The Differences in Necessary Competencies, Skills, and Performance Abilities Among Thai Board-Certified Occupational Medicine Physicians and Basic Occupational Medicine Certified Physicians.

Background: Occupational physicians in Thailand are classified into two groups: Thai board-certified occupational medicine physicians (TBOMPs) and Basic occupational medicine certified physician (BOMCPs). Variations in training duration result in differences in professional competencies. Although national regulations allow both groups to perform similar duties, disparities in training have raised concerns regarding competency, necessitating further investigation.

Budget Impact Analysis of Intravitreal Injections Used to Treat Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema in the Dubai Healthcare System.

Objectives: With the rising prevalence of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), this study assesses the budget impact of current intravitreal injections (faricimab, brolucizumab, ranibizumab, and aflibercept) on Dubai's private sector. The aim is to identify the most cost-effective intervention by evaluating utilization costs based on injection frequencies and direct acquisition expenses.

Methods: An Excel-based budget impact model, aligned with the current standard of care, incorporates direct medical costs only, acquisition prices of the 4 interventions, procedure costs, optical coherence tomography diagnosis and consultation visit costs, and average administration costs in Dubai's healthcare system.

Choroidal thickness in Waardenburg syndrome.

To assess the choroidal thickness in differently pigmented areas of the fundus in a 46-year-old female with Waardenburg syndrome. Retrospective, case review. Choroidal thickness was measured using swept-source optical coherence tomography (SS-OCT, Topcon DRI OCT-1 Atlantis) and compared between the pigmented and hypopigmented areas within the same eye and between the two eyes.

Severe bone marrow suppression due to methotrexate toxicity following aceclofenac-induced acute kidney injury.

Methotrexate is one of the most commonly used drugs in autoimmune disorders like rheumatoid arthritis. Gastrointestinal symptoms like nausea and stomatitis, skin rashes, alopecia, central nervous system symptoms like headache and confusion, hepatotoxicity and myelosuppression are some of the adverse effects. However, low oral doses on a weekly basis seldom show any signs of toxicity.

Denture Care Practices and Perceived Denture Status among Complete Denture Wearers.

Aims And Objectives: Considerable importance to oral health care was lacking in India, and oral health neglect continues to exist, which is evident in the low utilization rates and poor oral health status. Conventional dentures are the most common alternative in restoration of lost teeth. Without proper denture care practices, there is an increased risk of developing a multitude of problems.

Real-time colour pictorial radiation monitoring during coronary angiography: effect on patient peak skin and total dose during coronary angiography.

Aims: The aim of this study was to evaluate whether a real-time (RT) colour pictorial radiation dose monitoring system reduces patient skin and total radiation dose during coronary angiography and intervention.

Methods And Results: Patient demographics, procedural variables and radiation parameters were recorded before and after institution of the RT skin dose recording system. Peak skin dose as well as traditionally available measures of procedural radiation dose were compared.

Conventional extracapsular cataract extraction and its importance in the present day ophthalmic practice.

Purpose: A retrospective study aimed to evaluate high risk cases where conventional Extracapsular cataract extraction (ECCE) was performed, their intra-operative and post-operative outcomes.

Setting: Sri Srinivasa Sankara Nethralaya (Tirupati) Tirumala Tirupati Devastanams Central Hospital, Tirupati, India.

Subjects And Methods: Retrospective study of 207 patients who underwent ECCE at the hospital between august 2010 to June 2012.

Alcohol-based chlorhexidine vs. povidone iodine in reducing skin colonization prior to regional anesthesia procedures.

Background: Povidone-iodine is a commonly used antiseptic for preparing the skin for regional anesthesia. However chlorhexidine solution has been demonstrated superior for skin preparation before insertion of intravascular devices, taking of blood cultures and before epidural insertion in children. The information regarding the initial efficacy of these disinfectants has not yet been defined The purpose of the present study was to investigate the initial efficacy ofan alcohol-based chlorhexidine and povidone iodine solution as the antiseptic of choice for all regional techniques.

Grade 3 ischemia on the admission electrocardiogram is associated with severe microvascular injury on cardiac magnetic resonance imaging after ST elevation myocardial infarction.

Background: Grade 3 ischemia during ST elevation myocardial infarction (STEMI) is defined as ST elevation with distortion of the terminal portion of the QRS on electrocardiogram (ECG). The aim of this study was to evaluate the effect of ischemic grade on cardiac magnetic resonance (CMR) imaging infarct characteristics such as infarct size, microvascular obstruction (MVO), intramyocardial hemorrhage (IMH), and myocardial salvage.

Methods: Patients with STEMI treated with primary percutaneous coronary intervention had a 12-lead ECG on presentation for analysis of ischemic grade.

Dynamic Changes in ST Segment Resolution After Myocardial Infarction and the Association with Microvascular Injury on Cardiac Magnetic Resonance Imaging.

Background: persistent ST elevation after reperfused ST elevation myocardial infarction (STEMI) is believed to be related to poor microvascular perfusion. Cardiac magnetic resonance imaging (CMR) can evaluate microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) both of which represent severe microvascular damage, have independent prognostic value and are dynamic and evolving over the first 48hours after reperfusion. The aim of this study was to assess whether the development of MVO or IMH has an impact upon ST segment resolution.

Serum thromboxane B2 compared to five other platelet function tests for the evaluation of aspirin effect in stable cardiovascular disease.

Background: To assess the role of serum thromboxane B(2) (TXB(2)) measurements and the correlation between platelet function studies, in patients with stable cardiovascular disease on aspirin or clopidogrel.

Methods: 76 patients (47 on aspirin, 16 clopidogrel, 13 both) underwent assessment of TXB(2), whole blood aggregometry (WBA) after stimulation with (i) arachidonic acid (0.5mM), (ii) ADP (5 microM), (iii) collagen (1 and 5 microg/ml), PFA-100, and Cone and Plate Analyzer.

Multivessel coronary-ventricular fistulae and ischaemia on cardiac MRI.

Multivessel coronary ventricular fistulae is a rare coronary anomaly whose origin is believed to be from an arterioluminal or arteriosinusoidal connection with the ventricle. The clinical and haemodynamic significance of these fistulae have been a source of controversy despite varying methods of evaluation. A 69 year old female with exertional dyspnoea, atypical chest pain and multivessel coronary to left ventricular fistulae underwent cardiac MRI with adenosine stress.

Radiation exposure during elective coronary angioplasty: the effect of flat-panel detection.

Background: Coronary angiography and angioplasty have to date been performed using digital angiography and fluoroscopic systems which incorporate an image intensifier (II). More recently flat-panel (FP) detectors have been introduced which are thought to improve spatial resolution. However, there is limited data on the effect of flat-panel detection on radiation exposure.

Myocardial release of nitric oxide during ischaemia and reperfusion: effects of L-arginine and hypercholesterolaemia.

Aims: Nitric oxide (NO) may modulate myocardial ischaemia/reperfusion (I/R) injury, but effects of hypercholesterolaemia on myocardial NO release during I/R are unknown.

Methods: A NO-specific carbon fibre electrode continuously measured coronary sinus [NO] during 60 min low-flow ischaemia (1 ml/min) and 60 min free reperfusion (I/R) in isolated rabbit hearts. Experimental groups (n=7 per group) were control, L-arginine supplement (200 microM), N-nitro-L-arginine methyl ester (L-NAME) treatment (8 microM) and hypercholesterolaemic.

Serial angiography in patients with acute coronary syndromes: effect of antithrombotic therapy on angiographic lesion severity.

Background: Patients presenting with acute coronary syndromes (ACS) commonly have a responsible culprit coronary lesion. There is limited data on the natural history of this culprit lesion in the short term and whether there is a change in morphology of this lesion in the days following presentation. Furthermore, the effect of antithrombotic therapy on this process is unknown.

Angioplasty facilitated permanent pacing in de novo superior vena cava obstruction.

The finding of complete occlusion of the superior venal cava during the performance of cardiac pacing is rare. We report a case where performance of angioplasty aided the successful completion of permanent pacemaker implantation.

Elevated circulating levels of matrix metalloproteinase-9 and -2 in patients with symptomatic coronary artery disease.

Background: Matrix metalloproteinases (MMP-9 and MMP-2) have been implicated in development of atherosclerosis and plaque rupture in acute coronary syndromes (ACS).

Aim: To determine the relationship between circulating MMPs and symptomatic coronary artery disease.

Methods: Plasma levels of MMP-9 and MMP-2 were measured in patients with ACS, stable angina (SA) and in controls, using a quantitative gelatin zymography.

Proteomics of ischemia/reperfusion injury in rabbit myocardium reveals alterations to proteins of essential functional systems.

Brief periods of myocardial ischemia prior to timely reperfusion result in prolonged, yet reversible, contractile dysfunction of the myocardium, or "myocardial stunning". It has been hypothesized that the delayed recovery of contractile function in stunned myocardium reflects damage to one or a few key sarcomeric proteins. However, damage to such proteins does not explain observed physiological alterations to myocardial oxygen consumption and ATP requirements observed following myocardial stunning, and therefore the impact of alterations to additional functional groups is unresolved.

Sonovue improves endocardial border detection and variability in assessing wall motion score and ejection fraction during stress echocardiography.

Background: Stress echocardiography is useful for assessing patients with coronary artery disease unable to undergo formal exercise testing. Considerable skill is required to avoid large intra- and inter-observer variability due to poor endocardial definition. Intravenous ultrasound contrast agents are now available which may improve this variability.

New bifurcation stenting technique: shunt stenting.

The optimal treatment of bifurcation lesions remains controversial. We describe a new technique we term shunt stenting. This technique incorporates both the new technology of drug-eluting stents and a novel procedure for optimizing the ostial side branch stent positioning.

Disassembly of a rotablator: getting out of a trap.

The rotablator burr rarely becomes trapped within calcified lesions. Manual traction can be ineffective and dangerous. We report a case that illustrates a novel technique involving use of a percutaneous snare in conjunction with partial disassembly of the rotablator device to remove a trapped burr without need for open surgical intervention.

Duration of ischaemia determines matrix metalloproteinase-2 activation in the reperfused rabbit heart.

It has been hypothesised that activation of matrix metalloproteinase-2 (MMP-2) contributes to reversible myocardial dysfunction (stunning) following short-term ischaemia and reperfusion. Gelatin zymography was used to measure release of both pro-MMP-2 (72 kDa) and MMP-2 (62 kDa), into the coronary effluent from isolated, perfused rabbit hearts during 90 min aerobic perfusion (control), or low-flow ischaemia (15 or 60 min at 1 mL/min), followed by 60 min reperfusion. In controls, pro-MMP-2 was detected in the coronary effluent throughout the first 30 min of aerobic perfusion, but MMP-2 was not detected.

Stent deployment within a guide catheter aids removal of a fractured buddy wire.

We report a case of fractured buddy wire that was successfully removed by deploying a stent within the guide catheter, trapping the fractured segment of wire between stent and endoluminal surface of the guide catheter. This technique provides an alternative to either percutaneous snare or surgical intervention.