Comparison of corneal endothelial cell density in patients of pseudoexfoliation syndrome with normal population

Objective: To compare the corneal endothelial cell density in patients of Pseudoexfoliation syndrome [PXS] with normal healthy controls. Study Design: Cross sectional comparative. Place and Duration of Study: This study was carried out at Armed Forces Institute of Ophthalmology, Rawalpindi from Mar 2016 to Jan 2017

Patients and Methods: Patients of PXS and healthy subjects of both genders between ages of 40 and 50 years, with best corrected visual acuity of 6/6 on snellen visual acuity chart were included in the study. All the participants including controls and PXS patients were subjected to ophthalmic clinical examination including corrected distance visual acuity, slit lamp examination by the single trainee researcher to exclude bias. Participants in both groups were evaluated for corneal endothelial cell density [ECD] by using non-contact, TOPCON SP 3000P Specular microscope. Sampling bias was eliminated by analyzing 100 cells in the center of each specular microscope photograph and mean of three readings was analyzed

Results: Both the groups were similar with respect to gender and age. In our study sample there were 29 [58%] males in PXS group and 24 [48%] males in control group with no statistical significant [p-value > 0.05] difference between gender distributions of both groups. The mean age of the PXS group was 46.34 +/- 2.932 years, and in control group was 45.54 +/- 2.887 years [p-value >0.05]. The mean value of ECD was found to be 2021.548 +/- 528.142 cells/mm2 in PXS patients and the mean value of ECD in healthy subjects was noted to be 2772.692 +/- 383.395 cells/mm2, showing significantly lower ECD in PXS cases. Similarly, significantly higher number of cases 22 [44%] had CED <2000 in PXS as compared to normal healthy subjects

Conclusion: Corneal endothelial cell density decreases in patients of pseudoexfoliation syndrome and this must be considered while planning any intraocular surgery including cataract extraction

Comparison of plasma homocysteine [HCY] levels in normal population and patients of pseudoexfoliation syndrome

Objective: To compare mean plasma homocysteine [HCY] levels [measured in umol/L] of normal population with patients having pseudoexfoliation syndrome [PXS]. Study Design: Cross sectional comparative study. Place and Duration of Study: This study was carried out at Armed Forces Institute of Ophthalmology, Rawalpindi, from May 2016 to Apr 2017

Patients and Methods: In this study 60 patients of PXS and 60 healthy subjects of both genders between ages of 40 and 50 years, with best corrected visual acuity of 6/6 on snellen visual acuity chart were included. All the participants were subjected to ophthalmic clinical examination including corrected distance visual acuity and slit lamp examination. Participants in both groups were evaluated for plasma homocysteine levels, by collection into a heparinized tube and later transferred in ice blocks. The samples were centrifuged at 4000 rpm for 5 minutes and stored at -20°C until the biochemical assay. HCY levels were determined by high performance liquid chromatography [HPLC]

Results: Total 120 participants of both groups were similar with respect to gender and age [p-value>0.05]. There were 36 [60%] males and 24 [40%] females in PXS group and in control group there were 29 [48.3%] males and 31 [51.7%] females. The mean age of PXS group was 44.68 +/- 3.234 years and for healthy control group it was 45.0 +/- 3.13 years. The comparison of homocysteine level between healthy controls and PXS patients showed a highly significant [p-value<0.01] difference between both groups. The mean homocysteine level was [32.14 +/- 14.33] in PXS group as compared to healthy controls [14.41 +/- 4.51]. The comparison of proportions of homocysteinemia showed that the rate of homocysteinemia was significantly [p-value<0.05] greater among patients of PXS. There were 24 [40%] participants in healthy control group who had homocysteinemia in comparison with 58 [96.67%] patients who had homocysteinemia among PXS group

Conclusion: Plasma HCY levels were raised in patients of pseudoexfoliation syndrome as compared to normal population, hence these patients may be considered for further systemic investigations by a medical specialist

Left atrial to left ventricular end diastolic diameter ratio in left ventricular diastolic dysfunction

Background: Diastolic dysfunction [DD] is difficult to diagnose and characterize despite many techniques. It is known that left atrial diameter [LAD] increases and left ventricular internal end diastolic diameter [LVIDD] remains the same in moderate to severe diastolic dysfunction [grade II and above] but a ratio between these two [LAD/LVIDD] has never been used to assess diastolic dysfunction. This study aims to analyze the relationship between the ratio, left atrial diameter/ left ventricular internal end diastolic diameter [LAD/LVIDD] and diastolic dysfunction [grade II and above]. This study also aims to give a statistical model based upon this relationship that is able to help in diagnosing diastolic dysfunction

Methods: This case control analytical study was carried out at the Department of Cardiology, Holy Family Hospital, Rawalpindi, from Jan 2014 to Jan 2016. On the basis of echocardiographic findings, 226 patients were identified as normal healthy control group whereas 226 patients were identified as having diastolic dysfunction of grade II and above and were categorised as disease group. Doppler diastolic function parameters were used to assess diastolic function in all of these 452 patients. Appropriate statistical methods were then applied on the data by using IBM statistical package for social sciences [SPSS]

Results: LAD/LVIDD was correlated to diastolic dysfunction at r=0.858 [p<0.01]. A binary logistic regression model using age, sex and LAD/LVIDD gave an accuracy of 96.9% in diagnosing diastolic dysfunction. LAD/LVIDD in the model had an odds ratio of 2.678?1024. A Receiver Operation Characteristic curve between diastolic dysfunction and LAD/LVIDD yielded a specificity of 93.8% and sensitivity of 99.1% at the cut-off value of 0.7268

Conclusion: A new parameter, left atrial diameter [LAD] to left ventricular internal end diastolic diameter [LVIDD] ratio [LAD/LVIDD], is significantly correlated to diastolic dysfunction [grade II and above]. It is also a significant predictor for diastolic dysfunction

Gender Wise HIV Disease Awareness among Primary School Teachers in Islamabad

To assess the level of awareness and methods of primary prevention about HIV/AIDS among primary school teachers. A descriptive cross-sectional study of 60 male and female teachers, between 25-40 years of age, teaching for at least three years in public and private schools situated in suburb of Islamabad, was conducted using a structured questionnaire. A stratified random sampling design was used to collect data. Analysis was done on SPSS version 17. The study was conducted at Golra Station suburb in Islamabad from October 2012 to December 2012. 77 percent respondents have heard about the AIDs, 40 percent believe that they should not quit good relations with the AIDs Patient, 88 percent believe it is our moral obligation to help the aids victims, 50 percent believe AIDS is a major issue, and same strength responded that it is not their problem. Most of the respondents believe that AIDS is a preventable disease. Majority of the respondents are of the opinion that Government is not solely responsible to control AIDS, all the stake holders must participate in the control of AIDS. It is inspirational to know that majority has knowledge relating to HIV/AIDS. The study emphasizes the need to educate the teaching community about the prevention methods and to endow them with the crucial information and skills to facilitate them to inculcate knowledge to the younger generation at a younger age group as this can challenge the moral and ethical issue relating with the sexual spread of AIDS. However, taboos of public discussions of sexual illness remain a key limitation towards preventive activities

Histamine-induced versus exercise-induced asthma in young adults

The objective of the study was to measure the prevalence of exercise induced asthma among young medical students of Rawalpindi Medical College, Rawalpindi and to compare airway responses to histamine and exercise challenge. Ninety-eight medical students from Rawalpindi Medical College, Rawalpindi were selected after obtaining written consent. They were asked to fill up questionnaire before taking history and doing their physical examination. Each subject was put on exercise by cycle ergometer to such an extent that 80-90% of maximum predicted heart rate was obtained and then same exercise was continued for 6-8 minutes or till symptoms of asthma developed. Before and after exercise challenge, lung functions were measured by using vitalograph compact spirometer and percentage fall in these results was calculated. In another 40 medical students, histamine inhalation challenge was given by increasing dilutions of histamine acid phosphate with the help of Boreal Nebulizer and airway responses were measured with the help of a spirometer. The overall prevalence of exercise and histamine induced asthma in young medical students was found to be 39% and 92% respectively. The comparison between percentage fall of forced expiratory volume [FEV[1]] in first second and peak expiratory flow rate [PEFR] after exercise and after histamine was significant. The present study revealed that overall exercise induced asthma was more common in our subjects as compared to other studies. Moreover, it was also seen that histamine challenge is a more sensitive test as compared to exercise challenge test for detecting latent asthma.

Frequency of congenital nasolacrimal duct obstruction

To determine the frequency of congenital nasolacrimal duct obstruction in children having congenital malformations of the eyes coming to the tertiary care eye hospital. Descriptive study done at Al Shifa eye hospital Rawalpindi from January 2004 to December 2007. Retrospective case record analysis of all children coming to the hospital with congenital malformation of nasolacrimal duct along with other congenital malformations of the eyes were included in the study. Children with no congenital anomalies of the eyes but having nasolacrimal duct obstruction were excluded. Congenital malformations of eyes were seen in 514 cases [289 males and 225 females]. The age distribution was from birth to 15 years, with majority seen between 0-2 years. Out of 514 cases, 103 had congenital abnormalities of lacrimal apparatus with 20% having nasolacrimal duct obstruction. Persistent tears were the major presenting feature. Nasolacrimal duct obstruction was the commonest congenital malformations of the eyes which can be easily corrected

Perforated peptic ulcer a review of 36 cases

To evaluate the epidemiology of peptic ulcer perforation in Armed Forces and further management / outcome of the patients. Data of 36 patients with perforated peptic ulcer collected. This data was analyzed on SPSS 13. CMH Rawalpindi from Jan 1979 to July 1981, Jan 1985 to Dec 1987 and Jan 2001 to Dec 2003. Out of 36 patients 35 were male and only one was female. Twenty four [67%] were between 31-50 years. No past history was taken from eight [22%] patients. Thirty four [94%] patients presented with duodenal perforation. Twenty patients [55%] had rigidity all over abdomen and peristalsis were present in ten [28%] patients who reported within twelve hours. Seventy eight [78%] were diagnosed by history and simple radiological examination. All the patients were treated by laparotomy [simple closure with omental patch]. Post operative complications occur in ten [28%] patients and mortality rate was 8%. Predominantly the peptic ulcer perforation occurs between 30-50 years of age. The incidence reduces with succeeding years of study. Post operative complications were less in younger age group .Early diagnosis can be made easily by taking good history and performing simple radiological examination

Temporary tarsorrhaphy - use of commercial glue [ELFY]

To assess the use of commercial glue [Elfy] for achieving temporary tarsorrhaphy Case series Place and duration of study: Study was conducted at CMH Kharian from January to September 2008. Patients and Method: The various ocular surface disorders which were managed by the temporary tarsorrhaphy with the commercial glue [Elfy] were analyzed. The duration of lid fusion with Elfy and any adverse affects were also noted. Elfy was applied just below the margin of lower eyelid. Then, using a spatula, upper lid was apposed to the lower lid for 1-2 seconds in order to create fusion. If patient required topical treatment, lateral two thirds of the lids were fused and drops instilled through medial one third. In rest of the cases, full length fusion was achieved. In a total of 32 patients Elfy was applied. Eighteen [56%] were males and 14 [44%] were females. Age ranged from six years to seventy five years with mean age of 22.6 years [SD+21.84]. Ocular diseases requiring lid fusion included, infective corneal ulcer/abscess in 21 cases [65.6%], shield ulcer in vernal keratoconjunctivitis in 3 cases [9.4%], facial palsy in 2 cases [6.2%], alkali burns in 2 cases [6.2%], neurotrophic ulcer in 2 cases [6.2%], Mooren ulcer in 1 case [3.1%], Grave's disease in 1 case [3.1%]. Lid fusion persisted for a mean duration of 7.6 + 4 days [range 2 -20 days]. Duration of fusion was less if skin or lashes of upper lid were fused with only skin of lower lid. But it remained for longer duration when eyelashes of both the lids were stuck together. 6 [19%] patients had a burning sensation for fraction of a second, one patient [3%] complained of gritty sensation on skin due to which she removed the Elfy. All the corneal ulcer cases had clinical improvement. Commercial glue [Elfy] is useful as a temporary measure for tarsorrhaphy

Attitude of medical students towards psychiatry in NWFP

Worldwide literature shows negative attitude of medical students towards psychiatry, which determines future of this subject. Some work has been conducted in two provinces [Sindh and Punjab] of Pakistan in this regard. The Objective of this cross sectional study was conducted to find out the attitude of medical students in NWFP towards psychiatry. The survey was conducted at two different days of the month of July on final year students of two recognized medical colleges of NWFP. The sample consisted of 281 subjects of which 165 [58.3%] were males and 116 [41%] were females. Five Point Attitude scale [ATP 30] was used to assess the attitude. The data collected was labelled and analyzed with the help of SPSS version 10. There were total 30 items in the questionnaire of attitude study. Both male and female students showed positive attitude towards most of the items except few, towards which the attitude of the students was neutral. The results seem consistent with the local literature. Over all attitudes of medical students was positive. However, attitude of female students towards some of the items were more positive as compared to their male counterparts

Gronblad-Standberg syndrome: a case report and review of literature

Gronblad-Strandberg syndrome is a rare congenital hereditary dysplasic disorder of the connective tissue, characterized by a progressive abnormal mineralization and dystrophic calcification of elastic tissue and collagen. The term Gronblad-Strandberg syndrome is used when angioid streaks in eye occur in association with pseudoxanthoma elasticum [PXE] of skin. We report a young patient having characteristic skin and eye manifestations of the syndrome. He was evaluated thoroughly regarding extent and potential systemic complications of the disease and was counseled accordingly. Since dermatologists are generally not familiar with historical background and ocular findings of the disease, a brief review of these two aspects is also made

Choroidal metastasis from renal cell carcinoma presenting with cataract

We report a case of rare involvement of the eye with choroidal metastasis from renal cell carcinoma presenting 08 years after the primary tumor was removed. The patient initially presented with cataract most probably induced by the tumor. After cataract extraction, tumor was detected when it induced vitreous involvement and retinal detachment. Enucleation was performed and an extraocular mass was also excised. Histopathology confirmed the diagnosis of metastasis from renal cell carcinoma in the ocular tumor, extraocular mass and the vitreous

Intralesional corticosteroid injection vs surgical treatment of chalazia in pigmented patients

To compare the outcome of intralesional corticosteroid injection and surgical treatment of chalazia. An interventional comparative study. PNS Shifa, Naval Hospital, Karachi from 1st September 2002 to 31st August 2003. During a 9-month recruitment period all patients attending PNS Shifa, Naval Hospital, Karachi, for treatment of chalazia were inducted in the study. A 141 patients with chalazia completed the study. Patients received either incision-curettage [surgical treatment/ ST group] or intralesional corticosteroid injection treatment [steroid injection/ SI group]. The same procedure was repeated in unsuccessful cases only once. Z-test of proportion was used as appropriate statistical test of significance at p <0.05 for the comparison of the results between the two groups. The success was achieved in 59 out of 75 patients [79%] in ST group and 41 of 66 patients [62%] in SI group at first visit after two weeks [p-value <0.01]. The success in ST group improved to 89% [67 out of 75 patients] after second operation and to 80% [53 out of 66 patients] in SI group after second injection of the steroid given at second week [p-value < 0.14]. Intralesional steroid injection is an effective and safe alternative procedure for the treatment of chalazia. The results are comparable to surgical treatment especially after second injection. It is not associated with any serious complications although skin depigmentation is relatively common in coloured population

Mucormycosis: a devastating fungal infection in diabetics

Mucormycosis is a highly invasive, devastating and usually fatal fungal infection of the sinuses, brain, or lungs that occurs primarily in people with immune disorders. Despite advances in diagnosis and treatment, a high mortality still exists. We present a middle aged diabetic male with this serious fungal infection involving nose, paranasal area and adjacent periorbital regions with a high risk of progressing further towards the dura mater. He was promptly diagnosed and managed with serial surgical debridements with systemic antifungals and was later fitted with a nasal prosthesis

attitude and perception of hospital doctors about the management of psychiatric disorders

To determine perception and the attitude of non-psychiatric doctors about psychiatric problems working in a tertiary care hospital. Cross-sectional survey. Postgraduate Medical Institute, Lady Reading Hospital, Peshawar. The questionnaires distributed were returned within one week duration. All the doctors working in Lady Reading Hospital, Peshawar for more than one year except house officers and those working in Paediatrics, Radiology and Administration Block were given anonymous questionnaires. Two hundred and ten doctors returned the questionnaires. One hundred and eighty-three [87%] of respondents were male. Ninty-eight percent of doctors agreed that psychological factors were important in the cause and outcome of physical disorders but only 26.7% agreed that management of emotional issues is medical responsibility. There was no statistically significant difference between physicians and surgeons in their attitude towards importance of psychological factors in the physical disorders. Doctors working in tertiary care hospital have adequate awareness about the psychological and emotional factors in medical and surgical patients. However, some barriers against the provision of bio-psychosocial care seem to be present