other studies demonstrated no difference in survival outcomes. There was insufficient data to undertake subgroup meta-analysis of patient age, duration of symptoms, K27M histone mutations and AVCR1 mutations. Survival outcomes of high grade brain stem gliomas have remained very poor, and do not clearly vary according to classification, phase of study or use of different therapeutic interventions. Future studies should harmonize outcome and prognostic variable reporting to enable accurate meta-analysis and better exploration of prognosis.     

Nd:YAG laser therapy for non-resolving premacular subhyaloid hemorrhage in Saudi patients

Purpose

To report anatomical and visual outcomes of Nd:YAG laser posterior hyaloidotomy (NYPH) in Saudi patients affected by Premacular subhyaloid haemorrhage (PMSHH).

Inter-method variability of hepatitis B surface antigen quantification in a cohort of Egyptian patients with chronic hepatitis B virus

Background and study aimsHepatitis B (HB) surface antigen (HBsAg) levels can predict clinical and treatment outcomes in chronic HB virus (HBV) infection. We aimed to compare the performance of two different assays [Elecsys® (Roche) and Architect? (Abbott)] for HBsAg quantification and evaluate HBsAg levels in the various immune phases in a cohort of Egyptian patients with chronic HBV.Patients and methodsQuantitative HBsAg by Elecsys® and Architect? assays, measurement of routine biochemical and serological markers, and transient elastography were performed in 92 patients with chronic HBV. Results of the two assays and other tests were compared.ResultsNinety-two treatment-naive patients with chronic HBV, (70% males; mean age, 36.1 ± 10.5 years) were recruited from Cairo Fatemic Hospital. Patients were categorized as HBeAg positive (n = 22) and HBeAg negative (n = 70). The Architect? and Elecsys® assays were significantly correlated (intraclass correlation coefficient: 0.913; 95% CI: 0.870–0.943; p < 0.001). However, Deming regression, Passing and Bablok, and Bland–Altman statistical analyses showed discordance among the assays. HBsAg levels by both assays were significantly higher in the HBeAg positive than patients with HBeAg-negative (p = 0.033 and 0.013, respectively). HBsAg levels in the Architect? and Elecsys® assays were significantly higher in HBeAg-negative chronic hepatitis than in HBeAg-negative chronic infection (p = 0.002 and 0.004, respectively)ConclusionBoth assays for qHBsAg were found to be simple and reproducible tests that could classify patients and provide additional evidence on the natural history of HBV.     

Temporal bone metastasis as a sign of relapsing chronic lymphocytic leukemia

Otologic manifestations in chronic lymphocytic leukemia (CLL) are common presentations. However, temporal bone metastasis is rarely described as a sign of relapsing CLL. A 65-year-old male diabetic patient known to have CLL on remission presented to the outpatient otolaryngology clinic with a one month history of progressive bilateral otalgia and right otorrhea, despite multiple courses of antibiotics. He was admitted with suspicion of malignant otitis externa. Left ear showed large hemorrhagic bullae on the posterior segment of tympanic membrane. Left sided facial paralysis developed on the third day of admission. Full recovery of facial paralysis is achieved by 10 days course of corticotherapy. Histological examination of middle ear tissue biopsy showed infiltration by monotonous small lymphoid cells, showing round nuclei, condensed chromatin suggestive of CLL. Although rare, unusual otologic manifestations should raise the suspicion of a temporal bone metastasis as a sign of relapsing CLL.The incidence of otologic complains in leukemia patients ranges from 16.8-48%.1 Hearing loss, conductive, or sensorineural, is the most common symptom. In addition, patients may complain of tinnitus, vertigo, otalgia, otorrhea, and otorrhagia.2 Although, otologic manifestations are very common in those patients, leukemic infiltration of the temporal bone is very rare, and only few cases are reported in the literature. We report a case of relapsing chronic lymphocytic leukemia (CLL) presenting with otitis media and lower motor neuron facial paralysis. Our objective in presenting this particular case is to highlight the rare temporal bone complications and management in CLL.     

Paediatric autoimmune liver diseases: A descriptive study of patients from Saudi Arabia

Background and study aimsAutoimmune liver diseases (ALDs) are a clinico-pathologic spectrum of disorders that share some similarities. They are formally classified as autoimmune hepatitis (AIH), isolated autoimmune sclerosing cholangitis (ASC), and the overlap syndrome of these. We describe the clinical, biochemical, and outcomes data of a cohort of autoimmune ALDs patients in a tertiary care centre.Patients and methodsThis is a cross-sectional study conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Data were collected in 2007–2018. All cases were 18 years old or younger at the time of diagnosis. The data collection comprised clinical, laboratory, imaging, treatment, and longitudinal follow-up data.ResultsTwenty-five patients were identified; 14 (56%) were females. Twenty-one patients (84%) had AIH-1,1 patient (4%) had AIH-2, and 3 patients (12%) had autoimmune sclerosing cholangitis (ASC). An insidious course was found in 21 (84%) cases. Acute hepatitis and fulminant hepatic failure was found to be very rare. Eight cases (32%) had cirrhosis at diagnosis. A total of 20 cases (80%) had complete remission following therapy. The median follow-up period was 45 months. There was no mortality, and only one patient was referred for transplant. Thus, the transplant-free survival was 96%.ConclusionsOur study showed predominance of AIH-1 over AIH-2. Response to treatment in our cohort was found to be similar to the results found in some other key studies. Prognosis and transplant-free survival is better than many published paediatric studies.     

Blood and brain glutamate levels in children with autistic disorder

Despite of the great efforts that move forward to clarify the pathophysiologic mechanisms in autism, the cause of this disorder, however, remains largely unknown. There is an increasing body of literature concerning neurochemical contributions to the pathophysiology of autism. We aimed to determine blood and brain levels of glutamate in children with autistic disorder and to correlate between them. The study included 10 children with autism and 10 age- and sex-matched healthy controls. Blood glutamate levels were measured using high performance liquid chromatography technique. Brain glutamate levels were measured using proton magnetic resonance spectroscopy. The mean blood and brain glutamate levels were significantly higher in patients than controls (p < 0.001). There was highly significant positive correlation between blood glutamate level and brain glutamate levels in the four tested brain regions (p < 0.001). Glutamate plays an important role in the pathogenesis of autism. Further larger studies are required to support our findings.     

The influence of biofilm maturation on fluoride’s anticaries efficacy

Clinical Oral Investigations - (1) To explore the influence of biofilm maturation and timing of exposure on fluoride anticaries efficacy and (2) to explore biofilm recovery post-treatment. Bovine...