Comparison of rapid and conventional corneal collagen cross linking in patients having Keratoconus

To compare the effect of rapid and conventional methods of corneal collagen cross linking [CXL] on visual acuity [VA] and corneal parameters in Keratoconus. Randomized control trial. Armed Forces Institute of Ophthalmology, Feb 2012 to Apr 2013. Thirty patients, fifteen in each group, were randomized by non probability consecutive sampling to rapid or conventional CXL group. Pre and post operative [6 months] best corrected visual acuity [BCVA], anterior and posterior keratometric [K] values and pachymetry were recorded. Intra and inter group comparison of all these parameters were statistically analyzed. All thrty patients showed either stabilization or improvement in BCVA. Both groups showed comparable results in terms of improvement BCVA [p = 0.682], reduction in the corneal thickness at thinnest point [p = 0.062], anterior flat and steep K [p = 0.633, p = 0.443 respectively] and posterior flat and steep K values [p = 0.130, p = 0.068] at six months duration. Conventional and rapid methods of CXL are comparable in terms of their effect on VA and corneal parameters

Frequency of hepatic encephalopathy in HCV cirrhotic patients with and without diabetes mellitus

Objective: to compare the frequency of hepatic encephalopathy [HE] in HCV cirrhotic patients with and without Diabetes Mellitus

Material and Methods: this cross sectional survey of 100 patients was conducted in all medical units of Mayo Hospital Lahore after meeting the inclusion criteria. Patients were classified as diabetic if they were on oral hypoglycemic agents or insulin or have BSF>126mg/dl and non-diabetic if they had BSF<126 mg/di. The assessment for presence or absence of hepatic encephalopathy was determined using criteria defined in operational definition. HCV LIVER CIRRHOSIS is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scare tissue and regenerative nodules. Cirrhosis was confirmed by Ultrasonography abdomen and hepatitis C was confirmed with ELISA test

Results: mean age of patient was 44.43+/-10.16 years with minimum and maximum ages 18 and 60 years respectively. Frequency of DM was determined as 34% among HCV cirrhosis patients while in 66% patients the diabetes was not seen. Hepatic encephalopathy was seen in 31 [91.2%] of diabetics and in 48[72. 7%] of non-diabetic patients. HE was not seen in 21 % of patients in which 3 were diabetics and 18 were non diabetic. In this study frequency of HE was higher in diabetic group as compared to non-diabetic group i.e. P- value=0.032

Conclusion: according to this study, frequency of Hepatic encephalopathy [HE] is significantly higher in diabetic patients as compared to non-diabetic patients i.e. P value 0.032. Frequency of HE was seen in 91.2% of the diabetic patients and in 72. 7% of non-diabetic patients

Indications and complications of intestinal stomas -a tertiary care hospital experience

An intestinal stoma is an opening of intestine on the anterior abdominal wall made surgically. The commonly performed procedures include colostomy and ileostomy. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it. An observational study was carried out in Services Hospital Lahore, over a period of two years from Feb. 2007 - 09. A total of 85 patients needing intestinal stomas, ileostomy or colostomy, were included in the study. Patients under 12 years, with enterocutaneous fistula and urinary conduits were excluded from study. Indications, immediate and late complications of stomas were recorded. Reversal of stoma usually performed after 12 weeks and complications of reversal were also recorded. Majority [73%] of patients were males. There were 36 ileostomies and 49 cases of colostomy making a total of 85 patients. Main indications of Ileostomy were intestinal tuberculosis [58%], enteric perforation [31%] and penetrating injuries [5.5%]. Colostomy was mostly required in penetrating injuries [33%], blunt trauma [23%] and intestinal obstruction [28%]. In a total 0/35 stomas local complications appeared in 54 [41.77%]. General problems included anxiety, psychological and social isolation. Skin excoriation and ulceration were the most common [25%]; they were worse in ileostomy than colostomy. In laparotomy wound infection [9.4%], stoma diarrhea [7%], stoma retraction [6%] and prolapse [6%] were other notable comp-lications. A mortality rate of 1.6% was found in cases of ileostomy. Hospital admission ranged from 10 - 62 days. 62 stomas including 25 ileostomies and 37 colostomies were closed on an average of 3 months after primary operation. There were 9 cases of wound infection, three anastamotic leakages and a single mortality [1.6%] in the stoma reversal group. Common indications for intestinal stomas were abdominal trauma, intestinal tuberculosis and enteric perforation. Main complications included local skin problems, stoma diarhoea, prolapse and retraction. Early identification and treatment of tuberculosis and enteric fever can reduce stoma formation and its associated complications

Bullying of medical students

To assess the frequency and forms of bullying experienced by medical students, and the associated factors. Cross-sectional questionnaire-based survey. The study was conducted at a private Medical College of Lahore, from January to February 2010. All the students of first and fourth year classes were included in the study with voluntary and anonymous participation. Self administered-questionnaires were given to the students which were completed by them in the presence of the surveyor. A modified version of the British Medical Associations [BMA] medical student's welfare and education survey form was used for data collection. The data was recorded and analyzed using the statistical package for social sciences version 16.0. Data was described in the form of frequencies and percentages. Chi-square test and Fisher exact test were used to test statistical significance between categorical variables at p

Role of neo-adjuvant chemoradiation in locally advanced rectal cancers

To determine the radiologic downstaging and histological response after neo-adjuvant concurrent chemoradiation in locally advanced rectal cancers. Case series. Radiation Oncology department of Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from December 2004 to November 2005. Thirty patients with histopathologically confirmed locally advanced carcinoma rectum who had not received any treatment [chemotherapy, radiotherapy or surgery] prior to presentation were enrolled. Radiation therapy was delivered with a three-field technique to a dose of 50.4 Gy over 5 weeks at the rate of 1.8 Gy/day. Two cycles of chemotherapy were given synchronously, which comprised of 5-fluorouracil 350 mg/m[2] and folinic acid 20 mg/m[2] continuous intravenous infusion over first five days and last five days of radiotherapy. Surgery was planned 4-6 weeks later to chemoradiation after radiologic post therapy staging. Viable specimens were identified and toxicity was observed. All patients completed treatment without modification. Radiologic downstaging was found in 56.7%, stable disease was seen in 30.0% and progressive disease was present in 13.3% of the patients. Radiologically complete resolution of tumour was not observed. Pathological complete resolution of tumour was achieved in 3.3% and near complete resolution was observed in 13.3% of the patients. In 86.6% cases, a total gross tumour resection with no macroscopic residual disease was possible. All the patients tolerated the treatment well. Neo-adjuvant chemoradiation for locally advanced rectal cancers is associated with high resectability rate and is relatively safe with acceptable morbidity which favours its use in future

Raised intraocular pressure; frequency after Nd: YAG laser capsulotomy

To measure the rise in intraocular pressure after neodymium:yttrium-aluminum-garnet [Nd:YAG] Laser capsulotomy in pseudophakic patients aged 50 years and above. Prospective study. Study was done from May 2005 to Dec 2005. [Eight months duration] Eye department Military Hospital Rawalpindi. A total of 100 patients, presenting in Eye department, Military Hospital Rawalpindi, fulfilling inclusion and exclusion criteria were included. With a minimum number of bursts of 3.6 mj / shot energy level with Nd: YAG laser, a 3 to 4 mm hole in the posterior capsule was created. The intraocular pressure was measured 1 hour, 3 hours, 1 day and 1 week after the laser. The rise in intraocular pressure was noticed in 6 [6%] patients after Nd:YAG laser capsulotomy. Five out of six patients had fibrous type of posterior capsular opacification while one patient had Elschnig's pearl. Male to female Ratio was 7:3. Our findings suggest that the rise in intraocular pressure is an infrequent complication of Nd:YAG Laser capsulotomy

Frequency of pseudoexfoliation syndrome in patients undergoing cataract surgery in eye department Military Hospital Rawalpindi

To determine the frequency of Pseudoexfoliation syndrome [PXS] in patients greater than 40 years of age, undergoing cataract surgery in Eye department Military Hospital Rawalpindi.Quasi experimental Study. Eye Department Military Hospital Rawalpindi, for 06 months duration, from March 2005 to August 2005. A total of 1008 patients, greater than 40 years of age, admitted in Eye department Military Hospital Rawalpindi for cataract surgery were included. Patients were examined on slit lamp for evidence of PXS and those with the disease were subjected to further thorough examination including Visual acuity, Goldmann applanation tonometry, gonioscopy, slit lamp examination before and after dilation of the pupil and fundus examination. Out of 1008 patients 36 [3.57%] were found to be having PXS, out of which 29 patients were male and 7 females. Male to female ratio was 4:1 appx. The disease was bilateral in 66.7% [24 cases] and unilateral in 33.3% [12 cases]. The frequency increased with advancing age. Frequency of PXS increases with the advancing age with associatation but associated with grade in insignificant