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Mustafa Kayabaşı,1 Seher Köksaldı,2 Ahmad M Mansour,3 Ziya Ayhan,1 Ali Osman Saatci1 1Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey; 2Department of Ophthalmology, Mus State Hospital, Mus, Turkey; 3Department of Ophthalmology, American University of Beirut, Beirut, LebanonCorrespondence: Ali Osman Saatci, Department of Ophthalmology, Dokuz Eylul University, Mustafa Kemal Sahil Bulvarı, No: 73, A Blok, Daire 9, Narlıdere, İzmir, Turkey, Email osman.saatci@gmail.comPurpose: To analyze the multimodal imaging characteristics of intraretinal macroaneurysms.Patients and Methods: Intraretinal aneurysms larger than 150 μm in diameter on fluorescein angiography were termed as intraretinal macroaneurysm and grouped as primary and secondary according to the absence or presence of any coexisting posterior segment diseases.Results: A total of 20 intraretinal macroaneurysms were observed in 18 eyes of 18 patients. Mean age of the cohort was 65.44 ± 9.14 years (Range; 49– 82 years). Mean diameters of intraretinal macroaneurysms were 238.20 ± 61.12 μm (Range; 163.00– 292.50 μm) and 242.72 ± 49.58 μm (Range; 168.00– 328.00 μm) on fluorescein angiography and optical coherence tomography, respectively. Primary group had 10 eyes with 11 intraretinal macroaneurysms, whereas eight eyes had nine intraretinal macroaneurysms in the secondary group. Three of the eight eyes (37.5%) had diabetic retinopathy, four (50%), retinal vein occlusion, and one (12.5%), posterior uveitis in the secondary group. No statistically significant differences were found between the two groups in terms of age, sex, presence of intraretinal or subretinal fluid, the mean age, the mean central macular thickness, the mean distance of intraretinal macroaneurysms from the fovea, the mean diameter of intraretinal macroaneurysms measured on fluorescein angiography, and the mean diameter of intraretinal macroaneurysms measured on optical coherence tomography. Presence of intraretinal fluid was significantly more frequent than the presence of subretinal fluid in all eyes (p = 0.004).Conclusion: Intraretinal macroaneurysms are diagnosed more and more with the utilization of multimodal imaging techniques. We propose a simple classification system in order to help achieving a standardized terminology and ensure consistent understanding. The classification can be simplified as primary or secondary intraretinal macroaneurysm according to the absence or presence of the associated posterior segment disorders.Keywords: fluorescein angiography, intraretinal macroaneurysm, macular edema, optical coherence tomography, PEVAC, retinal capillary macroaneurysm

Alexandre Assi,1 Ahmad M Mansour,2 Abdul Razzak Charbaji,3 Maurizio Battaglia Parodi4 1Beirut Eye Clinic and VitreoRetinal Department, Beirut Eye Specialist Hospital, Beirut, Lebanon; 2Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 3Department of Statistics and Research Methodology, Lebanese American University, Beirut, Lebanon; 4Department of Ophthalmology and IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, ItalyCorrespondence: Ahmad M Mansour, Department of Ophthalmology, American University of Beirut, POB 113-6044, Beirut, Lebanon, Tel +9613377633, Email ammansourmd@gmail.comPurpose: To study the anatomic outcome of leaving vitreous cortex remnants (VCR) during pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD).Methods: The study comprised patients with RRD who had PPV by a single surgeon between January 2019 and December 2020 and followed for 6 months. After intravitreal injection of triamcinolone acetonide, the topographic pattern of VCR at the periphery (p) and macula (m) was divided into 2 types by extent: complete or 4 quadrants (pVCR4Q), and between 2 and 4 quadrants ≥ 2 quadrants (pVCR> 2Q), or by location > 1 inferior retinal quadrant (pVCR> 1InfQ), and at the macula (mVCR). Anatomical failure or retinal re-detachment within 6 months after surgery was the primary outcome measures. The occurrence of grade C proliferative vitreoretinopathy (PVR) and epiretinal membrane (ERM) were used as secondary outcome indicators.Results: A 6-month prospective follow-up was performed on 103 patients. pVCR4Q was detected in 31 eyes, pVCR> 2Q in 40 eyes, pVCR> 1InfQ in 40 eyes and mVCR in 54 eyes. Recurrent RRD developed in 9 (8.7%) eyes, PVR grade C in 6 (5.8%) eyes and ERM in 11 (10.7%) eyes. According to multivariate regression analysis, the existence of any type of VCR did not correlate with anatomical failure, PVR or ERM.Conclusion: The initial success rate of PPV and the growth of PVR or ERM do not appear to be impacted by keeping VCR.Keywords: vitreous cortex remnants, pars plana vitrectomy, primary rhegmatogenous retinal detachment, epiretinal membrane, proliferative vitreoretinopathy

Ahmad M Mansour,1,2 Khalil M El Jawhari3 1Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 2Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon; 3Medical University of Lodz, Lodz, PolandCorrespondence: Ahmad M MansourDepartment of Ophthalmology, American University of Beirut, PO Box 113-6044, Beirut, LebanonTel +9613377633Email ammansourmd@gmail.comPurpose: To analyze potential risk factors associated with eyelash impaction into meibomian gland orifice.Methods: Retrospective review of one tertiary clinic over a period of 10 years.Results: In this study, 18 patients were included, with a mean age of 61.6 years at diagnosis. Ten patients were symptomatic in the form of ocular irritation or foreign body sensation. The location of the impaction included 15 nasal half and 3 temporal half of the lid, 6 upper lid and 12 lower lid, 8 right side and 10 left side. Risk factors included dry eyes (10), allergic conjunctivitis (4), severe rubbing of the eye (6), sleeping on the eye (2), and recent phacoemulsification (1).Conclusion: Ocular rubbing from either ocular allergy or dryness is associated with impaction of the lash into the orifice of the meibomian gland duct.Keywords: cilia, eyelash, lash impaction, meibomian gland duct orifice

Ahmad M Mansour,1,2 Khalil El Jawhari,3 J Fernando Arevalo4 1Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 2Department of Ophthalmology, Rafik Hariri University Hospital, Beirut, Lebanon; 3Medical School, Medical University of Lodz, Lodz, Poland; 4Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA Purpose: The aim of this study was to investigate the possibility of decreasing the number of intravitreal anti-VEGF by peripheral pan-retinal photocoagulation (PPRP) in managing diabetic macular edema (DME) in a subcategory of patients who cannot comply to strict anti-VEGF follow-up protocols.Materials and methods: This is a pilot prospective study. Consecutive patients with naïve DME were offered the choice of treatment and extend intravitreal ziv-aflibercept if they showed willingness for good compliance or PPRP with modified pro re nata intravitreal injections.Results: Six eyes of 3 patients had PPRP versus 4 eyes of 4 patients had injections only. The number of anti-VEGF injections was markedly decreased when PPRP was administered from a mean number of injections of 16.8 (range 13–21; mean follow-up 24.3 months) to a mean number of 4.5 (range 0–8; mean follow-up 33.7 months). Mean initial central macular thickness (CMT) was 462.0 mm in the injection only group vs 457.3 mm in the PPRP group. Mean final CMT was 462.0 in the injection only group vs 350.0 in the PPRP group. Baseline and final mean logMAR (Snellen equivalent) best-corrected visual acuity was initially and finally 0.84 (20/137) and 0.60 (20/80) in the injection only group and 0.70 (20/100) and 0.69 (20/98) in the PPRP group, respectively. The monthly cost for the PPRP group was one-third of the monthly cost for the injection only group.Conclusion: PPRP allowed for a decrease in the number of intravitreal anti-VEGF injections in selected DME patients (sick, difficult to ambulate, financial burden, and fear of injections). Keywords: vascular endothelial growth factor, laser therapy, diabetic retinopathy

Ahmad M Mansour,1,2 Jay Chhablani,3 J Fernando Arevalo,4,5 Lihteh Wu,6 Ravi Sharma,3 Suthasinee Sinawat,7 Tharikarn Sujirakul,8 Alexandre Assi,9 Wandsy M Vélez-Vázquez,10 Mohamad A Mansour,1 Ozcan Kayikcioglu,11 Cem Kucukerdonmez,12 Ali Kal13 1Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 2Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon; 3L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; 4Department of Ophthalmology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA; 5Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 6Asociados de Macula Vitreo y Retina de Costa Rica, San José, Costa Rica; 7Department of Ophthalmology, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand; 8Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 9Beirut Eye and Ear Specialty Hospital, Beirut, Lebanon; 10Retina Associates, Guaynabo, Puerto Rico; 11Celal Bayar University, Manisa, Turkey; 12Ekol Eye Hospital, Izmir, Turkey; 13Department of Ophthalmology, Baskent University, Konya, Turkey Purpose: To report the visual and anatomic outcomes of albino retinal detachment (ARD) repair. Methods: Collaborative retrospective analysis of ARD. Outcome measures were number of surgical interventions, final retinal reattachment, and best corrected visual acuity (BCVA) at last follow-up. Results: Seventeen eyes of 16 patients (12 males; mean age =37.8 years) had the following complications at presentation: macula off (14), total (7) or inferior detachment (5), proliferative vitreoretinopathy (5), detectable break (16), lattice (5), horseshoe tears (9), and giant tear or dialysis (4). Mean number of interventions was 1.8 (range =1–5) and included cryopexy (15) with scleral buckle (11), and/or vitrectomy (8). Mean initial BCVA was counting finger (CF) 1 m and at last follow-up (mean 77 months) CF4m with mean improvement of 4.5 lines (early treatment diabetic retinopathy study) (P=0.05). Intraoperative choroidal hemorrhage occurred in three eyes. The retina was finally attached in 14 eyes, with residual inferior detachment in three eyes with silicone oil in situ. Silicone oil was kept in six of seven eyes because of residual inferior detachment (3) and removal of silicone oil, which led to redetachment (1) or fear of redetachment (2). Conclusion: Repair of ARD may require several interventions, with the need to keep silicone oil in several cases due to nystagmus and reduced melanin pigment. Keywords: cryopexy, foveal hypoplasia, nystagmus, retinal detachment, scleral buckle, silicone oil, vitrectomy

Ahmad M Mansour,1,2 Rafic S Antonios,1 Iqbal Ike K Ahmed3 1Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 2Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon; 3Department of Ophthalmology, University of Toronto, Toronto, ON, Canada Background: Complete removal of the cortex has been advocated to prevent posterior capsular opacification but carries the risk of zonular dehiscence, hence there is a need for a safe maximal cortical cleanup technique in eyes with severe diffuse zonulopathy in subjects above age 90. Methods: We used bimanual central cortical cleaning by elevating central fibers and aspirating them toward the periphery. Peripheral cortical fibers were removed passively only when they became loose due to copious irrigation. A one-piece foldable implant was inserted without a capsular tension ring. Postoperative corticosteroid drops were used. Results: This technique was safely performed in a dozen eyes with severe pseudo-exfoliation or brunescent cataract with weak zonules. Posterior capsular rupture, iritis, vitreous loss, and lens subluxation were not observed. Moderate capsular phimosis occurred but with maintained central vision. Conclusion: The dogma of “complete cortical cleanup” in severe zonulopathy needs to be revisited in favor of a clear visual axis with maximal preservation of the damaged zonules. This technique is ideal in patients above age 90 where posterior capsular opacification and late dislocation of intraocular lens–capsule bag complex are unlikely to occur until several years postoperatively. Keywords: brunescent cataract, cortex aspiration, phacoemulsification, pseudo-exfoliation, weak zonules

Remya Paulose,1 Jay Chhablani,1 Chintan J Dedhia,1 Michael W Stewart,2 Ahmad M Mansour3,4 1Smt. Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India; 2Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 3Department of Ophthalmology, American University of Beirut, 4Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon Aim: To report the efficacy of intravitreal ziv-aflibercept injections in eyes with macular edema due to retinal vein occlusions (RVOs). Methods: Consecutive patients with persistent or recurrent macular edema (central macula thickness >250 µm) due to RVO were enrolled in this prospective study. Study eyes received intravitreal injections of ziv-aflibercept (1.25 mg/0.05 mL) at baseline. Patients were reassessed monthly for 4 months and given additional injections pro re nata for worsening best-corrected visual acuity (BCVA), intraretinal edema or subretinal fluid seen on spectral domain optical coherence tomography, or central macular thickness (CMT) measurements >250 µm. The primary endpoint was improvement in mean CMT at 4 months. Secondary endpoints included improvement in mean BCVA, and ocular and systemic safety signals. Results: Nine eyes (five central and four branch RVOs) of nine patients were enrolled. The mean ± standard deviation CMT decreased from 604±199 µm at baseline to 319±115 µm (P=0.001) at 1 month and to 351±205 µm (P=0.026) at 4 months. The mean BCVA did not improve significantly from baseline (1.00 LogMAR) to the 1-month (0.74 LogMAR; P=0.2) and 4-month (0.71 LogMAR; P=0.13) visits. No safety signals were noted. Conclusion: In this small prospective study, intravitreal ziv-aflibercept significantly improved mean CMT in eyes with persistent or recurrent macular edema due to RVOs. Prospective, randomized trials comparing ziv-aflibercept with standard pharmacotherapy are needed to better define efficacy and safety. Keywords: ziv-aflibercept, retinal vein occlusion, cystoid macular edema

Ahmad M Mansour1,2 1Department of Ophthalmology, American University of Beirut, 2Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon Purpose: We report an unusual case of bilateral vertical lacquer crack with no history of ocular trauma and with progressive marked enlargement and consequent visual loss. Methods: Three-year follow-up was completed using best-corrected visual acuity, serial fundus photographs, intravenous fluorescein angiography, and optical coherence tomography. Results: We report the occurrence of lacquer crack in a 43-year-old woman with no history of trauma except for laser in situ keratomileusis surgery for mild myopia (as reported by the patient) in the past 5 years and habitual ocular rubbing. Lacquer crack started in the right eye and became evident 1 year later in the left eye. Serial photography after repeated intravitreal injections of ranibizumab for subfoveal choroidal new vessel showed the lacquer crack widened gradually in both eyes. Axial length measurement revealed the presence of high myopia. Best-corrected visual acuity dropped to 20/200 bilaterally. Conclusion: We hypothesize that a thin Bruch's membrane in high myopia is prone for small rupture initially either spontaneously or following laser in situ keratomileusis and subsequent widening of the rupture by oculopression and intravitreal injections from rise in intraocular pressure. Keywords: angioid streak, Bruch's membrane rupture, choroidal rupture, choroidal neovascularization, high myopia, lacquer crack, LASIK

Ahmad M Mansour, Mahmoud O Jaroudi, Rola N Hamam, Fadi C Maalouf Department of Ophthalmology, American University of Beirut, Beirut, Lebanon Abstract: Closed-globe traumatic cataract is not uncommon in males in the pediatric age group. However, there is a relative paucity of literature on isolated posterior lens capsule rupture associated with closed-globe traumatic cataract. We report a case of a 6-year-old boy who presented with white cataract 1 day after blunt trauma to the forehead associated with posterior capsular rupture that was detected by B-scan ultrasonography preoperatively. No stigmata of trauma outside the posterior capsule could be detected by slit-lamp exam, funduscopy, and optical coherence tomography. Phacoemulsification with posterior chamber intraocular lens implant was performed 24 hours after trauma, with the patient achieving 6/6 visual acuity 1 week and 6 months after surgery. Our case is unique, being the youngest (amblyogenic age) to be reported, with prompt surgical intervention, and with no signs of trauma outside the posterior capsule. Keywords: posterior capsule rupture, forehead trauma, traumatic cataract, pediatric cataract

Ahmad M Mansour,1,2 Hana A Mansour,3 J Fernando Arevalo4,5 1Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon; 2Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 3Department of Biology, American University of Beirut, Beirut, Lebanon; 4Retina Department, The King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; 5Retina Department, Wilmer Eye Institute, The Johns Hopkins University, Baltimore, MD, USA Abstract: This patient presented for surgery at the age of 32 years, 14 months after his initial complaint of metamorphopsia and visual loss in the right eye. Past tests demonstrated a whitish epiretinal membrane (ERM) with translucent stress lines over a thickened macula. Visual acuity was found on last presentation to be normal with minimal alteration on Amsler grid testing. A torn ERM was found in the center with left-over ERM temporally and rolled-over ERM nasally at the site of the epicenter with no posterior vitreous detachment. Visual recovery occurred gradually over several days 2 months prior to presentation apparently following heavy weight-lifting with a sensation of severe eye pressure. Sequential funduscopy and optical coherence tomography scans demonstrated the peeling of an ERM accompanied by normalization of foveal thickness. Valsalva maneuver had put excessive tension on ERM which tore in its center at the weakest line with gradual contraction of the ERM away from the fovea towards the peripapillary area. This is a new mechanism of self-separation of ERM induced by Valsalva. ERM in young subjects is subject to rupture and subsequent separation by tangential traction. There are three mechanisms for spontaneous separation of ERM: 1) posterior vitreous detachment with pulling of ERM by detaching vitreous (most common in adults); 2) the contracting forces of the immature ERM become stronger than its adhesions to the retina resulting in slow tangential traction on the edges of the ERM and gradual separation from the edges towards the center (remodeling common in youngsters); and 3) acute tearing of ERM at its weakest central point and retraction of part of the membrane towards the epicenter (current case report). Keywords: valsalva maneuver, posterior vitreous detachment

Ahmad M Mansour,1,2 Haytham I Salti11Department of Ophthalmology, American University of Beirut, 2Rafic Hariri University Hospital, Beirut, LebanonAbstract: We present two patients with active, foul-smelling, methicillin-resistant ­Staphylococcus aureus (MRSA) wounds of the forehead and sternum following craniotomy or open heart surgery. Both had debilitating cataracts and were told by the infectious diseases team that cataract surgery is very risky. Both underwent sequential bilateral phacoemulsification with no sign of infection. Patients with active MRSA wound infections may safely undergo cataract surgery with additional precautions observed intraoperatively (good wound construction) and postoperatively (topical antibiotics and close observation). Banning such surgeries can unnecessarily jeopardize the lifestyles of such patients.Keywords: cataract, infection, methicillin-resistant Staphylococcus aureus, phacoe­mulsification

Ahmad M Mansour,1 Jong Wook Lee,2 Seung Ah Yahng,2 Kyu Seop Kim,3 Maha Shahin,4 Nelson Hamerschlak,5 Rubens N Belfort,6 Shree K Kurup71Department of Ophthalmology, American University of Beirut, Rafic Hariri University Hospital, Beirut, Lebanon; 2Division of Hematology, Seoul St Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea; 3Department of Ophthalmology, Seoul St Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea; 4Department of Ophthalmology, Mansoura University, Mansoura City, Egypt; 5Oncology and Hematology Program, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil; 6Vision Institute, Hospital São Paulo, Federal University of São Paulo, Brazil; 7Department of Ophthalmology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USAAbstract: Aplastic anemia (AA) is a rare disease with few reports on its ophthalmic ­manifestations. The ocular findings are described in a retrospective consecutive series of 719 AA Korean patients followed at the Hematology Clinic of The Catholic University of Korea. Out of a total of 719 patients, 269 patients had eye examinations, 156 patients had retinal evaluation, and 37 (23.7%) had retinal findings. These 37 patients had unilateral retinal ­hemorrhage in seven and bilateral retinal hemorrhage in 30 with mean hemoglobin of 6.6 g/dL (range 2.7–12.6 g/dL) and platelet counts of 18.8×109/L (range 4–157×109/L); central retinal vein occlusion-like picture occurred in nine patients and these had similar rheology to the rest of the subjects; optic disc edema, cotton-wool spots, macular edema, and dry eyes occurred in two, three, five, and three patients, respectively. In this Korean series of 141 subjects with AA, systemic bleeding occurred in 24.8% of subjects, retinal hemorrhage in 37% of subjects, and any bleeding site (eye or elsewhere) occurred in 47.5% of subjects with AA. A literature review (1958–2010) of 200 AA cases revealed retinal hemorrhages in 56%, subhyaloid or vitreous hemorrhage in 9%, peripheral retinal vasculopathy in 5.5%, and cotton-wool spots, Sjögren’s syndrome, or optic disc edema in 4% each. The prevalence of retinopathy among series of AA patients varied from 20% to 28.3%, which is consistent with the Korean series of 24.8%. Management of AA patients needs to involve multiple specialties, including hematologists, ophthalmologists, and infectious disease specialists. Keywords: aplastic anemia, eye, retinopathy, retinal hemorrhage, retinal vasculopathy, thrombocytopenia

Ahmad M Mansour,1 Mahmoud O Jaroudi21Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 2Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, LebanonIntroduction: Hemorrhagic retinal macrocysts are extremely rare retinal lesions that can be mistaken for malignancy with subsequent enucleation. Such a case was diagnosed, by a retina specialist based on ultrasonography, as a choroidal melanoma with exudative retinal detachment and the patient was advised to have brachytherapy.Case presentation: A 15-year-old Caucasian boy suffered sudden visual loss in the left eye and exam revealed vitreous hemorrhage. Magnetic resonance imaging revealed the mass as hyperintense on T1-weighted images and isointense on T2-weighted images with no enhancement after gadolinium dye. Following scleral buckle, the hemorrhagic retinal macrocyst collapsed gradually over a period of 5 weeks. The patient recovered visual acuity of 6/7.5 at the 1-year follow up.Conclusion: A hemorrhagic retinal macrocyst can be erroneously diagnosed as choroidal melanoma. Hints for the presence of retinal macrocysts include: egg shape; cyst wall configuration; no attachment to the choroid; and presence of retinal detachment.Keywords: choroidal melanoma, retinal macrocyst, retinal detachment

Ahmad M Mansour,1,2 Friederike Mackensen,3 Padmamalini Mahendradas,4 Moncef Khairallah,5 Timothy YY Lai,6 Ziad Bashshur11Department of Ophthalmology, American University of Beirut, 2Rafic Hariri University Hospital, Beirut, Lebanon; 3Interdisciplinary Uveitis Center, University of Heidelberg, Heidelberg, Germany; 4Departments of Uveitis and Retina, Narayana Nethralaya, Bangalore, India; 5Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia; 6Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong KongPurpose: To assess the 5-year visual outcome of intravitreal bevacizumab in inflammatory ocular neovascularization.Methods: Retrospective, multicenter, consecutive case series of eight patients with inflammatory ocular neovascularization refractory to standard therapy who were treated with intravitreal bevacizumab and followed for 5 years after first injection. The outcome measures included improvement of best-corrected visual acuity expressed as logarithm of minimum angle of resolution.Results: Mean best-corrected visual acuity significantly improved from 0.58 at baseline (6/23 or 20/76; standard deviation = 0.32) to 0.20 at final assessment (6/10 or 20/32; standard deviation = 0.25) (n = 8; P = 0.02), a gain of 3.8 lines (median: three injections; eight eyes; eight patients). No ocular or systemic complications from intravitreal bevacizumab were noted.Conclusion: At 5 years, intravitreal bevacizumab sustained significant visual improvement in ocular neovascularization due to a variety of inflammatory ocular diseases without major complications after a median of three injections.Keywords: bevacizumab, choroidal neovascularization, punctate inner choroidopathy, toxoplasmosis, uveitis, Vogt–Koyanagi–Harada syndrome

Ahmad M Mansour1, Maha Shahin2, Peter K Kofoed3, Maurizio B Parodi4, Michel Shami5, Stephen G Schwartz6, Collaborative Anti-VEGF Ocular Vascular Complications GroupDepartment of Ophthalmology, 1American University of Beirut, Beirut, Lebanon, Rafic Hariri University Hospital, Beirut, Lebanon; 2Mansoura University, Mansoura City, Egypt; 3Glostrup Hospital, University of Copenhagen, Denmark, National Eye Clinic, Kennedy Center, Glostrup, Denmark; 4University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy; 5Texas Tech University Health Sciences Center, Lubbock, TX, USA; 6Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Naples and Miami, FL, USAAim: To record ocular vascular events following injections of vascular endothelium growth factor (VEGF) antagonists.Methods: Collaborative multicenter case series (48 cases), literature reviews (32 cases), and reports to the FDA (64 cases) of patients that had vascular occlusions during anti-VEGF therapy were collected and analyzed.Results: A total of 144 cases of ocular vascular events were identified, with these diagnosed a median of 15 days after anti-VEGF injection. The majority of patients had pre-existing risk factors for cardiovascular events and nine patients had a prior history of glaucoma. Mean visual acuity dropped by 6.4 lines with severe visual loss after injection to NLP (five eyes), LP (six eyes), and HM (two eyes). The overall risk of ocular vascular events following a VEGF antagonist injection was 0.108% in the general population and 2.61% in the diabetic population. Mean retinal arterial constriction after intravitreal bevacizumab in 13 eyes was 21% (standard deviation = 27%), and mean retinal venous constriction was 8% (standard deviation = 30%).Conclusion: Ocular vascular events are rare during anti-VEGF therapy, but can lead to severe visual loss and may be caused by a number of factors including the vasoconstrictor effect of the drug, a post-injection rise of intraocular pressure, patient stress as a result of the procedure, and the patient's natural history of underlying ocular or systemic diseases. The diabetic population appears to have a tendency towards ocular vascular occlusions.Keywords: Bevacizumab, retinal artery occlusion, retinal vein occlusion, retinal capillary occlusion, ranibizumab

The translation of song lyrics is challenging for translators primarily due to the intricate poetic and musical elements, which often compel them to employ specific strategies for effective translation. This study was an attempt to investigate the translation strategies in selected translated movie song lyrics and explore the challenges in translating the lyrics. In this qualitative study, the songs were purposefully selected from “Mulan” (1998) and “Aladdin” (2019) movies. Low’s (2013) translation strategies were applied during the process of translation. The “Translation” (transfer of material with a reasonably high degree of semantic fidelity), and “Replacement” (a re-creation of text by only preserving the music element) strategies were found as the common strategies in the translation of song lyrics. The use of a replacement strategy could be due to technical difficulties in translating songs, such as the constraint of rhythm, hence a total replacement of meanings to match the rhythm of the song. A significant challenge in translating song lyrics from English to Chinese was in translating the concept of face-saving, which is an eminent process in social interactions in Chinese culture. It was concluded that the use of a translation strategy depended on the lyrics, translators’ creativity, melody, rhyme, and the differences between the languages and cultures, while the “skopos”, i.e., the correspondence of aim/purpose in the source and target cultures should play the key role.

The quality of some Chinese literary translations has raised concerns among some translation scholars. This qualitative study presents an examination of Juliane House’s latest translation quality assessment model in evaluating the quality of ‘Sweltering Summer’, the English translation of ‘Yanre de xiatian’, a short Chinese story. House’s model reveals that the translation quality is dependent on the matching degree of the textual profile and function between the original and translation. The article concludes that despite minor discrepancies along the dimensions of field, tenor, and mode leading to minor disagreements of ideational and interpersonal functional components between the source text and the target text, the original and its overt translation are largely equivalent at the level of language/text, register, as well as genre, and the overall quality of the translation remains adequate by providing mismatch and match examples and interpretations in support of the conclusion. This study confirms the feasibility and reliability of House’s model, offering insights for translation scholars interested in assessing translation quality in the realm of short literary works and providing constructive suggestions for translators of Chinese literature. Future research could explore sufficient syntactic and textual examples using quantitative data and the mismatches between the original and the translated texts.

Abstract Background Various organisms, such as bacteria, viruses, and fungi, can cause corneal ulcers. One of the leading causes of vision loss and disability worldwide is corneal ulceration. Practical, accessible, and affordable treatment for this disease seems essential. Materials and methods Fifteen New Zealand rabbits infected with Staphylococcus aureus (ATCC 25923) corneal ulcers were randomly divided into three groups of five for the present study. (I, II, and III). Group I was used as the control group (without treatment). The second group received an iodine solution (1.25%) without a nanoparticle structure (betadine). The third group received an iodine solution with a nanoparticle structure used as eye drops. Drops in the corneal ulcer group were used five times daily for 14 days. Microbial counts and disease severity scores were measured on the first, second, fifth, and fourteenth days and compared between groups separately for each disease. Results The results showed that the changes in microbial load were significant in the group that received betadine and nanoparticles. The microbial load was further reduced when using iodine nanoparticles than betadine. The betadine and nano-iodine groups significantly reduced the severity of the disease in rabbits with corneal ulcers (p

Objective: Candida albicans and Candida tropicalis are the most common fungal species in humans. The present study aimed to investigate the effect of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser on inhibiting the growth of Candida albicans and Candida tropicalis in vitro. Methods: Candida albicans and Candida tropicalis species were cultured in sub-dextrose agar containing chloramphenicol and exposed to Nd:YAG laser (1064 nm). The laser was emitted at the pulse frequency of 1 Hz (1 pulse per second) for 7 or 13 seconds. At each pulse duration, the energies of 40, 60, 80, or 100 mJ were delivered to microbial plates. After radiation, the number of colonies was counted and reported as colony-forming units per milliliter (CFU/mL). Results: There was a significant reduction in the number of Candida albicans and Candida tropicalis colonies after Nd:YAG laser radiation, compared to the control group (P

Although cohesion and coherence of a speech are significant, and there is an array of studies exploring these elements, particularly political speeches, many still struggle to apply the correct grammar and lexical cohesion as well the correct thematic structure in speech construction. This study aims to investigate the cohesion and coherence of speeches that are constructed through textual metafunction using thematic structures and cohesive devices. The study intends to answer two research questions. 1. What are the thematic structures and cohesive devices used in the speeches delivered by the Director General of the World Health Organization? 2. How are these thematic structures and cohesive devices used to produce cohesion in these speeches? This study used a mixed-method approach, combining corpus analysis with qualitative descriptive analysis. Twelve speeches from the website of the World Health Organization were chosen using a purposive sampling method. Thematic patterns and the distribution of cohesive devices in the speech corpus were analysed and identified. Findings showed that unmarked topical themes were employed the most, whereas interpersonal themes were used the least. The most dominant cohesive device was repetition, followed by reference, conjunction, and collocation. Ellipsis was sparsely employed to avoid redundancy. These mechanisms contributed to constructing cohesion and coherence, which help audiences understand the speeches better. The findings of the study may have significant implications for enhancing communication across a range of fields by offering useful insights on the efficacy of utilising cohesive devices and thematic structures in speeches, particularly those delivered by prominent public figures.

Abstract Background The global crisis of antibiotic resistance increases the demand for the novel promising alternative drugs such as antimicrobial peptides (AMPs). Here, the antibiofilm activity of the WLBU2 peptide against Pseudomonas aeruginosa (P. aeruginosa) isolates was investigated in this study. Methods Two clinical MDR and carbapenem resistant P. aeruginosa (CRPA) isolates, and standard P. aeruginosa ATCC 27,853 were investigated. The MIC and MBC of WLBU2 were determined. The MBIC was determined to evaluate inhibitory activity of WLBU2 on biofilm formation and MBEC to dispersal activity on preformed biofilm. The relative expression levels of biofilm-associated genes including rhlI, rhlR, lasI and lasR were analyzed using RT-qPCR. In vivo evaluation of inhibitory effect of WLBU2 on biofilm formation was performed in the murine models of P. aeruginosa biofilm-associated subcutaneous catheter infection. Results MIC and MBC of WLBU2 for both MDR and ATCC 27,853 P. aeruginosa strains were 8 and 16 µg/mL, respectively, while both the MIC and MBC against the CR strain were 4 µg/mL. MBIC was estimated to be 64 µg/ml for all strains. MBEC against MDR and ATCC 27,853- P. aeruginosa strains was 128 µg/ml and against CRPA was 64 µg/ml. The bacterial adhesion to a static abiotic solid surface (the surface in the polypropylene microtiter wells) was significantly inhibited at 1/4× MIC in all P. aeruginosa strains and at 1/8× MIC in CRPA strain (P

Advertising is an important issue in the world and has a deep effect on various aspects of our individual and social lives. The effect of this phenomenon on the economy, culture, society and even politics is constantly increasing, and the lack of appropriate laws in this area will provide a good platform for abusers. The issue of advertising is very important for products that are directly related to consumer health. The most important problem in the field of health advertising in the Iranian legal system is the multiplicity and fragmentation of the resolutions that have existed for a long time. However, it can be said that each resolution addresses the issue from a specific perspective, but there are sometimes overlaps, and contradictions regarding the competent authorities provided for the issuance of advertising licenses and the authorities dealing with violations, guaranteeing the implementation of violations of the rules governing advertising, etc. In recent years, not only has there been no effort to resolve this issue, but in some cases, it has increased these ambiguities. In this article, we will explain the situation of the Iranian legal system in this regard, while referring to the European Union's directives on health.

One of the elements of contracts containing bilateral financial obligations is the equilibrium in the value of the consideration. "Equilibrium" is the product of the correct (correct, complete, timely) performance of all financial obligations affecting the value of the considerations. However, sometimes financial obligations are not properly performed due to factors like ignorance, delay, violation, impossibility, a fundamental change of circumstances, etc. And the equilibrium of value expected by the parties will be disturbed. Legal texts and jurisprudential and legal opinions mention granting the right of termination as the only remedy to deal with this defect. However, accepting the monopoly of termination, considering its basis, is associated with problems. The impediment to the survival of the contract on the one hand, and the disadvantages of terminating the contract as an exclusive sanction of the imbalance, on the other hand, show the necessity of an alternative way. The present article uses a library method. To prepare an alternative way after examining the intellectual underpinnings such as the theory of contract maintenance and its comparative study, by presenting an economic analysis of the transaction, applying the La Zarar rule, while overcoming possible barriers to recourse. In parallel, it proposes a judicial intervention strategy to return to the equilibrium requirements of the value desired by the parties by relying on an interpretation of the intentions of the parties or a reference to legal principles. In this regard, this article first studies the different dimensions of the concept of balance in the value of waste. Then, explaining the principles of deviating from the monopoly of termination in case of imbalance and doubt in its obstacles, provides the necessary ground for accepting judicial intervention as a solution within the termination of the contract.

Faced with the Covid-19 pandemic worldwide, instructors and learners had to turn to online learning and teaching instead of the traditional physical mode. With this shift to online education, the innovative pedagogical approaches play a key role in facilitating effective communication and teaching approaches. The purpose of this review paper was to explore the merits and challenges of Collaborative Learning approach in online mode of teaching. Using a review protocol, the most recent and relevant studies were identified by searching the keywords from reliable databases, and descriptions were provided. Problems such as accessibility, learner motivation, technical issues, digital skills, time management, and cost-efficiency were identified as some of the challenges in most of the studies reviewed. It was concluded that Collaborative Learning in teaching Translation is an effective and dynamic approach that could contribute to the autonomous learning. A mix of both online and face to face modes of teaching, i.e., blended (hybrid) learning, was recommended as effective for Translation students. Finally, instructors were recommended to remind students about their responsibity regularly for more productive interaction, and effective engagement in the discussions and activities, as well as voicing out their opinions. This could make the learners become more crtitical and flexible learners who are constantly involved in teamwork and can accomplish Translation projects and assignments successfully.

A Retrospective study includes records of 1832 patients with dyspeptic symptoms who underwent endoscopic examination in Al-Mawani Teaching Hospital during the period from October 2015 - October 2019 were analyzed. 942 (51.4%) were males and 890(48.6%) were females, 794 (43.3%) had no endoscopic abnormalities,1038 (56.7%) had endoscopic finding. Oesophagitis was seen in 149 (8.1% ) patients , gastritis was seen in 603 (32.9%) patients, duodenal ulcer was seen in 257(14%) patients with male to female ratio (1.8:1) and peak age group between (20-40) years. Gastric ulcer was seen in 47 (2.5%) patients with male to female ratio (1.2:1)and peak age group between (40-60) yrs, and ratio of duodenal to gastric ulcer was (5.5-1). Combined duodenal and gastric ulcer was found in 4(0.2%) patients, gastric cancer was found in 10 (0.54%) patients with peak age group between (50-70) years. It is concluded that endoscopy is golden standard test for diagnosis of gastroduodinal pathology

Audiovisual translation of humor has long been a challenge faced by translators. It is inevitable for translators to remove or reduce some of the humorous effect in the target language despite their endeavor to preserve the humor elements. This qualitative study aimed to investigate the reasons behind the loss of humor in translation of the humorous scenes from an American comedy cartoon, SpongeBob SquarePants. Sperber and Wilson (1986)’s Relevance theory and Chaume (2004)’s Constraints of Dubbing framework were adopted in this study. The analysis was carried out by comparing the Zabalbeascoa (1993; 1996)’s humorous loads in each identified scenes in English and the Chinese dubbed version. The findings indicated that community and institution, community sense of humor and linguistic elements are prone to be lost in this type of translation not merely due to the linguistic and cultural asymmetry but also because of the synchronization constraints of dubbing. It was found that the substitution strategy which preserved the humor effect became ineffective because the new humorous elements recreated by the translator may not be synchronized with the actor’s lip movements, actions and length of utterance displayed on screen. Despite the unavoidable loss of the untranslatable elements, the maximum preservation of visual and non-marked elements which can be deciphered by the target audience without making unnecessary efforts compensates for the loss, contributing to the popularity and success of this comedy product in the target language and culture.

Nowadays, information asymmetry or inequality of information between the parties and consequently the ignorance of one side about issues related to the contract is an existing fact in all contracts. This relative ignorance of one of the contract parties ranges from minor to severe. From the perspective of Islamic jurisprudence, severe information asymmetry disrupts the contract economic character and the order established by the will of the parties and makes them confronted by al-gharar as a guarantee. In this article, by relying on library resources and with an analytical-descriptive approach, an attempt has been made to explain and distinguish the two concepts of information asymmetry and al-gharar, as well as the criteria for identifying them in the insurance contracts. The insurance contract is focused due to the fact that, on the one hand, information is doubly crucial as necessitated by the nature of the contract, and on the other, al-gharar is doubtfully attributed to the contract, which has been answered by emphasizing the negligent nature and the ignorance intentionally interwoven with the contract. However, the subtle point here is that the negligent nature of the insurance contract will not lead to the acceptance of any ignorance and asymmetry of information there, hence the lack of al-gharar as a consequence.

With the development of biomedical research, we are observing the emergence of new issues and, consequently, new legal challenges that it is necessary to study with legal and jurisprudential standards. A Clinical Trial is a kind of experimental research and the most valid type of research to prove the cause and effect relationship between therapeutic intervention and treatment. These types of research have wide jurisprudential and legal dimensions. Informed consent is the process by which a participant or their legal representative sees and understands information about the trial and agrees with it. Ambiguity in the legal status of the informed consent of the person participating in Clinical Trials is a challenge that requires attention and accuracy. The research method of this article is descriptive-analytical, and the method of collecting information is based on the library method. The study findings show that by comparing the consent of Clinical Trials (different from medical consent) with legal bases, it is clear that the specific status of the consent and its conditions and characteristics are such that it should be studied in the framework of indefinite contracts. The contract is generally subject to the general rules of the contract and is specifically subject to other relevant provisions in this field, including the "Ethical Guidelines for Clinical Trials". By examining the jurisprudential arguments and legal rules, it can be said that concluding Clinical Trial contracts to test a new method of treatment or medicine on the physical integrity of the volunteers is permissible even if there is minor or severe damage under particular conditions. Because often, these contracts are concluded in the direction of something rational and expedient interest

Due to the differences in the structure and performance of "Companies Providing Intelligent Transportation Services" with "Traditional Transportation Companies", their activities have faced many legal challenges. One of the challenges concerning these companies is their "Legal Nature". This study aims to identify the legal nature of "Companies Providing Intelligent Transportation Services" in the legal systems of Iran, the United States, and the European Union. This research is applied in terms of purpose and is written based on the descriptive-analytical method and based on library documents and resources. In this paper, Snapp and Uber Companies have been studied. Using technologies such as artificial intelligence, mobile phones, and the Internet, these companies present themselves as mere intermediaries between the driver and the passenger user; Therefore, they are not a party to the contract of carriage and will not be responsible for these services. However, the research findings, which have been obtained based on the study of the technical and legal structure of the performance of these companies, refute the mentioned claims and show their role beyond an intermediary. Using their apps, companies have strongly interfered in the relationships between their drivers and passenger users (Matching and Connecting them, Determining the price of transportation, Requesting ratings for each other, and managing them according to the mentioned ratings, etc.), which determines their legal nature. Also, Companies use their internal "Terms and Conditions" to regulate drivers and passenger users within their rules and require them to comply with their regulations. As a result, these factors have led various governments to subject the legal nature of these companies to "Transportation" regulations by enacting specific regulations or identifying them as one of the existing entities, and identifying them as "Carriers".

The use of realia as an additional teaching material incorporated in the language classroom has long been documented. It is used in classroom instruction to enhance students’ real-life experiences. However, there often exists a gap between the content taught in the classroom and its association with the real-life given the dynamic and complexity of each discipline that could restrict demonstration of real-life examples in the class. Although realia are easily obtainable, not all classrooms are supposed to employ additional materials as such due to the stipulated syllabus or content appropriateness. Various types of educational and illustrative realia like virtual realia, magazines, pictures, and songs are employed in the classroom practices and they are proven effective and yielded encouraging implications. Given the importance and longstanding usage of realia in classroom practices, this review aimed to review the types, implications, and limitations of realia in the recent educational context, specifically in the language classroom. It was concluded that the extensive use of realia may enrich students’ learning experiences in various levels of language classroom as supported by the literature. The current review also provides practical implications to students, educators and stakeholders to gauge a more in-depth understanding about the use of realia in classroom practices.

This study investigated the molecular epidemiology of carbapenem-resistant classic Klebsiella pneumoniae (CR-cKp) and carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp) isolates in southwestern Iran. From 2019 to 2021, 136 (88.9%) cKp and 17 (11.1%) hvKp isolates were identified using biochemical tests and polymerase chain reaction (PCR). Antibiotic resistance, beta-lactamases, and clonal relatedness of carbapenem-resistant isolates were investigated using disk diffusion, PCR, and enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR), respectively. The different markers of hvKp isolates were as follows: string test (35.3%, n = 6/17), magA (11.8%, n = 2/17), rmpA (11.8%, n = 2/17), rmpA2 (52.9%, n = 9/17), iucA (52.9%, n = 9/17), and peg344 (35.3%, n = 6/17). Also, 55.1% (n = 75/136) of cKp and 47.1% (n = 8/17) of hvKp isolates were CR-cKp and CR-hvKp, respectively. All CR-hvKp (100.0%, n = 8) isolates were MDR. Colistin, tetracycline, and tigecycline were the most effective antibiotics. The occurrence of beta-lactamase genes in 75 CR-cKp and 8 CR-hvKp isolates was as follows: blaNDM (41.3, 25.0%), blaIMP (4.0, 0.0%), blaVIM (8.0, 0.0%), blaGES (14.7, 25.0%), blaOXA–48–like (20.0, 0.0%), blaCTX–M (26.7, 12.5%), blaSHV (24.0, 12.5%), blaTEM (10.7, 0.0%), blaFOX (6.7, 0.0%), blaDHA (6.7, 0.0%), blaCMY (5.3, 0.0%), blaLAT (12.0, 0.0%), and blaACT (8.0, 0.0%). ERIC-PCR showed a high diversity among isolates. In this study, the occurrence of MDR CR-hvKp isolates harboring blaNDM and blaGES was detected for the first time in southwestern Iran. To prevent the spread of CR-hvKp and reduce selection pressure, long-term surveillance and more effective treatment strategies should be implemented.

Objective: To describe and expand the phenotype of anti-MDA5-associated rapidly progressive interstitial lung disease (MDA5-RPILD) in Canadian patients.Method: All proven cases of MDA5-RPILD hospitalized in the University of Montreal's affiliated centres from 2004 to 2015 were selected for inclusion.Results: Of nine consecutive patients, RPILD was the presenting manifestation in seven, whereas two patients developed RPILD 2 years after the onset of arthritis and of chronic interstitial lung disease. In the case with arthritis, RPILD was probably triggered by initiation of tumour necrosis factor-α-inhibitor therapy. In most patients (89%), RPILD was accompanied by concomitant onset of palmar/lateral finger papules, skin ulcerations, and/or mechanic's hands. All patients experienced profound weight loss over 1-2 months (mean ± SD 10.2 ± 4.8 kg). All had arthralgias and/or arthritis. Six patients were clinically amyopathic; only one patient had creatine kinase (CK) levels > 500 U/L. Initial ferritin and transaminase levels were elevated in 86% and 67% of patients, respectively. The antinuclear antibody (ANA) test was negative for nuclear and cytoplasmic staining; antisynthetase autoantibodies were negative. Three patients died; time from initial symptoms to death ranged from 7 to 15 weeks. All six survivors received mycophenolate mofetil and/or tacrolimus as part of induction and/or maintenance therapy.Conclusion: In an inpatient setting, RPILD associated with characteristic skin rashes, profound weight loss, articular symptoms, normal or low CK with elevated ferritin, and absent fluorescence on ANA testing should alert the clinician to the possibility of MDA5-RPILD. T-cell-mediated therapies may play a role in this highly lethal condition. [ABSTRACT FROM AUTHOR]

Credit risk as a possibility of a debtor’s default in its obligations has led creditors to acquire some tools to cover it. Credit default swap as a derivative is one of the most effective risk management tools, because in addition to risk management, it provides an opportunity for the spread of secondary markets and the deepening of the capital market. Credit insurance is another type of credit risk management tool that is often confused with default swaps. Finding some homologies between credit insurance and credit default swap geos back to our legal and jurisprudential system as well as the Western law. Due to the acceptance of insurance in Islamic jurisprudence, these similarities have been used to justify credit default swap contract. In this research, an attempt has been made to draw a border between these two institutions. It should be noted that recognizing the nature of credit default swaps will affect the assessment of the validity of such a contract from a jurisprudential point of view, and this discussion is crucial as it shows the possibility of accepting credit default swaps in the Iranian capital market.

Background: Increased resistance of Candida albicans to standard antifungal agents has caused special attention to medicinal plants. The aim of this study was to evaluate the effect of Jaftex mouthwash on the growth of C. albicans and Candida tropicalis. Methods and Material: In this in vitro study, standard strains of C. albicans and C. tropicalis were used. Jaftex mouthwash was prepared with the active ingredient (10g/100cc) of aqueous extract of oak fruit hull (Jaft), Zataria multiflora, and Satureja bachtiarica. The mouthwash was diluted in half, 8 different concentrations were obtained. 10 μl volume of each dilution was poured on discs mounted linearly on the culture medium inoculated with the target fungus. After 24 h, due to the slow growth rate of these fungi, the Petri dishes were incubated at 37°C and the mean minimum inhibitory concentration (MIC) was determined for each fungus. The modified E. test method was used to measure the MIC of Jaftex mouthwash for the two fungi. The experiment was repeated three times for each fungus and the mean value was measured. Results: The mean value of MIC for C. albicans and C. tropicalis was 0.0625 (mg/mL) and 0.0833 (mg/mL), respectively. Candida albicans appeared to be more sensitive to Jaftex, but no statistically significant difference was observed. Conclusion: Jaftex mouthwash inhibits the growth of C. albicans and C. tropicalis. The use of this mouthwash is recommended for treatment of oral candidiasis.

Objectives: To evaluate the potential probiotic properties of Lactobacillus strains isolated from feces of infants and also to determine their antimicrobial activity against some enteropathogenic bacteria. Methods: The Fecal samples were prepared from 120 infants aged less than 24 months. In total, 105 Lactobacillus strains were identified by phenotypic tests. Thirty isolates were randomly selected to study their potential probiotic properties. These isolates were examined for resistance to acid (pH: 2.5, 2 h) and bile (oxgall 0.3%, 8 h), adhesion to HT-29 cells, antibiotic susceptibility, and antimicrobial activities. Results: On basis of 16S rRNA sequencing, 30 isolates identified as Lactobacillus fermentum (n = 11; 36.7%), Lactobacillus plantarum (n = 9; 30%), Lactobacillus rhamnosus (n = 6; 20%), and Lactobacillus paracasei (n = 4; 13.3%). All tested strains survived at acid and bile conditions. Six Lactobacillus strains revealed high adherence to HT-29 cells. Three strains including the L. fermentum (N2, N7), and the L. plantarum (N20) showed good probiotic potential and inhibited the growth of Yersinia enterocolitica ATCC 23715, Shigella flexneri ATCC 12022, Salmonella enterica ATCC 9270, and enteropathogenic Escherichia coli (EPEC) ATCC 43887. The antibiotic resistance test showed that all the isolates were susceptible to tetracycline, and chloramphenicol. Conclusions: Lactobacillus strains like L. fermentum (N2, N7), and the L. plantarum (N20), could be potential probiotic, but further in vitro and in vivo studies on these probiotic strains are still required.

Limited liability of shareholders of corporations is the primary principle of corporate law in most countries. Limited liability is however subject of debates by law and economic scholars. The research method applied in this research is theoretical analysis and the research approach is non-normative analyzing the possible solution without considering status que in search of most efficient solution. Limited liability is not efficient in terms of economic analysis of law, particularly in the context of company group, which is the main actor of the today’s world. The externalities created by abuse of company form exceed its benefits. Common law doctrine of veil piercing sets aside the veil of corporation and holding shareholders personally liable for company debts in case of abuses by shareholders or lack of observance of company formalities. This doctrine can modify the effect of the externalities and reduce moral hazard created by limitation of liability. Such theory or similar mechanisms, except with special regulations related to the tax and banking system, do not exist in Iran legal system. Therefore legislation in this regard is recommended.

The practice of ‘writing to learn’ has been propounded as fast-tracking the dynamic process of noticing problems in L2 writing. However, a marked melioration in learners’ attempted output requires a form of corrective feedback, among which modeling has proven to bear vigorous input enhancement effects. The present study attempted to inspect what EFL learners notice throughout their own output and exposure to model texts and how this noticing acts upon their short-term and long-term writing performance. In a repeated measure quasi-experimental design, the performance of 43 Iranian EFL learners on narrative writing tasks was collected upon pre-test, post-test, and delayed post-test. The participants indicated their noticing of linguistic problems through note-taking during the writing task followed by the exposure to two model texts and two revisions of the original writing, immediately, and two months later. The type of linguistic features noticed was studied through qualitative analysis. Paired-samples t-tests were conducted to compare students' accuracy performance before and after noticing. The results indicated that learners’ grammatical accuracy was improved by noticing. As to the nature of incorporated features, learners' noticing played a prompting role in the effectiveness of models since learners retained those lexical and grammatical features compatible with their own noticing. It is argued that the participants' engagement in output activity has increased their awareness of the required linguistic features, facilitating their noticing of those features through exposure to positive feedback. The findings provide further evidence for the constructive role of output in language learning.

Objective: To compare the effect of shallomin (pure fraction of Allium hirtifolium) with podophyllin 25% solution on external genital human papillomavirus warts in women. Methods: This study was a randomized controlled trial which was performed on two groups of 25 Iranian women with external genital warts at Imam Khomeini Hospital in Ahvaz, Iran. In the first group, shallomin was used once a day for six weeks at home. In the second group, 25% podophyllin solution, was applied on the lesion once weekly for six weeks. Results: Shallomin and podophyllin resulted in wart clearance in 13/23 (56.5%), and 12/24 (50%) of patients, respectively. The clearance rate for shallomin was not significantly different from that of podophyllin (P=0.082). Six weeks after the treatment, the sizes of the lesions in the shallomin group and the podophyllin group decreased by (1.43±0.53) mm and (1.64±0.70) mm, respectively. Conclusion: Shallomin is an effective treatment for genital warts, with similar efficacy to that of podophyllin.

This article discusses Electronic Funds Transfer (EFT) based on an assignment framework. Payment order in EFT is considered to be an assignment offer. If the Fund Transfer is considered on this basis, it must contain conditions for the emergence of an assignment and its legal consequences. In this respect, debt or credit as subject matter of this agreement is available in most cases of EFT, even if there is no debtor and creditor relationship between the issuer of the payment order and beneficiary. In terms of intent for creation an assignment, since the issuer is willing to transfer funds that is being holding by bank and there is no need for debtor’s consent and there is no fiduciary relationship between them, the legal relationship created between the issuer and the bank has to be interfered as an assignment. As regards consequences, by accepted this idea, the right of the bank to reject Fund Transfer order can easily be interpreted. Having said that, what a bank does on order after receipt of payment order should not be considered to be the acceptance of the offer, because this is a regular and preliminary process. Since the doctrine is not able to respond to some situations for Fund Transfer, including Fund Transfer to another account of the issuer, it has been subject to some criticisms.

Background: Thyroidectomy is the most frequent procedure in endocrine surgery. Since thyroid is the highly vascular organ, therefore, prompt and meticulous hemostasis is extremely important. Although conventional thyroidectomy is used frequently with acceptable outcomes, it is time-consuming and resulted in significant intraoperative blood loss with possible risk of injury to parathyroid glands and laryngeal nerves. The advent of ultrasonically activated focus harmonic device in thyroid surgery was encouraging for improving safety, effectiveness, and reduction of operative time. Aim of this Study: The purpose of this study was to analyze the effectiveness and surgical outcomes of using ultrasonic harmonic scalpel for thyroid surgery compared to conventional techniques (clamping and suture ligation (knots tying) and electrocautery. Patients and Methods: This is a prospective, randomized study in which 64 patients with various types of goiters presented for thyroidectomy. The patients were divided into two comparable groups. Group A (32 patients) included patients who had focus harmonic thyroidectomy and Group B (32 patients) included patients who received conventional thyroidectomy. Results: Focus harmonic thyroidectomy showed significant reduction in operative time, intraoperative blood loss, volume of postoperative fluid drainage, and postoperative pain scores compared with conventional thyroidectomy. There were no significant differences in the incidence of postoperative hypocalcemia and laryngeal nerve injury between both the groups. The total cost of focus harmonic thyroidectomy and hospital stay were also less compared with conventional techniques. Conclusions: Focus harmonic thyroidectomy was a safe, effective, faster, and beneficial alternative to conventional technique since it reduces the time of surgery, blood loss, postoperative drainage, and pain with comparable postoperative complications.

LAPAROSCOPIC VERSUS OPEN REPAIR OF PERFORATED PEPTIC ULCER Abutalib B Alluaibi@, Ali Y Al-Wajeeh$ & Mansour Amin Mohammed* @MB,ChB, FIBMS, General Surgeon, Al-Mawanee General Hospital, Basrah. $MB,ChB, CABS, General Surgeon, Al-Mawanee General Hospital, Basrah. *MB,ChB, DS, CABS, MRCS, Lecturer, Dept. of Surgery, College of Medicine, Basrah, IRAQ. Abstract Peptic ulcer is the most common GIT disorder with a prevalence of 2%, peaking around the age of 70 years. Laparoscopic repair of perforated peptic ulcer began to evolve and replace the ordinary upper laparotomy. We studied 47 patients suffering from perforated duodenal or gastric ulcer in Al-Mawanee General Hospital in Basrah in the period 2014-2017, the patients were categorized into 2 groups: 1st group(24 patients) managed laparoscopically and the 2nd group (23 patients) managed by open approach. Perforation found to occur more with duodenal ulcer (29 pt. 61.70%) and more in male patients (26 pt. 55.33%). The peak perforation seen in age group >60 years and the commonest risk factors was the NSAIDs usage. Operative time was insignificantly longer in laparoscopic approach. However, the laparoscopic approach has less post operative pain and less overall complications (4 pt. 16.6% vs. 8 pt. 34.7%). In conclusion, laparoscopic repair of perforated peptic ulcer is a feasible operation and considered promising with less postoperative pain, less postoperative complications and better cosmetic results.

A COMPARATIVE STUDY BETWEEN HARMONIC SCALPEL HEMOSTASIS AND CONVENTIONAL HEMOSTASIS IN TOTAL AND SUBTOTAL THYROIDECTOMY Mohammed Salim Mohammed*, Jasim D Saud#, Mansour Amin Mohammed$ & Mazin H Al-Hawaz@ *MB,ChB, Board Candidate. #MB,ChB, FICMS, CABS, Consultant Surgeon, Basrah General Hospital. $MB,ChB, DS, CABS, MRCS, Lecturer, Dept. of Surgery, College of Medicine. @ MB,ChB, CABS, DGS, FRCS, Prof. of General Surgery, Basrah Medical College., Basrah, IRAQ. Abstract Thyroid gland is highly vascularized organ, so good hemostasis during total or sub-total thyroidectomy is crucial to decrease the complications and to improve the outcome. This study aimed to evaluate the advantages and disadvantages of using harmonic scalpel device in comparison with conventional hemostasis for total and subtotal thyroidectomy in terms of operative time, nerves injury, post-operative blood loss, hematoma development, hypocalcemia and length of hospital stay. This study included 80 patients who underwent total or subtotal thyroidectomy. They were divided into two groups according to the type of hemostasis: conventional hemostasis group and harmonic hemostasis group. Different diseases were included (multinodular goiter, toxic goiter and malignant diseases). The results showed that time of operation was significantly shorter in the harmonic hemostasis group (79.52±14.98 min) than conventional hemostasis group (100.92 ±10.64 min) with p value 0.0001, also post-operative blood loss was lower in harmonic hemostasis group (52.5±26.23 ml) than conventional hemostasis group (75.13±17.8 ml) with p value 0.0001. Other outcome such as recurrent laryngeal nerve injury, post-operative hematoma, post-operative hypocalcemia and length of hospital stay did not show significant difference between the groups. In conclusion, using harmonic scalpel device in total or subtotal thyroidectomy reduced the operative time and post-operative blood loss, without any change in the incidence of nerve injury, hematoma, hypocalcemia and the length of hospital stay.

Background: University students are a target population for a number of research studies due to a high prevalence of mental health and psychosocial problems. Aims: To examine the relationship between depressive symptoms, hostility, and substance use among university students in Jordan. Methods: This is a descriptive correlation study. Data were collected on demographics, depressive symptoms, hostility, and substance use from 572 university students in Jordan. Results: Almost 75% of the university students exhibited some degree of depressive symptoms. Tobacco, painkillers, stimulants, tranquilizers, inhalants, and alcohol respectively were the most used substances. Depressive symptoms were positively correlated with hostility and tobacco use. Similarly, depression had a positive correlation with the frequency of using painkillers, inhalants, stimulants, tranquilizers, and heroin. Male and female university students were not different in their depressive symptoms, hostility, and frequency of substance use. Conclusions: Depressive symptoms, hostility, and substance use were positively correlated. Mental health care providers need to understand the relationship between depressive symptoms and hostility and substance use among university students in Jordan. [ABSTRACT FROM AUTHOR]

Background: Chlamydia trachomatis (C. trachomatis) is the main cause of bacterial sexually transmitted infections. In women, this infection can lead to tubal infertility. Objective: In this study we investigated C. trachomatis among infertile and fertile women with both polymerase chain reaction (PCR) and ELISA methods in Ahvaz, Iran. Materials and Methods: This case-control study was conducted at the Infertility Clinic of University Jahad, Ahvaz, Iran from January to August 2017. A total of 225 vaginal swabs and blood samples (100 infertile and 125 fertile women) were collected. Detection of C. trachomatis DNA was performed from vaginal swabs by amplification of MOMP gene. Also, anti C. trachomatis immunoglobulin M (IgM) and immunoglobulin G antibodies in the serum samples were recognized by enzyme-linked immunosorbent assay (ELISA). Results: Results showed that, 6 (6%) infertile and 2 (1.6%) fertile women were positive for IgM (p=0.21). Also, PCR was positive for C. trachomatis infection in 5 infertile (5%) and 2 fertile women (1.6%) (p=0.35). We did not find any seropositive immunoglobulin G in both groups. Conclusion: In this study, no significant difference was found between fertile and infertile groups for C. trachomatis infection. Also, the correlation between IgM and PCR results revealed a relatively strong agreement and seems both PCR and IgM assays are appropriate for the accurate diagnosis of C. trachomatis infections.