Comparative study of anxiety in informed and non-informed patients in the preoperative period

Operation anxiety constitutes a significant phenomenon, detectable in numerous sleep related and psychological symptoms, as in its impact on the patient's health, the operation and post-operation process. For decades this problem (almost unknown in Lebanese scientific research), was the object of a vast theoretical project and numerous North American and European studies. Within the framework of this investigation, we studied the influence of structured information, provided by operating room nurses, on the patient's anxiety during the preparatory stage. The problem is all the more significant and relevant given that it is all but ignored in Lebanese hospitals. By adopting the basic hypothesis that "structured preparatory information diminishes the patient's anxiety" we wanted to examine the eventual links between the patient's anxiety level and his/her personal, socio-cultural and psycho-medical characteristics (sex, age, marital status, education, standard of living, medical history, type of surgery, type of anesthesia, etc.). Using the same methodological approach, we adopted Spielberger's steps in measuring anxiety after having acquired the proper authorization from Professor Spielberger himself, who furnished us with the certified Arabic version of these steps and their interpretation. A questionnaire allowed the identification of test groups' characteristics. We chose our setting the operating theatre at the Nini hospital in Tripoli, North Lebanon. Our investigation essentially began in September/October 2003. We formulated a sample of sixty patients within the operating community by means of a random sampling technique and a well-defined exclusion criteria. With the same technique we divided two groups of thirty patients: group A1 which was informed and A2 which was uninformed and used as test subjects. The data gathered by the investigation was incorporated into the SPSS software. The results of the comparative analysis operating between the two groups' anxiety scores confirmed the afore-mentioned hypothesis. However, these results did not establish any significant links between anxiety levels and the majority of the test groups' characteristics. By confirming the hypothesis that preparatory information reduces the patient's anxiety, this investigation has opened the door to important practical consequences leading to the following recommmendation: quality health-care in Lebanese hospitals would greatly improve by adopting a protocol of information booklets and preparatory meetings with the patient, with the added benefit of valorizing the role of the operating room nurse. At present, the absence of any structured preparatory information represents a significant deficiency in Lebanese hospitals.     

Erectile dysfunction in diabetic patients

Erectile dysfunction (ED) appears to be highly prevalent in diabetic patients (around 50% at 50 years of age) and more severe than in the rest of the population. Its etiology is multifactorial in this subset of patients. ED is highly correlated to multiple vascular risk factors and can be considered as a manifestation of endothelial dysfunction in general, alerting the physician to look at underlying silent coronary bed atherosclerosis. It is also dependent on the poor control of diabetes and on the presence of its chronic complications. Because of the multiple etiologies of ED in diabetics, a multifactorial approach is warranted to get an optimal response in treating such patients: diabetes control, use of phosphodiesterase 5 inhibitors, psychosexual counseling, and choice of antihypertensive medications.     

Paediatric uveitis: a Sydney clinic experience

PURPOSE: The aim of this study was to retrospectively review uveitis cases at The Children's Hospital at Westmead, Sydney, since its inception in 1997 to 2001, including patients presenting at the Camperdown, Sydney, campus between 1989 and 1997 attending Westmead for further care. Comparison is made with international centres. METHODS: Information was obtained from medical records. RESULTS: Forty patients (53 eyes) presented, of whom 23 (57.5%) were female and 17 (42.5%) were male (mean age 6.7 years). Of 53 eyes, 35 (66%) had anterior uveitis, three (5.7%) intermediate uveitis, seven (13.2%) posterior uveitis and eight (15.1%) panuveitis. Twenty-seven (67.5%) patients had disease unilaterally and 13 (32.5%) bilaterally. Twenty-four (60%) cases were idiopathic. Seven (17.5%) cases were associated with juvenile rheumatoid arthritis, three (7.5%) with herpes zoster, two (5%) with herpes simplex, two (5%) with toxocara, one (2.5%) with toxoplasma, and one (2.5%) with ulcerative colitis. Complications included cataract in 14 (26.4%) eyes; band keratopathy in four (7.5%) eyes; macular scarring in three (5.7%) eyes; and glaucoma in four (7.5%) eyes. Last measured acuity was 6/6 for 19 (35.8%) eyes, < or =6/18 for 15 (28.3%) eyes and <6/60 for eight (15.1%) eyes. CONCLUSIONS: Despite small numbers, the comparisons of this study with some international studies, and its contrasts with other studies, are due to similarities and differences amongst these studies with respect to factors of referral bias, and the aetiological basis of disease.     

Infections following laser in situ keratomileusis: an integration of the published literature

Infections occurring after laser in situ keratomileusis (LASIK) surgery are uncommon, but the number of reports have steadily increased in recent years. This systematic, comprehensive review and analysis of the published literature has been performed in order to develop an integrative perspective on these infections. We have stratified the data by potential associations, microbiology, treatment, and the degree of visual loss, using Fisher's exact tests and Student's t-tests for analysis. In this review, we found that Gram-positive bacteria and mycobacterium were the most common causative organisms. Type of postoperative antibiotic and steroid use was not associated with particular infecting organisms or severity of visual loss. Gram-positive infections were more likely to present less than 7 days after LASIK, and they were associated with pain, discharge, epithelial defects, and anterior chamber reactions. Fungal infections were associated with redness and tearing on presentation. Mycobacterial infections were more likely to present 10 or more days after LASIK surgery. Moderate or severe visual reductions in visual acuity occurred in 49.4% of eyes. Severe reductions in visual acuity were significantly more associated with fungal infections. Flap lift and repositioning preformed within 3 days of symptom onset may be associated with better visual outcome.     

LASEK results

Laser subepithelial keratomileusis (LASEK) has become a viable alternative to photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in selected patients. LASEK may decrease the complications associated with PRK, including postoperative pain and slow visual rehabilitation. In this article, the authors present the visual outcomes and complication rates of LASEK based on the retrospective case review of 101 consecutive patients (163 eyes) treated with LASEK surgery over the past 6 years. Seventy-eight percent of these eyes showed complete epithelial healing by day 3, and there were no incidents of recurrent erosions. As with LASIK, the achieved correction for LASEK was greater than the treatment dose (requiring undercorrection nomogram adjustments). Mean logMAR UCVA was 0.03 (20/20) at 1 year. LASEK seems to be a safe and effective option for patients who request refractive surgery.     

Questioning the need for routine bone marrow aspiration and lumbar puncture in patients with retinoblastoma

Purpose: This study assesses the value of routinely investigating children with retinoblastoma with bone marrow aspiration and lumbar puncture, staging investigations not without risk and trauma to the patient, emotional stress on parents and financial cost to the community. Methods: Medical files and specimens were obtained and examined for patients with retinoblastoma presenting to the Royal Alexandra Hospital for Children, Camperdown and the Children's Hospital at Westmead, Sydney, from 1975 to 2001. Results: In total, 123 patients presented; 62 (50.4%) were boys and 61 (49.6%) were girls. Of these 123 patients, 74 (60.2%) had unilateral disease, 46 (37.4%) involving the left eye and 28 (22.8%) involving the right eye. There were 47 (38.2%) patients with bilateral disease, and two (1.6%) with trilateral disease. Mean age of presentation was 17.9 months (23.1 months for unilateral subjects; 10.3 months for bi­lateral subjects; 3.5 months for trilateral subjects). There were 13 (10.6%) with a positive family history. Of 74 unilateral subjects, 70 (94.6%) required enucleation and four (5.4%) were salvaged. Of 47 bilateral subjects, 13 (27.7%) did not require enucleation, 27 (57.4%) required unilateral enucleation and seven (14.9%) required bilateral enucleation. Both trilateral subjects died. Of all 123 subjects, 112 (91.1%) had bone marrow aspiration and lumbar puncture performed during initial assessment, and none showed evidence of malignancy. Conclusions: Given the small but significant risks associated with these procedures, the results of this study cannot support bone marrow aspiration and lumbar puncture as routine investigations in all patients presenting with retinoblastoma, suggesting a more limited usage of these investigations is warranted.     

Reversal of pentylenetetrazol-induced potentiation phenomenon by theta pulse stimulation in the CA1 region of rat hippocampal slices

The effect of theta pulse stimulation (TPS) on pentylenetetrazol (PTZ)-induced long-term potentiation of population spikes was studied in the CA1 region of rat hippocampal slices. The field excitatory postsynaptic potential (fEPSP) and population spikes (PS) were recorded from strata radiatum and pyramidale, respectively, following stimulation of Schaffer collaterals. A transient PTZ application produced a long-lasting enhancement of PS amplitude. A 3-min episode of TPS delivered at test-pulse intensity failed to reverse the PTZ potentiation. However, the same stimulation at a higher intensity produced complete reversal of the PTZ potentiation when delivered during the last minutes of PTZ application. Prior application of high-intensity TPS also decreased the amount of PTZ potentiation, whereas it had no long-lasting effect on baseline synaptic responses. High-intensity TPS induced reversal was blocked by adenosine A1 receptor antagonist and, furthermore, was reduced by protein phosphatase 1 inhibitor. The results suggest that mechanism of PTZ-induced LTP reversal involves activation of adenosine receptors and protein phosphatases.