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The North-West Province is predominantly a rural area, and traditional healers remain the most important and influential members of the rural communities. A qualitative, explorative, descriptive and contextual research design was used. In-depth, individual focused and interactive interviews were held with eight traditional healers from the rural areas of Mmabatho-Mafikeng. In addition, field notes and observations were utilised. The objective of this article is to explore the views of the traditional healers regarding termination of pregnancy (TOP) law. The results reflected the following themes: termination of pregnancy is killing; a child is a precious gift from God and the ancestors; there are alternatives to TOP; people who had any type of abortion should be cleansed with “dipitsa” or herbs; TOP may be allowed only in case of rape and incest, rape and incest offenders should be severely punished; and the traditional healers were not consulted during formulation of the TOP Law. It is therefore recommended that traditional should be involved in TOP workshops and educational programmes to enable them to provide counselling before and after abortion.

Background: Lebanon is part of the global DISCOVER study, a global, noninterventional, multicentre, prospective study with 3-years of follow-up., Aims: The aim of this study is to describe real-world clinical practice in terms of type 2 diabetes mellitus (T2DM) disease management and treatment patterns within Lebanon., Methods: Baseline demographic and clinical parameters were captured on a standardized case report form, according to routine clinical practice at each clinical site., Results: We recruited 348 patients. At the initiation of second-line therapy, mean duration of diabetes was 6.7 [standard deviation (SD) 6.5] years; mean HbA1c and fasting plasma glucose levels were 8.5% (SD 1.6%) and 178.7 (SD 56.5) mg/dL respectively. Almost half the patients were hypertensive (45.1%) or had dyslipidaemia (48.6%). Metformin monotherapy was used as first-line therapy in 56.9% of the patients and upfront dual therapy in 25%. The primary reason for changing firstline therapy was poor glycaemic control. The main factors in choosing the second-line therapy were efficacy, tolerability and hypoglycaemia., Conclusion: Clinical inertia was evident in this cohort of patients as they had suboptimal glycaemic control at the time of enrolment and the initiation of second-line therapy. Treatment intensification is required to reduce diabetes-related adverse outcomes., (Copyright © World Health Organization (WHO) 2021. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: Diabetic hypoglycaemia affects medication adherence, patients' productivity and quality of life. It is also associated with an increased risk of cardiovascular complications., Aims: To examine the impact of hypoglycaemia in insulin-treated patients in the Lebanese cohort of the Hypoglycaemia Assessment Tool (HAT) study., Methods: The HAT study was an observational study covering a 6-month retrospective and a 4-week prospective period in 24 countries including Lebanon. Data were collected using self-assessment questionnaires and patient diaries from 1158 invited lebanese patients, aged ≥ 18 years, with type 1 or type 2 diabetes mellitus (T1DM/T2DM) treated with insulin for > 12 months. The primary endpoint was the proportion of patients experiencing ≥ 1 hypoglycaemic event during the 4-week follow-up period., Results: After 4 weeks of follow-up, 177/225 [78.7%; 95% confidence interval (CI): 72.7-83.8] of patients with T1DM and 291/630 (46.2%; 95% CI: 42.2-50.2) patients with T2D experienced at least 1 hypoglycaemic event. Rates of nocturnal and severe hypoglycaemia were 10.7 (95% CI: 9.1-12.3) and 13.2 (95% CI: 11.5-14.9) events/patient-year for T1DM, and 3.3 (95% CI: 2.8-3.8) and 4.2 events/patient-year (95% CI: 3.6-4.8) for T2DM, respectively. Fear of hypoglycaemia was significantly associated with nocturnal and severe hypoglycaemia in both diabetes types (P < 0.001)., Conclusion: The results suggest that the less-advanced healthcare systems in Lebanon are implicated in lower levels of patient knowledge about hypoglycaemia and related preventive measures. Treatment strategies and glycaemia goals should be individualized according to patient preference, medical benefits, and risk of hypoglycaemia., (Copyright © World Health Organization (WHO) 2020. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

The aim of the present study was to test the cognitive ethology approach, which seeks to link cognitions and behaviours as they operate in everyday life with those studied in controlled lab-based investigations. Our test bed was the understanding of first-person and third-person perspectives, which in lab-based investigations have been defined in a diverse and multi-faceted manner. We hypothesized that because these lab-based investigations seek to connect with how first- and third-person perspective operates in everyday life, then either some of the divergent lab-based definitions are missing their mark or the everyday conceptualization of first- and third-person perspective is multi-faceted. Our investigation revealed the latter. By applying a cognitive ethology approach we were able to determine that a) peoples' everyday understanding of perspective is diverse yet reliable, and b) a lab-based investigation that applies these diverse understandings in a controlled setting can accurately predict how people will perform. These findings provide a 'proof of concept' for the cognitive ethology approach. Moreover, the present data demonstrate that previous lab-based studies, that often had very different understandings of first- and third-person perspective, were each in and of themselves valid. That is, each is capturing part of a broader understanding of perspective in everyday life. Our results also revealed a novel social factor not included in traditional conceptualizations of first-person third-perspective, that of eye gaze, i.e., eye contact is equated strongly with first-person perspective and the lack of eye-contact with third-person perspective.

Disorders of wound healing characterized by impaired or delayed re-epithelialization are a serious medical problem. These conditions affect many tissues, are painful, and are difficult to treat. In this study using cornea as a model, we demonstrate the importance of trefoil factor 3 (TFF3, also known as intestinal trefoil factor) in re-epithelialization of wounds. In two different models of corneal wound healing, alkali- and laser-induced corneal wounding, we analyzed the wound healing process in in vivo as well as in combined in vivo/in vitro model in wild type (Tff3(+)(/)(+)) and Tff3-deficient (Tff3(-)(/)(-)) mice. Furthermore, we topically applied different concentrations of recombinant human TFF3 (rTFF3) peptide on the wounded cornea to determine the efficacy of rTFF3 on corneal wound healing. We found that Tff3 peptide is not expressed in intact corneal epithelium, but its expression is extensively up-regulated after epithelial injury. Re-epithelialization of corneal wounds in Tff3(-/-) mice is significantly prolonged in comparison to Tff3(+/+) mice. In addition, exogenous application of rTFF3 to the alkali-induced corneal wounds accelerates significantly in in vivo and in combined in vivo/in vitro model wound healing in Tff3(+/+) and Tff3(-/-) mice. These findings reveal a pivotal role for Tff3 in corneal wound healing mechanism and have broad implications for developing novel therapeutic strategies for treating nonhealing wounds.

Aim: We examined the effectiveness of arcuate incisions by femtosecond laser treatment for high astigmatism in corneal transplants., Background: High astigmatism is a well known complication after corneal transplantation and is difficult to treat. At present, there are many surgical procedures for the correction of high astigmatism after PKP in case of an unsuccessful contact lens therapy., Patients and Methods: Ten patients with a high postoperative astigmatism underwent arcuate keratotomy with the Femtec laser. We performed two arcuate incisions on each transplant. With the femtosecond laser technology it is possible to perform precise incisions where the depth and length of the arcus can be programmed., Results: The best corrected visual acuity was improved in eight out of ten patients. The visual acuity of two patients did not change. The average corneal astigmatism was reduced by three dioptres. The average refractive astigmatism was reduced by four dioptres., Conclusion: Arcuate incisions with the femtosecond laser on patients with high astigmatism subsequent to corneal transplantation are an effective and safe treatment.

The invention of realistic portraiture to reveal "inner life" is attributed by some art historians to Jan van Eyck who worked in Flanders from 1420 onwards. We show, using clinical neurological examination of the gold mask of Agamemnon dating from 1550-1500 BC and of the portraits of Henry III and his son Edward I -- important English royals -- painted between 1216 and 1307, that realistic portraits were made well before the 15th Century. Thus artists unwittingly used neurology as part of their realistic approach to the presentation of the face. Because neurological diagnosis is often visual, neurology, in turn, has a rich potential to unveil examples of realism in art. We consider the art pieces examined here also pertinent to art historians, as they assess the role of art in documenting history.

Background: The success of penetrating keratoplasty (PKP) after penetrating eye injuries is often worse than in keratoplasty with Fuchs' endothelial dystrophy. However, comparable investigations are rare. Therefore, we have retrospectively analyzed the results and complication rates of PKPs in patients who experienced penetrating eye injuries., Patients and Methods: Between 1990 and 1997 forty-four patients who received a corneal transplant at Kiel University Eye Hospital after penetrating eye injury (study group S) were analyzed. 29 patients were re-examined (visual acuity testing, slit lamp microscopy, applanation tonometry, stereo testing, corneal TMS topography, keratometry, endothelial microscopy, perimetry, indirect retinoscopy, testing of the retinal visual acuity and probatory contact lens fitting). Postoperative follow-up ranged between 1 and 6 years (median 3 years). The results were compared to a group of corneal grafts performed in patients with Fuchs' endothelial dystrophy (K, n = 18 patients, 25 eyes, median follow-up 2.8 years)., Results: 38males and 6 women had had a bilateral visual acuity of 0.8 or better before the accident, except for three cases. At the time of eye injury the patients' age ranged from 4 to 76 years. The eye trauma was caused by splinters of metal (45 %), glass (20 %), wood (16 %) or stone (11 %). In 73 % of the cases the injury was confined to the anterior segment of the eye (S1). The posterior part of the eye was involved in 27 % (S2). BCVA of S before keratoplasty (KP) was 1/15 on average (K 0.2), at least one year after KP 0.25 (K 0.4); post KP S1 was better than S2 (p = 0.0234), and K better than S (p = 0.0009). In group S 29 patients received a graft at random because of a central corneal scar, 14 patients received an HLA-typed graft with 2.3 mismatches on average. 93 % of the grafts (41 patients) were clear at the last examination, 8 patients showed rejection episodes, half of them were reversible. 5 patients received a second graft because of an irreversible rejection or endothelial decompensation. BCVA improved by at least one line in 84 % in S (K 92 %). BCVA was unchanged after KP in 6.8 % (K 8 %). In 9.1 % of S BCVA after KP was worse (K 0 %). 32 out of 44 patients had a BCVA of 0.1 or better after the last check-up, 13 out of 44 patients presented with a BCVA of 0.5 or better (K40 %). 15 out of 29 patients separately tested showed stereopsis compared to 8 preoperatively in S. In 48 % of the patients studied stereovision could not be restored. 82 % of the patients suffered from topographical irregular astigmatism in S, the superficial geometry of recipient's cornea seems relevant for astigmatism of the graft. Frequent postsurgical complications consisted of secondary glaucoma (S 27 %, K 4 %), immunological rejections (S 18 %, K 0 %), and amblyopia (S 14 %, K 0 %)., Conclusion: Compared to patients with Fuchs' dystrophy the results of grafting after eye injuries are significantly worse. This relates to BCVA, astigmatism, frequency of secondary glaucoma and graft rejection.

Background: The treatment of immunological corneal disease and melting is still a challenge for any ophthalmologist. Adequate systemic treatment as well as the surgical intervention with an allogeneic corneal graft needs time. In case of emergency a gore-tex(R) patch is an alternative option., Patients and Method: We report on the pre- and postoperative courses of six eyes suffering from rheumatic corneal ulcer resp. immune mediated descemetocele treated by a gore-tex(R) patch. Follow-up ranged between 6 to 30 months., Results: In all cases corneal perforation could be prevented, the artificial graft kept the anterior chamber tight. No infection or graft extrusion developed., Discussion: Different surgical methods are optional in the treatment of rheumatic and immunologic corneal diseases (lamellar or penetrating keratoplasty à chaud, conjunctival flap, amniotic membrane transplantation, contact lenses with adhesive). Another possibility, the gore-tex(R) patch, is an easily available and easy-to-handle tissue, which allows stabilisation of the situation and saves time.

The special anatomy and physiology of the eye predestine it to function as the primary mediator between the world within us and the world without. The way we respond to and reflect on our world is strongly associated with our eyesight. Since antiquity literature, the most important medium for propagating knowledge, has abounded with symbols for the motif 'eye,' symbolizing the responsibility, independence and significance of the visual sense. Today the mechanisms of the modern information media engulf us with new and permanent stimuli. If we surrender ourselves uncritically to this profusion of images, we risk 'overstraining' our sense of sight and losing the connection between perception and cognition. In the following a few references to the international non-medical literature may explain and illustrate the functions of the eye as a metaphor for the mind and describe the past and the prospects of visual perception.

We present a case of persisting diplopia after bilateral laser in situ keratomileusis in a patient with high anisometropia and amblyopia. Treatment of this complication by ocular-muscle surgery was not possible because of missing fusion. We suggest that, especially in cases with anisometropia, a complete examination of binocularity be performed before refractive surgery.

Unlabelled: In recent years good results after treatment of different superficial corneal pathologies with the excimer laser 193 nm have been reported. Thiel-Behnke dystrophy is a hereditary form of anterior stromal dystrophy, a promising layer for successful phototherapeutic keratectomy (PTK). This type of dystrophy was first described in 1967 in Kiel., Patients and Methods: Ten members of the original family of 1967 were re-examined at the University Eye Hospital, Kiel. A phototherapeutic keratectomy was performed in six eyes because of the typical honeycomb corneal surface irregularity and superficial haze. Two of these eyes had a recurrence of the primary disease on the graft. Four eyes had been untreated so far. The best spectacle corrected visual acuity preoperatively was between 20/200 and 20/40. For all treatments the MEL 60 excimer laser (Aesculap Meditec) was used. To even out the peaks and valleys of the irregular surfaces, modulating agents were applied in decreasing concentrations. The follow-up period is now between 8 months and 4 years., Results: All eyes showed significant visual improvement postoperatively with a best spectacle corrected visual acuity of 20/32 and higher. In one of the postkeratoplasty eyes with the longest follow-up after PTK, the original disease has begun to recur., Conclusions: Phototherapeutic keratectomy is a successful therapy for Thiel-Behnke dystrophy; it results in quick recovery of patients and their vision. Stable visual acuity and corneal transparency have been observed that last for years. Recurrences after penetrating keratoplasty or after PTK can be positively retreated. A (re-) keratoplasty may be postponed or avoided.

Anti-Semitism and National Socialism destroyed the existence of many individuals. Their names and biographies disappeared into oblivion. The bequest of ophthalmo--historical papers by Ms. Jutta Lauber, daughter of the Austrian ophthalmologist Hans Lauber (1876-1952), allowed us to trace the fate of the Jewish ophthalmologist Oskar Fehr (1871-1959). In the first decades of the 20th century Oskar Fehr was an internationally renowned ophthalmic surgeon and pathologist. Disregarding political adversities and ignoring personal losses and hardships he dedicated his life to the service of human health.

Purpose: To evaluate refractive error changes after phototherapeutic keratectomy (PTK)., Setting: University Eye Hospital, Kiel, and University Eye Hospital, Hulle, Germany., Methods: The MEL 60 excimer laser (Aesculap Meditec) was used in all cases. To even out the peaks and valleys of irregular surfaces, modulating agents were applied. The study included 45 patients with various preoperative corneal diseases: central scars, recurrent erosions, corneal dystrophies, and surface irregularities. Subjective and objective refraction, keratometry, slitlamp photography, and corneal topography were performed preoperatively and postoperatively. The follow-up was up to 24 months., Results: Twenty-six patients had stable postoperative refractions. Thirteen patients developed a hyperopic shift; the highest observed amount was +4.0 diopters. In seven patients, the astigmatic error increased, although no significant change in axis was measured. Three patients had a myopic shift., Conclusion: After PTK, all types of refractive change can occur. The greatest risk is that of a hyperopic shift. We saw a correlation between the degree of hyperopia and the ablation depth. Methods for preventing such changes include (1) a large treatment zone, (2) use of a polishing program involving a low viscosity fluid at the end of the laser procedure, (3) a two-step treatment in selected cases to avoid ablations that are too deep.

The lives of Carl Koller (1857-1944), Sigmund Lustgarten (1857-1911) and Sigmund Freud (1856-1939) are characterized by several interesting similarities. In their early achievements in medical research they were pathfinders of the first successful local anesthetic: cocaine. All three became later victims of antisemitism. Attention is paid to their personal relationship during their time in Vienna, on occasion of the 140th anniversary of their birth.

Background: Combined malformations (hamartomas) of the retina and the retinal pigment epithelium are extremely rare. Confusion of these pigmented lesions with choroidal melanomas or other malignancies is possible., Materials and Methods: We present the cases of a 7-year-old girl who developed accommodative convergent strabism and the case of an 8-year-old boy with deterioration of visual acuity in the left eye. On examination the anterior segments were normal in both cases. Funduscopically both eyes showed a centrally located large, partly pigmented and slightly prominent tumor, which extended fanlike into the normal-appearing retina. Both lesions were partly obscured by grayish-white, semitranslucent and thickened retina with retinal folds and overlying tortuous vessels. On follow-up examination one lesion seemed to be slightly more pigmented whereas the other lesion remained unchanged., Results and Discussion: Combined malformations of the retina and the retinal pigment epithelium were originally described as clinical entities (hamartomas) by Gass in 1973. A few additional cases were subsequently published by McLean in 1976, by Laqua and Wessing in 1979 and some other authors. Laqua and Wessing were the first to give a report of a histologic study in one case with a macular lesion that showed two distinguishable components. The outer pigmented portion consisted of hypertrophied retinal pigment epithelium; the inner unpigmented portion consisted of a malformed and thickened retina which, however, showed normal layering. The clinical characteristics are usually diagnostic. Fluorescein angiography is helpful in establishing the diagnosis and ruling out differential diagnoses., Conclusion: Although long-term follow-up did not show evidence of growth patients with combined malformation of the retina and retinal pigment epithelium should be followed up regularly.

Background: After 193 nm excimer laser photorefractive keratectomy (PRK) for myopia, superficial opacities in the ablation zone and regression of refractive results can occur. Clinical studies have emphasized that corneal clarity and early refractive stability can be achieved with laser in situ keratomileusis (LASIK). We present clinical and histological results that compare PRK and LASIK for the treatment of myopia in rabbits., Materials and Methods: We treated 12 New Zealand white rabbits with PRK and 12 with LASIK using a 193-nm excimer laser (Aesculap Meditec). In both techniques, the identical excimer software and ablation parameters of -10 D treatment depth were used. Six months after surgery, all eyes were removed and prepared for light, fluoresence and transmission electron microscopy., Results: At the time of enucleation, nine eyes in the PRK group had a moderate to high degree of haze (grade 2 to 3), whereas after LASIK, all corneas showed an almost clear interface in the ablation zone. Correspondingly, all histological investigations after LASIK showed a regular stromal architecture, in contrast to the obvious anteri or stromal disorganization after PRK., Conclusion: The preserved integrity of the superficial corneal layers after LASIK ensures quick wound healing with minimal tissue proliferation, resulting in a transparent corneal interface. This technique appears especially suitable for correcting high myopia.

Purpose: To assess the effectiveness of excimer laser correction of high astigmatism after keratoplasty., Setting: Kiel University Eye Hospital, Kiel, Germany., Methods: In a prospective study, we treated high astigmatism in 16 patients using a 193 nm excimer laser with a rotating mask system to make a toric ablation. Thirteen patients had postkeratoplasty astigmatism, 3, idiopathic natural astigmatism. Preoperative refractive cylinder ranged from 3.0 to 9.0 diopters (D). Minimum follow-up was 6 months., Results: Mean uncorrected visual acuity increased by 3.3 lines in 13 patients. Best corrected visual acuity decreased by no more than two lines in 6 patients and improved by at least one line in 6 patients. Mean cylindrical reduction was 2.8 D. Haze was classified from 0.5 to 2.0., Conclusions: In this study, the excimer laser technique effectively reduced high corneal astigmatism. The main problems incurred were development of a hyperopic shift and, in some patients, an uncertain refractive outcome. Reasons for inadequate correction of postkeratoplasty astigmatism included a slightly decentered mask and irregular astigmatism from the circular scar.

One hundred and fifty-two patients with the Williams-Beuren syndrome were examined to assess the frequency and severity of ophthalmological features associated with the disorder. Eighty-two (54%) had strabismus, all but three, esotropia. One hundred and seventeen (77%) patients had blue irides, 10 (7%) green, and 25 (16%) brown. One hundred and twelve (74%) showed a typical so-called stellate iris pattern of the anterior stroma. Whitish anomalies were also detectable in brown irides. Two 9-year-old patients and one 46-year-old patient had initial cataract. Of all the patients with funduscopy, 22% had retinal vascular tortuosity. One patient had suspected Rieger syndrome. Two patients had ptosis, one with a Marcus-Gunn phenomenon. No ocular manifestation of hypercalcaemia was noted.

Medicine and literature are related because they research the same subject: man. Physician and writer in one person may be traced throughout the centuries. The writings of the Austrian romancier and dramatist portray the physician in an outstanding position. The artistry and power of his words culminate in a monstrous scolding of physicians sprayed over the rhetoric targets and the audiences ending in a unison disqualification of physicians per se. The unremitting insults originate in the early youth of the writer who suffered from pulmonary disease and lived through the chaos of post-World War II medicine. At the same time they constitute an attempt at self preservation. In his gasp for breath, literally and metaphorically, he faces an ignorant and restricting environment of which he must free himself. Otherwise he would fall victim to suffocation by the world's indolence and his own perseverance. His chagrin at physicians is uttered strongly in a verbal barrage unheard of hitherto. In a bellicose effort to break-up good form into shrill dissonances he irritates and provokes the reader. He shatters conventional thinking and is able to reconsider and question petrified opinions. Such inner self examination is an important basis not only of the conduct of physicians.

Background: Argon fluoride excimer laser (193-nm) can perform precise corneal ablation with submicron accuracy and minimal reaction to the adjacent tissue. A possible application is anterior lamellar keratectomy to remove superficial corneal opacities and to smooth corneal irregularities., Patients and Methods: Between August 1993 and June 1994 we performed a phototherapeutic keratectomy (PTK) in 35 patients with different corneal diseases by excimer laser (Aesculap-Meditec). 3 cases (2 corneal dystrophies and 1 patient with a traumatic corneal opacity after chemical burn) are described more exactly with operative methods and postoperative results., Results: By slitlamp microscopy we observed an improvement of the primary corneal disorder in all cases. Changing of refraction (hyperopic shift and newly formed astigmatism) arose in 2 out of 3 patients., Conclusions: Phototherapeutic keratectomy by excimer laser represents a secure, less invasive alternative to surgical methods promising quicker visual recovery. Often a penetrating keratoplasty can be avoided or delayed.