Diagnostic value of b-scan ultrasound in ophthalmic tumors

Background: Ophthatamic ultrasonography is a useful diagnostic tool for intraocular evaluation

Objectives: The objective of this study was to detect and characterize the ocular and orbital tumors with the help of B-scan ultrasound

Patients and Methods: This was a prospective descriptive study conducted in Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, for a period of two years from January 2009. Contact B-scan methodology with 7.5 MHZ linear probe was used in which probe was directly placed on closed eyelids. Scanning was performed in longitudinal as well as transverse planes and with eye movements in all directions. 51 consecutive patients of either sex and age were examined, referred from different ophthalmology centers and clinics having clinical suspicion of orbital masses

Results: Total 51 cases were examined, 27 [53%] were males and 24 [47%] were females. Right eye was involved in 51% cases, left was in 43% cases and both eyes were involved in 6% cases. Out of 51 cases, 88% cases were diagnosed to be extra ocular orbital tumors and 12% were intra ocular tumors. Among all tumor types, pseudo tumor was commonest variety and was 26%

Conclusion: Ultrasonography of eyes [B-scan] is non invasive, relatively cheaper and easily available method to diagnose orbital tumors

Red cell transfusion; triggers used in operating room

The purpose of this study was to determine and quantify those factors that anesthetist's use when deciding to transfuse blood in operating room. CMH abbottabad Nov to Dec 2008. Survey report. Prospective cross-sectional descriptive from operation theatre of Combined Military Hospital Abbottabad a tertiary care hospital. With consent from the local ethics committee, an audit was carried out using a questionnaire designed to examine some of the factors that could be important in the decision-making process surrounding blood transfusion during intermediate and major surgery. Anesthetists were asked to fill in the audit forms and to indicate whether they were going to give blood or not. Fifty two audit forms, completed during intermediate or major surgery, were analyzed to determine the strengths of certain factors in the decision-making process related to transfusion. Fifty one forms had a satisfactorily complete data set with hemoglobin concentrations Hb between 6.6 and 15.0 g/dL. This study demonstrates that, of the physiological factors, the hemoglobin concentration was the most important factor used for red cell transfusion, and the presence of ongoing bleeding an important contextual factor. Peer pressure to transfuse became apparent at a [Hb] of about 8.5 g/dL. The patients were transfused at the average Hb value of 10.8 g/dL. This average Hb of transfused patients is much higher than current Hb trigger thresholds of 7.0-8.0 g/dL

Efficacy of interferon therapy in patients of chronic hepatitis B viral infection treated at MH Rawalpindi

The consequences of acute and chronic HBV infection are major public health problems. These infections may progress to cirrhosis, liver failure, and Hepatocellular carcinoma Treatment of chronic replicative hepatitis B virus [HBV] infection is aimed at stopping viral replication and preventing the development of chronic liver disease. To determine the efficacy of Interferon therapy in patients of chronic Hepatitis B treated at MH Rawalpindi, by comparison of PCR for HBV DNA before and after Interferon therapy. Quasi-experimental study. Military Hospital, Rawalpindi from July 2003 to December 2005. The efficacy of a 4-month course of subcutaneously administered human recombinant interferon Alfa was studied. A total of 50 patients of proven chronic viral hepatitis B with presence of hepatitis B surface antigen and hepatitis B virus DNA [HBV DNA] in the serum were enrolled over the span of 30 months. All patients were treated with 5 mega units of recombinant interferon alfa-2b subcutaneously once daily for 4 months. PCR for HBV DNA was performed at the end of fourth month in treated patients as a predictor of response to interferon therapy. The treatment was well tolerated, only in three patients treatment was ceased due to severe depression while none of the other patient required dosage reduction or cessation of treatment because of side effects. In 22 treated persons [44.0%] PCR for HBV DNA becomes negative showed response to treatment. This finding is statistically significant [p less than 0.05]. Interferon Alfa has significant efficacy in chronic Hepatitis B. Patients of chronic Hepatitis B in whom Interferon therapy is not contraindicated should be treated with Interferon Alfa to avoid long term complication of infection

Reactive lymphocytosis; an enigma of diagnosis

A case of reactive lymphocytosis is described who despite all the relevant investigations and clinical evaluation eluded a conclusive diagnosis

beta thalassaemia imported from the mediterranean to the subcontinent?

The study was conducted to determine the source of beta thalassaemia mutations in Pakistan with the help of tracing the HLA antigens and common mutations. A total of one hundred and fifty five subjects [n=155] were included in the study. It included fifty-four patients of thalassaemia major [n=54] and their one hundred and one [n=101] siblings. HLA typing by lymphocytotoxicity method was performed for HLA class I antigens. Retrospective analysis was carried out for common beta thalassaemia associated mutations. The most frequent HLA class I frequencies and beta thalassaemia mutations were compared with different populations of the world to establish genetic ancestry of our patients. Our analyses showed that HLA B35 was present in our thalassaemics in the highest frequency. The antigen frequency [af] of HLA-B35 was 0.37 in thalassaemics while it was 0.21 in normal population [p=0.004]. The af of HLA-B35 was 0.24 in siblings of thalassaemics [p=0.06] versus normal population. However, increased expression of HLA B35 has not been reported in a number of the thalassaemic populations studied for HLA antigen. The combined HLA class I frequencies for our population have the closest match with those found in Caucasian population of the Mediterranean region. The study of the mutations for beta thalassaemia shows the mutation Fr 8/9 [G+] to be present in the highest frequency in areas of northern Pakistan. The HLA and mutation analysis show a trend for this mutation to be Asian-Indian in origin. The other common beta thalassaemia mutation that is prevalent in Southern region of Pakistan is IVS-l-5 substantiated by HLA and mutation analysis studies. It is probably of Arabic decent, as it occurs along the seashore of old trade route extending from Yemen to Philippines. There is evidence that beta thalassaemia mutations arose denovo spontaneously in Pakistan and India and then spread within pedigrees. However there is a chance that IVI-l-5 mutation may have been imported from Arabic Peninsula. It will be interesting to study HLA frequencies / RFLPs of Sindhi and Baluch populations and compare them with seashore areas enroute

Posttransplant Guillain Barre Syndrome

This case report describes a patient with severe aplastic anaemia, who developed Guillain Barre Syndrome [GBS] 10 weeks after allogeneic haematopoietic stem cell transplantation [HSCT] from HLA-matched siblingíyounger sister. GBS was preceded by pneumonia, herpes labialis and oral candidiasis a week earlier. Treatment with ventilatory management, intravenous human immunoglobulin [IVIg] and antimicrobials resulted in smooth recovery in thirty-one days