Purpose: To compare vision-related quality of life (QoL) between surgical and nonsurgical interventions in Iraqi patients with unilateral keratoconus (KC) and to identify independent clinical predictors of QoL outcomes. Methods: This multicenter cross-sectional study enrolled 490 patients with unilateral KC. Participants were stratified into surgical (n = 240; intracorneal ring segments [ICRS], deep anterior lamellar keratoplasty [DALK], or penetrating keratoplasty [PKP]) and nonsurgical (n = 250; corneal collagen crosslinking [CXL], rigid gas-permeable, or scleral lenses) groups. Clinical assessments included best-corrected visual acuity (BCVA), maximum keratometry (Kmax), spherical equivalent, and disease stage. QoL was measured using the validated 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Subgroup analyses, pairwise comparisons, and multivariate regression were conducted to identify determinants of QoL. Results: Surgical patients demonstrated significantly higher NEI-VFQ-25 composite and subscale scores than nonsurgical patients (p < 0.001), with marked improvements in general vision, mental health, and daily activities. Subgroup analyses confirmed that ICRS provided superior outcomes in mild-to-moderate KC compared to CXL and contact lenses, while DALK and PKP yielded comparable benefits in advanced disease. Stratified analyses revealed sex-based and age-related differences, with females and older patients reporting better QoL. Multivariate regression analysis identified surgical treatment, BCVA ≤0.3 logMAR, patient satisfaction with surgery, and mild KC as independent positive predictors of QoL, whereas advanced stage, male sex, higher Kmax, and increasing age were identified as negative predictors. A treatment–age interaction indicated that younger patients benefited more from timely surgery. Conclusions Surgical interventions, particularly ICRS and PKP, are associated with superior QoL compared with nonsurgical options in Iraqi patients with KC. These findings underscore the importance of incorporating patient-reported outcomes into clinical decision-making and support individualized, stage-based surgical referral, especially in resource-limited settings.

AIM:To investigate the effect of wearing corneoscleral contact lens on visual acuity, and corneal parameters in keratoconus patients.METHODS:In this prospective study, 43 cases(83 eyes)with keratoconus were included and examined. A corneoscleral contact lens was fitted, and thorough exams were carried out at baseline, 3 and 6 mo after wearing lenses, including slit lamp examination, objective and subjective refraction, uncorrected visual acuity(UCVA), and best-corrected visual acuity(BCVA), keratometry(Kmax, K1 and K2), central corneal thickness and endothelial cells count.RESULTS: Mean BCVA(LogMAR)improved from 0.34±0.23 with the spectacles to 0.03±0.05 with the corneoscleral contact lenses in 6 mo(P<0.001). Kmax changed from 52.80±5.93 D to 51.51±5.64 D in 6 mo(P<0.001), central corneal thickness changed from 483.84±34.69 μm to 476.28±35.38 μm(P<0.001), and endothelial cell count changed from 2559.18±275.7 cells/mm2 to 2572.73±274.3 cells/mm2 after wearing corneoscleral contact lens for 6 mo(P<0.001).CONCLUSION: Corneoscleral lenses could significantly increase visual acuity, since there were no clinical noticeable changes in the corneal parameters, this lenses can be used safely in patients with keratoconus.

BACKGROUND: Ikaros family zinc finger 1 (IKZF1) is a transcription factor with an important role in controlling hematopoietic proliferation and function, particularly lymphoid cell differentiation. It was previously shown that various mechanisms and expression patterns of Ikaros are linked to a variety of cancers. We hypothesized that aberrant methylation (hypomethylation) of the IKZF1 promoter region might be one of the causes of B-cell acute lymphoblastic leukemia (B-ALL). In B-ALL patients, an increased expression of this gene is a potential cause of B-cell differentiation arrest and proliferation induction. Therefore, as more than 90% of patients with ALL are <15 years old, we investigated the methylation pattern of the IKZF1 promoter in childhood B-ALL. METHODS: Twenty-five newly diagnosed B-ALL cases were included (all younger than 15 yr). In addition, we selected 25 healthy age- and sex-matched children as the control group. We collected the blood samples in EDTA-containing tubes and isolated lymphocytes from whole blood using Ficoll 1.077 Lymphosep. Next, we extracted genomic DNA with the phenol/chloroform method. Two microgram of DNA per sample was treated with sodium bisulfite using the EpiTect Bisulfite Kit, followed by an assessment of DNA methylation by polymerase chain reaction (PCR) analysis of the bisulfite-modified genomic DNA. RESULTS: Our data highlighted a hypomethylated status of the IKZF1 promoter in the ALL cases (96% of the cases were unmethylated). In contrast, the control group samples were partially methylated (68%). CONCLUSION: This study demonstrated a hypomethylated pattern of the IKZF1 promoter region in childhood B-ALL, which might underlie the aberrant Ikaros expression patterns that were previously linked to this malignancy.
B-Lymphocytes ; Child ; DNA ; DNA Methylation ; Ficoll ; Hematologic Neoplasms ; Humans ; Leukemia ; Lymphocytes ; Methods ; Methylation ; Polymerase Chain Reaction ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Promoter Regions, Genetic ; Sodium ; Transcription Factors ; Zinc Fingers

PURPOSETo identify and appraise the published studies assessing interventions accounting for reducing fatigue and sleepiness while driving.

METHODSThis systematic review searched the following electronic databases: Medline, Science direct, Scopus, EMBASE, PsycINFO, Transport Database, Cochrane, BIOSIS, ISI Web of Knowledge, specialist road injuries journals and the Australian Transport and Road Index database. Additional searches included websites of relevant organizations, reference lists of included studies, and issues of major injury journals published within the past 15 years. Studies were included if they investigated interventions/exposures accounting for reducing fatigue and sleepiness as the outcome, measured any potential interventions for mitigation of sleepiness and were written in English. Meta-analysis was not attempted because of the heterogeneity of the included studies.

RESULTSOf 63 studies identified, 18 met the inclusion criteria. Based on results of our review, many interventions in the world have been used to reduce drowsiness while driving such as behavioral (talking to passengers, face washing, listening to the radio, no alcohol use, limiting the driving behavior at the time of 12 p.m. - 6 a.m. etc), educational interventions and also changes in the environment (such as rumble strips, chevrons, variable message signs, etc). Meta-analysis on the effect of all these interventions was impossible due to the high heterogeneity in methodology, effect size and interventions reported in the assessed studies.

CONCLUSIONResults of present review showed various interventions in different parts of the world have been used to decrease drowsy driving. Although these interventions can be used in countries with high incidence of road traffic accidents, precise effect of each intervention is still unknown. Further studies are required for comparison of the efficiency of each intervention and localization of each intervention according to the traffic patterns of each country.