Causes of visual impairment in children with low vision

To determine the main causes of visual impairment in children with low vision. To assess the need of spectacles and low vision devices [LVDs] in children and to evaluate visual outcome after using their LVDs for far and near distance. Observational study. Khyber Institute of Ophthalmic Medical Sciences, Peshawar, Pakistan, from June 2006 to December 2007. The clinical record of 270 children with low vision age 4-16 years attending the Low Vision Clinic were included. All those children, aged 4-16 years, who had corrected visual acuity [VA] less than 6/18 in the better eye after medical or surgical treatment, were included in the study. WHO low vision criteria were used to classify into visually impaired, severe visually impaired and blind. Results were described as percentage frequencies. One hundred and eighty nine [70%] were males and 81 [30%] were females. The male to female ratio was 2.3:1. The main causes of visual impairment included nystagmus [15%], Stargardt's disease [14%], maculopathies [13%], myopic macular degeneration [11%] and oculocutaneous albinism [7%]. The percentages of visually impaired, severe visually impaired and blind were 33.8%, 27.2% and 39.0% respectively. Spectacles were prescribed to 146 patients and telescopes were prescribed to 75 patients. Spectacles and telescope both were prescribed to 179 patients while Ocutech telescope was prescribed to 4 patients. Retinal diseases nystagmus and macular conditions were mainly responsible for low vision in children. Visually impaired children especially with hereditary /congenital ocular anomalies benefit from refraction and low vision services which facilitate vision enhancement and inclusive education

Demographic pattern of male breast cancer: an institutional based study

Male breast cancer incidence rises with age with peak in the 6[th] and 7[th] decade. It is one of the rare diseases and accounts for less than 1% of all malignancies worldwide. It is usually diagnosed in the late stage with poor prognosis. The purpose of this study was to know the demographic pattern and tumour characteristic of breast cancer in men reported at Institute of Radiotherapy and Nuclear Medicine [IRNUM], Peshawar. Retrospective data was collected from the [IRNUM], Peshawar for a period of three years [2006-2008]. The evaluation was done from the histopathological reports of mastectomy and biopsy specimens. All male patients in the age group 26-86 year with breast cancer were included in the study. The age of the patients and tumour characteristics recorded were size, grade, type, skin involvement and stage. Total number of male patients with breast cancer were 31 [2.1%] out of the total patients with breast malignancy during the study period with the mean age of 58.3 years. Tumour size ranged from 2 to 12 Cm. with average of 3.6 Cm. Invasive ductal carcinoma was found in 87%, papillary carcinoma in 6.5%, each of malignant fibrous histocytoma and sarcoma in 3.2% cases. Maximum number of patients was of grade II [41%].Patients in whom stage of the disease was known were 22 cases with 45.5% had stage III disease and 32% had stage IV disease. Skin involvement was found positive in 8 [25.8%]. Due to poor health care system breast cancer is diagnosed in a late stage of the disease and prognosis is poor

Clinical audit of treatment of acute watery diarrhoea in paediatrics unit, Hayatabad medical complex, Peshawar

To look into the treatment given to children with acute watery diarrhea by Trainee Medical Officers at the time of admission and to compare it with the standard treatment protocol as recommended by World Health Organization for the treatment of acute watery diarrhoea. This was a retrospective study conducted in Department of Pediatric Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar from June 15 to August 15, 2008. Treatment charts of children admitted with acute watery diarrhoea were studied for demographical findings, degree of dehydration and other clinical findings and treatment given at the time of admission. The data was statistically analyzed by SPSS version 10. Eighty children were included in the study. The age range was from one month to five years with mean age of 25.5 months. The majority were in the range of 1 to 3 years with male to female ratio of 1.4:1. Majority [68.75%] had bowel movements more than 6 times/24 hours. Blood in the stool was present in only five cases [6.25%]. Thirty-five [44%] and 12 [28%] were presented with some and severe dehydration respectively at the time of admission. Analysis of drug treatment [antibiotics, anti-protozoal, anti-emetics, stool hardeners, probiotics] showed that 65 [81.25%] children received appropriate treatment as per recommendations of World Health Organization. All children were discharged uneventfully. Continuous training and supervision of the Trainee Medical Officers is required to implement standard treatment of acute watery diarrhoea according to laid down World Health Organization guidelines. Such activities will help to reduce inappropriate use of drugs and wrong treatment for diarrhea

Hemisoleus muscle flap, a better option for coverage of open fractures involving middle third of tibia

Local reconstructive options for middle third of leg make good use of Soleus muscle flap. Soleus being the prime ankle planter flexor and stabiliser of the ankle in ambulation cannot be sacrificed without significant morbidity. Soleus is a bipennate muscle with independent blood supply of each half. Using one half retains its important function, increases arc of rotation, and makes it easy to orientate for coverage of defect of any shape thus obviating the need for use of whole Soleus muscle flap. Due to this geometrical advantage, it is a superior option than the whole Soleus. We conducted a study to evaluate the reliability of the medial hemisoleus muscle flap for coverage of middle third tibial defects. This descriptive study was conducted at department of plastic surgery, Jinnah Hospital, Lahore from August 2008 to May 2009. Ten patients with middle third tibial defects were included in the study. All the patients were provided soft tissue coverage with proximally based medial hemisoleus muscle flap with split thickness skin graft on it. All the flaps survived with primary healing of the wound except one patient who developed wound infection which settled after wound drainage and irrigation. Hemisoleus muscle flap is a valuable local option for soft tissue coverage of middle third of lower leg. It does not sacrifice the whole function of the Soleus muscle. Due to its longer arc of rotation, this flap can cover the defects of different size and shape in middle third of leg

Spectrum of ocular surface squamous neoplasia

To describe the pattern of ocular surface squamous neoplasia [OSSN], clinical presentations, the risk factors and treatment options. An observational case series. Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, from April 2003 till August 2006. The study included 36 eyes of 35 patients with biopsy-proven ocular surface neoplasia. The details of patients regarding age, gender, laterally and risk factors were entered into a specially-designed proforma. Each patient was also assessed blomtcroscoplcally for type and complications of ocular surface neoplasia. The frequency of OSSN was 0.37 among admitted hospital patients. Among 36 cases of OSSN, squamous cell carcinoma of the conjunctiva was the most common type of OSSN seen in 63.9%, followed by carcinoma in situ of conjunctiva in 25% and carcinoma in situ of cornea in 11.1%. Male patients outnumbered female [65.7% vs 34.3%] with 71.42% of patients above 60 years of age. The risk factors identified were: old age, ultraviolet B exposure and xeroderma pigmentosa. Treatment consisted of local resection with or without adjuvant therapy in 61.1%, exenteration in 30.5%, enucleation in 5.5% and chemo/radiotherapy in 2.7%. Intraocular invasion was seen in 5.5% and orbital spread in 30.5%. The frequency of OSSN was 0.37% among admitted patients. Identification of exact etiological factors will enable to formulate strategies that are likely to decrease the incidence of this disease and the associated morbidity and mortality

Clinical pattern of panic attacks in panic disorder in a tertiary care hospital

Panic disorder is a major cause of psychiatric morbidity. There are no local studies on the subject although clinical observations indicate that it is relatively common. To study the clinical characteristics of panic attacks in panic disorder in this part of the country and compare it with some of the previous studies. A descriptive cross-sectional study. Psychiatry outpatients department of Ayub Teaching Hospital, Abbottabad. March 2004 to June 2004. Characteristics of panic attacks in fifty consecutive panic disorder patients reporting to hospital outpatients department were studied using a semi-structured proforma and compared with western studies. Statistical analysis was done, using the Chi Square test and p-value was calculated. Statistically significant differences were found in fear of dying, parasthesia, and derealization/depersonalization between the present study and two western studies. As there are ce rtain statistically significant differences from western studies, the study needs to be replicated on a larger more representative population

Spectrum of histopathological features in non-infectious erythematous and papulosquamous diseases

This prospective study consisted of 38 patients clinically diagnosed as having one of the papulosquamous diseases. Appearance and distribution of the lesions were recorded. The histopathological features of the lesions were studied in the weekly clinicopathological conference. The cases were sub-grouped into 8 categories. 25 of these patients were males and rest females, showing predominance of males suffering from this skin disease. Maximum number of patients fell in the age group of 21 to 30 years. Clinicopathological correlation was carried out. 29 out of 38 cases [76.30%] showed compatible clinical as well as histopathological diagnoses. Microscopic features of all the biopsies were scrutinized. It was noted that the majority of the findings of our cases agreed to the literature findings. The additional findings present in our study cases not given in the literature were mentioned separately. The diagnostic microscopic features not present in our cases were also recorded