Visual acuity, refraction error, age at onset, age at surgery, interval between onset and surgery, amblyopia, anisometropia and type of surgery were found not to influence the surgicaloutcome. A similar finding was reported by Keenan et al.  regarding the effect of these factors on the outcome except, that visual acuity was not involved in his analysis. Although other studies found that visual acuity  and refractive error  affect surgicaloutcome, patients with higher myopic refractive errors tend to have less favorable outcome (larger postoperative deviation). A study by Yoo and Kim  revealed that the postoperative surgicaloutcome was influenced by the duration of the misalignment, rather than the age at surgery. Surgery within 24 months of misalignment favourably affected the percentage of patients who achieved successful outcome in the treatment of infantile exotropia. The study done by Jeoung et al.  found significantly higher surgical success in patients with unilateral recess/resect procedure than those having bilateral lateral rectus recession. The same result was also found by Millan et al.  but preoperative deviation was up to 60 PD. However, it did not result in successful outcomes for deviations of over 65 PD . Other of studies have evaluated the effect of these factors on the response of surgery, we found that the response of surgery was only positively correlated with preoperative angle of deviation in which the response of surgery increased as the preoperative angle increases as you are doing more amount of surgery, this has been demonstrated in previously studies [9-12,15-16].
Corticosteroid are the mainstay of uveitis therapy. The amount and duration of corticosteroid therapy must be determined on an individual basis. The minimum amount needed to control inflammation should be prescribed to reduce complications of the treatment. If steroid therapy is needed longer than 2-3 weeks, the dosage should be tapered before discontinuation. The dosage may need to be increased when surgical intervention is required to prevent exacerbation of the uveitis postoperatively.
Thus all patients diagnosed having primaryexotropia i.e., constant and intermittent (poorly controlled and basic type) were selected for this study based on inclusion and exclusion criteria. The lower age for inclusion was 5 years as I wanted to limit my study to the patients in whom accurate measurements could be obtained with the prism cover test. The selection was completed after permission of the Jinnah Postgraduate Medical Centre Ethical Committee and informed consent which was taken from the patients and in case of small children from their parents. Purpose and procedure of the study were explained to all patients. After explaination of the surgical procedure patients underwent surgery i.e., lateral rectus muscle recession (maximum upto 10 mm) and medial rectus muscle resection (upto 6 mm) of one eye, according to the park’s method (Table 1)  based on prism cover test measurements obtained with the appropriate optical correction in place. Surgery was performed by a single surgeon under local anaesthesia in adults but children were operated under general anaesthesia.
In the present investigation, inclusion criteria were strictly established and postoperative rehabilitation was done using the same protocol at our institution. There- fore, only surgicalfactors could be assessed and dis- cussed. Several surgicalfactorsaffecting the wound healing after TKA has been reported so far. For example, surgicalfactors include the location of the incision, lon- ger tourniquet use, and poor soft tissue handling. Previ- ous studies indicated that medial parapatellar skin incision provided the worse outcome of the wound heal- ing than anterior midline skin incision . Neverthe- less, in the more recent study, wound healing of these two incisions were reported to be similar . In the current study, for that reason, medial parapatellar skin incision was used. Concerning the tourniquet time, Olivecrona et al. reported that tourniquet time over 100 min was associated with an increased risk of com- plications after TKA (OR 2.2, CI 1.5–3.1) . In our Table 1 Hollander Wound Evaluation Score (HWES) 
34 from 44 grafts were treated successfully by surgery (77.3%). Thrombectomy alone was sufficient in 6 cases (17.6%). In 28 cases (82.4%) underlying causative le- sions. e.g. anastomotic stenosis were unmasked and treated by patch (proximal or distal anastomosis) (20.5%) or angioplasty alone (20.5%) or patch in combination with an angioplasty (8.8%). In case of persistent occlu- sion blood flow was restored by jump bypass or new bypass graft (32.3%). 2 bypass grafts couldn’t be re- opened. Reocclusion occurred in 6 cases in the first 30 days. 2 patients died a few days after thrombectomy; one due to acute myocardial infarction and one due to persis- tent limb ischemia with progredient ischemia and pallia- tive therapy. After a median observation time of 14.7 months (1 - 56 months) 4 further patients in thrombolysis group and 5 patients in thrombectomy group were de- ceased. 30 of 48 (62.5%) bypass grafts treated with in- traarterial thrombolysis overall were patent. Primary pate- ncy in thrombolytic group was 46.7%. 16 patients (53.3%) needed a reintervention. 12 patients received surgical treatment due to reocclusion (6 new bypass grafts, 2 jump bypasses, 4 patches) and 9 patients a major amputation. 4 patients needed a percutaneous transluminal angioplasty.
Postoperative alignment was measured on postoperative day 1, month 1, 3, 6, year 1, and at final follow-up. The main outcome measures included the postoperative esode- viation angles at each follow-up day, the final success rate, and the factorsaffectingsurgical outcomes (i.e. sex, age at onset, age at surgery, refractive error, symptom duration, amblyopia, stereopsis, fusion by Worth-4-dot, alternate fix- ation, accompanying strabismus, preoperative follow-up period, and type of surgery). Surgical success was defined as esotropia or exotropia of 8 PD or less at distance and near.
Primary posterior capsulotomy and anterior vitrectomy are considered “routine surgical steps,” especially in younger children. Previously, preparation for secondary intraocular lens (IOL) implantation at a later date was not considered. However, widespread acceptance of IOL im- plantation in children has caused this to be revised. Thus, management of the posterior capsule should eliminate or delay the formation of visual axis opacity and yet leave sufficient capsular support to achieve the desired “in- the-bag” (or ciliary sulcus) fixation of an IOL. Even when IOL implantation is not performed with the pri- mary procedure, it is important to treat and prepare the eye in such a way that secondary implantation can be achieved subsequently.
The patients suffering from infective keratitis were selected and treated medically. For the cases which did not improve by medical treatment, surgical treatment using therapeutic penetrating keratoplasty was done and the The patients were followed up and assessed at the end of one month and one year and the outcome was analysed considering the following factors.
Controlling divorce is highly difficult. However, parents during their marriage, communication and management of divorce period should be managed so that harm to children will be minimized. This can be considered helpful. Regarding this matter, parents can receive regular educational lessons as it is hard to anticipate when one will be divorced.
In our study we did not have patients with high degree of hyperopia witch according to some publication has been thought to be an important risk factor in producing a consecutive exotropia . Amblyopia—another factor witch increase the risk of developing consecutive XT was found in 67.6% in our series. It is very important that amblyopia be fully treated in childhood and even after surgery the treatment of residual amblyopia should con- tinue as a good visual acuity and binocular vision are factors of postoperative stability and can prevent the later exodrift.
Generalized hypoperfusion (fatal if persistent) may result from oligemic, cardiogenic, endotoxic and neurogenic shock. Local limb hypoperfusion may result from injured blood vessels and may lead to tissue destruction and death of affected organ. Prevent further blood loss by direct pressure. Replace fluid losses- trendelenberg position, auto transfusion, whole blood transfusion. Resuscitate by IV sodium chloride or ringer lactate. Correct acidosis. If required (ph <7.25) inject sodium bicarbonate. Monitor sensorium, urine output, pulse rate, ECG and data from CVP line (if facilities are available). Shock is usually controlled while the patient’s airway is cleared by another person. Internal hemorrhage will require immediate surgical intervention. Hypovolemic shock is best prevented or controlled by starting intravenous infusion in atleast 2 extremities. A balanced solution like Ringer’s lactate is usually started until blood is available. Blood for typing and cross matching is also drawn. Response to therapy is monitored by skin perfusion, urine output and CVP readings.
The aim of this research is to assess the relationship among the smoking status of primary school children with demographics and the smoking characteristics of their parents. In addition, to identify any factor(s) considered strong predictor(s) of academic achievement. A descriptive cross-sectional design was used in this study. A cluster random sample of 453 primary school children was obtained from both genders. Smoking was measured by the self-reported smoking behavior questionnaire and the educational achievement was measured by “Jordan Certificate of Primary Education.” The results indicate that there is a significant correlation between smoking status r pb ((451) = -.44, p < .001), age of smoking initiation r ((451) = -.30, p < .001), daily
subscales representing different strategies chosen by mothers to settle children to sleep: 1) Active Physical Comforting (e.g. the use of cuddling or settling in the parental bed; 2) Encouraging Autonomy (e.g. leave to cry; 3) Settle by Movement (e.g. the use of car or stroller rides; 4) Passive Physical Comforting (e.g. standing next to the cot without picking the infant up); 5) Social Comforting (e.g. talking softly). Mothers were asked to rate how frequently they used each of these behaviours to settle their child to sleep, on a five-point scale, from 0 (never) through to 4 (very often). High scores indicated this strategy was used more commonly by mothers to settle their infants. Morrell & Cortina- Borja (2002) demonstrated the reliability and validity of the PIBBS in several studies. In a sample of 99 mothers and their 13 month old infants, Cronbach’s alpha was reported as 0.71 indicating moderate internal consistency for the test items. The PIBBS was also found to be correlated significantly with entries recorded in Richman’s sleep diary (r = .73, p < .001) thus demonstrating convergent validity. As the PIBBS assessed different but moderately correlated behavioural strategies, the authors suggested that the subscales should be used rather than the total score (Morrell & Cortina-Borja, 2002). For the purpose of this study only the Active Physical Comforting subscale (6 Items) was used. Cronbach’s alpha for the Active Physical Comforting factor was .72 indicating moderate internal consistency.
Mode of delivery in the study was vaginal in 56.4% and caesarean section in 43.6%. This was not statistically significant. There are many factors that led to this outcome like maternal age, parity, gestational age at which the women were induced, BMI, Bishop score, indication of induction and method of induction which were explained earlier. A recent study in 2016 showed that 63.5% had vaginal delivery and 36.5% had caesarean section following induction of labour. 18
The aforementioned studies were either indicated pre- vention programs (youth with elevated symptoms) or selective prevention programs (youth with a high risk because of parental illness only). In our study, we aim at combining the two and thus selecting ultra high risk offspring. In line with earlier studies, we select youth with current symptomatology (of anxiety or mood). In addition, we wanted to make a selection of the symptom- free children. We know that some of the offspring may develop disorders over time, even though they currently do not report such symptoms. Recently, we have devel- oped a prognostic index that predicts the development of anxiety or mood disorders in offspring (High Risk Index (HRI; de Vries, Landman-Peeters, Burger, Reichart, Nauta, den Boer, Nolen, Ormel, & Hartman: Predicting mood- and anxiety disorders in offspring of patients with a depressive disorder, unpublished manuscript)). This was done on the basis of a study examining offspring (n = 434) of patients with a unipolar mood disorder in a large prospective study, the ARIADNE-cohort (Adoles- cents at Risk of Anxiety and Depression, and Neurobio- logical and Epidemiological approach ). Three factors were associated with an increased risk of developing anx- iety or mood disorders: female sex, having two affected parents, and suicide attempt(s) of one of the parents. In children with two or three risk factors (20% of the sam- ple) the cumulative incidence of mood and anxiety disor- ders was 70% at the age of 20. In children with one or no risk factor, percentages dropped to 45% and 25% re- spectively. In the current study, inclusion is therefore
The induction of Islamic Banking System was aroused around the world of Muslim that they are able to do their business as the Islamic teaching gives direction according to the Shariah rules and regulation (Khan et al, 2012). Islamic banking system was in place but it was not focused by the scholars or the preachers but in 1963 only bank was established on the Islamic principles with the name of MitGhamr Saving Bank in the Egypt; it was not a successful effort because they were not able to focus upon the management and marketing of the bank (Obeid et al, 2016). The purpose of the research is to examine or investigate those factors that are impacting upon adaptation of Islamic perspective of banking in regard with Iraq. Iraq is a Muslim country and they are in the rehabilitation phase in which infrastructure development, economic activities and revival of political stability is going on; so it will be effective to undertake the Islam’s perspective banking in the state will be a different feature to undertake the provide effective platform to the people of Iraq to conduct their business according to the Islamic teaching adequately (Ameen and Willis, 2015). The study includes different variables on the basis of the need and the preferences based upon the importance in the study.
Definition of terms: Cured: a patient whose sputum smear or culture was positive at the beginning of the treatment but who was smear or culture negative in the last month of treatment and on at least one previ- ous occasion. Treatment completed: - a patient who completed treatment without evidence of failure but with no result to show that sputum smear or culture result in the last month of treatment and on at least one previous occasion were negative either test were not done or because results are unavailable. Treatment failure: a patient whose sputum smear or culture is positive at 7 months or later during treat- ment. Died: - a patient who dies for any reason during or before starting the course of treatment. Lost to fol- low-up: - a patient who did not start treatment or whose treatment was interrupted for the consecutive two months or more. Not evaluated: - a patient for whom treatment outcome not assigned. This includes cases “transferred out” to another treatment units as well as cases for whom the treatment outcome is not known for the reporting unit. Treatment success: - the sum of cured and treatment completed (9).
while the remaining underwent either tonsillectomy or adenoidectomy alone. The four patients in that study who did not have evidence of adenotonsillar hypertrophy on DISE underwent medical management only. Overall, DISE changed the management from the traditional AAP-based paradigm in 9/37 (24%) patients, which is not significantly different from ours (35%), only that their sample size was considerably smaller. Another German study on 25 children simi- larly claimed that a 20% change in the initial manage- ment plan was observed . Boudewyns et al.  also reported that findings other than adenotonsillar obstruction were found in 57% of patients, which is again in agreement with our study. Additionally, they also identified two patients (5%) with LM, consistent with our findings, but on the other hand, they did not find any lingual tonsil hypertrophy nor did they comment on significant chronic rhinitis. Their study reported a surgical success rate of 91% in the 22 patients who had PSG data available, indicating good outcomes based on DISE-directed surgery.
tendons in children <5 years age resulting in greater effect of recession and changes in the periocular tissue in long-standing exotropia in older children, requiring augmented dosage to overcome their elastic forces. 67 68 In the authors’ opinion, best outcomes are obtained between 4 and 7 years of age allowing for more accurate preoperative evaluation, reducing the chances of post- operative suppression and amblyopia and good motor alignment (except in case of large angle of exotropia with poor or worsening control and stereopsis, in which case an early surgery is indicated).
When OCR occurred after first mechanical stimulation of the EOM, the counter-regulatory process could lead to the adaption of a subsequent stimulus, due to the oc- currence of OCR. We speculated that this process could affect the infrequency of OCR in the second operated muscle. Thus, the first operated muscle, with multiple surgeries, might be vulnerable to OCR, regardless of the specific muscle or surgical technique. Machida et al. re- ported that uniformed and objective EOM tension with- out atropine as premedication and recovery for OCR were evaluated at the strabismus surgery .