Cataract surgery? Is topical anesthesia for all is a future in cataract surgery? A comparison between topical and retrobulbar anesthesia in terms of pain during cataract surgery

To compare the effectiveness of topical and retobulbar anesthesia in term of pain relief in patients subjected to cataract surgery. This comparative study was conducted at Department of Ophthalmology, Bahawal Victoria Hospital Bahawalpur from 18th July, 2012 to 18th January, 2013. Total 100 patients with cataract were included in this study. Mean age of the patient was 64.14 +/- 8.7 years. No. of patients in RA group who reported the pain scores [0- 4] during cataract surgery, was 46 [effectiveness was positive in 92% patients], while it was 33 [effectiveness was positive in 66% patients] in TA group. A significant difference between effectiveness of both anesthetic groups was observed. [P = 0.001]. It is observed that topical anesthesia in cataract surgery is a simple, safe and noninvasive technique but it cannot be proposed as a very good alternative to retrobulbar anesthesia in cataract surgery of all patients regarding its effectiveness interms of pain relief

Learning through small group discussion versus didactic lectures

To study and compare the impact of didactic lecturing with small group discussion among undergraduate medical students. Study Design: Sequential mixed method. Quaid-e-Azam Medical College, Bahawalpur, from January 2012 to October 2012. Results of 2 final year classes comprising 566 students [of sessions 2011 and 2012] were analyzed and 30 students from the existing final year were selected for focus group discussion by non-probability convenience sampling technique. In the first phase, quasi experimental design was employed. Small group discussion [SGD] learning format was used as an intervention on the interventional group [277 students] and results were compared with the scores of previous final year student [historical control group: 289 students] who learnt through didactic lecturing. In the second phase, focus group discussions of current final year was arranged to dig out their views about SGD intervention. The quantitative data was analyzed by using SPSS version 17. Content analysis method was applied for qualitative analysis of focus group discussions. The mean scores were 1006 +/- 60 in interventional group as compared to 1026 +/- 57 in non-interventional group [p<0.001]. In second phase, the focus group discussion, students [30], found lecturing was a better way of learning than SGD in terms of content coverage according to 15 students [62.5%], senior people teaching: 9[37.5%], who were better prepared: 6[25%]. Whereas, the downside of small group discussion was related to the fact that the junior teachers were involved in teaching according to 15 [62.5%] who were less prepared: 11 [45.8%] and lack of uniformity in practicing the intervention in different wards: 10 [41.7%].Students consider SGD as a relatively less favored mode of information transfer owing to multiple factors influencing the learning process of students as opposed to didactic lecturing in our set-up

The Outcomes of Pars Plana Vitrectomy without Tamponade for Tractional Retinal Detachment Secondary to Diabetic Retinopathy

Objectives: The objective of this research was to evaluate the outcomes of pars plana vitrectomy (PPV) without the use of an ocular tamponade in patients with tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR) presenting to Bahawal Victoria Hospital, Bahawalpur, Pakistan. Methods: This was an interventional study conducted at the Department of Ophthalmology, Bahawal Victoria (B.V.) Hospital, Bahawalpur, Pakistan, from July 2011 to July 2012. A total of 75 patients (84 eyes) with TRD secondary to PDR were treated by PPV without using an ocular tamponade. All patients included in the study had a TRD secondary to PDR but did not have or develop retinal breaks before or during the study period. The surgical procedure included a PPV combined with the removal of the tractional retinal membranes and the application of endolaser photocoagulation to the retina. The mean follow-up period was 12 months. Results: The study included 75 patients (84 eyes). Among these, 40 patients were females and 35 males. Successful retinal reattachment was observed in 78 of the operated eyes (92.8%). In these patients, the retina remained attached until the end of the 12 month follow-up period. Improvement in best corrected visual acuity (BCVA) was seen in 63 eyes (75%). The visual acuity remained unchanged in nine eyes (10.7%). Mean improvement in BCVA was 2.00 ± 1.24 at baseline to 1.24 ± 1.22 (P = 0.010) at the end of the follow-up period. Conclusion: In the absence of retinal breaks, a TRD secondary to PDR can be successfully treated and improved by PPV without the use of an ocular tamponade.

Vaginal delivery versus cesarean section; birth outcome in primi gravdae breech

It is to compare neonatal morbidity in terms of birth trauma, respiratory distress syndrome, APGAR score in Primigravida with breech presentation delivered vaginally and emergency cesarean section. Cross-sectional comparative study. Obstetrics and Gynaecology Unit-l, Bahawal Victoria Hospital, Bahawalpur from 1-5-2007 to 30-4-2008. The study was carried out on all Primigravida with breech presentation reported through emergency in labour delivered vaginally and by emergency cesarean section. The variable analyzed were birth trauma, respiratory distress syndrome and APGAR score at 1 and 5 minutes. Students-t test was used for comparison between means and chi square test for comparison between percentages. Significance was taken at P<0.05. It was found that mean APGAR score at 1 and 5 minutes is 7.31 and 9.066 in vaginal and 8.533 and 9.644 in cesarean group. Respiratory distress syndrome is more in cesarean [4.4%] than vaginal group [2.2%]. Observed neonatal trauma is more in vaginal group [6.7%] than cesarean section [2.2%]. Neonatal morbidity appears to be more in vaginal breech delivery than I cesarean section for Primigravida with breech presentation at term

Supratarsal injection of triamcinolone for vernal keratoconjunctivitis

We conducted this study to find out safety and effectiveness of supratarsal injection of Triamcinolone in Vernal Keratoconjunctivitis [VKC]. This study was conducted from 1[st] February 2006 to 15[th] July 2007 in Department of Ophthalmology BVH, Bahawalpur. Eight hundred and eighty eyes of 440 diagnosed patients of VKC, of either sex and all ages were included in the study. Patients with raised LOP, post-herpetic corneal scar, tightly closed eyelids were excluded from the study. It was a prospective, uncontrolled trial. The patients were enrolled and given the first supratarsal injection of Triamcinolone. Their record was maintained and all the patients were followed up for obtaining the data about effectiveness and side effects of therapy. We treated 880 eyes of 440 patients, out of which 81.82% were males. Mean age was 16 years [Range: 2-42 years]. All of the patients had itching of eyes and the rest of the clinical features were redness, cobble-stone papillae and Tranta's dots. Mean duration of disease was 18 weeks [Range: 4 weeks to 6 months]. Patients were followed up and multiple injections were given to control the disease. Transient redness was most common among the side effects of injection therapy. Study shows lO0% effectiveness of supratarsal injection of Triamcinolone acetonide in VKC although recurrence was seen. Supratarsal injection of Triamcinolone is safe, cost-effective and simple way of management of VKC. Curative treatment for VKC still remains elusive

review of 100 cases of ocular trauma admitted in eye ward. Presentation, management and visual outcome

To report different causes of ocular trauma in hospital admitted cases, their mode of presentation, management and visual outcome and to explore possible methods of reduction of ocular trauma in our setting. Hospital based retrospective descriptive and Observational study. The study was conducted in eye department of Bahawal-Victoria hospital from August 2007 to August 2009. 100 patients with first time ocular trauma of any age and sex were included in this study. Previous ocular trauma or ocular surgery patients were excluded. Visual acuity on presentation, rupture of globe, perforating injury, retinal detachment, endophthalmitis, intra-ocular foreign body and need for surgical intervention and visual outcome were determined. Out of 100 patients 88% were male and only 12% were females. 67% patients presented before 8pm. Majority [32%] of the cases were between 21-30 years of age. Open globe type injury [73%] was more common than close globe type [27%]. Most tears [46.57%] were corneal while 9% cases had FB in anterior segment and 17% in posterior segment. Regarding management 23% were managed medically while 77% required combined medical and surgical treatment. Despite of treatment, 12% eyes lost total vision due to phthisis bulbi, endophthmitis, and non-attachable retinal detachment. Ocular trauma in hospital admitted cases carries poor visual outcome due to severity and nature of trauma, late presentation, associated infection, poor socio-economic status. Visual outcome is dependent on location of wound, cleanliness, prompt and timely diagnosis and management