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Background:  Polar symptoms (PS)-symptoms with opposite values-are frequently used in homeopathy, but have many misleading entries in the repertory. This is caused by using absolute occurrence of symptoms, causing the same medicine to appear in both (opposite) symptom rubrics, and by lack of comparison with other medicines. Some PS, like 'aversion/desire for sweets' have a frequency distribution that is not evenly distributed around the neutral value: a desire for sweets is much more common than aversion. A desire for sweets is an indication for a specific medicine only if this desire occurs more frequently in this specific medicine population than in the remainder of the population. We need to find the best way to represent this difference., Methods:  A multi-centre, explorative, prospective, observational study was conducted by nine centres of the Central Council for Research in Homoeopathy. Two-hundred and sixteen patients were enrolled with chronic cough lasting more than 8 weeks, and received usual homeopathic care. During intake, 30 general PS, 27 polar cough symptoms and 3 non-polar cough symptoms were checked. Different ways of representing results were explored, including two quantities borrowed from mechanics: Centre of Mass (CoM) and Leverage., Results:  At the fourth follow-up, three medicines with more than 10 cases with good results were identified: 20 Phosphorus , 19 Pulsatilla and 13 Sulphur . The mean value of the frequency distribution of some symptoms in the whole sample was considerably different from the neutral value. Comparing a medicine population with the remainder of the respective population can give results that differ from polarity analysis. For some symptoms, the 'distance' (Leverage) between the CoMs of the medicine population and the remainder of the population was clearer than the likelihood ratio (LR)., Conclusion:  If the LR value is not clear about the prognostic value in PS, notions from mechanics such as CoM and Leverage can clarify how to interpret a polar symptom., Competing Interests: None declared., (Faculty of Homeopathy. This article is published by Thieme.)

Objective: There is poor adherence to medication in patients of South Asian origin with RA. There are limited numbers of interventions to improve patient engagement. The objective of this study was to explore how patients of South Asian origin make sense of their disease after receiving written leaflets compared with online information or visualizing real-time Doppler US images of their inflamed joints., Methods: Patients of South Asian origin with RA were recruited from two National Health Service hospitals in the West Midlands, UK. In-depth semi-structured interviews were undertaken after exposure to vignettes designed to elicit patients' perspectives on: written leaflets; online information to complement face-to-face interaction with health-care professionals; and Doppler US during the early stages of the disease journey. Data were analysed thematically until data saturation was reached in 20 individuals., Results: The responses to vignette scenarios were described by the patients. Overall, patients found real-time Doppler US more valuable in understanding RA and RA medications compared with other methods. Patients reported that Doppler US reduced anxiety and helped to address misconceptions about the long-term disease and its ability to be controlled., Conclusion: We have developed new understanding regarding the educational utility of a Doppler US session in patients of South Asian origin and how these sessions can be optimized to increase patient engagement and adherence to medication., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Several options have been proposed for eradication of germ cells (GCs) in mammals such as treatment with cytotoxic drugs, irradiation, cold ischemia and hyperthermic treatment. Some of these methods have been also tried in fish but conditions for complete sterilisation of gonads have not been established. Here, we report the production of sterile adult common carp Cyprinus carpio in 10 weeks by the heat and chemical treatments. The cytotoxic drug busulfan (40mg/kg) was intraperitoneally injected into the animals at 2-week intervals (5 doses in total), and they were maintained in water at 38°C between Weeks 1 and 10. The effectiveness of the treatments was assessed using gonadal index, histology, and vasa gene expression. At the end of Week 10, very severe gonadal degeneration was observed in fish treated with the heat-chemical combination, and 100% of male and female fish were devoid of endogenous GCs. The average levels of vasa transcript were 0.01±0.005 and 0.02±0.016 for males and females, respectively. By contrast, high temperature alone caused minor gonadal degeneration and the gene transcript were 0.59±0.131 for male and 0.62±0.13 for female. In Week 20, after the recovery period of 10 weeks at 25°C, the gonadal germ cell did not recover from the sterile condition in any of the sampled individuals. The change in colouration of gonads was an additional useful index of the degree of gonadal sterility., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Clinicians are often intrigued by the varied manifestations of the gingival tissue. Gingival overgrowth is a common clinical finding and most of them represent a reactive hyperplasia as a direct result of plaque-related inflammatory gingival disease. These types of growth generally respond to good plaque control, removal of the causative irritants, and conservative tissue management. This case series highlights three different cases of localized gingival overgrowth and its management with emphasis on the importance of patient awareness and motivation.

Background: The aim of this study was to compare the effectiveness of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) with three, monthly, intravitreal bevacizumab (IVB) injections for refractory diabetic macular edema., Materials and Methods: This was a prospective, randomized, comparative, interventional study. Forty-four patients were enrolled and randomized in two groups. Twenty-two eyes enrolled in Group I received three IVB injections at monthly interval. Twenty-two eyes were enrolled in Group II which underwent PPV with ILM removal. The primary outcomes measured were: (1) Best corrected logMAR visual acuity (BCVA) using Snellen's visual acuity chart. (2) Central macular thickness (CMT) on optical coherence tomography. The secondary outcome measures were: Complication rates like (1) progression of lens opacities, (2) high intraocular pressure needing further treatment/procedure, (3) development of vitreous hemorrhage related to the procedure employed, (4) retinal detachment and (5) severe inflammation/endophthalmitis., Results: In Group I (IVB): 3 (13.6%) eyes showed no change in BCVA; 3 (13.6%) eyes reported decrease in BCVA and 16 (72.8%) eyes showed improvement in BCVA; (P = 0.0181). In Group II (PPV): 4 (18.2%) eyes showed no change in BCVA; 5 (22.7%) eyes showed decrease and 13 (59.1%) eyes showed improvement in BCVA (P = 0.0281). Mean decrease in CMT in IVB group was 108.45 μ, whereas mean decrease in CMT in PPV group was 161.36 μ. No major complications were seen in either group., Conclusion: Posttreatment decrease in CMT was more in PPV group and vision improvement more in IVB group. However, no statistically significant difference between the two methods was found.

Purpose: To report the results of pars plana vitrectomy (PPV) assisted by ophthalmic endoscope (OE) in severe ocular trauma cases which are unsuitable for PPV using wide-angle contact/non-contact lens due to media haze and/or disorganised anterior segment., Methods: Prospective, non-comparative, interventional case series. Main outcome measured was anatomic status of the retina postoperatively, secondary outcome measured was functional status regarding vision, intraocular pressure and control of inflammation in cases of endophthalmitis., Results: Fifty trauma cases were included in the study. Out of these, 43 eyes had open globe injuries (32 eyes without intraocular foreign body (IOFB), and 11 eyes with retained IOFB), and seven eyes had post-traumatic endophthalmitis. In the open globe injury group, 36 (83.7%) eyes reported improvement in vision. In endophthalmitis group, five eyes showed improvement in vision., Conclusions: OE provided a clear view to conduct PPV in select trauma cases where delay in surgery due to hazy media or due to non-availability of donor cornea for simultaneous penetrating keratoplasty can lead to severe proliferative vitreoretinopathy changes.

Aims: The aim of the study was to report the incidence of retinopathy of prematurity (ROP) and severe ROP and identify the risk factors for their development in a large nursery in Kuwait., Materials and Methods: This was a retrospective, interventional, non-comparative, hospital-based study. Retrospective review of ROP records of premature babies having either birth weight of less than 1501 g or gestational age at birth of 34 weeks or less and born between January 2001 and August 2003., Statistical Analysis: By univariate and multivariate logistic regression analysis., Results: Out of the 599 babies studied, 38.9% developed ROP and 7.8% needed treatment for severe ROP. Multivariate analysis showed low birth weight (OR 13.753, 95% CI 3.66-51.54; ( P < 0.001), gestational age (OR 13.75, 95% CI 3.66-51.54; P < 0.001), surfactant (OR 1.72, 95% CI 1.04-2.83; P = 0.032) and stay in the intensive care unit for longer than 15 days (OR 2.25, 95% CI 1.05-4.85; P = 0.033) to be significant for the development of any ROP. Low birth weight (OR 22.86, 95% CI 3.86-134.82; P = 0.001), bacterial sepsis (OR 3.27, 95% CI 1.51-7.05; P = 0.002) and need for surfactant (OR 4.41, 95% CI 0.94 -20.56; P = 0.059) were found to be the risk factors for severe ROP needing laser treatment., Conclusion: The incidence of both any ROP and ROP needing treatment are comparable to other studies. Low birth weight is the most important risk factor for both any ROP and severe ROP.

The unprotected human eye is extremely sensitive to laser radiation and can be permanently damaged from direct or reflected beams. Two cases of retinal injury by laser exposure outside hospital setting are reported. Two patients presented in retina clinic in Al-Bahar eye center in Kuwait with complaints of decrease in vision following exposure to unknown light. Case 1 was exposed to a laser used in military warfare and Case 2 exposed to laser pointer. Routine slit lamp examination and fundus examination of the patient was done along with fundus fluorescien angiography (FFA) and Optical coherence tomography (OCT). Patients were followed up in out patient department for 6 months. Patient with military laser exposure had severe permanent vision loss and persisted even after 6 months. Patient exposed to laser pointer beam had transient visual loss, which improved to 20/25 at 7 months follow-up. Laser retinal damage should be suspected in any patient with visual complaints after obvious exposure to unknown strong light. The treatment for laser retinal injuries is extremely limited and hence prevention is essential., (Copyright 2010, SLACK Incorporated.)

Purpose: To study the incidence of endophthalmitis after vitrectomy and after combined vitrectomy and phacoemulsification surgery and to report the results of treatment in such cases., Methods: This is a retrospective, noncomparative, interventional study based at a tertiary ophthalmology center in Kuwait. Cases of vitrectomy only and combined vitrectomy with phacoemulsification surgery performed during the period from January 1, 1997, to December 31, 2007, were included. Patients undergoing vitrectomy for traumatic etiologies and endophthalmitis were excluded. Patients who developed endophthalmitis after vitrectomy were identified and their records were analyzed., Results: Six patients developed endophthalmitis among 2965 cases of all vitrectomy procedures, resulting in an incidence of 0.20%. The incidence of endophthalmitis was 0.12% for cases undergoing vitrectomy (3 out of 2564 cases) and 0.75% for cases undergoing combined vitrectomy and phacoemulsification surgery (3 out of 401 cases), respectively. Three cases were culture positive. Four cases ended up with final visual acuity of perception of hand movements or worse., Conclusions: Incidence of endophthalmitis in our series was higher than in other studies. The visual results were poor in 4 out of 6 cases. Earlier diagnosis and more aggressive approach may be needed to improve the results of treatment in these cases.

Palladium(II) and platinum(II) complexes having the general composition [M(L)] X2 (where M=Pd(II) and Pt(II), L=3,4,12,13-tetraphenyl-2,5,11,14,19,20-hexaaza tricyclo [13.3.1.1.(6-10)] cosa-1(19), 2,4,6,8,10,(20),11,13,15,17-decaene (L1); 3,4,13,14-tetraphenyl-2,5,12,15-tetraaza tricyclo [11,0,0,(6-11)] cosa-1(16),2,4,7,9,6(11),12,14,17, 19-decaene (L2); 2,3,8,9-tetraphenyl-1,4,7,10-tetraaza cyclododeca-1,3,7,9-tetraene (L3) and X=Cl(-)) have been synthesized. The ligands were characterized on the basis of elemental analyses, IR, 1H NMR and EI mass spectral studies while that of the complexes were characterized on the basis of elemental analyses, molar conductance measurements, magnetic susceptibility measurements, IR, and electronic spectral techniques. All the complexes were found to be diamagnetic. The structures consist of monomeric units in which the Pd(II) and Pt(II) atoms exhibit square planar geometry.

Ni(II) and Cu(II) complexes having the general composition [M(L)(2)X(2)] [where L=2-pyridinecarboxaldehyde thiosemicarbazone, M=Ni(II) and Cu(II), X=Cl(-), NO(3)(-) and 1/2 SO(4)(2-)] have been synthesized. All the metal complexes were characterized by elemental analysis, molar conductance, magnetic moment, mass, IR, EPR and electronic spectral studies. The magnetic moment measurements of the complexes indicate that all the complexes are of high-spin type. On the basis of spectral studies an octahedral geometry has been assigned for Ni(II) complexes whereas tetragonal geometry for Cu(II) except [Cu(L)(2)SO(4)] which posseses five coordinated geometry. The ligand and its metal complexes were screened against phytopathogenic fungi and bacteria in vitro.

A series of metal complexes of Cu(II) and Ni(II) having the general composition [M(L)X(2)] with benzil bis(thiosemicarbazone) has been prepared and characterized by element chemical analysis, molar conductance, magnetic susceptibility measurements, and spectral (electronic, IR, EPR, mass) studies. The IR spectral data suggest the involvement of sulphur and azomethane nitrogen in coordination to the central metal ion. On the basis of spectral studies, an octahedral geometry has been assigned for Ni(II) complexes but a tetragonal geometry for Cu(II) complexes. The free ligand and its metal complexes have been tested in vitro against a number of microorganisms in order to assess their antimicrobial properties.

Purpose: To evaluate the efficacy and safety of 1% rimexolone versus 1% prednisolone acetate ophthalmic suspension in the treatment of anterior uveitis., Methods: A randomised triple masked, parallel comparison of rimexolone and prednisolone acetate ophthalmic suspensions was carried out on 78 patients with acute, chronic and recurrent anterior uveitis. Treatment regimen included instillation of one or two drops of drug one hourly through the waking hours during the first week, two hourly in the second week, four times a day in the third week, two times a day for the first 4 days and once a day for the 3 days in the last week. The patient was clinically evaluated on the 3-4th, 7-10th, 14th, 21st and 28th days. The patient was also reviewed on the 30th day. Anterior chamber cells and flare reactions were compared for evaluating the efficacy of the drugs., Result: Rimexolone is as effective as prednisolone acetate ophthalmic suspension in the treatment of anterior uveitis. The largest difference found was 0.1 in the flare reaction (statistically insignificant; p = 0.3) and 0.2 score units (statistically significant; p = 0.01) in the cells. Overall, comparison of the drugs shows no clinical significance in the treatment of anterior uveitis by either drug. Difference in intraocular pressure (IOP) was also statistically insignificant (p > 0.05). However, three patients in the prednisolone acetate group and 1 patient from the rimexolone group showed a rise in IOP., Conclusion: Rimexolone 1% ophthalmic suspension is as effective as and safer than prednisolone acetate 1% ophthalmic suspension in the treatment of anterior uveitis.

Objective: Many screening and follow-up methods are available for detecting diabetic retinopathy (DR). However, once patients develop retinopathy, it is unclear as to what method should be used for their review. This study is designed to assess the correlation between fundus digital image and clinical examination and to develop a screening program for the early detection of sight-threatening DR using a Canon CF 60 UV fundus camera., Methods: Patients who were not treated for DR earlier were enrolled in the study. All patients underwent digital fundus photography. The photographs were evaluated and compared with the clinical findings as recorded by retinal specialists. DR and macular edema were analyzed separately, and the correlation was statistically measured. The kappa statistic was used to estimate the extent of the agreement between the two procedures., Results: A total of 92 eyes of 51 patients were eligible to be entered in the study. Comparison of the digital image of the fundus and the examination by an ophthalmologist showed a good correlation. The kappa score for retinopathy was estimated to be 93% with 95.6% concordance. The kappa score for diabetic maculopathy was 88% with concordance of 92.2%., Conclusion: We conclude that digital images provide an efficient method for diagnosing and classifying sight-threatening DR, particularly proliferative diabetic retinopathy (PDR). However, agreement between the digital fundus camera and clinical examination by an ophthalmologist for diabetic maculopathy detection, though substantial statistically, was not very satisfactory. It was also felt that the digital photographs can be used as a tool for teleophthalmology and can be integrated as a screening system in Kuwait.

This report describes a case of frosted branch angiitis associated with AIDS.

Features suggestive of thrombotic thrombocytopenic purpura (TTP) are known to occur in patients with systemic lupus erythematosus (SLE). We report a patient who had TTP which resolved with plasma exchange and immunosuppression, but presented three years later with features of SLE. The diagnosis satisfied all the required criteria in both instances. The interrelationship between the two conditions is discussed.