A 63-year-old gentleman presented with a two-day history of sudden, painless blurring of vision in the left eye, immediately after waking up in the morning. He is known to have had diabetes mellitus and hypertension for seven years, and a recent attack of angina pectoris. There was no history of trauma and no associated neurological abnormalities. Visual acuity was 6/6 in the right eye and ‘Counting Fingers' in the left eye. Ocular examination was normal in the right eye (Panel A). Pupil examination of the left eye (Panel B) showed the presence of a relative afferent pupillary defect (RAPD), in addition to the above shown abnormality in the fundus. What is the diagnosis? Answer: refer to page 153

(Refer to page 131) Answer: Left Non-arteritic Anterior Ischaemic Optic Neuropathy (AION) Panel A shows a normal right fundus with a normal optic disc and retina, and the left fundus (Panel B) showing sectoral optic disc swelling with corresponding flame-shape haemorrhage.

BACKGROUND:Titanium clip, commonly used in abdominal surgery and obstetrics and gynecology surgery,
has a great damage to the vascular tissue, and its excessive clipping can cut off the vessel and produce artifacts and deflection MRI on MRI and CT scan. In addition, its biocompatibility is not wel that increases the risks for
local inflammatory response and scarring.
OBJECTIVE: To observe the clinical efficacy of absorbable ligating clip in laparoscopic hysterectomy and to evaluate its clinical value.
METHODS: Ninety-eight patients undergoing laparoscopic hysterectomy were randomly divided into two groups: 49 patients in the observation group were subjected to occlusion of the uterine artery by a Johnson absorbable ligating chip and then complete removal of the uterus; 49 patients in the control group were subjected to occlusion of the uterine artery with a titanium clip. Hospital stay and postoperative complications were recorded and
analyzed between the two groups.
RESULTS AND CONCLUSION: The use of absorbable ligating clip in laparoscopic hysterectomy significantly shortened the hospital stay, and postoperative pain, adhesions, pelvic fluid, fever and other complications were significantly reduced (P< 0.05). In addition, no postoperative infection occurred in the two groups and there was no significant difference in the class A healing rate between the two groups (P > 0.05). The results suggest that absorbable ligating clip with better biocompatibility can help to reduce tissue reactions and promote tissue repair, which is characterized as effective, safe and reliable.

Introduction: Knee deformity associated with osteoarthritis (OA) is one of the most common complications seen in patients referred to orthopaedic surgeons. High tibial osteotomy (HTO) is an accepted method for treatment of medial knee osteoarthritis with varus deformity. The aim of this study was to compare results of osteotomy methods in patients with genu varum (GV) deformity. Methods: In this cohort study, the sample consisted of 32 patients with genu varum deformity (42 knees) who were divided into two groups and matched according to age and gender. The patients were treated with open or closed wedge osteotomy. After surgery, they were followed-up and compared for 6 months. Results: The sample consisted of 25 women (87.2%) and 7 men (21.8%). Ten patients (31.2%) presented with bilateral deformity. The incidence of complications was the same for both procedures (12.5%); this included one peroneal nerve injury following closed wedge surgery. Overall, patient satisfaction was 87.5% and 75% for the open and closed wedge methods respectively. Operative time, days to full weight bearing, and days to return to routine activities were significantly shorter for patients treated with the open wedge method (p<0.001). Conclusion: Open wedged HTO is associated with shorter operating time, shorter recovery time, higher patient satisfaction, and probable lower risk of neurological injury.

Background: We aimed to test a new approach for repairing cerebrospinal fluid (CSF) leaks and to determine the demographic, diagnostic, and treatment factors associated with the successful management of intracranial complication. Owing to the high frequency of endoscopic surgeries and the low cost of medical care in Iran, we decided to report our experience of reconstruction after CSF leaks. Methods: We retrospectively reviewed our experience in the diagnosis and management of CSF rhinorrhoea in Iran between 2005 and 2012. The locations of all pre-repair leaks were identified using simple, readily available methods. The follow-up time ranged from 2 to 72 months. Results: Of the 37 participants, 59.5% were men and the mean age was 33 years. The success rate was 86.1%, and the most common aetiological factor was trauma (57%). The most common location was the ethmoidal fovea (45.9%), followed by the sphenoid sinus (24.3%), the cribriform plate (13.5%), and the posterior table of the frontal sinus (5.4%). Conclusions: Medical care in Iran has considerable budget restrictions. This study advocates a practical method of treatment for patients in similar circumstances, with a success rate of 86.1% when compared to the 90.6% achieved with other techniques.

Animals ; Embryo, Mammalian ; Humans ; Photoreceptor Cells, Vertebrate ; metabolism ; physiology ; Retinal Ganglion Cells ; metabolism ; physiology ; Retinal Pigments ; metabolism

Diagnosis-related group (DRG) system is patient classification system designed to produce limited number of classes which are relatively similar in terms of resource consumption and clinical characteristics. The aim of this study was to assess the level of knowledge, attitude and practice (KAP) of Turkish health care providers toward DRG system implemented in Turkey.A total of 238 healthcare providers were randomly selected from two urbanand one rural hospital in Turkey.A questionnaire was used for data collection; contacting 32 items (10 items about knowledge, 12 items about attitude and 10 items about the practice) and its validity and reliability were confirmed. Data analysis was performed using chi-square and multivariate logistic regression.In this study,only one third of healthcare providers showed good knowledge (35.7%) and good practice (37.4%) about DRG system,compared to 54.2% of them showed good attitude.There was significant difference between age, gender, occupation groups and whether the respondents have attended a workshop for DRG system in terms of KAP (p > 0.05).These results indicated the need for further actions to implement DRG system in terms of creation of suitable environment and increasing awareness among healthcare providers, especially male, medical doctors, nurses, elderly, and those who have never attended a workshop, in addition to regular review to ensure the program would reach its targets.

The surface facial imagings have many applications in medical fields. The recent past has seen great advances in three dimensional imaging which include laser scanning or stereophotogrammetry. Here, we reviewed various systems with reference to image acquisition, advantages and disadvantages. Examples of important clinical application with reference to the human face are also discussed. Finally, a 3D imaging system at Universiti Sains Malaysia (USM) is described.

Sodium valproate is one of the most common first-line antiepileptics prescribed for primary and secondary generalised seizures. However, serious complications associated with sodium valproate, such as acute pancreatitis, need to be considered when choosing this medication for treating epilepsy in certain populations such as children and persons with intellectual disability. We report a case of a 21-year-old man with intellectual disability who presented to the emergency department with an acute abdomen, vomiting and diarrhoea. He had to undergo an emergency exploratory laparotomy during which acute necrotising pancreatitis was diagnosed intra-operatively. We believe that the recent increase in sodium valproate dosage for his epilepsy was the cause of the pancreatitis. Carers of such persons should be adequately informed regarding possible life-threatening complications of medications prescribed to avoid delay in diagnosis and unwanted incidents.
Pancreatitis ; Valproic Acid ; Anticonvulsants ; Intellectual Disability ; complications

We present an unusual case of a penetrating toothbrush injury in a 6-year old child. The injury was sustained due to a fall at home and resulted in accidental implantation of an adult toothbrush in the facial soft tissues. The toothbrush was removed under general anaesthesia without any complications. This case highlights a rare presentation involving extra oral penetration of a toothbrush which is not reported previously in the literature.
Wounds and Injuries ; Toothbrushing ; Child