To compare the visual and refractive outcomes of wavefront-optimized (WFO) ablations (wavelight allegretto) and wavefront-guided (WFG) ablations (VISX Custom Vue). Overall, two consecutive groups of eyes were treated for myopia and myopic astigmatism with laser in-situ keratomileusis. One group was treated with WFO ablation and the other group was treated with WFG ablation. Preoperative and 1, 3 and 6 months postoperative refractive evaluation (efficacy, safety, predictability, accuracy, stability, and refractive astigmatism), higher order aberrations (HOAs), and contrast sensitivity were analyzed. The WFO group comprised 20 eyes of 11 patients and the WFG group comprised 34 eyes of 17 patients. Postoperatively, the mean refractive spherical equivalent was −0.21±0.30 D in WFO group and −0.23D±0.57 D in WFG group. The mean values for postoperative uncorrected distance visual acuity were 0.93±0.15 and 0.96±0.16 in WFO and WFG groups, respectively. Safety index was 1.11 in WFO group and 1.17 in WFG group. Six months postoperatively, in WFO group, the induced HOA root mean square (RMS) was 0.25±0.21 μm (<i>P</i>=0.007), induced coma RMS was 0.07±0.23 μm (<i>P</i>=0.84), and induced spherical aberration RMS was 0.03±0.12 μm (<i>P</i>=0.467), whereas induced trefoil RMS was −0.09±0.23 μm (<i>P</i>=0.003). In WFG group, induced HOA RMS was 0.9±0.11 μm (<i>P</i>=0.002), induced coma RMS was 0.01±0.30 μm (<i>P</i>=0.065), and induced spherical aberration RMS was 0.09±0.17 μm (<i>P</i>=0.214), whereas induced trefoil RMS was 0.04±0.15 μm (<i>P</i>=0.005). Contrast sensitivity testing showed a statistically significant improvement in both groups at low spatial frequencies test. Both WFG and WFO showed comparable accuracy, efficacy, and safety with nearly equal induction of all HOA.

We scanned uniformly-sized particles of brass, aluminum, glass, and plastic at ultrasonic frequencies of 10 and 50 MHz to determine the effects of material type and transducer frequency on the ultrasonographic appearance of these particles. The particles were scanned in vitro against both anechoic and echoic backgrounds and in vivo, implanted in the angle of rabbit eyes. Both the metals and glass produced reverberations against an anechoic background; the plastic particles appeared as discrete objects, with no reverberations. Against an echoic background, the plastic particles created prominent shadows, while the metal ones did not. When placed in the angle of a rabbit eye, with the exception of the plastic at 10 MHz, all the materials could be differentiated from surrounding tissues at both frequencies. However, the appearance of the foreign body and the surrounding tissues, as well as their exact location and size, were most obvious with the 50-MHz system. In general, the particles produced more reverberations at 10 than at 50 MHz, and more prominent shadowing at 50 than at 10 MHz. In summary, high-frequency imaging enabled superior characterization of all the particles.

PURPOSE: To discuss the relation between congenital upper eyelid coloboma and cryptophthalmos and to present a new grading for both conditions.

METHODS: Observational case series study. Twenty-six children (age range, one day after birth to 15 years old) were included in the study: 19 with upper eyelid coloboma, 4 with classic cryptophthalmos, and 3 with both eyelid coloboma and cryptophthalmos.

RESULTS: Of the 19 cases of upper eyelid coloboma, 5 occurred in isolation, 11 were associated with facial deformities, and 3 were part of a first arch syndrome (according to the Mustarde classification). All cases of classic cryptophthalmos were sporadic and nonsyndromic. All patients with coloboma with facial deformities, cryptophthalmos, and both eyelid coloboma and cryptophthalmos had similar associated facial abnormalities.

CONCLUSION: Upper eyelid colobomas with facial deformities and cryptophthalmos can be considered as one anomaly. A new grading for this anomaly has been suggested. Grade 1: Coloboma without cryptophthalmos. Grade 2: Coloboma with abortive cryptophthalmos. Grade 3: Coloboma with complete cryptophthalmos. Grade 4: Classic cryptophthalmos (absence of all eyelid structures and the eye is completely covered with skin). Grade 5: Severe cryptophthalmos (with severe deformity of the nose and ectropion of the upper lip).

Background: General anesthesia is the typical anesthetic technique for laparoscopic intervention, however, the use of regional anesthesia in the laparoscopic field started to gain familiarity. Shoulder tip pain is a major intraoperative concern that may hinder the feasibility of laparoscopic interventions under spinal anesthesia.

Aim of the study: To evaluate the effect of the intrathecal addition of dexamethasone versus fentanyl on the severity of intraoperative shoulder tip pain during gynecologic laparoscopic surgeries.

 Methods: This RCT included 120 patients, randomized into three equal groups (Group D: received 15 mg bupivacaine and 8 mg dexamethasone intrathecally, Group F: received 15 mg bupivacaine and 25 µg fentanyle intrathecally and Group C: received 15 mg bupivacaine and normal saline intrathecally.

 Results: Significantly fewer patients experienced intraoperative shoulder tip pain in Groups F (n=17) and D (n=19) compared with Group C (n=30), P < 0.005, with no statistical difference detected between Groups D and C. Only two patients in both Groups D and F experienced moderate pain intensity versus eight patients in Group C, P = 0.011. The incidence of postspinal shivering was lower in Groups D and F in comparison to Group C; P = 0.002.

Conclusion:

The use of dexamethasone or fentanyle intrathecally may reduce the incidence and severity of shoulder tip pain during laparoscopic ovarian cystectomy under spinal anesthesia.

Keywords: Dexamethasone, Laparoscopy, Fentanyl, Shoulder Tip Pain, Spinal Anesthesia.

A prevalent increase in antimicrobial resistance represents a universal obstacle for the treatment of Staphylococcus aureus (S. aureus) infection, especially in critically ill patients. Silver nanoparticles are defined as  broad spectrum bactericidal agents, which might be effective against vancomycin resistant S. aureus (VRSA). In this study, we  examined the bactericidal efficacy of silver nanoparticles on VRSA  in 150 blood and sputum samples isolated from intensive care patients. Methicillin resistant  S. aureus (MRSA) isolates were identified in 83 samples, with an incidence of 55.3%.  Meanwhile, VRSA isolates were found in 11 and 8 isolates (a total of 19 isolates out of 150) from sputum and blood samples, with an incidence of 14.67% and 10.67% respectively, with a total incidence of 12.67%. Vancomycin intermediate S. aureus (VISA) isolates had an inhibitory zone ranging from 9 to 13 mm, which was found in 13 out of 19 isolates, whereas VRSA isolates had an inhibitory zone ranging from 0 to 6 mm, which was detected  in 6 out of 19 isolates.  The findings of this study confirm that silver nanoparticles are effective treatment against VRSA.

Keywords: nanoparticles; vancomycin resistance; S. aureus.

Background: A bilateral superficial cervical plexus block provides good analgesia for neck surgery, including thyroidectomy. However, the duration of a single shot nerve block is usually short. Therefore, adjuvants are used in peripheral nerve blocks, especially with ambulatory surgery, where the analgesia duration is very important.

Methods: Sixty patients scheduled for thyroidectomy were randomly assigned to one of two groups. Group C received general anesthesia and a bilateral intermediate cervical plexus block with isobaric 10 ml bupivacaine 2% + 2ml NS deposited on each side. Group D received general anesthesia and bilateral intermediate cervical plexus block with 10 ml isobaric bupivacaine 2% + 4mg (2ml) dexamethasone deposited on each side. Primary outcome was postoperative analgesia evaluated by the VAS score. Secondary outcomes were perioperative IL6, blood glucose level, and postoperative nausea and vomiting.

Results: Postoperative pain VAS scores were significantly lower in the dexamethasone group than control group; mean VAS score at 6h postoperatively was 0.4 in Group D vs. 1.8 in Group C; P <0.001, at 8h it was 0.4 vs. 2.6; P <0.001 in Group D and C, respectively, and in 24h it was 3.5 in Group D vs. 5 in Group C; P 0.003.  Analgesia duration was significantly longer in the dexamethasone group: 12h versus 6 h in the control group; P<0.001. Postoperative IL-6 at 8 and 24 hours postoperatively were significantly lower in the dexamethasone group than the control group (36.8 vs 21; P <0.001) and (18.9 vs 13; P<0.001), respectively. Non-significant changes could be detected between both groups in intraoperative bleeding and postoperative glycemic control.

Conclusion: The addition of 8 mg dexamethasone to ultrasound-guided intermediate cervical plexus block can enhance analgesia duration and reduce postoperative opioid consumption and postoperative IL-6 levels with no significant effect on postoperative glycemic control in non-diabetic patients undergoing thyroidectomy under general anesthesia.

Keywords: ultrasound-guided cervical plexus block, perineural dexamethasone, thyroidectomy.

Background: shoulder pain secondary to laparoscopic interventions may cause more discomfort to the patient than the incision site pain, with a reported incidence varies from 35% to 80%.

Aim of the study: - Evaluate the effect of intrathecal dexmedetomidine on incidence and severity of  laparoscopy-triggered shoulder tip pain.

 Methods: Sixty patients, 1st patient recruited on the 1st of July 2017, undergoing elective laparoscopic ovarian cystectomy under spinal anesthesia were randomly allocated into one of two groups. Group C: received intrathecal hyperbaric Bupivacaine 3.5 ml plus 0.5 ml normal saline. Group D: received intrathecal hyperbaric Bupivacaine 3.5 ml plus 10 μg dexmedetomidine (0.5 ml). Measurements: Data on the severity of intraoperative shoulder pain was collected using visual analogue scale.

 Results: Twenty-four patients in Group C, the complaint of intraoperative shoulder tip pain, 16 patients (53.3%) required fentanyl which was given in 25 μg increments and total fentanyl consumption for 16 patients was 875 μg. Two patients were converted into general anaesthesia as pain was intolerable (≥ 4). In Group D, five patients (16.7%) experienced shoulder pain intraoperative with a mean VAS score 0.37± 0.9.

Conclusion: intrathecal dexmedetomidine can effectively decrease the incidence and severity of shoulder tip pain during laparoscopic ovarian cystectomy under spinal anesthesia.

Keywords: Dexmedetomidine, Laparoscopy, Spinal anesthesia, shoulder tip pain.