Clinical Characteristics of Cataract Patients with Pseudoexfoliation Syndrome at Jimma University Specialized Hospital,South West Ethiopia

Background

Pseudoexfoliation is the most common identifiable cause of secondary glaucoma and pseudoexfoliation patients have higher rates of intraoperative and postoperative complications of cataract surgery compared to those without the condition. Hence, the objective of this study was to assess the clinical characteristics of pseudoexfoliation syndrome among cataract patients examined at Jimma University Specialized Hospital, Southwest Ethiopia.

Methods

A cross-sectional clinic based study was conducted from January–March 2009. A total of 402 subjects with cataract were examined for the presence of pseudoexfoliation material, type of cataract, intraocular pressure, glaucoma and other factors. The presence of any exfoliation material on the iris, pupil and lens capsule was examined. Data were computed using SPSS version 16.0.

Results

Out of the 402 patients examined, 144(35.82%) of them had presenile and senile cataract with pseudoexfoliation and out of these 144 cases, 48(33%) were unilateral and 96(66.7%) were bilateral. Furthermore, 41(28.5%) cases had raised intraocular pressure, of which 2(4.9%) cases had chronic angle closure glaucoma and 39(95.1%) of the cases had open angle pseudoexfoliative glaucoma. There was also lens sublaxation in 10(6.9%) of the cases and dislocation in 6(4.2%) of the cases. The prevalence of PEX was higher (41%) in the age group of 70 years and above followed by 60–69 years (27.8%).

Conclusion

A significant number of patients with PEX had poor zonular integrity and high IOP and/or glaucoma. Population based studies are recommended to assess its prevalence in the general population and its association with cataract and glaucoma.     

Testing the Safe Abortion Care model in Ethiopia to monitor service availability, use, and quality

Objective

To implement the Safe Abortion Care (SAC) model in public health facilities in the Tigray region of Ethiopia and document the availability, utilization, and quality of SAC services over time.

Methods

The project oriented providers in 50 public health facilities in Tigray to the SAC model. Changes in SAC indicators between baseline and endline were assessed using a retrospective review of procedure logbooks at baseline and prospective monitoring of procedure logbooks for facility performance after introduction of the SAC model.

Results

Availability of SAC services increased from 39% to 86% of the recommended number of 5 facilities per 500 000 population, primarily as a result of functional improvements at health centers. Decentralization was accompanied by a 94% increase in the annualized number of women who received services. The proportion of uterine evacuation procedures for induced abortion rose from 7% to 60% (P < 0.01), and the proportion performed with recommended technology increased from 30% to 85% (P < 0.01). The proportion of abortion patients who received modern contraception also increased from 31% to 78% (P < 0.01).

Discussion

While widespread service delivery improvements were recorded using the SAC monitoring approach, the project design was built around existing programmatic activities of the local health authority and reflects some related research limitations. For example, there was no comparison group of facilities, timing did not allow for prospective collection of the baseline data before the intervention, and facilities received different levels of monitoring support.

Conclusion

Using the SAC model, public health facilities tracked progress and made needed adjustments, which improved service delivery. Continued focus on critical safe abortion care elements should increase the availability, quality, and use of life‐saving care to reduce preventable abortion mortality in the region.     

Knowledge, attitude and practice of home-based care for HIV/AIDS patients by their family/ caregivers at Jimma Town

BACKGROUND: About 1.5 million people are currently living with HIV/AIDS in Ethiopia-one of the largest HIV infected populations in the world. The current prevalence rate of infection is estimated at 4.4% nationally. Hospital bed occupancy rate due to AIDS has reached over 50% in urban hospitals creating a severe burden to the health service system in the country, or else US $3.4 million is needed in order to increase their bed capacity. Here arises the need to look for a better way of caring for people living with HIV/AIDS. Home care would thus offer the only feasible option for this need as it can mobilize the considerable reservoir of caring and sympathy that exists within a community beyond that of cost cutting. The study was conducted to determine the knowledge, attitude and practice of family/caregivers regarding home-based care for people living with HIV/AIDS. METHODS: This was a cross-sectional community-based study conducted among 274 family/caregivers who were giving care for people living with HIV/AIDS in urban setting of Jimma town from June - August 2005. A structured and pre-tested questionnaire was used to collect data on socio-demographic characteristics, knowledge and attitude towards home based care practice. Data collection was done by interviewing family/caregivers at their respective houses and analyzed using SPSS for windows version 11.0. RESULTS: Over three fourth of the studied subjects (91.6%) were knowledgeable about home based care and 88.7% showed favorable attitude. Ninety two point eight percent agreed that home is a better place for the care of PLWHA than hospital. Single caregivers were about four times more likely to be knowledgeable about home care as compared to their counterparts (OR = 3.98 (95% CI: 0.50, 88.08), but the finding was not statistically significant (p > 0.05). Neighbors and friends were two times more likely to have favorable attitude towards HBC as compared to family members, OR = 1.96 (95% CI: 0.74, 5.21) but, the finding is not statistically significant (p > 0.05). CONCLUSION: The study highlighted that the majority of family members/caregivers have good knowledge and favorable attitude towards HBC and over half favored this care. Therefore, appropriate use of the above promising findings and experience of innovative approaches of HBC from other countries is recommended for further, more organized and effective home-based care practice.     

Surgical robotics beyond enhanced dexterity instrumentation: a survey of machine learning techniques and their role in intelligent and autonomous surgical actions

Purpose

Advances in technology and computing play an increasingly important role in the evolution of modern surgical techniques and paradigms. This article reviews the current role of machine learning (ML) techniques in the context of surgery with a focus on surgical robotics (SR). Also, we provide a perspective on the future possibilities for enhancing the effectiveness of procedures by integrating ML in the operating room.

Methods

The review is focused on ML techniques directly applied to surgery, surgical robotics, surgical training and assessment. The widespread use of ML methods in diagnosis and medical image computing is beyond the scope of the review. Searches were performed on PubMed and IEEE Explore using combinations of keywords: ML, surgery, robotics, surgical and medical robotics, skill learning, skill analysis and learning to perceive.

Results

Studies making use of ML methods in the context of surgery are increasingly being reported. In particular, there is an increasing interest in using ML for developing tools to understand and model surgical skill and competence or to extract surgical workflow. Many researchers begin to integrate this understanding into the control of recent surgical robots and devices.

Conclusion

ML is an expanding field. It is popular as it allows efficient processing of vast amounts of data for interpreting and real-time decision making. Already widely used in imaging and diagnosis, it is believed that ML will also play an important role in surgery and interventional treatments. In particular, ML could become a game changer into the conception of cognitive surgical robots. Such robots endowed with cognitive skills would assist the surgical team also on a cognitive level, such as possibly lowering the mental load of the team. For example, ML could help extracting surgical skill, learned through demonstration by human experts, and could transfer this to robotic skills. Such intelligent surgical assistance would significantly surpass the state of the art in surgical robotics. Current devices possess no intelligence whatsoever and are merely advanced and expensive instruments.

     

Familial Lymphomas A review of the literature with report of cases in Jerusalem

Non-Hodgkin's lymphoma Although non-Hodgkin's lymphoma (NHL) is a common disorder, there are relatively few reports occurring in family groups. Extensive review of the literature by Ladish et al. in 1978¹ revealed 38 multiple-case families with NHL, most of whom were sibpairs, either sibs alone (6.3%) or sibs plus other relatives (13%), including a pair of monozygotic twins². The mean age of diagnosis in these cases was 23.5 years compared with 42.3 years for the general population with NHL. About half of the familial cases were extranodal (44 cases), primarily involving the gastro-intestinal tract in 26 cases, with the distal small bowel and cecum being most frequently affected. No histologic type was predominant in the affected families³. As described for Hodgkin's disease (HD)^4,5 increased incidence with small family size has been observed for NHL; however, no change in risk has been seen with increasing family size⁶.     

Spatial farming systems diversity and micronutrient intakes of rural children in Ethiopia

Own production contributes much of the food supply in smallholder production systems in low- and middle-income countries like Ethiopia. Understanding the potential as well as constraints of these production systems in terms of nutrient supplies is thus a critical step to design interventions to improve nutrient intakes. The objectives of this study were (1) to assess the usual total intakes of vitamin A, iron and zinc among rural children and (2) to investigate whether the intakes these nutrients are associated with differences in the dominant farming systems between spatial clusters. Using nationally representative intake data of 4,902 children 6–35 months of age, usual intake and the proportion of inadequate intakes of vitamin A, iron and zinc were calculated. A multi-level model was used to examine the association between individual-level and cluster-level variables with the usual total dietary intakes of these nutrients. The diet was dominated by starchy foods. Consumption of animal source foods, vitamin A-rich fruits and vegetables was low. We found a high prevalence of inadequate intake of vitamin A and zinc (85.4% and 49.5%, respectively). Relatively, low prevalence of inadequate intake of iron (8.4%) was reported. The spatial farming systems diversity across the rural clusters explained 48.2%, 57.2% and 26.7% of the observed variation in the usual total dietary intakes of vitamin A, iron and zinc, respectively. Our findings indicated the importance of farming system diversity at the landscape level as one of the determinant factors for individual usual total dietary intakes of vitamin A, iron and zinc.