Surgical and visual outcomes of retinal detachment surgery in eyes with chorio-retinal coloboma

Objective: To evaluate the anatomical and visual outcome of surgical management of retinal detachment associated with chorio-retinal coloboma

Study Design: Prospective interventional case series

Place and Duration of Study: This study was conducted at Al-Shifa Trust Eye Hospital Rawalpindi from Jan 2012 to Dec 2013

Material and Methods: Twenty one eyes [21 patients] that underwent surgery for retinal detachment associated with chorio-retinal colobomas were selected. Evaluation was done on the basis of type of intervention, final visual acuity and anatomical outcome and complications. Out of 21, 19[90.47%] eyes underwent pars plana vitrectomy with silicone oil [SO] and 2[9.52%] underwent primary scleral buckling surgery. SO was removed in 9 [47.36%] eyes at final follow up. Encircling band was placed in 12 [63.15%] eyes based on peroperative judgment of surgeon. Intra-operative lensectomy was performed in 6 [28.57%] eyes. The main outcome measures were retinal re-attachment and visual recovery. Statistical analysis was performed using "IBM statistical package for social sciences [SPSS] Statistics" [version 17.0, Chicago, Illinois, USA]. Qualitative variables were described using percentage; quantitative data were defined using mean +/- standard deviation. The pre op and post op frequency of best corrected visual acuity [BCVA] was compared using Wilcoxan Signed Ranks Test. Confidence interval was 95% [level of significance p<0.05]

Results: The mean number of operations per eye were 1.57 +/- 0.74; mean follow-up was 13.1 months [range 12-18]. The retina remained attached in 18 eyes [85.71%] at final follow-up. The post op BCVA improved significantly as compared to pre op BCVA [p< 0.01]. Mean pre op BCVA was counting fingers [CF] and mean post op value of BCVA was 3/60

Conclusion: Pars plana vitrectomy along with silicon oil tamponade for retinal detachment related to choroiretinal coloboma improves the long-term anatomical outcome however no significant improvement in visual acuity was observed

Outcome of mediastinal lypmh node biopsy by cervical mediastinoscopy

Objective: To analyze the outcome of mediastinal lypmh node biopsy by conventional mediastinoscopy for diagnostic purpose in patients with mediastinal lymph node enlargement

Study design: Descriptive case series

Place and Duration of study: The study was conducted at 2 private hospitals of Karachi, from July 2012 to June 2014

Methodology: Patients aged 12 year and above, of either sex, who presented with CT-proven mediastinal lymph node enlargement in whom diagnosis could not be confirmed via other investigations, were included. Patients underwent conventional mediastinoscopy under general anesthesia. Patients with previous history of thyroid or neck surgery, severe superior vena caval syndrome [SVC] or cervical spondylosis were excluded from the study. Multiple lymph node stations were biopsied and sent for histopathology. Biopsy reports were followed and results analyzed

Results: Out of 32 patients 19 were males and 13 females. Age range was from 25 to 55 year. The most common diagnosis was tuberculosis. The mean duration of the procedure was 40 minutes. Lymph node stations 2 and 4 were most commonly biopsied and an average of 4 biopsy samples were obtained per patient

Conclusion: Mediastinscopy is an invaluable and relatively cost effective procedure in the diagnosis of patients with mediastinal lymph node enlargement in whom the diagnosis could not be confirmed by other investigations

Changes in macular thickness and visual acuity after intravitreal bevacizumab injfection in patients with retinal vein occlusion

To evaluate the effect of singel Intravitreal Bevacizumab [Avastin] injection on visual acuity [VA] and central retinal thickness [CRT] in patients with macular edema secondary to branch retinal vein occlusion [BRVO] or central retinal vein occlusion [CRVO]. Prospective, non-randomized, interventional case series. This study was conducted at Al-Shifa Trust Eye Hospital Rawalpindi from March 2012 to February 2013. Twenty three patients with macular edema attributable to vein occlusion received intravitreal injection of Bevacizumab 1.25 mg. Nine patients had central retinal vein occlusion [CRVO] and 14 patients had branch retinal vein occlusion [BRVO]. Complete ophthalmic examination including best corrected visual acuity [BCVA] and optical coherence tomography [OCT] was done at base line and follow up visits. At base line mean visual acuity was Log MAR 0.73 and showed improvement to mean Log MAR 0.39 at 12 weeks after intravitreal Bevacizumab [IVB] injection. Mean CRT was 527 micro m at baseline that decreased to 274 micro m after 12 weeks of IVB treatment. Intravitreal Bevacizumab appears to result in significant short term improvement of VA and macular edema secondary to vein occlusion

Pattern of magnetic resonance imaging and magnetic resonance venography changes in cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis is a common but highly under-recognised condition, which is missed not only by general practitioners but also by neurologists. Computerised tomography [CT] or magnetic resonance imaging [MRI] of brain alone is not sufficient to diagnose this condition. Objective of this study was to explore the pattern of magnetic resonance imaging [MRI] and magnetic resonance venography [MRV] changes in cerebral venous sinus thrombosis [CVST]. This was a descriptive study in which 52 cases of cerebral venous sinus thrombosis with special emphasis on their MRI and MRV findings were included. The study was conducted in Neurology Unit, Lady Reading Hospital, Peshawar, Pakistan, from January 2010 to July 2011. All patients suffering from cerebral venous sinus thrombosis were included in the study. Multi-planar/multi-sequential, Tesla 1.5 MRI/MRV time of flight images were done in all cases where there was suspicion of cerebral venous sinus thrombosis. Out of 52 patients with cerebral venous sinus thrombosis 41 [78.84%] were female and 11 [21.15%] were male. Mean age was 37 +/- 5 years. Definite risk factors were found in 38 [73.076%] patients with pregnancy, use of oral contraceptives or puerperium being the most frequently found risk factor in 20 [73.076%] patients. Most common complaint was headache found in 41 [78.84%] patients, followed by focal neurological deficits, and altered mental status and seizures. Papilloedema was seen in 20 [38.46%] patients. The cerebral venous sinuses most frequently involved were transverse and sigmoid sinuses in 17 patients [32.69%] while superior sagittal sinus alone in 10 [19.23%] patients. Overall CT brain was normal in 30% and MRI brain in 23.07% patients; however, MRV of these patients revealed CVST. Imaging plays a primary role in the diagnosis of cerebral venous sinus thrombosis because the clinical picture of CVST is non-specific and highly variable. Thrombosis of cerebral venous system is readily picked-up on MRV even if it is missed by CT scan or MRI.

Legionella infection; an environmental and clinical study during hajj season

Respiratory system is most commonly affected during Hajj season. [1] to determine the prevalence of Legionella in drinking water, cooling sprinklers and other sources of water consumed in pilgrimage area of the holy city, Makkah; [2] to study the prevalence of pneumonia caused by Legionella species from clinically suspected cases; and [3] to determine whether there is any relationship disease incidence and water supply system. The clinical samples were received from in-patients of the following five Ministry of Health [MOH] Hospitals; Hera General Hospital, Al-Noor Specialist Hospital, King Faisal Hospital, King Abdul-Aziz Hospital, and Ajyad Hospital during Hajj 2003. The patients included in the study were those who fulfilled the following criteria; clinically diagnosed as pneumonia, negative on routine cultures and found negative for acid fast bacilli [AFB] from sputum/bronchial aspirate [BAL]. Serological tests was done by Enzyme linked Immunosorbent assay [ELISA] for Legionella antibodies total lgG and IgM. Out of total 133 patients suspected for Legionella, 83 [62.4%] were male and 50 [37.6%] female. The male versus female ratio was 1:0.6. The major age group affected was between 50-70 years [63.2%]. There were 4 [3.0%] cases of Legionella species isolated from microbiological cultures. The overall seropositive rate among clinically suspected cases was 4.51%. A total of 560 water samples were collected from Arafat, Muzdalifa, Mena, and areas around the Holy Mosque and found negative for Legionella species. Pneumonia was one of the most common illnesses among pilgrims. The water supplied to all areas of the pilgrimage was free from the Legionella and no link has been established among the patients with water supply systems. Both clinicians' awareness and availability of specialized laboratory tests for atypical pneumonia such as Legionella is necessary. Although, all water samples found negative for Legionella but it is recommended to screen all water reservoirs for Legionella annually before Hajj season

[Epidemiology of chronic kidney disease in Iran and worldwide]

Chronic kidney disease [CKD] is a worldwide public health problem. Increasing evidence indicates that earlier stages of CKD can be detected through laboratory testing, and that therapeutic interventions implemented early in the course of CKD are effective in slowing or preventing the progression toward end stage renal failure and its associated complications. Each physician should consider how he/she can contribute to an increase in the local screening, identification, and treatment efforts for CKD. Multidisciplinary collaboration between physicians, health care workers, and the government is necessary to halt the progression of CKD. Unfortunately, there is paucity of data concerning epidemiologic characteristics of CKD in Iran, resulting in lost opportunities for prevention. The present article summarizes recent observations about CKD epidemiology, both in Iran and worldwide

Essential medicines management during emergencies in Pakistan

This paper illustrates the experiences of essential medicine management in providing cure and care to victims of Pakistan's 2005 earthquake in a safe, rational and effective mode. The health interventions assured access to essential medicine, sustained supply, inventory control through a computerized logistic support system and rational use of medicines. World Health Organization Pakistan outlined modalities for acceptance of donated medicines, assisted in speedy procurement of medicines and designed customized kits. Proper storage of medicines at controlled temperature was ensured in warehousing facilities in 12 locations. A steady supply of medicines and their consumption without stock-outs in the 56 first-level care facilities of calamity-hit areas helped to ascertain the average consumption and cost of essential medicines and supplies for the catchment population. Tools for quantification and forecasting of medicines and supplies were developed and shared. Medicines and medical supplies were efficiently used resulting in minimum wastage

Fluoroquinolone and macrolide co-resistance in clinical isolates of Campylobacter species: a 15-year study in Karachi, Pakistan

Fluoroquinolone and macrolide antibiotics are generally considered as first-line drugs for the treatment of severe campylobacteriosis. This study was conducted to analyse the trend of erythromycin and ofloxacin resistance among Campyiobacter spp. isolated from stool specimens over a period of 15 years [1992-2007] at The Aga Khan University clinical laboratory in Karachi, Pakistan. A total of 83 396 stool specimens were processed, with a 14% isolation rate for enteric pathogens. The isolation rate of Campylobacter spp. was low during 1992-93 [6%-13%], peaked in 1996 [46%], then ranged from 20% to 40%. We report a rising trend in ofloxacin resistance, re-emergence of erythromycin resistance and indications of co-resistance to both drugs in clinical isolates of Campylobocter spp.

Increased isolation of Vibrio cholerae O1 serotype Inaba over serotype Ogawa in Pakistan

Although the predominant Vibrio cholerae serotype in Pakistan is Ogawa and serotype Inaba is rare, there has been a significant increase in the isolation of Inaba in our referral laboratory in Karachi. This paper reports this observation and further analysis of previous cholera data from 1993 to 2005 to assess the trend of occurrence and resistance pattern of V. cholerae strains. From January to September 2005, 245/3292 [7.4%] specimens yielded growth of V. cholerae. Of these, 243 were serotype Inaba, outnumbering serotype Ogawa. This recent Inaba strain is 100% resistant to cotrimoxazole, 3% resistant to chloramphenicol and not resistant to ampicillin, tetracycline and ofloxacin. This sensitivity pattern is almost similar to that of the previous predominant serotype Ogawa

Blood Culture and sensitivity pattern in neonotology unit of children hospital Lahore

To identify spectrum of organisms causing neonatal sepsis and the sensitivity pattern against commonly used antibiotics. Prospective descriptive study. Blood samples were taken from all neonates with clinical suspicion of sepsis before start of antibiotics and sent for culture by standard method. The data obtained from January 2004 to June 2004 was analyzed and results were tabulated. A total of 1900 blood samples were taken. Cultures were positive in 524 samples [27.6%]. E Coli was the most common organism found [31.67%] followed by Staph Epidermidis [24.80%], Klebsiella [19.08%] and Pseudomonas [14.69%]. Amikacin was the most effective drug followed by Co-Amoxi Clav, Ciprofloxacin, Imipenem and Ceftazidime in that order. Gram positive and gram negative organisms showed a high degree of resistance against Ampicillin and Gentamycin respectively. Neonatal sepsis is one of the leading causes of morbidity and mortality. Gram negative organ isms are the major cause of neonatal sepsis in NNU of Children Hospital. In this study these organisms showed resistance against commonly used antibiotics [Ampicillin, Gentamycin and Cefotaxime].There is a need to modify already existing protocol in NNU of Children Hospital

Dyslipidemia in type II diabetes and the effect of glycaemic control on type II diabetes

Lipid profile of Type II Diabetes patients was determined before and after treatment. The study was carried out on 180 [Male/Female: 91/89] treated patients who were registered in Chittagong Diabetic Hospital and 80 [Male/Female: 42/38] newly diagnosed diabetic patients who were selected randomly. 40 [Male/Female: 20/20] non-diabetic healthy subjects were selected for control. All the subjects included in this study were between the age of 40-70 years. In the study, fasting plasma glucose [FPG], serum total cholesterol [TG], serum triglyceride [TG], high density lipoprotein-Cholesterol [HDL-C] were measured. Low density lipoprotein-Cholesterol [LDL-C] was also determined [using Friedwald's formula]. When the lipid profiles of untreated diabetic patients were compared with the control, an increase in TC, HDL-C, LDL-C and TG were found in the former. The increase in TC and LDL-C was highly significant [p<0.001], increase in TG was found significant [p<0.005] whereas increase in HDL-C was not significant. When the lipid profile of treated patients was compared with the untreated patients, decrease in TC, TG and LDL-C in the former patients was found as highly significant [p<0.001] for all parameters, whereas, decrease in HDL-C was found to be less significant. In untreated Type II Diabetes Mcllitus, significant positive correlations were found between fasting plasma glucose [FPG] and [a] TC [r = + 0.01, p<0.0l], [b] TG [r = + 0.07, p<0.01], [c] LDL-C [r = + 0.04, p<0.01] whereas, no significant correlation was found between glucose and HDL-C concentrations. In Type II Diabetes Mellitus, subjects, after treatment, significant positive correlations were also found between fasting plasma glucose and [a] TC [r =+0.21, p<0.01], [b] TG [r = + 0.26, p<0.01], [c] LDL-C [r = + 0.19, p<0.01], whereas no significant correlation was found between glucose and HDL-C concentrations. It was evident from this study that lipid abnormalities exist in Type II Diabetes and significant improvement against lipid abnormalities occur after treatment. Lipid abnormalities were related to glycaemic control

Comparison of double disc and combined disc method for the detection of extended spectrum B lactamases in enterobacteriaceae

To compare double disc approximation and combined disc method for their ability to detect extended spectrum b lactamase [ESBL] production in enterobacteriaceae and determine the percentage of isolates which are falsely reported as sensitive in absence of ESBL detection, in a clinical microbiology laboratory of a tertiary care hospital between September - October 2002. Selected isolates were identified according to standard biochemical tests. Disc susceptibility tests were performed according to NCCLS. ESBL detection by combined disc [cefotaxime [30ug] versus cefotaxime plus clavulanate [30+10 ug]] was compared with detection using double discs [amoxy-clavulanic acid [20+10 ug] and aztreonam [30ug] applied 10 mm apart]. Results were interpreted according to NCCLS and analysed on SPSS version 10. ESBL production was detected in 140 [30%] isolates by combined disc method and 139 [29.5%] by double disc method. There was no significant difference between two methods. Of the ESBL positive isolates 41[29%] gave zone diameters that were within the sensitivity range cutoff and would have been falsely reported as being beta lactam sensitive in absence of ESBL detection. ESBL detection should be routinely performed in clinical laboratories as false reporting would result in treatment failure despite in vitro sensitivity. No difference was found between the combined disc and double disc methods hence either of two could be used

Seasonal variation in bacterial pathogens isolated from stool samples in Karachi, Pakistan

To determine the seasonal variation of the commonly isolated bacterial pathogens in stool samples. A retrospective descriptive study was undertaken of all the stool samples submitted from within Karachi to the Aga Khan University Hospital Laboratory over a period of five years [January 1997- December 2001] in order to determine the commonly isolated bacterial pathogens and to predict their seasonal variation. A total of 16379 stool samples were included in this review. Bacterial isolates were found in 6670 stool samples [culture detection rate=40.7%]. The mean age at the time of culture of each sub-group was <1 year group [6.58 +/- 3.1 months], 1-5 years [2.13 +/- 0.94 years], 5-14 years [8.3 +/- 2.6 yrs] and adults [43.2 +/- 18.5 years]. Male: Female ratio was 1.2:1. Vibrio cholera 01 Ogawa [32.8%], Campylobacter jejuni [17.3%], Enteropathogenic Escherichia coli [9.9%], Salmonella paratyphi b [6.6%] and Shigella flexneri [6.2%] were the most common organisms isolated. These organisms show a distinct seasonal variation with summer predilection. In contrast to the previous studies from South Asia, which have identified E. coli, followed by Vibrio cholerae as the most common enteric isolates, we found Vibrio cholera 01 Ogawa followed by Campylobacter jejuni as the most common enteric pathogens isolated in an urban setting. It is important to consider seasonal variation when empirically treating diarrheal diseases in our region

Fatal buran injury in females: oil stove is the main culprit

Burn care in a developing country remains a challenge. 20 patients with acute burn injuries pertaining to on oil stove were treated in 30 months. 85% females and 15% males, of these 47% were young house wives burnt within the earlier years of their marriage. The age groups involved were between 11 and 40 with a mean of 20.9 years. The TBSA [total body surface care] ranged from 10 to 100% with a mean of 48.3%

Isolated caecal diverticulitis

Solitary caecal diverticulitis are often diagnosed preoperatively as acute appendicitis. Operative diagnosis is also difficult, and carcinoma is suspected. Such a case is reported

Goiter in school going children in Murree Hills

In 31 schools in tehsil Murree 2860 children were examined, for presence of goitre. In girls, 47.9% had goitre while 46.5% of boys had goitre. The overall prevalence rate being 47.4%