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

Objective: To investigate the effect of acupoint catgut-embedding therapy on non-alcoholic fatty liver disease (NAFLD). Methods: Twenty-three participants were subjected to acupoint catgut-embedding therapy for 3 sessions. The second session was performed one month after the first session and the third session two months after the second session. Three months after the third session of catgut-embedding therapy, the patients were subjected to fibroscan analysis. A total of 20 acupoints were selected in three sessions. Same acupoints were selected for all the patients at the same session but different points were selected at different sessions.Results: Of the 23 participants, 5 cases showed significant improvement and 8 cases showed moderate improvement as the steatosis stage was reduced by 1 or 2 degrees. The whole group showed significant improvements in terms of patient score, fat percentage, NAFLD steatosis stage, weight loss and abdominal circumference reduction after acupoint catgut-embedding therapy (all P<0.05). Conclusion: The acupoint catgut-embedding therapy can significantly improve the important factors in patients with NAFLD.

The purpose of this study to determine the clinical characteristic of the associated risk factors of acute myocardial infarction patients (AMI) among the Hunan Han population in China. The retrospectively collected the records data of 595 both STEMI and NSTEMI patients from the first Xiangya hospital, Hunan, China over a period of January 2018 and December 2018. These studies revealed clinical characteristics with associated risk factors among acute myocardial infarction patients. A total of 595 diagnosed acute myocardial infarction patients participated in this study among males 70.9% and females 29% with mean age e 52.9+11.3 years. While 90% had STEMI and 9.9 % had NSTEMI. The chest pain 94.4%, 86% and shortness of breath 55%, 100% presented with STEMI and NSTEMI groups respectively. Smoking incidence in male subject 70.3% had higher than in female subject 29.1 % (P<0.05). Hypertension and diabetes mellitus found 59%, 69.5% in male participants as compared to 40.6%, 30.4% in female participants respectively (P<0.05). However, no statistical difference was found among dyslipidemia males 48.6% and females 47.4%. The most common type of AMI was STEMI and usually presented with chest pain and shortness of breath. The AMI patients were more found in male and common associated risk factors were smoking and hypertension followed by diabetes mellitus and dyslipidemia.

A 58-year-old Malay lady, presented with gradual loss of vision in the right eye for 1 month duration. It was associated with right sided headache, nausea and vomiting. Patient had a history of contact with tuberculosis patient. On examination, visual acuity in right eye was no perception of light with presence of relative afferent pupillary defect. The left eye visual acuity was 6.0/7.5. There was a total restriction of extraocular movement in all direction (frozen eye) in the right eye. Both anterior segments were unremarkable. Fundoscopy in both eyes showed normal appearance of optic disc and retinal vessels. Other cranial nerves were normal. Lungs were clear and had no lymphadenopathy. Chest radiograph was normal. Erythrocyte sedimentation rate was elevated by 35 mm/h and Mantoux test was positive (20 mm). MRI of brain and orbit demonstrated thickening and irregularity of the right optic nerve on axial view with doughnut sign on coronal view. Patient was diagnosed to have optic perineuritis secondary to tuberculosis. She was treated with anti-TB drugs. Systemic corticosteroid was commenced after 2 weeks. The visual acuity was improved to hand motion after 1 month with almost complete resolution of extraocular movement.

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.