Purpose: to review recent literature concerning long-term health issues and transitional care in esophageal atresia (EA) patients. PubMed, Scopus, Embase and Web of Science databases were screened for studies regarding EA patients aged more than or equal to 11 years, published between August 2014 and June 2022. Sixteen studies involving 830 patients were analyzed. Mean age was 27.4 years (range 11–63). EA subtype distribution was: type C (48.8%), A (9.5%), D (1.9%), E (0.5%) and B (0.2%). 55% underwent primary repair, 34.3% delayed repair, 10.5% esophageal substitution. Mean follow-up was 27.2 years (range 11–63). Long-term sequelae were: gastro-esophageal reflux (41.4%), dysphagia (27.6%), esophagitis (12.4%), Barrett esophagus (8.1%), anastomotic stricture (4.8%); persistent cough (8.7%), recurrent infections (4.3%) and chronic respiratory diseases (5.5%). Musculo-skeletal deformities were present in 36 out of 74 reported cases. Reduced weight and height were detected in 13.3% and 6% cases, respectively. Impaired quality of life was reported in 9% of patients; 9.6% had diagnosis or raised risk of mental disorders. 10.3% of adult patients had no care provider. Meta-analysis was conducted on 816 patients. Estimated prevalences are: GERD 42.4%, dysphagia 57.8%, Barrett esophagus 12.4%, respiratory diseases 33.3%, neurological sequelae 11.7%, underweight 19.6%. Heterogeneity was substantial (> 50%).Conclusion: EA patients must continue follow-up beyond childhood, with a defined transitional-care path by a highly specialized multidisciplinary team due to the multiple long-term sequelae.   The online version contains supplementary material available at 10.1007/s00431-023-04893-6. Esophageal atresia (EA) is a rare congenital disorder consisting of the disruption of the esophageal continuity, with or without the persistence of a tracheoesophageal fistula (TEF). The estimated birth incidence is 1:2500–3000 live births with a slight male preponderance [The aim of this study was to review the recent literature concerning long term follow-up and transitional care in adolescent and adult EA patients, in particular to determine whether structured transitional care programs are being followed and their impact on patients’ health.This review was performed according to the PRISMA   and SWiMPubMed, Embase, Scopus and Web of Science were screened electronically until July 2022, using the key words “transitional care AND esophageal atresia OR long term follow-up AND esophageal atresia”. The search and selection criteria were restricted to the English language. Reference lists of relevant articles and reviews were hand searched for additional reports. The publication span included the period August 2014–June 2022.Inclusion criteria were: (1) original studies and (2) sufficient data concerning EA patients aged equal or more than 11 years. The age limit of 11 years old was defined in order to have enough long-term follow-up for outcome evaluation and to avoid including in the analysis younger children. Two authors (GB and MG) reviewed all abstracts independently. Agreement about potential relevance was reached by consensus, and full-text copies of those articles were obtained. Quality assessment was performed by two authors (GB and MG) using the Newcastle–Ottawa Scale .For the descriptive analysis we excluded: (1) articles published before August 2014 to avoid overlap with the results of another exhaustive meta-analysis that summarized the literature from 1993 to July 2014 [Studies were assessed according to the following variables: population , clinical characteristics , surgical features  and outcomes grouped by systems . The same reviewers mentioned above independently extracted relevant data regarding study characteristics, patients’ features, and outcomes. Inconsistencies were discussed by the reviewers and consensus reached. If more than one study was published for the same cohort with identical end points, the report containing the most comprehensive information on the population was included to avoid overlapping populations. Results are presented with descriptive statistics. Quantitative variables were summarized as mean and ranges, while qualitative variables were summarized as frequency rates. Results for each outcome were calculated considering the subtotal of patients obtained by the studies that reported the outcome. Statistical analysis was performed using Microsoft Office Excel.2 statistic was then applied in order to estimate the amount of inconsistency between included studies , and the following categorization was taken in account: I2 ranging between 0 to 25% = low heterogeneity; I2 ranging between 26 and 50% = moderate heterogeneity; I2 ≥ 50% = substantial heterogeneity. Publication bias was then investigated through calculation of the contour-enhanced funnel plots, and Egger test for quantitative publication bias analysis (at a 5% of significance level). Radial plots were then calculated and visually inspected to rule out small study bias. All analyses were performed by means of “meta”, “metafor”, and “robvis” packages with R (version 4.0.3) and RStudio (version 1.1.463) software. The aforementioned packages are an open-source add-ons for conducting meta-analyses.Additionally, pooled estimates for the occurrence of main findings were calculated through a meta-analysis that, in order to cope with the presumptive heterogeneity in study design, was designed through a random effect model. I1025 articles were screened. Excluding duplicates, 16 articles met the inclusion criteria and were considered for descriptive analysis, including 830 patients, while 11 articles met the inclusion criteria for the meta-analysis, with a total of 816 patients . Sex was specified in 507 patients: 259 (51%) were male, 248 (49%) female. The most common subtype (according to Gross classification) was type C , followed by: type A , type D , type E  and type B . In 324 (39%) cases the subtype was not described. The reported associated congenital anomalies were: cardiac in 53 patients (6.4%); gastrointestinal in 28 (3.4%); vertebral in 27 (3.2%); renal in 23 (2.8%); musculoskeletal in 8 (1%); VACTERL/VACTER association in 17 (2%); other than the previously cited in 19 (2.3%). In 472 (57%) cases the presence or absence of other congenital anomalies was not reported. The type of repair was reported in 496 patients: the most common was primary repair , followed by delayed repair , and esophageal substitution . In the latter subgroup, the transposition performed was gastric in 37 cases, colonic in 5 and jejunal in 2; the transposed organ was not specified in 8 cases. Concerning other surgeries during childhood, esophageal dilatations are reported in 142 patients (17%), with a range of 1–108 dilatations per patient [All studies reported data concerning gastrointestinal outcomes. One hundred sixty one patients , 20 wereRespiratory outcomes were reported in 600 out of 830 patients. Nineteen patients underwent prospective clinical examination, spirometry and spiroergometry . PersistMusculoskeletal outcomes were described in 74 patients. Recent X-ray examinations were reviewed in 4 cases . ScoliosNeurological sequelae were delineated in 135 patients: there are 12 reported cases of mental retardation (8.9%) and 1 of cerebral palsy (0.7%).Mental health and quality of life (QoL) were evaluated in 5 studies, totaling 208 patients; a reduced QoL compared to healthy peers was identified using validated questionnaires in 19 cases (9%). Mental disorders were present in 20 patients (9.6%): depression in 9, PTSD (post-traumatic stress disorder) in 6 and a raised risk to develop an overt mental illness in 5 .Among other long term outcomes observed (700 patients), 93 patients (13.3%) were underweight and 42 (6%) had a reduced height compared to general population, while only 13 patients were obese (1.8%). 3 patients (0.4%) underwent a renal transplant in adulthood. Chronic anemia was reported in 18 cases (2.6%), 15 of whom were corrected through gastric transposition. Allergy or food intolerance were described in 9 patients (1.3%). Interestingly, 72 patients (10.3%) had no care provider .Eleven studies with more than 5 patients were considered for meta-analysis after quality assessment with New-Ottawa scale Table . A totalTen studies reported data on GERD (340 patients). The estimated prevalence is 42.4%, with a 95% CI  of 33.2% to 52.1% and heterogeneity of 80%.Dysphagia was reported in 9 studies (280 patients), with an estimated prevalence of 57.8% (95% CI 37.1% to 76.1%) and heterogeneity of 90%.Barrett esophagus was described in 4 studies (64 patients). The estimated prevalence is 12.4% (95% CI 3.1% to 38.3%) and heterogeneity of 88%.Overall, respiratory sequelae  were reported in 6 studies (115 patients), with an estimated prevalence of 33.3% (95% CI 10.1% to 69%) and heterogeneity of 92%.Neurological sequelae were described in 3 studies (18 patients). Estimated prevalence is 11.7% (95% CI 6.7% to 19.8%), with a heterogeneity of 58%.Lastly, 6 studies reported 93 underweight patients, with an estimated prevalence of 19.6% (95% CI 11.6% to 31.1%) and heterogeneity of 86%.Details of the meta-analysis can be found in the Advances in surgical techniques and intensive care have resulted in a radical improvement in the survival of patients with congenital anomalies as EA. At the same time, these advances present new challenges for the pediatric surgeon, by creating a subset of adult patients with characteristic long-term outcomes and specific needs. Transitional care has been defined as a planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health-care systems . It is gThe analyzed sample includes 830 adolescent and adult EA patients’, aging from 11 to 63 years. Findings concerning long term outcomes were consistent with other reports in literature, in particular with a recent meta-analysis by Connor et al. , as gastRespiratory symptoms have been underreported compared to digestive ones, being specified in 600 out of 830 patients. The most common were persistent cough (8.7%); chronic respiratory diseases (8.7%) and recurrent respiratory infections (4.3%); our data were not sufficient to determine the correlation with GERD. Respiratory symptoms reported in EA children can persist in adulthood, as already highlighted in previous studies . The etiThe musculoskeletal morbidities described appear consistent with those thoroughly reported in literature . AlthougConsidering neurological outcomes, 8.9% of patients were diagnosed with mental retardation; it was not possible to define the correlation with prematurity, associated congenital anomalies or other perinatal factors. Impairment in motor and cognitive function in EA children are well described in literature . Early iAccording to our data, 9% of patients reported a reduced QoL and 9.6% presented a mental disorder or a raised risk to develop one. An adequate transitional care program, including psychiatric and psychological support, can prevent development and worsening of such conditions, whereas the absence of such programs cause patients to feel “thrown into the unknown” , negativInterestingly, a reduced weight (13.3%) and height (6%) can persist in adult EA patients. A recent study , highligLastly, 10.3% adult EA patients reported to have no care provider ; this daThe meta-analysis allowed us to define estimated prevalence for major outcomes , confirming that a significant proportion of EA patients is affected by long term health problems with a potentially high impact on quality of life. The most significant outcome appears to be dysphagia, with an estimated prevalence of 57.8%. However, due to the substantial heterogeneity of the included studies, no conclusions concerning the effective impact of these conditions can be drawn. Prospective transitional care programs can be useful to define the prevalence of long-term outcomes and how they can be reduced with adequate follow-up.Limitations and bias derive from the features of the studies included in this review: most studies are retrospective studies lacking some of the target data, therefore a complete evaluation of all long-term outcomes was not possible and a more extensive meta-analysis could not be performed. Furthermore, no study reported transitional care programs and a long-term evaluation of their impact on patients’ health.It is well known that numerous long-term outcomes can persist in EA patients throughout adolescence and adulthood. Patients with congenital malformations seek for information concerning transfer to adult care and require a regular follow-up by specialized centers . AlthougSupplementary file1 (DOCX 16 KB)Below is the link to the electronic supplementary material.


To evaluate hand-assisted laparoscopic donor nephrectomy (HALDN) in terms of intraoperative and postoperative results.After institutional review board approval was obtained, a total of 1864 HALDN operations performed between March 2007 and January 2022 were retrospectively analyzed. Age, sex, body mass index (BMI), status of smoking and presence of previous abdominal surgery, laterality, operative time, transfusion requirement, port counts, length of extraction incision, time until mobilization, time until oral intake, donor serum creatinine levels before and one week after the surgery, length of postoperative hospital stay, intraoperative complications, and postoperative recovery and complications were recorded and statistically analyzed. Multiple renal arteries, BMI, right nephrectomy and male sex were also separately evaluated as risk factors for complications and operative time.A total of 825 (44.26%) male and 1039 (55.74%) female patients were enrolled in the study. The mean age of the patients was 45.79 ± 12.88 years. There were a total of 143 complications  consisting of 68 (3.65%) intraoperative and 75 (4.02%) postoperative complications. Open conversion was necessary for 10 patients (0.53%) to manage intraoperative complications. Reoperation was needed for 1 patient due to bleeding 6 h after the operation. Multiple renal arteries were a risk factor for intraoperative complications and prolonged operative time. Right nephrectomy and male sex were also related with longer operative times.HALDN is a safe procedure associated with low complication rates. Kidney transplantation is the best treatment option for end-stage renal disease. As minimally invasive surgery has become more popular, living donor nephrectomy has evolved from open surgery to laparoscopic and robotic surgery. Laparoscopic donor nephrectomy (LDN) has been accepted as the standard method of kidney procurement from live donors .Minimally invasive surgical techniques have the advantages of less postoperative pain, shorter hospital stay, less incisional morbidity, shorter recovery time and better cosmetic results . Since dLDN was first described by Ratner and colleagues . ModificThis study presents our 15 years of experience with HALDN in 1864 patients, underlying the technical experience of our center, as well as reviewing the incidence and type of perioperative and postoperative complications encountered.st hour and 24th hour VAS score, length of postoperative hospital stay, intraoperative complications, and postoperative recovery and complications.This study included 1864 consecutive kidney donors who underwent HALDN procedures between March 2007 and January 2022. All medical data were collected retrospectively from a single transplant group. The following parameters were recorded: donor age, sex, body mass index (BMI), status of smoking and presence of previous abdominal surgery, laterality, operative time, transfusion requirement, port counts, length of extraction incision, time until mobilization, time until oral intake, donor serum creatinine levels before and one week after the surgery; 1Multiple renal arteries, BMI ≥ 30, right LDN and male sex were picked as risk factors for complications and compelling factors for the procedures according to the current literature . These tThe standard approach was HALDN, and all donor nephrectomies were performed by the same surgical team with the same standard technique . We usuaKocak’s modified Clavien classification system for HALDN procedure was used to grade all intraoperative and postoperative complications as a standard method . The nonSPSS version 25 was used for statistical analysis. All numerical data were extracted as the mean ± standard deviation. Chi-square test was used to compare complications, open conversions and nonnumerical demographic data. Mann-Whitney U test was used to compare numerical demographic data, port counts, length of incision, operative time, time until mobilization, and time until oral intake after completing homogeneity evaluation. The odds ratio for multiple renal arteries, BMI, right LDN, and male sex in terms of complication rates were also calculated with Fisher’s exact probability test.2. A total of 163 (8.7%) right and 1701 (91.2%) left HALDN were performed. All demographic data are summarized in There were a total of 825 (44.26%) male, 1039 (55.74%) female patients enrolled. The mean age of the patients was 45.79 ± 12.88 years (range: 18–84 years). The mean BMI of the patients was 27.58 ± 4.5 kg/mThe mean operative time was 86.68 ± 36.31 min . The mean length of hospital stay was 2.00 ± 1.15 days. The mean time to oral intake was 7.28 ± 1.1  h. A total of 398 (21.3%) patients were with multiple renal arteries. The mean preoperative and postoperative day 7 serum creatinine values of the donors were 0.74 ± 0.15 mg/dL and 1.15 ± 0.27 mg/dL, respectively. Postoperative mean first hour VAS score was 4.46 ± 2.30 and postoperative 24-h VAS score was 0.49 ± 0.77. The mean port count was 2.19 ± 0.58 , the mean length of incision was 6.92 ± 0.83 cm .All intraoperative complications are summarized in There were 10 open conversions (0.53%). Eight of these conversions were related to renovascular and vascular complications: 2 renal artery injuries, 1 renal vein injury, 1 inferior vena cava injury, 1 lower pole artery injury, and 3 stapler incidents. The other 2 conversions were due to adrenal bleeding. The estimated blood loss for most of the kidney donors in this study was negligible; only 4 (0.21%) of patients required blood transfusion.In total, there were 75 (4%) postoperative complications  complications using the proposed classification system; 41 (34.7%) of the complications were defined as grade 1, 19 (16.10%) as grade 2a, 40 (33.80%) as grade 2b, 10 (8.40%) as grade 2c, and 8 (6.70%) classified as grade 3. There were no grade 4 complications .There were a total of 372 patients with multiple renal arteries. The intraoperative complication rate was 5.10% (20 patients) for patients with multiple renal arteries versus 1.70% (25 patients) for patients with single renal arteries (p < 0.01). Multiple renal arteries were defined as a risk factor for intraoperative complications with a 2.99 odds ratio. Multiple renal arteries were also related with longer operative time compared to single renal arteries.2. Obesity was neither a risk factor for intraoperative complications nor a factor for prolonged operative time.A total of 589 (31.5%) donors had a BMI greater than 30 kg/mIn this series of HALDN patients, right donor nephrectomy was performed with a rate of 8.70% (163 patients). Mean operative time was longer for right donor nephrectomies when compared to left donor nephrectomies with durations of 106.32 ± 30.27 min vs. 84.71 ± 36.22 min, respectively (p < 0.01). Right donor nephrectomy was not a risk factor for intraoperative complications (odds ratio: 1.90).Mean operative time was longer for male donors compared to female donors with durations of 90.52 ± 34.95 min vs. 83.67 ± 37.08 min, respectively (p < 0.01). Male sex was not a risk factor for intraoperative complication rate.Multiple renal arteries were defined as a risk factor with a 2.99 odds ratio. BMI ≥ 30, right nephrectomy, and male sex was not a risk factor for complications . MultiplPerioperative and postoperative outcomes of 1864 consecutive HALDN cases from a single group are summarized in this study. The overall complication rates of our series were 7.6% consisting of 68 (3.65%) intraoperative and 75 (4.02%) postoperative complications.Strivastava et al. reported 8.60% complication rates in 1430 cases of LDN series . In a meThe vast majority of the intraoperative complications were vascular and renovascular complications. There were 10 open conversions (0.53%). Eight of these conversions were related to renovascular and vascular complications. The other 2 conversions were due to nonvascular complications. Our open conversion rate was remarkably low when compared to the literature. An explanation for this low rate could be the management of intraoperative complications, particularly vascular and renovascular ones, laparoscopically avoiding an open conversion.We also evaluated the operative time as an indicator that determines the difficulty of an operation. Multiple renal arteries, right LDN, and male sex were prolonging the operative time while BMI had no effect on operative time. The variables that prolonged operative time were similar to the literature besides BMI, which was not a compelling factor for our patients contrary to the literature. According to the literature, obesity was related with longer operative time and longer length of hospital stay. The complication rates and morbidity were not related to obesity ,12. HoweRight LDN is related with increased operative time, hospital stay, and increased allograft failure in the literature –16. The Since we entirely focused on donor morbidity in our present study and decided not to report recipient outcomes, long-term graft survival and recipient data were not presented here. We believe that the retrospective nature of our study is the major limitation. To our knowledge, this is one of the largest published HALDN series in the world including nearly 2000 patients.HALDN is a proven safe procedure for donor nephrectomy with lots of reliable evidence in the literature. However, the contribution of larger series to current literature is undeniable. Multiple renal arteries were found to be a risk factor for intraoperative complications and male sex, multiple renal arteries, and right donor nephrectomy were related with longer operative times.


Background: The satisfaction level of doctors regarding the workplace environment signifies both the psychological and physical environment. One of the many challenges to conquer was the adaptation to a steadily changing working environment and the development of a proper working environment during the COVID-19 pandemic.Objectives: The objective of this study was to evaluate the level of satisfaction of doctors regarding the workplace environment. Methods: A cross-sectional study was conducted from January to December 2020. A total of 217 conveniently selected doctors working at selected tertiary hospitals in Dhaka city were interviewed using a pretested, structured questionnaire. The Minnesota Satisfaction Questionnaire (MSQ) was used to assess the level of job satisfaction on a 5-point Likert scale consisting of 20 items. The percentile score was used to categorize the respondents as highly satisfied (75 and above), averagely satisfied (26 to 74), and dissatisfied (below 25). Bivariate and multivariate analyses were performed. Result: Among the 217 respondents, the total mean MSQ score was 3.62±0.23 regarding job satisfaction. About two-thirds of the respondents (63.1%) reported an average level of satisfaction. More than two-thirds of respondents (69.6%) expressed high satisfaction regarding the physical work environment, while the majority of respondents (93.1%) expressed high satisfaction with the psychosocial work environment. However, no significant association was found between outcome and input variables (p>0.05). Conclusion: The study findings showed that satisfaction regarding the psychological environment was higher among the respondents than that of physical working conditions. Evidence-based measures are to be addressed in hospitals to achieve the optimum level of satisfaction among doctors during pandemics. A poor work environment in hospitals may hamper work performance and promote pessimistic attitudes towards patients and colleagues. Job satisfaction has proven to be an important factor influencing productivity and is of great interest to healthcare organizations . To survThe COVID-19 pandemic has significantly influenced the health system worldwide. The working life of doctors continues to change significantly and will change further in the next few years . In the A cross-sectional study was conducted from January 1 to December 31, 2020, to assess the satisfaction level of doctors regarding their work environment in select tertiary hospitals , Sir Salimullah Medical College and Hospital (SSMC), and Shaheed Suhrawardy Medical College and Hospital (ShMCH)) during the COVID-19 pandemic. A non-probability convenient sampling technique was used to collect data from 217 respondents . The sample size was calculated using the n = z2pq/d2 formula. The data collection was carried out using a pretested structured questionnaire through face-to-face interviews after obtaining informed written consent from each participant.The questionnaire was composed to collect data regarding the physical environment, psychological environment, personal satisfaction, and job security, along with the socio-demographic information of the respondents. The Minnesota Satisfaction Questionnaire (MSQ) was used to assess the level of job satisfaction. The questionnaire included 20 items. Each item refers to reinforcement in the work environment. Five response alternatives were presented for each item: very dissatisfied; dissatisfied; neither (dissatisfied nor satisfied); satisfied; and very satisfied. Previous research yielded excellent coefficient alpha values (ranging from 0.85 to 0.91) that have made the MSQ scale a well-known and stable instrument over time. The percentile score was used to categorize the respondents as highly satisfied (75 and above), averagely satisfied (26 to 74), and dissatisfied (below 25). After completion of data collection, to maintain consistency, the data were checked and edited manually and verified for any omission, error, or irrelevance before tabulation. Data were coded, entered, and analyzed on a laptop using SPSS Statistics version 23 . Bivariate and multivariate analyses were performed to identify any association between outcome and input variables. The findings of the study are presented by frequency percentage in tables and graphs. The mean and standard deviations for continuous variables and frequency distributions for categorical variables were used to describe the characteristics of the total sample. The calculated sample size was 198. To minimize dropout, we made a 10% increase, and the sample size was 217. The privacy and confidentiality of each participant were strictly maintained. Ethical approval was obtained from the Institutional Review Board (IRB) of the National Institute of Preventive and Social Medicine (NIPSOM), Dhaka, Bangladesh .This study's findings showed that half of the respondents (50%) were from the age group 31 to 35 years, where the mean (± SD) age was 33.2 (± 4.2). About three-fifths of the respondents (58.1%) were male. Most of the respondents were Muslims (85.3%) and married (84.3%). The participants had different educational qualifications; among them, 17.5% had only an MBBS degree, while others had additional degrees  had a working experience of six to 10 years , which was 3.68 (± 0.14) had a work experience of 16 to 20 years. To detect the statistical significance, an ANOVA test was done. The differences were statistically non-significant (p>0.05)  MSQ score was 4.68 (± 0.62), obtained for activity by the respondents. The lowest mean (± SD) was 2.19 (±1) for working conditions. The general mean MSQ score was (± SD) 3.62 (± 0.23) (Table Around two-fifths (41.9%) of the respondents worked for eight hours Figure .The study's findings were compared to the mean MSQ scores in the three different hospitals. The highest mean (±SD) was 3.65 (±0.21), found in SSMC Table .About two-thirds of the respondents (63.1%) reported an average level of satisfaction. More than two-thirds of respondents (69.6%) expressed high satisfaction regarding the physical work environment, while the majority of respondents (93.1%) expressed high satisfaction with the psychosocial work environment Table .Around 79.7%, 79.3%, 59.4%, and 58.6% of the respondents were reported to be satisfied regarding the rest room, noisy/overcrowded working place, diagnostic equipment, and cleanliness, respectively. Satisfaction regarding the availability of PPE was 24.9%  were satisfied with job retention. One-third of the respondents (33.1%) were satisfied with their salary, and 10.1% of the respondents were satisfied with the health insurance facility Figure .In response to a question regarding security services for doctors in hospitals, 34 15.66%) MBBS doctors, 27 (12.44%) FCPS doctors, 13 (5.99%) MDs, and four (1.84%) MS doctors reported that they had security services in their workplace. Whereas four (1.84%) MBBS doctors, five (2.30%) FCPS doctors, one (0.46%) MD, and one (0.46%) MS doctor worked in an environment without security services  doctors with ages ≤30 had health insurance, and 14 (6.45%) doctors with ages 31 to 35 had health insurance. On the other hand, 48 (22.12%) doctors aged ≤30, 76 (35.02%) doctors with ages between 31 and 35, 30 (13.82%) doctors with ages between 36 and 40, and 10 (4.61%) aged >40 years had no health insurance policy  within the age group 36 to 40, and the lowest score is (3.61 ± 0.24) within the age group up to 30, and similarly in the 31 to 35 age group and respondents above 40 years of age (3.65 ± 0.19). The total mean MSQ score regarding job satisfaction in different age groups is 3.62 ± 0.23. To see the impact of different age groups on job satisfaction, a one-way ANOVA test was done. The differences were statistically non-significant p=0.686) . To see the impact of gender variation on job satisfaction, an unpaired t-test was done, and the result was found to be non-significant (p=0.860) Table .The mean MSQ score in the different marital statuses regarding job satisfaction is almost similar: the mean ± SD in married and unmarried groups is 3.62 ± 0.24 and 3.61 ± 0.21, respectively. The differences are statistically non-significant. To find out the statistical significance, an unpaired t-test was done  is found in only MBBS respondents. For participants who have additional FCPS, MS, and MD degrees, the scores were (3.66±0.24), (3.53 ± 0.23) and (3.68 ± 0.17), respectively. In other educational qualifications , the score was 3.59 ± 0.24. To see the impact of different educational qualifications on job satisfaction, an ANOVA test was done. The differences were statistically non-significant (p = 0.082) Table .The mean MSQ score regarding job satisfaction in different work experience groups was found to be almost similar. The respondents with the highest mean ± SD 3.68 ± 0.14 have working experience of 16 to 20 years. The second highest mean ± SD 3.67 ± 0.23 was for the group with 11 to 15 years of work experience. The group with work experience up to five years has a mean ± SD 3.63 ± 0.23. Next, the respondents with a mean ± SD 3.59 ±0.24 were those with a working experience of six to 10 years. The respondents with the least mean ± SD 3.47 ± 0.20 have work experience below 20 years. To detect the statistical significance, an ANOVA test was done. The differences were statistically non-significant (p=0.322) Table .This cross-sectional descriptive study focused on evaluating the satisfaction of doctors regarding the working environment in selected tertiary hospitals. The study showed that half of the respondents (50%) were in the age group of 31 to 35 years. Another study mentioned that among the healthcare professionals of combined military hospitals in Bangladesh, more than two-fifths (41.1%) were in the age group of 26 to 35 years . About tThe study also showed that a maximum of 84.3% of respondents were married. Age, gender, and marital status have often been studied as the underlying variables of job satisfaction. According to this study, no significant association was found between job satisfaction and socio-demographic profile (p>0.05). Earlier research has found a significant relationship between job satisfaction and age, gender, and marital status, while others have discarded any such relationship . In thisA satisfaction score was also calculated for each of the 20 items on the MSQ scale. The highest mean (± SD) was 4.68 (± 0.62) which was regarding activity, and the lowest mean (± SD) was 2.19 (± 1) was about working conditions. The general mean (± SD) was 3.62 (± 0.23). Another study showed the average MSQ score of all surveyed doctors was 3.11±0.87. The three highest-scored items for doctors were the way company policies were put into practice, the working conditions, and praise for doing a good job [About two-thirds of the respondents (63.1%) reported an average level of satisfaction regarding general working conditions. Out of 217 respondents in this study, less than one-third (30.4%) had high satisfaction, and more than two-thirds (69.6%) had average satisfaction regarding the physical working environment. The study showed that with regard to the psychosocial environment, the majority (93.1%) of doctors reported high levels of satisfaction, while 6.9% reported average levels of satisfaction. Another study conducted during the COVID-19 pandemic showed similar findings. Evidence shows that multiple workplace-related factors affect the effectiveness of people who work there. These can include the working space, water supply, electricity supply, ventilation system, cleanliness facility, infection control facility, availability of PPE, restroom condition, etc. An organization’s overall productivity and quality of individual work influence job satisfaction . This stJob design seeks to integrate means by which job characteristics can be changed, like workload, work variety, and workplace supervisory support, which will lead to enhanced worker satisfaction and hence increased performance . In our In our study, satisfaction regarding job retention, the right position, promotion, and health insurance was 81.6%, 63.6%, 46.5%, and 10.1%, respectively. Another study showed that the right position and promotion opportunities, benefits, health insurance, and rewards reflect job satisfaction among public healthcare workers in Pakistan . DoctorsThe information gathered was challenging to obtain since some of the participants were hesitant to share their genuine opinions. This study may be a source for future studies in different hospitals with a vast scope.The COVID-19 pandemic was a major public health threat. The role of doctors was crucial, and they served as frontline soldiers. Unsatisfactory working conditions restrict doctors from rendering their capabilities. To fulfill the guidelines of care during COVID-19 or any pandemic situation, doctors need a workplace that permits them to work enthusiastically. This study revealed that about two-thirds of the respondents in the current study reported an average level of satisfaction. Satisfaction regarding the psychological environment was higher among the respondents than that regarding physical working conditions. To ensure that doctors are as satisfied as possible during pandemics and to provide quality care to patients, hospitals must use evidence-based interventions.


To examine whether extended interscan time (IST) on optical coherence tomography angiography (OCTA) can detect slow retinal blood flow, which is undetectable on default IST, in the healthy macula.2 of 14 healthy eyes of 14 healthy volunteers with no history or evidence of systemic and macular diseases was performed. ISTs were set at 7.6 , 12.0 (IST12.0), and 20.6 msec (IST20.6). Ten OCTA images were acquired at each IST, and an averaged image was created. For each averaged OCTA image obtained at IST7.6, IST12.0, and IST20.6, we defined the area surrounded by the innermost capillary ring as the foveal avascular zone (FAZ). We qualitatively evaluated the delineation of the capillaries consisting of the FAZ and quantitatively measured the FAZ area at each IST.OCTA  scanning of a macular area measuring 4 × 4 mm7.6 to IST12.0 and IST20.6 could newly delineated retinal capillaries that were undetectable at the default IST; new capillaries were detected in 10 (71%) eyes at IST12.0 and 11 (78%) eyes at IST20.0. The FAZ areas were 0.334 ± 0.137 mm2, 0.320 ± 0.132 mm2, and 0.319 ± 0.129 mm2 for IST7.6, IST12.0, and IST20.0, respectively; the FAZ areas at IST12.0 and IST20.0 were significantly decreased compared with that at IST7.6 .Extensions from ISTIn OCTA for healthy participants, extensions of the ISTs newly detected retinal capillaries with slow blood flow around FAZ. The FAZ shapes varied with different ISTs. Thus, the blood flow dynamics are not physiologically uniform around FAZ. Compared with conventional OCTA, this protocol enables a more detailed evaluation of retinal circulation and provides a better understanding of the physiological circulatory status of the healthy retina, and may enable the assessment of circulation in the very early stages in diseased eyes. Fluorescein angiography (FA) and indocyanine green angiography (ICGA) are imaging modalities used for visualizing the retinal microvasculature , 2. FA/IOptical coherence tomography angiography (OCTA) is an imaging modality that can be performed noninvasively and easily without dye injections and evaluate the detailed vascular lesion in three dimensions . The OCTThe blood flow in the capillaries that form the foveal avascular zone (FAZ) is prone to stagnation for some reason in common retinal circulatory diseases, such as DR and RVO, and FAZ tends to enlarge. FAZ enlargement is considered an important clinical marker because of its significant associations with disease severity , 12. HowRecently, a methodology, called variable IST analysis (VISTA), was developed to detect abnormal blood flow in OCTA by changing the ISTs . Novel fThis observational study was approved by the Institutional Review Board of the Kyoto University Graduate School of Medicine  and adhered to the tenets of the Declaration of Helsinki. Written informed consent was obtained from each participant before initiating any study procedures or examinations.We included 14 healthy eyes of 14 healthy volunteers with no history or evidence of systemic and macula diseases . The meaWe excluded eyes with ocular diseases such as keratoconus, high myopia (severity exceeding −6 diopters), and/or high astigmatism (severity exceeding ±3 diopters). We also excluded eyes with poor-quality OCTA images  caused by eye movement or media opacities.At the time of inclusion in the study, each participant underwent high-resolution spectral-domain OCTA  in addition to routine examinations, including the measurement of the best-corrected visual acuity (BCVA) using a Landolt chart, measurement of the intraocular pressure using the non-contact tonometor , the axial length was measured using an interferometer , slit-lamp biomicroscopy, and OCT. In all cases, the subjects had their resting blood pressure measured approximately 30 min before OCTA was performed. All examinations were performed on the same day.2 (464 × 464 pixels) was scanned using ISTs of 7.6 msec (IST7.6), 12.0 msec (IST12.0), and 20.6 msec (IST20.6) in a repeated mode, which enables capturing the same area when the ISTs are changed. The participants underwent imaging ten times at each IST, and the averaged OCTA images were created. All OCTA images were acquired at the same resolution to eliminate differences in imaging conditions other than IST. The region from the inner limiting membrane to the inner segment-outer segment line, which included all capillaries in the inner retina, was targeted for evaluation to ensure that segmentation would not affect the depiction of blood vessels.For OCTA images, a macular area measuring 4 × 4 mmWe defined FAZ on an OCTA image at each IST using the FAZ measuring tool of the software (Canon Inc.), which automatically determined FAZ as the area without blood vessels in the macula. Additionally, we qualitatively evaluated the capillaries with the high-intensity area comprising the contour of FAZ.While measuring the FAZ area, we unified the measurement range among the participants by correcting the AL-related magnification using the modified Littmann formula (Bennett procedure) –20. The For OCT-A1, the standard AL provided by the manufacturer was set to 24.20 mm. In each case, the FAZ area was multiplied by the area ratio to derive the axial-length-corrected FAZ area.Statistical analyses were performed using JMP 16 . All values are presented as the mean ± standard deviation. We converted the decimal BCVA measured using a Landolt chart to a logarithm of the minimum angle of resolution (logMAR).7.6, IST12.0, and IST20.6 were analyzed using the Shapiro–Wilk test to evaluate the distribution of normality. Statistical significance was set at p<0.05. The FAZ areas captured at all ISTs were within the distribution of normality. Comparisons between the FAZ areas captured at IST7.6 and those captured at IST12.0 and between the FAZ areas captured at IST7.6 and those captured at IST20.6 were performed using the paired t-test.The FAZ areas captured at IST7.6 (default setting) to IST12.0 and IST20.6 could newly detect retinal capillaries that were undetectable at the default IST7.6  eyes at IST20.0.Extensions of the IST2 for IST7.6, 0.320 ± 0.132 mm2 for IST12.0, and 0.319 ± 0.129 mm2 for IST20.0; The axial length corrected FAZ areas were 0.353 ± 0.137 mm2 for IST7.6, 0.339 ± 0.133 mm2 for IST12.0, and 0.337 ± 0.130 mm2 for IST20.0; the axial length corrected FAZ areas decreased significantly at IST12.0 and IST20.0 compared with that at IST7.6  . The capillaries that required extended IST in this study to be depicted would have a slower velocity . A previCompared with healthy eyes, the retinal blood flow in diseased eyes tends to be deteriorated , 14. NisThis study has several limitations. First, this study was a cross-sectional study, and longitudinal changes in the retinal circulatory status were not observed. Second, we used three ISTs in the analysis, and the results of other ISTs are unknown. Third, the number of eyes included was limited. The protocol in this study was applied for examining the region around FAZ, and the retinal circulatory status in other outer retinal areas was unknown.Nevertheless, the extensions of ISTs newly detected retinal capillaries with slow blood flow around FAZs of healthy eyes, and the FAZ shapes changed as the ISTs varied. These findings indicate that the retinal circulation is not physiologically uniform around FAZ. The protocol of this study may have the potential to enable a detailed assessment of the circulatory status in healthy eyes and eyes with retinal diseases. Further prospective studies with a greater number of participants and pathologic eyes are required to confirm the findings of the present study.


Primary breast lymphoma (PBL) is a rare disease, treatment of which excerpts does not reach a consensus. This retrospective study was conducted to analyze clinical features and survival outcomes of different therapeutic methods.Records of 67 patients with stage IE/IIE primary breast lymphoma were reviewed from the medical record system. Survival information was gathered by searching the outpatient system. Clinicopathological characteristics were compared by chi-squared or Fisher’s exact tests. A comparison of survival curves was performed by log-rank tests. The Cox proportional hazard model was applied for multivariate analysis.p = 0.001) and rituximab use (p < 0.001) were statistically associated with longer PFS in patients with PBL. Nodal sites involved and radiotherapy administration were significant predictors for 5-year OS. Multivariate analysis suggested that nodal sites involved (p = 0.005) and radiotherapy administration (p < 0.003) were independent prognostic factors for OS in patients with PBL (p < 0.05). Radical surgery was not an independent factor for patients with PBL.At the median follow-up time of 65.23 months , there were 27 (40.3%) relapses, 28 (41.8%) distant metastases, and 21 (31.3%) deaths. The 5-year progression-free survival (PFS) and overall survival (OS) were 52.1% and 72.4%. Pathological types (DLBCL vs. non-DLBCL, Radiotherapy improved the survival of patients with PBL. Radical mastectomy offered no additional benefit in the treatment of PBL.The online version contains supplementary material available at 10.1186/s12957-023-03007-8. Primary breast lymphoma (PBL) is defined as malignant lymphoma primarily occurring in the breast with no evidence of presentation elsewhere . It reprCurrently, it is widely accepted that chemotherapy, used alone or in combination with radiation, is the optimal treatment regimen for patients with PBL , 13–16. This study only included patients with PBL who were diagnosed with stage IE and IIE disease according to the Ann Arbor staging system, excluding those with the involvement of other sites. For this potentially curable neoplasm, we aimed to identify the prognostic factors and optimal treatment approaches, especially the potential population of PBL patients who might benefit from radical surgery.We retrospectively reviewed the records of 67 patients with PBL who were treated consecutively at Tianjin Medical University Cancer Institute and Hospital from December 2003 to December 2017. The definition of PBL was proposed by Wiseman et al. [The patients were followed up in the outpatient department of Tianjin Medical University Cancer Institute and Hospital at 3-month intervals for the first year, at 6-month intervals for the following 2 years, and then annually. The follow-up period continued until the deaths of the patients or the cutoff date of October 2022. The median follow-up time was 65.23 months . During the follow-up time, five cases were lost follow-up and excluded, with 67 patients remaining in the study.Progression-free survival (PFS) was defined as the time interval from the start of treatment to the first documentation of disease progression or death due to any cause. Overall survival (OS) was defined as the time from initial diagnosis of PBL to death for any reason. SPSS statistical software (version 25.0) and R statistical software (version 4.2.1) were used in this study. A comparison of survival curves was performed by log-rank tests. The Cox proportional hazard model was applied for multivariate analysis. Clinicopathological characteristics were compared using either chi-squared or Fisher’s exact tests.The median age of these patients was 53.4 years range 21–82 years), and the median tumor size was 3.7 cm (range 1.4–10.0). Thirty (44.8%) cases involved the left breast, and the remaining involved the right breast. None of the patients in this study had bilateral involvement. Twenty-two (32.8%) patients had involvement of the axillary lymph nodes at diagnosis, and 13 (19.4%) had involvement of the supraclavicular lymph nodes, with or without concurrent axillary lymph node involvement. The majority of patients (94.0%) did not exhibit any B symptoms at presentation, which included fever, weight loss, and night sweats. Sixteen (23.9%) patients exhibited elevated lactate dehydrogenase (LDH) levels. All cases had Eastern Cooperative Oncology Group (ECOG) performance status scores of 0 or 1. The percentages of patients who presented with stage IE and IIE disease (Ann Arbor staging) were 64.2% and 35.8%, respectively; those with stage III/IV disease were excluded from the study. The pathological types include DLBCL (74.6%), mucosal-associated lymphoid tissue , follicular lymphoma , Hodgkin’s lymphoma , and other types (13.4%). Sixty-two (92.5%) patients were CD20-positive. The clinicopathologic characteristics of the patients with PBL are shown in Table –82 yearsThe treatment modalities are documented in Table At the median follow-up time of 65.23 months range, 9–150 months), there were 27 (40.3%) relapses, 28 (41.8%) distant metastases, and 21 (31.3%) deaths. Among the patients with relapse, 16 (59.2%) relapsed in the ipsilateral breast, 7 (25.9%) in the ipsilateral supraclavicular lymph nodes, and four (14.8%) in the axillary lymph nodes. Among the patients who developed distant metastases, the site of metastases included the liver (7.1%), lung (35.7%), bone (17.8%), central nervous system (25.0%), and other sites (14.2%). There was a total of 31 (46.3%) progression events. The 5-year PFS and OS were 52.1% and 72.4%, respectively     . Radical surgery was not an independent factor for patients with PBL. Twenty-one (48.8%) and ten (41.7%) patients in the biopsy group and mastectomy group progressed during the follow-up period. As shown in Fig. p = 0.22). Additionally, there were fourteen (32.6%) and seven (29.2%) deaths in the biopsy group and mastectomy group, respectively. The 5-year OS of the biopsy group and mastectomy group were 69.4% and 77.8%, respectively; this difference was not statistically significant (p = 0.4)  Fig. A and rit01) Fig. B were st05) Fig. C and rad03) Fig. D were inThe conventional definition of PBL proposed by Wiseman and Liao  restrictp < 0.05).Multiagent anthracycline-based chemotherapy, possibly with rituximab, is considered the optimal treatment approach for patients with PBL , 14, 32.Additionally, locoregional treatment, especially radiotherapy, is also considered an appropriate treatment approach. Our results showed that radiotherapy could significantly improve the OS of patients with PBL and was also associated with a trend of improving PFS. Although the majority of studies proved that radiotherapy combined with chemotherapy offers a benefit to patients with PBL , 34, 35,In addition to radiotherapy, surgery is another locoregional treatment approach for patients with PBL. However, the role of surgery remains controversial. Jennings et al.  suggesteHowever, our study is limited in terms of variable treatment strategies and encompassed a relatively insufficient number of cases due to low incidences of PBL; these limitations make it difficult to draw definite conclusions regarding survival outcomes. Additional prospective clinical trials are required to verify our conclusions.In conclusion, the standard treatment modalities for PBL have not yet been established. Multiple treatment approaches, including anthracycline-containing chemotherapy, radiotherapy, and limited surgery, are recommended for the initial treatment of patients with PBL. Radiotherapy is an essential locoregional treatment method and improved the survival of patients with PBL. Radical mastectomy offered no additional benefit in the treatment of PBL.Additional file 1: Table S1. The baseline characteristics of patients after grouping by Local lesion manipulation.Additional file 2.


The erratum corrects a typo in Eq. (4) of the published article. J. Biomed. Opt.27(10), 106001 (2022) doi: 10.1117/1.JBO.27.10.106001 was originally published on 6 October 2022 with an error in Equation 4.This article [Original Corrected The authors checked their software and found that they had used the correct equation there, so the reported results were unaffected by the typo. The article was corrected and republished on 8 July 2023.


Despite global tuberculosis (TB) interventions, the disease remains one of the major public health concerns. Kenya is ranked 15th among 22 high burden TB countries globally.A cross-sectional study was conducted in Western Kenya, which comprises 10 counties. A multistage sampling method was used where a single sub-county was randomly selected followed by sampling two high volume health facility from each sub-county. Identification of spoligotype profiles and their family distribution and lineage level were achieved by comparison with SITVIT database.M. tuberculosis strains as compared to wild type. A total of 12 (2.0%) were orphaned M. tuberculosis strains which were spread across all the 10 counties of the study site. In multivariate logistic regression adjusting for potential cofounders three potential risk factors were significant. HIV status , Alcohol use  and cross border travel . Most M. tuberculosis clinical isolates showed genetic clustering with multivariate logistic regression indicating three potential risk factors to clustering. HIV status , Alcohol use  and cross border travel .Lineage distribution pattern revealed that the most predominant lineage was CAS 220 (39.8%) followed by Beijing 128 (23.1%). The other lineages identified were T, LAM, H, X, S and MANU which were quantified as 87 (15.7%), 67 (12.1%), 16 (2.8%), 10 (1.8%), 8 (1.4%) and 5 (0.9%) respectively. CAS and Beijing strains were the most predominant lineage in both HIV negative and positive TB patients. The Beijing lineage was also the most predominant in resistant M. tuberculosis across the 10 counties of Western Kenya. Predominant distribution of clustered genotype points to the fact that most TB cases in this region are as a result of resent transmission other than activation of latent TB.There exist diverse strains of  Mycobacterium tuberculosis, the causative agent of tuberculosis, is capable of surviving and replicating within macrophages and other human cells.Tuberculosis remains a global threat to public health and is the leading cause of death by a single infectious agent with 1.6 million deaths in 2017. An estimated 10 million people developed TB disease in 2017 but only 6.4 million (61%) were notified [For this reason, the bacterium has developed a unique mechanism to gain entry and survive in host cells. With the increasing incidence, tuberculosis has become one of the leading causes of death among immunocompromised patients especially those who are HIV-TB coinfected. Kenya’s TB prevalence survey of 2015 indicated that the disease incidence was 233 per 100,000 (95% CI 188–266) .Mycobacterium tuberculosis circulating in HIV negative and positive, and drug-resistant TB patients Western Kenya. The study also reports the existence of cross border transmission of tuberculosis. Evaluate the enablers, barriers and level of preparedness of western Kenya communities on tuberculosis cross border transmission.Western Kenya consists of 10 county governments  and M. bovis BCG (spacers 20–21 and 33–36) [Spoligotyping technique has been used in s typing . It is abination . This tebination , which cbination . The 43 bination . Classicd 33–36) . The preM. tuberculosis lineages. Strain structure will help understand factors contributing to M. tuberculosis success and survival strategies based on lineages and sub lineages survival characteristics. Cross border transmission of M. tuberculosis evaluation will help in form cross border events associated with it hence help in policy formulation of continuous surveillance and intervention at the border entry point. While determining enablers and barriers associated with cross boarder transmission prevention of M. tuberculosis is important in informing proper management and strategy for those identified to be carrying cross border strains.Strain structure identification will help determining the impact of differing genetic characteristics among Mtb complex strains on vaccine efficacy, treatment outcome, development of MDR/XDR Mtb strains, and epidemiological outbreaks by focusing on the best-adapted human A cross sectional study design was applied in the study with multistage sampling method to select a single sub-county in each of the study counties. Smear positive tuberculosis patients above 18 years who had resided in the study area for at least 6 months were eligible for enrolment with only those who consented to the study recruited. Tuberculosis-HIV coinfected and non-coinfected were proportionately recruited based TB-HIV coinfection prevalence in each county as reported by Ministry of Health.Mycobacterium tuberculosis culture. A cluster case was defined as any TB case from a study isolates whose strain type based on standard spoligotyping assay was not distinguishable from at least one other case. On the other hand, unique cases shared a unique strain not found in the study population.A case of tuberculosis disease was defined as a patient having two acid fast bacilli positive test or a single positive A multistage sampling method was used where a single sub-county was randomly selected followed by sampling two high volume health facility from each sub-county. Consenting study subjects with at least 2 smear positive sputum at the time of enrolment were randomly selected. A total of 553 samples were collected across 10 counties between 2018 and 2019. Sample size was calculated based on [Mycobacterium. Participants also underwent phlebotomy for HIV testing. The blood was delivered into Vacutainer Brand STERILE interior EDTA (K3) tubes and stored at –20 °C waiting processing. The samples were transported in cool boxes to MRL, MUSOM, Eldoret, and processed within 2 weeks [Two sputum specimens (spot and early morning) were collected from participants with presumptive TB under the supervision of trained and competent medical staff. Upon consenting to the study, the patients were requested to cough so that expectoration came from deep down the chest as possible, and spit into a sterile 50 ml screw cap tubes. The samples were refrigerated at 4 °C awaiting transportation in cool boxes to the Mycobacteria Reference Laboratory, Moi University School of Medicine  weekly for analysis. Samples were processed within 7 days of collection in order to minimize loss of viability of the  2 weeks .Mycobacterium strains from clinical samples. Briefly, the specimens ware decontaminated and digested with an equal volume of 4% sodium hydroxide for 15 minutes while vortexing after every 5 minutes. Decontaminated sputum was then transferred into a 50 ml corning tube, and then centrifuged at 3000 rpm for 15 minutes and the supernatant discarded. Phosphate-buffered saline  was added to the residue raising the volume to 50 ml. The content was then centrifuged at 3000 rpm for 15 minutes and the supernatant discarded. 0.5 ml of PBS, pH 6.8 was added to resuspend the pellets, then 0.5 ml of resuspended deposit was added to the MGIT culture tube which were then incubated into the BACTEC MGIT 960 system until positivity was observed for positive samples or up to 8 weeks for negative samples [BACTEC MGIT 960 assay was used in determining  samples . PositivMycobacterium tuberculosis complex, and those that did not show the purple–reddish color was considered as MOTTS and therefore eliminated from the study.The Capilla TB Test  was perfThe ABBL MGIT tube (from Becton Dickinson) containing 7 mL modified middle brook 7H9 broth was used, to which an enrichment supplement as well as a mixture of antibiotics consisting of polymyxin B, amphotericin B, nalidixic acid, trimethoprim, and azlocillin were added . After i11,000×g at room temperature. The supernatant was transferred to another sterile tube and DNA precipitated by the adding acrylamide (20 μg/ml), 0.05 volumes of 3 M sodium acetate and 2.5 volume of ethanol. The DNA was then washed, dried, and dissolved in 25 μl sterile triple distilled water [Each sample pellet was dispersed in 10 mM Tris-1 mM EDTA buffer containing 0.1% Tween 80 and 2 mg/ml lysozyme. The tube was incubated for 2 hrs at 37 °C with intermittent shaking and centrifuged. The pellet was lysed by redissolving in TE buffer containing Proteinase K (100 μg/ml) and 1% (w/v) sodium dodecyl sulphate and incubated for 1 hr. at 37 °C. Then, an equal volume of TE saturated phenol: chloroform: iso-amyl alcohol 25:24:1 v/v/v) was added. The aqueous phase was transferred to another sterile tube and 0.1 volume of cold 3 M sodium acetate (pH 5.2) was added. The sample was then mixed by inversion and placed on ice for 10 min before centrifugation for 1 min at a speed of :1 v/v/v Quantification of DNA was done spectrophotometrically by measuring absorbance at 260 nm for comparative quantitative analysis of DNA . Serial M. tuberculosis H37Rv and Mycobacterium bovis BCG strains were included as positive controls. Molecular biology-grade water was used as negative control. The spoligotypes (presence and absence of spacers) were then recorded in 43-digit binary format and compared with those recorded in the SpolDB4 database (http://www.pasteur-guadeloupe.fr:8081/ SITVIT_ONLINE/) to identify the Spoligotype International Type (SIT) and family [http://tbinsight.cs.rpi.edu/run_spotclust.html) [M. tuberculosis family similarity. In the SPOTCLUST analyses, the family assignation was retained when the probability is ≥90%. Nevertheless, the final designation of families and subfamilies was also based on the MIRU-VNTR data.In this study, the classical 43-spacer format of spoligotyping was performed as previously described . DNA samd family . For thest.html) , was useAssociation between patient characteristics and genotype clustering were evaluated using logistic regression and frequency analysis. The potential risk factors for clustering included age, HIV status, sex, level of education, occupation, monthly income, size of the house, cigarette smoking, alcohol use and cross boarder travels. Bivariate analysis was performed to determine the association of potential risk factors with genotypic clustering followed by multivariate logistic regression adjusting for potential cofounders. Since TB cases were from adjacent and approximate counties and that all cases were notified within the same calendar year, the specific geographical and temporal timing of cases were not used in the definition of a cluster. Lineage clustering rate was computed from the difference between the total strains clustered cases in each lineage and the number of clusters divided by the sum of cases in the MTB lineage.Participants in this study were 18 years and above with the most affected being between 25 and 30 years representing 33.1% of the total sample size. 48.3% of the participants were HIV positive while 51.7% were HIV negative. Majority of the participants were males (62.4%) while the rest were females. Most of the participants (44%) were primary school leavers, 26% with informal education, 23% secondary school leavers while participants with tertiary education were 7%. Self-employed participants 39%, those with informal employment were 23.6%, unemployed were 16.6% while 15% were employed with 1.8% still in school. Participants with monthly income in the bracket of 10,000–19,999 were 31.5% with the least being those with monthly income of Ksh. 50,000 and above , Indo Oceanic (MANU), East Asia strains and Beijing strains being identified across the 10 counties of Western Kenya. Lineage distribution pattern revealed that the most predominant lineage was CAS 220 (39.8%) followed by Beijing 128 (23.1%). The other lineages identified were T, LAM, H, X, S and MANU which were quantified as 87(15.7%), 67(12.1%), 16(2.8%), 10(1.8%), 8(1.4%) and 5(0.9%) respectively , 17 (3.1%), 2 (0.4%), 5 (0.9%) and 7 (1.2%) respectively , 17 .1%, 2 , followed by Beijing (4.9%) with 0.5% of the total samples typed were unknown , followed by Beijing (2.7%), T (2.0%) and LAM (1.6%). Subsequently, two unknown strains of .4%, follIn Kakamega, Beijing, CAS, H, LAM, T and X lineages were detected at the proportion of 2.4, 4.5, 0.2, 0.5, 1.6, 0.5 and 0.2% respectively. Subsequently, in Kisumu county just like in Kakamega County CAS lineage was the most prevalent at a proportion of 5.2%, followed by Beijing and LAM both with the proportion of 3.4 and 1.1%, H had a proportion of 0.2%, T and X having a proportion of 1.1 and 0.4% respectively. The proportion of unknown lineage in Kisumu County was 0.5%  followed by T lineage 1.3%). Beijing lineage identified in Migori were 3.6% in proportion to the total sample typed while LAM, H and X were represented by 0.5, 0.4 and 0.4% respectively  of 1.73, CI  of 0.42–5.21 and P value of 0.04. Those with monthly income of between Ksh. 1000-Ksh. 9999 were significantly associated with genotypic clustering having OR of 1.28, CI of 0.62–4.00 and P-value of 0.046. There was significant association between those living in single rooms with genotypic clustering with OR of 1.43, CI of 0.46–4.31 and P-value of 0.049. Alcohol and cross boarder travels were also significantly associated with genetic clustering with OR of 0.87, 0.93; CI of 0.34–5.34, 0.46–3.92 having P-values of 0.003, 0.002 respectively. In multivariate logistic regression adjusting for potential cofounders three potential risk factors were significant. HIV status , Alcohol use  and cross border travel  . Our findings indicate a circulation of diverse strains of M. tuberculosis in the study area. The study established that despite the existing of predominant strains like CAS, Beijing and LAM, there was no clear association with either HIV status of the patient or drug resistant M. tuberculosis.Strain structure identification is key in understanding the circulating e system . high pre system . The Hige system . It is t et al.,  thus thiM. tuberculosis strains in Western Kenya is highly diversified with Euro American strains , Indo oceanic (MANU) and East African strains being identified in addition to Beijing strain. Studies by Merker et al., [M. tuberculosis lineages in Western Kenya.The distribution of  et al.,  showed t et al., . This coSpoligotyping patterns of some clinical isolates could not be matched to other reported in international database hence referred to us orphaned. This unique strain needs further analysis using other molecular epidemiology tools including Mycobacterium Interspersed Repetitive Units (MIRU) or Variable Number of Tandem Repeats (VNTR) to shed more insights on their epidemiology. These orphaned strains could indicate either recent or sporadic TB infections in Western Kenya.M. tuberculosis in Western Kenya maybe an indicator of global diversity of M. tuberculosis strains with different origin given that there are several counties under study that are bordering neighboring countries like Uganda and Tanzania where most of these strains has been reported [The detection of different lineages of reported –35. The reported  which arThe discovery of wide spread Beijing strain which has been reported as the most lethal driver of drug resistance and reinfection  could beOn the other hand, despite Western Kenya Counties bearing the largest burden of HIV pandemic, there was no evidence that specific strains have an association of HIV even though the status is a risk factor to acquiring tuberculosis due to suppressed immune system. Despite other studies associating TB drug resistance to Beijing lineage, this study did not find any correlation between the strain and resistance. Therefore, resistance in this case could be associated to poor drug adherence, failure in prompt diagnosis, migration, poverty and increased TB/HIV cross infection .M. tuberculosis isolates from the study population were clustered which may inform that a large proportion of were recent infection. Further, this could indicate that the clustered strain might be having a higher transmissibility of higher chances off progressing into disease stage immediately after transmission. There was also a sizable number of unique strains, indicating the main drivers of persistent tuberculosis in the population that undergoes latent stage before reactivation occurs. This could be the main public health change in terms of control and prevention of tuberculosis in the population. Latency affects early diagnosis and therefore management of tuberculosis.Most of the M. tuberculosis strains globally [Significant association in bivariate analysis especially age, monthly income and size of houses used by patients could be as a result of potential cofounders, this could further be explained in multivariate logistic regression adjusting for potential cofounders which showed that the above factors were not significant. Multivariate logistic regression analysis showed HIV status, alcohol use and cross border travels as having significant association with genetic clustering of tuberculosis. HIV virus is known to fight the immune system hence exposing populations to opportunistic diseases like tuberculosis. Compromised immunity could accelerate disease progression to active tuberculosis immediately after infection. Alcohol is a social drink taken bay revelers who share cups, syphons and other drinking utensils. Western Kenya is one of the leading traditional, crude and other forms of alcohol users  further globally .M. tuberculosis across the 10 counties of Western Kenya. Predominant distribution of clustered genotype as opposed to unique points due to the fact that most TB cases in this region are as a result of resent transmission other than activation of latent TB.There exist diverse strains of Mycobacterium tuberculosis in 10 counties of Western Kenya calls for aggressive control and prevention strategies to curb mortalities associated with pulmonary tuberculosis. Spoligotyping patterns of some clinical isolates could not be matched to others reported in international database hence referred to us orphaned need to be further characterized using other molecular epidemiology tools including Mycobacterium Interspersed Repetitive Units (MIRU) or Variable Number of Tandem Repeats (VNTR) to shed more insights on their epidemiology. These orphaned strains could indicate either recent or sporadic TB infections hence the need for aggressive intervention.The identification of diverse M. tuberculosis circulating in Western Kenya population. Further we have demonstrated the existence of fast progressing pathogens to full blown disease stage and those that undergo latency through M tuberculosis cluster analysis. Additionally, the study has identified potential risk factors that are likely to be the drivers of tuberculosis in Western Kenya. However, we were unable to further characterize the orphaned strains through other available genotypic characterization tools to strengthen our findings.The study has demonstrated the existence of genetic diversity of


Methotrexate (MTX) use has been suspected of increasing the risk of skin cancer. The aim of this investigation was to examine the association between the use of MTX and the risk of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC) and cutaneous malignant melanoma (CMM).n = 131,447), cSCC  or CMM  from 2004 to 2018. We matched 10 controls to each case on sex and birth year using risk-set sampling and computed crude and adjusted odds ratios (ORs) using conditional logistic regression for the use of MTX (≥2.5 g) compared with never-use.In a nationwide Danish case–control study, we identified incident, histologically verified cases of BCC  1.29 (1.20–1.38), 1.61 (1.37–1.89) and 1.35 (1.13–1.61), respectively. For BCC and cSCC, ORs increased with higher cumulative doses. When restricting the study population to patients with psoriasis, the ORs were 1.43 (1.23–1.67), 1.18 (0.80–1.74) and 1.15 (0.77–1.72), respectively.We observed an increased risk of BCC and cSCC associated with the use of MTX with evidence of a dose–response pattern; however, the association was not consistent when restricting the study population to patients with psoriasis. Introduction of biologics has changed the treatment landscape for autoimmune and inflammatory diseases during the past two decades. However, methotrexate (MTX) remains an anchor drug in the dermatological and rheumatological treatment armamentarium. Due to its early introduction in the 1950s, MTX has to a large extent escaped the thorough clinical trials required for contemporary drug approvals . While nMTX has immunosuppressive effects and has been linked with photosensitising properties , 6, of wWe used Danish health and demographic registries to identify all cases of BCC, cSCC and CMM and compared their MTX use with that of matched population controls to obtain odds ratios (ORs) for MTX associated with BCC, cSCC and CMM.The Danish registries and databases used for this study have been comprehensively described in previous investigations –11, and We identified cases as patients with a histologically verified first-time diagnosis of BCC, cSCC (excluding squamous cell carcinoma in situ) or CMM (excluding in situ melanoma) from 2004 through 2018. We identified cases from the Danish Cancer Registry , using cWe collected data on MTX exposure from the Danish National Prescription Registry and the Danish National Patient Registry , 15. TheOur main exposure was pragmatically defined as a cumulated dose of ≥2.5 grams, which corresponds to 2.7 years of treatment at a maintenance dose of 17.5 mg MTX per week (2.5 mg per day). Further, we examined cumulative dose as an ordinal variable: 0–1.25; 1.25–2.5; 2.5–5; 5–7.5 and ≥7.5 g. Since recent MTX exposure is unlikely to increase cancer risk, we introduced a lag time by disregarding dispensings in the year before the index date.Potential confounders included (i) age, sex and calendar time (accounted for by study design); (ii) ever-use of drugs with photosensitising properties, including hydrochlorothiazide, oral and topical retinoids, antibiotics , psoralen plus ultraviolet A photochemotherapy (PUVA) , 17–19  analyses adjusted for age, sex, and calendar time by design, whereas the fully adjusted analyses included all listed covariates above. We evaluated the presence of a dose–response association by including cumulative dose as an ordinal variable in the regression model. In all analyses, we analysed BCC, cSCC and CMM separately and never-use of MTX was the reference group.P values for interaction using a likelihood ratio test of the model without interaction terms nested in the model with interaction terms.To evaluate effect measure modification (heterogeneity) according to specific patient/skin cancer characteristics, we computed fully adjusted ORs in subgroups of sex, age , and tumour localisation  by including an interaction term for the subgroup in the conditional logistic regression model. We estimated To reduce misclassification due to left censoring (the prescription registry was initiated in 1995), we conducted an analysis restricted to new users by excluding patients that filled any MTX prescription in the time period 1995–1996.To examine whether the choice of lag time influenced the results, we varied the lag time  used to define MTX exposure from 0 to 60 months in 6-month intervals.To evaluate whether our findings were susceptible to surveillance bias, we repeated the risk-set sampling and analysis restricted to individuals with psoriasis or psoriatic arthritis  before the index date .We performed all analyses using STATA Release 17.0, StataCorp, Texas. The study was approved by the University of Southern Denmark and according to Danish law, ethical approval is not required for registry-based studies.After exclusions, we identified 131,447 cases of BCC, 18,661 cases of cSCC, and 26,068 patients with CMM  were exposed to MTX with a cumulative dose ≥2.5 g compared with 8389 (0.6%) of controls, yielding a minimally adjusted OR (95% CI) of 1.45 (1.37–1.54). In the fully adjusted analysis, the OR was 1.29 (1.20–1.38). The OR increased with increasing cumulative dose  cSCC cases and 1296 (0.7%) controls had been exposed to MTX with a cumulative dose ≥2.5 g. This resulted in a minimally adjusted OR of 1.82 (1.58–2.10). After adjustment, the OR was 1.61 (1.37-1.89). A noticeable dose–response pattern was observed  were exposed to MTX with a cumulative dose ≥2.5 g compared with 1465 (0.6%) of controls, yielding a minimally adjusted OR of 1.25 (1.07–1.46). In the fully adjusted analysis, the OR was 1.35 (1.13–1.61). However, no evidence of dose response was observed  with 12 months of lag to 1.44 (CI 1.17–1.78) with 60 months of lag  randomised to low-dose MTX (mean dosage 14.9 mg weekly) and 2395 patients  randomised to placebo. Risk of skin cancer was increased in the MTX-treated group (2.2%) compared with the placebo (1.1%) with a HR (95% CI) of 2.1 (1.3–3.3). When stratifying by skin cancer type, the HR was 1.4 (0.7–2.7) for BCC, 3.3 (1.6–6.7) for cSCC, and 2.0 (0.5–8.0) for CMM . The risk increase was present in BCC  and cSCC , but only with an apparent dose–response association for BCC . An AmerWith regards to CMM, previous investigations have demonstrated positive as well as neutral associations. An Australian cohort study of patients with rheumatoid arthritis reported a SIR of CMM of 3.0 (95% CI 1.2–6.2) associated with the ever-use of MTX . In a reIn a recent systematic review and meta-analysis, including 12 investigations and 16,642 cases of melanoma, individuals with MTX use had a small increased risk of melanoma compared to non-users  .The specific indications for MTX treatment warrants discussion as the indications themselves might be associated with increased skin cancer risk. In a recent meta-analysis including patients with psoriasis, the pooled relative risk was 2.2 (95% CI 1.3–3.5) for cSCC and 1.3 (95% CI 0.7–2.3) for BCC. For severe psoriasis, the corresponding figures were 11.7 (95% CI 1.5–90.7) and 3.2 (95% CI 1.3–7.6) . In a DaTo summarise, we observed evidence of a dose-dependent increase in risks of BCC and cSCC, but not CMM, associated with use of MTX. However, the observed associations were of limited magnitude and supplementary analyses suggested that confounding and surveillance bias played a role. At present, our findings therefore cannot support that skin cancer risk should be an important consideration when prescribing MTX. However, our findings do deserve further attention for future investigations that would ideally include data on UV exposure.STROBE- checklistSupplemental material


To assess long-time results of primary surgical treatment in children with glaucoma after congenital cataract surgery.A retrospective study of 37 eyes from 35 children with glaucoma after congenital cataract surgery, who underwent surgery between 2011 and 2021 at the Childhood Glaucoma Center, University Medical Center Mainz, Germany. Only children, who received a primary glaucoma surgery in our clinic within the given time (n = 25) and had at least one-year follow-up (n = 21), were included in the further analysis. The mean follow-up time was 40.4±35.1 months. The primary outcome was the mean reduction in IOP (in mmHg) from baseline to follow-up visits after the surgery, measured with Perkins tonometry.8 patients (38%) were treated with probe trabeculotomy (probe TO), 6 (29%) with 360° catheter-assisted trabeculotomy (360° TO) and 7 (33%) with cyclodestructive procedures. IOP was significantly reduced after probe TO and 360° TO after 2 years, from 26.9 mmHg to 17.4 mmHg (p<0.01) and 25.2 mmHg to 14.1 mmHg (p<0.02), respectively. There was no significant IOP reduction after cyclodestructive procedures after 2 years. Both, probe TO and 360° TO led descriptively to eye drops reduction after 2 years, from 2.0 to 0.7 and 3.2 to 1.1. The reduction was not significant.In glaucoma after congenital cataract surgery, both trabeculotomy techniques, lead to good reduction of IOP after 2 years. There is a need for a prospective study with comparison to the use of glaucoma drainage implants. The prevalence of congenital cataract is 4.24 per 10.000 people and is the leading preventable cause of childhood blindness [Timely lentectomy in childhood  is cruciTreating glaucoma after congenital cataract surgery presents unique challenges . Eye droOur clinical experience coincides with the experience of Bothun et al. that angle surgery, such as trabeculotomy is often effective, not only in primary congenital glaucoma  but alsoOur study aimed to present a safe alternative operation technique to drainage implantation or trabeculectomy for treating glaucoma after congenital cataract surgery in children.A retrospective study of 37 eyes from 35 children with glaucoma after congenital cataract surgery, who underwent surgery between 2011 and 2021 at the Childhood Glaucoma Center, University Medical Center Mainz, Germany. Only children, who received a primary glaucoma operation in our clinic within the given time (n = 25) and had at least one-year follow-up (n = 21), were included in the further analysis. Surgery was indicated, if at least 2 criteria of The World Glaucoma Association Consensus were met: IOP above 21 mmHg, corneal findings such as Haab’s strie/megalocornea, optic disc excavation, increasing myopia or visual field loss (in older children). In cases where glaucoma after congenital cataract surgery was diagnosed late and the vision was severely impaired , or when only one eye was affected in the advanced stage of the disease, or if the child had other health issues, we considered a cyclodestructive procedure as the initial treatment option. IRB  waived the need for IRB approval, because of the retrospective nature of the study. The study and data collection were in conformity with all country, federal, and state laws. The study was in adherence to the tenets of the Declaration of Helsinki. The mean follow-up time was 40.4±35.1 months.The primary outcome was the mean reduction in IOP (in mmHg) from baseline to follow-up visits after the surgery, measured with Perkins tonometry. The following data were collected at the time of surgery and evaluated as well: demographics, number and type of surgical interventions, number of eye drops, cornea dimensions, corneal thickness and axial length. The surgical steps of trabeculotomies were described before . Surgerip-value <0.05 was considered statistically significant. Statistical analysis was performed using GraphPad Prism9  for Mac.Categorical variables were presented as absolute and relative frequencies, whereas mean and standard deviation were computed for approximately normal-distributed continuous variables. Evaluation of data normality was performed using the Shapiro-Wilk test. Categorical variables were compared using Fisher’s exact test. Non-normally distributed continuous variables were compared using Mann-Whitney and Wilcoxon tests. For multiple comparisons, non-parametric Kruskal-Wallis test and post hoc Dunn’s test were used. All statistical tests were two-sided and 21 eyes with glaucoma after congenital cataract surgery without previous glaucoma surgery and at least one-year follow-up were included in this study. Out of 21 patients in our study, 8 patients (38%) were treated with probe trabeculotomy (probe TO), 6 patients (29%) underwent 360° catheter-assisted trabeculotomy (360° TO) and 7 patients (33%) received cyclodestructive procedures. There was no statistical difference between those three groups concerning age, gender, preoperative IOP and number of preoperative eye drops, see Mean preoperative IOP measured with Perkins was 25.6 mmHg for the entire study population. At the last follow-up, a significant reduction in IOP was observed, with the mean IOP decreasing to 16.9 mmHg (-8.7 mmHg).After probe TO, there was a significant reduction in IOP from 26.9 mmHg to 16.4 mmHg after 1 year  and to 17.4 mmHg after 2 years , resulting in a 39.0% reduction in IOP after 1 year and 35.3% reduction after 2 years.Following 360° TO, the IOP decreased from 25.2 mmHg to 14.8 mmHg after 1 year  and 14.1 mmHg after 2 years , corresponding to a 41.3% reduction in IOP after 1 year and 44% reduction after 2 years.Cyclodestructive interventions lowered the IOP from 24.0 mmHg to 19.0 mmHg after 1 year  and 19.0 mmHg after 2 years , leading to a 20.8% reduction in IOP after both 1 year and 2 years. However, the reduction was not statistically significant. The IOP reduction of these three surgical techniques is illustrated in the There were no statistically significant differences observed in IOP reduction at both 1 and 2 years when comparing the probe TO, 360° TO and cyclodestructive procedures.The preoperative number of glaucoma medication was recorded as 2.4±1.5 for the entire study population. At the last follow-up, a significant reduction was observed, with the average number of medications decreasing to 0.92.After probe TO, the number of eye drops decreased from 2.0 to 0.7 after 1 year and to 0.9 after 2 years. Similary, after 360° TO, there was a reduction of eye drops from 3.2 to 1.2 after 1 year and 1.0 after 2 years.Cyclodestructive interventions led to a decrease in the number of glaucoma medication from 2.0 to 1.0 after 1 year and 1.0 after 2 years.After dividing the entire study population into three groups based on the surgical technique, the reduction in the number of glaucoma medication was no longer statistically significant. The glaucoma eye drop reduction after those three operations techniques are shown in the 4 Patients after probe TO did not need any eye drops to control glaucoma, in comparison to 2 patients after 360° TO and 1 patient after cyclodestructive intervention.Reoperation was conducted, when IOP was above 21 mmHg and there was a sign of progression in: corneal findings, optic disc excavation, myopia or visual field 4–6 weeks after the first operation, although the maximal possible local IOP lowering medication was given.During the 3-year follow-up period, two children having had a cyclodestructive procedure and one child after probe TO required reoperation. One patient who underwent cyclodestructive procedure needed another cyclodestructive procedure within the first year, subsequently an Ahmed drainage implant was inserted to control the IOP. The second patient received a Baerveldt drainage implant within the first two years, which led to IOP control for the follow-up period. The child having had probe TO received 360° TO within the first three years, which resulted in good pressure control thereafter.This study examined the outcomes of probe TO, 360° TO and cyclodestructive interventions for managing glaucoma after congenital cataract surgery. Significant reduction in IOP were observed after probe TO and 360° TO, but not after cyclodestructive procedures.Based on a recent review, the most appropriate surgical technique in glaucoma after congenital cataract surgery remains uncertain .According to the literature, drainage implants and trabeculectomy are commonly performed surgeries to reduce IOP in glaucoma after congenital cataract surgery. However, these techniques have their limitations. Drainage implants can be associated with sight-threatening complications , while tPromisingly, minimally invasive glaucoma surgeries (MIGS) are expected to play a role in glaucoma management after congenital cataract surgery, following encouraging results in a few studies , 25.In our study, significant reduction in IOP was observed after probe TO and 360° TO. The IOP decreased from 26.9 to 16.4 mmHg and from 25.2 to 14.8 mmHg after one year, respectively. These findings were consistent with a prospective study by Pakravan et al., which compared IOP reduction after trabeculectomy and Ahmed implant in children with glaucoma after congenital cataract surgery. In their study, the preintervention IOP was 31.0 mmHg and decreased to 14.7 after trabeculectomy and 14.4 mmHg after Ahmed implant, with a follow-up duration of 13.1 to 14.8 months . Kirwan Three independent studies evaluating the IOP reduction following drainage implantation consistently demonstrated similar results. In the first study, the IOP decreased from a baseline of 36 mmHg to 15 mmHg . The secEl Sayed et al. conducted a prospective study evaluating the outcomes of two-site trabeculotomy. Their findings showed a significant reduction in IOP from 22.3 to 14.1 mmHg one year after the surgery . SimilarIn our study, although the use of antiglaucoma eye drops was still necessary one year after probe TO and 360° TO, a notable reduction in the number of topical medications was observed. After probe TO, there was a reduction in eye drops from 2.0 to 0.7 and after 360° TO the reduction was from 3.2 to 1.2 after one year. This reduction was not statistically significant. In the study by Pakravan et al., it was reported that the number of antiglaucoma medications decreased from 3 to 1.67 after trabeculectomy and 3.3±0.5 to 1.6±0.51 after Ahmed implant . SimilarIn 3 years, 2 children who had cyclodestructive procedures and 1 child who had probe TO needed reoperation. However, in 18 children, the IOP was effectively controlled throughout the follow-up period. In the study by Kiwan et al., 3 out of 19 eyes maintained good IOP control for over 6 years . In the Our study has several limitations, primary due to its retrospective design. The selection of the surgical procedure was based on the surgeon’s preference, with trabeculotomy being the preferred method due to the extensive experience in our glaucoma center. It should be noted that glaucoma drainage implantation is not a primary procedure for managing glaucoma after congenital cataract surgery at our clinic. Nonetheless, this study provides valuable insights for making informed decisions in the clinic setting regarding the appropriate surgical treatment for glaucoma after congenital cataract surgery. Furthermore, it contributes to the establishment of treatment recommendation for this rare yet significant condition.Both trabeculotomy techniques have demonstrated significant long-term reduction in intraocular pressure (IOP) after 2 years in patients with glaucoma after congenital cataract surgery. These surgical methods offer a safe alternative with low reoperations rates, making them viable first-line surgical therapies. However, there is a need for a prospective study that compress these trabeculotomy techniques to drainage implantation to further evaluate their effectiveness and determine the optimal treatment approach for this patient population.S1 Table(XLSX)Click here for additional data file.